Sowing the seeds of doubt: a narrative review on metacognitive training in schizophrenia

Abstract

The present article provides a narrative review of empirical studies on metacognitive training in psychosis (MCT). MCT represents an amalgam of cognitive-behavioral therapy (CBT), cognitive remediation (CRT) and psychoeducation. The intervention is available in either a group (MCT) or an individualized (MCT+) format. By sowing the seeds of doubt in a playful and entertaining fashion, the program targets positive symptoms, particularly delusions. It aims to raise patients' awareness for common cognitive traps or biases (e.g., jumping to conclusions, overconfidence in errors, bias against disconfirmatory evidence) that are implicated in the formation and maintenance of psychosis. The majority of studies confirm that MCT meets its core aim, the reduction of delusions. Problems (e.g., potential allegiance effects) and knowledge gaps (i.e., outcome predictors) are highlighted. The preliminary data suggest that the individual MCT format is especially effective in addressing symptoms, cognitive biases and insight. We conclude that MCT appears to be a worthwhile complement to pharmacotherapy.

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

“…The most broadly researched of these, metacognitive training for schizophrenia patients (MCT), was originally designed as an eight module group intervention, but has also been implemented individually 176 .…”

High estradiol levels improve false memory rates and meta-memory in highly schizotypal women

“…It has been suggested, though, that delusions are underpinned, at least in part, by a general susceptibility to forming false beliefs/memories with a high level of confidence (Laws and Bhatt, 2005;. Therefore, investigating the factors influencing confidence in false memories could be of high clinical relevance by improving an understanding of the development and maintenance of delusions, and by potentially influencing individual treatment options for schizophrenia (Favrod et al, 2014; for a review, see Moritz et al, 2014).…”

Contextual Cognitive-Behavioral Therapies Across the Psychosis Continuum

“…Although several types of Metacognitive Therapy (MCT) exist and have been applied to psychosis with promising results (for reviews, see Moritz et al, 2014;Moritz, Woodward, & Balzan, 2016;, in the present review we will follow the conceptualization of Hayes et al (2011) that specifically points out the Wells' Metacognitive approach as part of the "Third Wave" of cognitive-behavioral therapies. Metacognitive Therapy (MCT; Wells, 2000) was developed based on the metacognitive model for emotional disorders and consists of promoting a different relationship to thoughts, beliefs, and metacognitive beliefs with the final aim being countering the cognitive attentional syndrome (CAS) -a specific way of thinking that would be responsible for emotional suffering and ultimately the development and maintenance of psychiatric disorders.…”