Metacognitive training for delusions (MCTd): effectiveness on data-gathering and belief flexibility in a Chinese sample

Abstract

Metacognitive training (MCT) was developed to promote awareness of reasoning biases among patients with schizophrenia. While MCT has been translated into 31 languages, most MCT studies were conducted in Europe, including newer evidence recommending an individualized approach of delivery. As reasoning biases covered in MCT are separable processes and are associated with different symptoms, testing the effect of selected MCT modules would help to develop a targeted and cost-effective intervention for specific symptoms and associated mechanisms. This study tested the efficacy of a four-session metacognitive training for delusions, MCTd (in Traditional Chinese with cultural adaptations, provided individually), as an adjunct to antipsychotics in reducing severity and conviction of delusions, jumping to conclusions (JTC) bias and belief inflexibility. Forty-four patients with delusions were randomized into the MCTd or the wait-list control condition. Patients on wait-list received the same MCTd after 4 weeks of treatment as usual (TAU). Assessment interviews took place before and after the treatment, and at 4-week follow-up. There was an additional baseline assessment for the controls. JTC and belief flexibility were measured by the beads tasks and the Maudsley Assessment of Delusions Scale. Attendance rate of the MCTd was satisfactory (84.5%). Compared to TAU, there was a greater reduction in psychotic symptoms, delusional severity and conviction following MCTd. There was a large treatment effect size in improvement in belief flexibility. Improvement in reaction to hypothetical contradiction predicted treatment effect in positive symptoms and delusions. JTC bias was reduced following MCTd, although the treatment effect was not significantly larger than TAU. Our results support the use of process-based interventions that target psychological mechanisms underlying specific psychotic symptoms as adjuncts to more conventional approaches.

Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study

“…It is probable that this inconsistency is due to selective floor effects in the MCT+ group: As shown in Tables 1 and 2, the randomization process resulted in differences between the two groups regarding baseline symptoms, which were lower in MCT+ patients -and, in fact, lower than in previous studies by our group (Moritz et al, 2013a;Moritz et al, 2011) and others (Favrod et al, 2014;So et al, 2015). This, in combination with the rapid improvement, led to very low symptom levels in these patients post-intervention, while the control group may have benefited from greater margins for change.…”

“…Previous studies have shown that use of MCT material in an individual treatment format can have beneficial effects on cognitive biases and/or delusions after very few sessions (Balzan et al, 2014;Balzan and Galletly, 2015;Ross et al, 2011;So et al, 2015;Waller et al, 2011). In a randomized, controlled, rater-blind trial of group MCT combined with individualized sessions (Moritz et al, 2011), patients in the MCT arm showed significantly greater improvement in delusion severity and conviction, as well as in jumping-to-conclusions, relative to the active control group.…”

Letter to the Editor: Should we focus on quality or quantity in meta-analyses?

“…We have checked the baseline data of the studies on delusions. The three studies with the highest baseline delusion scores were So et al (2015), and van Oosterhout et al (2014). Taking these three studies, the effect size is 0.49, while studies with the lowest delusion scores at baseline (Moritz et al 2011a(Moritz et al ,b, 2013Briki et al 2014;Gaweda et al 2015) have a pooled effect size of 0.25 on delusions.…”

“…In their introduction (Moritz et al 2011) refer to another meta-analysis by Jiang et al (2015) quoting significant effects for positive symptoms (as well as for delusions without the study by van Oosterhout et al 2014). The van Oosterhout et al (2014) study is a negative study, but it is the largest randomized controlled trial (RCT) and indeed was rated as the study with the lowest risk of bias by Jiang et al; it is not clear why one would discard the best study to date?…”

“…The van Oosterhout et al (2014) study is a negative study, but it is the largest randomized controlled trial (RCT) and indeed was rated as the study with the lowest risk of bias by Jiang et al; it is not clear why one would discard the best study to date? The developers could usefully be referred to the conclusion in the abstract of Jiang et al: 'The limited number of RCT trials, the variability of the method and time of the outcome evaluation, and methodological problems in the trials make it impossible to come to a conclusion about the effectiveness of MCT for schizophrenia.…”