Metacognitive therapy in people with a schizophrenia spectrum diagnosis and medication resistant symptoms: A feasibility study
ABSTRACT Cognitive behaviour therapy (CBT) for psychosis has been shown to be effective, but there are recent suggestions that it is less efficacious than initially thought. Metacognitive therapy (MCT), which focuses on metacognitive mechanisms, has led to positive results in other disorders, but has yet to be evaluated in people with schizophrenia spectrum diagnoses. This study evaluates the feasibility of MCT for people with psychotic disorders.
Ten participants with schizophrenia spectrum disorders received up to 12 sessions of MCT in an open trial. Outcomes included psychiatric symptoms measured using the PANSS, at baseline, 9 months (end of treatment) and at 12 months (follow-up), as well as dimensions of hallucinations and delusions, emotional dysfunction, self-rated recovery, social functioning and metacognitive beliefs.
T-tests and Wilcoxon's signed ranks tests revealed significant beneficial effects on several outcomes at end-of-treatment and follow-up. Cohen's d effect sizes were moderate to large (for PANSS total, d = 1.0 at end of treatment; d = 0.95 at follow-up). A response rate analysis found 50% and 40% of participants achieved at least a 25% reduction in PANSS total scores by end of therapy and follow-up, respectively. Exploratory analyses revealed that metacognitive beliefs significantly changed over treatment and follow-up periods.
This study had no control group and was not randomised; therefore, it is likely that effect sizes were inflated.
This study provides preliminary evidence that MCT is a feasible treatment for people with psychosis. An adequately powered randomised controlled trial is warranted.
- SourceAvailable from: Kenneth Connelly[Show abstract] [Hide abstract]
ABSTRACT: Social Anxiety Disorder (SAD) is one of the most common anxiety disorders and a highly disabling condition. SAD usually develops in early to late teens, with clinical trials highlighting impairments in mental health, general health, vitality and social functioning. Since Wells & Mathews (1994) introduced the metacognitive model, beliefs about thinking have been associated with the development of psychopathologies within clinical trials but, little is known about the contribution of individual differences in metacognition to SAD specifically. In this study a cross sectional design was utilised and opportunity sampling used for acquiring participants in order to assess the contribution of metacognition, a specific form of thinking style and cognition, when measured outside the clinical environment. Participants completed a questionnaire pack and the following hypotheses were tested; metacognition will correlate positively with social anxiety; metacognitive beliefs about uncontrollability and danger will be the strongest independent predictor of social anxiety; metacognition will display a role, which is independent of cognition, within social anxiety. Multiple regression analysis was run to test these hypotheses and to determine the best independent metacognitive predictors. The results supported each hypothesis and revealed three metacognitive predictors of social anxiety. Overall this study indicated that metacognition may have an important role in social anxiety, a role independent of cognition.
Article: Metakognitive TherapieZeitschrift für Klinische Psychologie und Psychotherapie 01/2014; 43(4):251-258. DOI:10.1026/1616-3443/a000279 · 0.79 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Metacognitive therapy (MCT) is a relatively new approach to treating mental disorders. The aim of the current meta-analysis was to examine the efficacy of MCT in patients with mental disorders. A comprehensive literature search revealed 16 published as well as unpublished studies on the efficacy of MCT, of which nine were controlled trials. These studies report on 384 participants suffering from anxiety or depression. Treatment efficacy was examined using a random effects model. On primary outcome measures the aggregate within-group pre- to posttreatment and pretreatment to follow-up effect sizes for MCT were large (Hedges' g = 2.00 and 1.65, respectively). Within-group pre- to posttreatment changes in metacognitions were also large (Hedges' g = 1.18) and maintained at follow-up (Hedges' g = 1.31). Across the controlled trials, MCT was significantly more effective than both waitlist control groups (between-group Hedges' g = 1.81) as well as cognitive behavior therapy (CBT; between-group Hedges' g = 0.97). Results suggest that MCT is effective in treating disorders of anxiety and depression and is superior compared to waitlist control groups and CBT, although the latter finding should be interpreted with caution. The implications of these findings are limited by small sample sizes and few active control conditions. Future studies should include larger sample sizes and also include comparisons of MCT with other empirically supported therapies.Depression and Anxiety 05/2014; 31(5):402-11. DOI:10.1002/da.22273 · 4.29 Impact Factor