Immediate and Sustained Outcomes and Moderators Associated With Metacognitive Training for Psychosis

Abstract

Key Points Question What are the immediate and sustained outcomes associated with metacognitive training (MCT) for psychosis, and are there specific treatment- or participant-related moderators of associations? Findings This systematic review and meta-analysis of 43 studies (40 reports synthesized in meta-analysis, N=1816; 6 reports included in narrative review) on individuals with schizophrenia spectrum and related psychotic disorders found MCT was associated with reduced delusions, hallucinations, and cognitive biases. Metacognitive training was also associated with reduced negative symptoms and improved self-esteem and functioning. Meaning The findings of this study suggest that MCT is an accessible evidence-based intervention, deliverable by a variety of mental health care professionals, and appears to be ready for large-scale implementation; MCT may merit inclusion in clinical guideline recommendations for the treatment of individuals with schizophrenia.

A pilot 1-year follow-up randomised controlled trial comparing metacognitive training to psychoeducation in schizophrenia: effects on insight

“…Although not consistently 18 , 19 , MCT was demonstrated to reduce positive 20 – 25 and negative 26 psychotic symptoms severity, cognitive biases, self-esteem and functioning 26 . However, evidence supporting the effects of specific MCT modules is limited 27 .…”

Editorial: Integrated therapy approaches in schizophrenia: Evidence and limitations

“…On the other hand, the Neuropsychological Educational to Rehabilitation [NEAR; ( 8 )] combined NR with educational tools of PEFT. The world-wide distributed and successfully evaluated MCT ( 9 ) combines meta-cognition with NR and may be closer to CBTp than CR, even if containing exercise on neurocognition. Finally, Integrated Neurocognitive Therapy (INT) combines partly PC-based exercises to all from US National Institute of Mental Health defined neurocognitive and social cognitive functions with some PEFT and CBTp techniques ( 10 ).…”

Heterogeneity in Response to MCT and Psychoeducation: A Feasibility Study Using Latent Class Mixed Models in First-Episode Psychosis

“…Metacognitive training (MCT) [ 6 ] has emerged as one of the most effective psychological treatments for positive symptoms of psychosis [ 7 ]. MCT combines psychoeducation, cognitive bias modification, and strategy teaching to correct data-gathering biases.…”

“…This approach aims to sow the seeds of doubt [ 8 , 9 ] by considering cognitive biases as a deviation from normality. Systematic-review findings have supported its efficacy in improving positive and negative symptoms, self-esteem, and functioning in schizophrenia [ 7 , 10 ], and recent studies have proven that it is also a valid intervention for people with FEP [ 11 ].…”

“…Although meta-analytic findings have supported the efficacy of MCT in psychosis [ 7 , 24 ], this is usually at a medium effect size [ 24 ]. However, this seems to be the case for most effective psychological interventions for psychosis [ 25 ].…”