The effectiveness of metacognitive training for patients with schizophrenia: a narrative systematic review of studies published between 2009 and 2015

Pankowski, Daniel; Kowalski, Joachim; Gawęda, Łukasz

doi:10.12740/pp/59113

Cited by 23 publications

(13 citation statements)

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“…They also showed that patients with schizophrenia who received MCT exhibited a significant positive change in attitude toward their illness compared with the active control condition and enhanced meaning-making in patients (52). A systematic review showed that MCT was effective in reducing cognitive biases and delusions and improving insights and several aspects of neurocognitive functions in schizophrenia (9).…”

Section: Discussionmentioning

confidence: 99%

“…Metacognitive training (MCT), a novel and widely used group intervention for patients with schizophrenia, may enhance patients' self-awareness and insights into these cognitive distortions to alleviate the positive symptoms of psychosis, especially paranoid ideation (8). A systematic review that covered 14 studies showed that MCT effectively decreased cognitive biases and delusions related to schizophrenia and improved insight in the patients with schizophrenia (9). Randomized controlled trials showed that MCT reduced positive symptomatology and influenced insight and social functioning (10,11).…”

Section: Introductionmentioning

confidence: 99%

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Metacognitive Training Modulates Default-Mode Network Homogeneity During 8-Week Olanzapine Treatment in Patients With Schizophrenia

Shan

Liao

et al. 2020

Front. Psychiatry

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Background: Previous studies have revealed the efficacy of metacognitive training for schizophrenia. However, the underlying mechanisms of metacognitive training on brain function alterations, including the default-mode network (DMN), remain unknown. The present study explored treatment effects of metacognitive training on functional connectivity of the brain regions in the DMN.Methods: Forty-one patients with schizophrenia and 20 healthy controls were scanned using resting-state functional magnetic resonance imaging. Patients were randomly assigned to drug plus psychotherapy (DPP) and drug therapy (DT) groups. The DPP group received olanzapine and metacognitive training, and the DT group received only olanzapine for 8 weeks. Network homogeneity (NH) was applied to analyze the imaging data, and pattern classification techniques were applied to test whether abnormal NH deficits at baseline might be used to discriminate patients from healthy controls. Abnormal NH in predicting treatment response was also examined in each patient group.Results: Compared with healthy controls, patients at baseline showed decreased NH in the bilateral ventral medial prefrontal cortex (MPFC), right posterior cingulate cortex (PCC)/ precuneus, and bilateral precuneus and increased NH in the right cerebellum Crus II and bilateral superior MPFC. NH values in the right PCC/precuneus increased in the DPP group after 8 weeks of treatment, whereas no substantial difference in NH value was observed in the DT group. Support vector machine analyses showed that the accuracy, sensitivity, and specificity for distinguishing patients from healthy controls were more than 0.7 in the NH values of the right PCC/precuneus, bilateral ventral MPFC, bilateral superior MPFC, and bilateral precuneus regions. Support vector regression analyses showed that high NH levels at baseline in the bilateral superior MPFC could predict symptomatic improvement of positive and negative syndrome scale (PANSS) after 8 weeks of DPP treatment. No correlations were found between alterations in the NH values and changes in the PANSS scores/cognition parameters in the patients. Conclusion:This study provides evidence that metacognitive training is related to the modulation of DMN homogeneity in schizophrenia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Metacognitive Training Modulates Default-Mode Network Homogeneity During 8-Week Olanzapine Treatment in Patients With Schizophrenia

Shan

Liao

et al. 2020

Front. Psychiatry

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“…Despite these limitations, significant reduction in positive symptoms beyond medication has been a consistent effect of MCT (Jiang, et. al., 2015; Moritz et al, 2014; Pankowski, Kowalski & Gaweda, 2016). Recently interventions targeting IA and IB (specifically overestimation of error) have emerged.…”

Section: Research and Clinical Significance Of Introspective Accuracymentioning

confidence: 99%

Impaired introspective accuracy in schizophrenia: an independent predictor of functional outcomes

Silberstein

Harvey

2018

Cognitive Neuropsychiatry

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Introduction. Individuals with schizophrenia present across a spectrum of symptomatology. Disability remains a debilitating reality across varying disease presentations and remains pervasive despite psychiatric medications. Cognition (neuro/social cognition) and negative symptoms have emerged as the strongest predictors of real-world disability, but account for <50% of the variance in outcomes. Methods. Our attempts to determine what accounts for the remaining 50% of variance has shown that poor introspective accuracy (IA) may be the most potent predictor of functional outcomes 25% of individuals with schizophrenia. We define IA as the adequacy of self-assessments of ability, skills, performance, or decisions. We suggest that IA is a progression of metacognition and can extend beyond cognition to include misestimation of prior and likely future performance in social or other adaptively relevant situations. Results. Additionally, IA is bidirectional and self-orientated. Emerging research has found that IA of neurocognitive ability better predicts everyday functional deficits than scores on performance-based measures or neurocognitive skills and has found that IA of social cognition accounts unique variance in real-world disability above social cognitive performance. Discussion. We argue that impaired IA, affecting 25–50% of patients with schizophrenia, in the absence or minimal presence of other impairments might be the most powerful predictor of functional outcomes.

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“…with schizophrenia [5,6]. Besides, Moritz et al revealed significantly positive effects of MCT on social functioning, self-esteem, and quality of life at 3 years follow-up [4].…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

“…Some randomized controlled studies revealed the efficacy of MCT in decreasing delusion severity [ 3 ], with sustained improvement even at 3 years follow-up [ 4 ]. Meta-analyses indicated that MCT could considerably improve positive symptoms, cognitive biases, and insight of patients with schizophrenia [ 5 , 6 ]. Besides, Moritz et al revealed significantly positive effects of MCT on social functioning, self-esteem, and quality of life at 3 years follow-up [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Increased regional homogeneity modulated by metacognitive training predicts therapeutic efficacy in patients with schizophrenia

Shan

Liao

et al. 2020

Eur Arch Psychiatry Clin Neurosci

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Previous studies have demonstrated the efficacy of metacognitive training (MCT) in schizophrenia. However, the underlying mechanisms related to therapeutic effect of MCT remain unknown. The present study explored the treatment effects of MCT on brain regional neural activity using regional homogeneity (ReHo) and whether these regions' activities could predict individual treatment response in schizophrenia. Forty-one patients with schizophrenia and 20 healthy controls were scanned using resting-state functional magnetic resonance imaging. Patients were randomly divided into drug therapy (DT) and drug plus psychotherapy (DPP) groups. The DT group received only olanzapine treatment, whereas the DPP group received olanzapine and MCT for 8 weeks. The results revealed that ReHo in the right precuneus, left superior medial prefrontal cortex (MPFC), right parahippocampal gyrus and left rectus was significantly increased in the DPP group after 8 weeks of treatment. Patients in the DT group showed significantly increased ReHo in the left ventral MPFC/anterior cingulate cortex (ACC), left superior MPFC/middle frontal gyrus (MFG), left precuneus, right rectus and left MFG, and significantly decreased ReHo in the bilateral cerebellum VIII and left inferior occipital gyrus (IOG) after treatment. Support vector regression analyses showed that high ReHo levels at baseline in the right precuneus and left superior MPFC could predict symptomatic improvement of Positive and Negative Syndrome Scale (PANSS) after 8 weeks of DPP treatment. Moreover, high ReHo levels at baseline and alterations of ReHo in the left ventral MPFC/ACC could predict symptomatic improvement of PANSS after 8 weeks of DT treatment. This study suggests that MCT is associated with the modulation of ReHo in schizophrenia. ReHo in the right precuneus and left superior MPFC may predict individual therapeutic response for MCT in patients with schizophrenia.

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The effectiveness of metacognitive training for patients with schizophrenia: a narrative systematic review of studies published between 2009 and 2015

Cited by 23 publications

References 0 publications

Metacognitive Training Modulates Default-Mode Network Homogeneity During 8-Week Olanzapine Treatment in Patients With Schizophrenia

Metacognitive Training Modulates Default-Mode Network Homogeneity During 8-Week Olanzapine Treatment in Patients With Schizophrenia

Impaired introspective accuracy in schizophrenia: an independent predictor of functional outcomes

Increased regional homogeneity modulated by metacognitive training predicts therapeutic efficacy in patients with schizophrenia

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