Steffen Moritz

University of Hamburg, Hamburg, Hamburg, Germany

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Publications (259)675.56 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Persistent psychotic symptoms represent a major challenge for psychiatric care. Basic research has shown that psychotic symptoms are associated with cognitive biases. Metacognitive training (MCT) aims at helping patients to become aware of these biases and to improve problem-solving. Fifty-two participants fulfilling diagnostic criteria of schizophrenia or schizoaffective disorders and persistent delusions and stabilized antipsychotic medication were enrolled in this study. Following baseline assessment patients were randomized either to treatment as usual (TAU) conditions or TAU+MCT. The intervention consisted of eight weekly 1-hour sessions (maximum: 8hours). Participants were assessed at 8weeks and 6-months later by blind assessors. Participants were assessed with the Psychotic Symptoms Rating Scales (PSYRATS) and the positive subscale of the PANSS. Between-group differences in post- and pre-test values were significant at a medium effect size in favor of the MCT for the PSYRATS delusion scale and the positive scale of the PANSS both at post and follow-up. The results of this study indicate that MCT training has a surplus antipsychotic effect for patients suffering from schizophrenia-related disorders who demonstrate only a partial response to antipsychotic treatment and that the effect of the intervention persists for at least 6months after the intervention.
    European Psychiatry 10/2014; 29:275-281. · 3.29 Impact Factor
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    ABSTRACT: Cognitive interventions increasingly complement psychopharmacological treatment to enhance symptomatic and functional outcome in schizophrenia. Metacognitive training (MCT) is targeted at cognitive biases involved in the pathogenesis of delusions.
    JAMA Psychiatry 08/2014; · 12.01 Impact Factor
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    ABSTRACT: Introduction. The aims of this study were to identify whether responses to paranoid thoughts distinguish patients with psychotic disorders from people in the population who have paranoid thoughts occasionally and to identify factors that are associated with and might explain the different ways of responding. Methods. Paranoid thoughts were assessed in patients diagnosed with a psychotic disorder (n = 32) and a population control sample (n = 34) with the Paranoia Checklist. Responses to paranoid thoughts were assessed with the Reactions to Paranoid Thoughts Scale (RePT) and social support, self-efficacy and cognitive insight were assessed as potential correlates of the responses to paranoid thoughts. Results. The patients showed significantly more depressed, physical and devaluating responses to paranoid thoughts and employed less normalising responses than the controls. The differences in normalising responses were explained by perceived social integration, whereas the differences in depressive responses were explained by the overall levels of depression and partly explained by externality and social integration. Conclusions. Maladaptive responses to paranoid thoughts could be relevant to the pathogenesis and maintenance of persecutory delusions. Interventions aimed at reducing paranoia could benefit from targeting dysfunctional responses to paranoid thoughts and by placing a stronger emphasis on treating depression and improving social integration.
    Cognitive Neuropsychiatry 07/2014; · 1.68 Impact Factor
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    ABSTRACT: Obsessions are traditionally defined as bothersome and repetitive thoughts that the patient is unable to resist. Preliminary evidence suggests that in a subgroup of patients with obsessive-compulsive disorder (OCD), obsessions are experienced as partially perceptual. The present study explored the frequency of perceptually laden obsessions and their relationship with illness insight and depression. Twenty-six patients with OCD were administered the newly developed Sensory Properties of Obsessions Questionnaire. Participants were asked to endorse on a 5-point Likert scale whether their obsessions were associated with perceptual features. Participants showed moderate symptom severity. A total of 73% affirmed that their obsessions contained perceptual features. The predominant perceptual channels were visual, tactile, and somatic (i.e., bodily sensations). The extent of perceptual aspects associated with obsessions was strongly correlated with lack of insight (Yale-Brown Obsessive-Compulsive Scale item 11) but not depression severity. The present study suggests that obsessive thoughts are frequently accompanied by perceptual sensations, which concurs with models assuming a continuum between hallucinations and intrusions. Apparently, the more "real" or authentic the obsessive thought is experienced, the less the afflicted person is able to dismiss its content as fully irrational or absurd.
    The Journal of nervous and mental disease. 06/2014;
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    ABSTRACT: Previous research on trichotillomania (TTM) has demonstrated an emotion regulation function of hair pulling behavior. One condition that can impede the regulation of emotions is alexithymia. The present study aimed to explore the relationship between the degree of alexithymia and the severity of hair pulling behavior in individuals with TTM. Multiple strategies were used to recruit a sample of 105 participants via the internet. All participants were diagnosed with TTM by an experienced clinician via a subsequent phone-interview. Multiple linear regression analysis was performed to test the potential predictive value of the different facets of alexithymia (20-item Toronto Alexithymia Scale) on the severity of TTM (Massachusetts General Hospital Hair-Pulling Scale). Both the difficulty in identifying feelings (DIF) facet of alexithymia (p = 0.045) and depression (p = 0.049) were significant predictors of the severity of TTM. In conclusion, alexithymia seems to play a role in hair pulling behavior in individuals with TTM. However, the significant association was small in terms of the overall variance explained, thus warranting further research. If replicated in prospective studies, then these results indicate that therapeutic approaches aimed at supporting patients in recognizing and differentiating feelings might be useful for the treatment of TTM.
    Psychiatry Research 05/2014; accepted 2014-03-24. · 2.68 Impact Factor
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    ABSTRACT: Symptom severity and neuropsychological deficits negatively influence functional outcomes in patients with schizophrenia. Recent research implicates specific types of biased thinking styles (e.g. jumping-to-conclusions) in the pathogenesis of schizophrenia. This is the first study to test the impact of jumping-to-conclusions on functional outcome in schizophrenia. The aim of the study was to investigate the association of psychopathology, neuropsychology and JTC with subjective quality of life, vocational outcome and housing status in schizophrenia. Analyses were carried out both cross-sectionally at baseline, and longitudinally over the course of symptomatic improvement in the immediate aftermath of a psychotic exacerbation. Seventy-nine patients with schizophrenia were included in the study. Data concerning the variables of interest were collected at baseline, after one month, and after six months. Positive symptomatology was the most significant predictor of subjective and vocational outcome and changes across time. Verbal memory deficits were associated with functional status cross-sectionally, whereas general cognitive capacity significantly predicted functional changes over time. Improvement of the jumping-to-conclusions bias positively affected vocational outcome. Though limited, the observed effect of this bias on real-world functioning highlights the possible usefulness of interventions aimed at improving (meta)cognitive deficits in schizophrenia.
    Psychiatry research. 05/2014;
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    ABSTRACT: Theoretical models postulate an important role of attributional style (AS) in the formation and maintenance of persecutory delusions and other positive symptoms of schizophrenia. However, current research has gathered conflicting findings. In a cross-sectional design, patients with persistent positive symptoms of schizophrenia (n = 258) and healthy controls (n = 51) completed a revised version of the Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R) and assessments of psychopathology. In comparison to controls, neither patients with schizophrenia in general nor patients with persecutory delusions (n = 142) in particular presented an externalizing and personalizing AS. Rather, both groups showed a "self-blaming" AS and attributed negative events more toward themselves. Persecutory delusions were independently predicted by a personalizing bias for negative events (beta = 0.197, P = .001) and by depression (beta = 0.152, P = .013), but only 5% of the variance in persecutory delusions could be explained. Cluster analysis of IPSAQ-R scores identified a "personalizing" (n = 70) and a "self-blaming" subgroup (n = 188), with the former showing slightly more pronounced persecutory delusions (P = .021). Results indicate that patients with schizophrenia and patients with persecutory delusions both mostly blamed themselves for negative events. Nevertheless, still a subgroup of patients could be identified who presented a more pronounced personalizing bias and more severe persecutory delusions. Thus, AS in patients with schizophrenia might be less stable but more determined by individual and situational characteristics that need further elucidation.
    Schizophrenia Bulletin 04/2014; · 8.80 Impact Factor
  • Schizophrenia Bulletin 02/2014; in press. · 8.80 Impact Factor
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    ABSTRACT: We found evidence that the usual developmental trends in children's spontaneous false memories were eliminated using novel stimuli containing obvious themes. That is, children created more false memories than adults when scenes needed to be remembered. In Experiment 1, 7- and 8-year-olds had higher false memory rates than adults when using visual scenes. Experiment 2 showed that gist cuing could not account for this effect. In Experiment 3, children and adults received visual scenes and story contexts in which these scenes were embedded. For both types of stimuli, we found that children had the highest false memory rates. Our results indicate that the underlying theme of these scenes is easily identified, resulting in our developmental false memory trend.
    Journal of Experimental Child Psychology 01/2014; 121C:28-41. · 3.12 Impact Factor
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    Jan Philipp Klein, Steffen Moritz
    Frontiers in Psychiatry 01/2014; 5:77.
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    ABSTRACT: Vulnerability–stress models implicate that alterations of the autonomous nervous system contribute to the development of psychosis. Previous research has found autonomic arousal alterations in psychotic disorders and at-risk individuals that are not explained by medication alone. To test whether these alterations are associated with the extent of an individual's vulnerability and whether they are specific to psychosis, we compared participants with psychosis (n = 23), first-degree relatives of individuals with psychosis (n = 21), and healthy participants with attenuated positive symptoms (n = 23) to participants with depression (n = 24) and healthy controls (n = 24). At rest, skin conductance level was assessed and photoplethysmography was applied to measure time- and frequency-domain heart rate variability (HRV). Univariate and multivariate analyses of covariance with perceived stress and psychophysiological values as dependent variables showed significant between-group differences for perceived stress (p = .010), heart rate (p = .022), time-domain HRV indices (all ps ≤ .027), and vagal activity (p = .017). Group differences in sympathetic activity were nonsignificant (p = .069). In an additional analysis with medication as a second between-group factor, the physiological between-group differences remained significant or trend significant (all ps ≤ .060). With the exception of sympathetic activity, participants with psychosis exhibited more extreme arousal than the control groups. First-degree relatives and participants with attenuated symptoms showed comparable autonomic activity to healthy controls. Thus, the hypothesized association of an alteration of arousal and vulnerability to psychosis was not confirmed. However, particularly low time-domain HRV was found for psychosis, with significant differences to healthy controls (all ps ≤ .007) and to depression (all ps ≤ .004), with the latter indicating a specificity to psychosis.
    Schizophrenia Research 01/2014; · 4.59 Impact Factor
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    ABSTRACT: Background. It has been previously demonstrated that a cognitive bias against disconfirmatory evidence (BADE; observed on delusion-neutral material) is associated with delusions, illustrating a cognitive process that may underlie maintenance of delusions despite counter-evidence and rational counter-argument. In past work, small samples of delusional patients, reliance on difference scores as opposed to aggregate scores, and choice of comparison groups may have reduced reliability of the results. In the present study we aimed to improve on this methodology with a recent version of the BADE task, and compare schizophrenia patients with/without delusions to OCD patients, a population not typically studied on this task. Method. A factor analysis was employed to identify cognitive operations underlying the BADE task, and how they differ across four groups of participants: (1) high-delusional schizophrenia, (2) low-delusional schizophrenia, (3) OCD patients, and (4) non-psychiatric controls. Results. A two-component solution was obtained, termed: (1) Evidence Integration (degree to which disambiguating information has been integrated) and (2) Conservatism (reduced willingness to provide high plausibility ratings when justified). Only Evidence Integration differed between severely delusional patients and healthy/patient controls, with delusional subjects giving higher ratings for disconfirmed interpretations and lower ratings for confirmed interpretations. Evidence Integration did not differ across the three control groups. Conclusions. A reduced willingness to adjust beliefs when confronted with disconfirming evidence may be a cognitive underpinning of delusions, and may not be characteristic of individuals with obsessive beliefs. This supports the possibility of the BADE operation being a useful target in cognitive-based therapies for delusions.
    Psychological Medicine 01/2014; 44:2729-38. · 5.59 Impact Factor
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    ABSTRACT: Background and Objectives Semantic network models suggest that individuals with obsessive-compulsive disorder (OCD) process words with multiple meanings (e.g., “knife”) more likely in an OC-related (i.e., “weapon”) than in a neutral way (i.e., “cutlery”). Initial evidence was found in an online study. The aim of the current study was to investigate semantic networks in a clinical sample and particularly to identify whether changes in semantic networks following the add-on intervention association splitting (AS) exceeded changes expected through cognitive behavioral therapy (CBT) alone. Methods An association task was presented to 36 healthy controls and 70 OCD patients over a period of eight weeks with OCD patients receiving CBT and an add-on intervention (randomized allocation to either AS or a computerized cognitive training). Participants were asked to generate up to five associations to standardized (OC-relevant, negative, neutral) and individual cue words. Associations were rated with regard to OC-relevance and valence. Results Analyses revealed that OCD participants produced a) significantly more OC-relevant associations and b) more negative associations than controls for cue words. In the OCD sample, the OC-relevance and valence of associations changed after therapy for personal cue words. This effect was associated with AS at statistical trend level. Limitations No clinical control group was recruited; no inter-rater reliability was assessed for the association task. Conclusions Some evidence for biased associative networks in OCD was found. Associations of individually chosen cue words proved to be modifiable by therapy.
    Journal of Behavior Therapy and Experimental Psychiatry. 01/2014;
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    ABSTRACT: Studies revealed that patients with paranoid schizophrenia display overconfidence in errors. The present investigation examined whether this pattern also holds true for visual perception. Nonclinical participants were recruited online. Individuals were asked to complete a questionnaire that included the Paranoia Checklist and were then presented with 24 blurry pictures; half contained a hidden object while the other half showed snowy (visual) noise. Participants were asked to state whether the visual items contained an object and how confident they were in their judgment. Data from 1,966 individuals were included. Participants high on core paranoid symptoms showed a poor calibration of confidence for correct versus incorrect responses. Participants high on paranoia displayed overconfidence in incorrect responses and demonstrated a 20% error rate for responses made with high confidence compared to a 12% error rate in participants with normal paranoia scores. Paranoia scores declined over time. For the first time, overconfidence in errors was demonstrated among individuals with high levels of paranoia in a visual perception task suggesting it is a ubiquitous phenomenon.
    Psychiatry Research 01/2014; · 2.68 Impact Factor
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    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 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 and may act as a facilitator to individualized psychotherapy.
    Clinical Psychology Review 01/2014; · 7.18 Impact Factor
  • Psychosis 01/2014;
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    ABSTRACT: Metacognitive training (MCT) is a novel group-based treatment program for schizophrenia and psychosis, and this has recently been expanded into an individualized treatment application labeled metacognitive therapy (MCT+). MCT+ is a hybrid of group MCT and cognitive behavioural therapy for psychosis (CBTp). In either version, the primary aim of MCT is to raise awareness in people with psychosis of the nature of the unhealthy thinking and reasoning patterns that underlie delusions by providing experiences of these thinking patterns, either in a group or individual setting. MCT unpacks the elements of biased thinking and reasoning styles that underlie delusions (“cognitive biases”), and introduces them experientially (in a wide range of situations) by walking participants through visual displays inspired by research into the cognitive underpinnings of delusions in schizophrenia. Breaking down the thinking that underlies delusions in this fashion helps participants compartmentalize and recognize the different thought patterns contributing to delusions. MCT and MCT+ are both currently available in multiple languages and can be downloaded at no cost online via This chapter will provide an overview for the MCT program, examine the evidence for the cognitive biases underlying each of its modules, and summarize a number of preliminary randomized controlled trials that suggest the efficacy of MCT in treating the symptoms of psychosis. We conclude that MCT is a potentially valuable tool for clinical care teams interested in novel, evidence-based non-pharmacological interventions.
    01/2014: pages 179-195; , ISBN: 9780124051720
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    ABSTRACT: Metacognitive training (MCT) is a novel group-based treatment program for schizophrenia and psychosis that aims to reduce delusional ideas by ameliorating the cognitive and social biases thought to underlie the formation and maintenance of these experiences, while strengthening metacognitive awareness for cognitive problems and dysfunctional coping. Built on the principles of cognitive-behavioral therapy for psychosis (CBTp), MCT unpacks the elements of biased thinking and reasoning styles that underlie delusions, and introduces them experientially by walking clients through visual displays inspired by research into the cognitive underpinnings of delusions in schizophrenia. Breaking down the thinking that underlies delusions in this fashion helps clients recognize the different thought patterns contributing to their delusional ideas. This chapter will provide an overview for the MCT program, covering the six cognitive and social biases targeted by the program (i.e., attribution biases, jumping to conclusions, belief inflexibility, overconfidence in errors, theory of mind deficits, and depressive cognitive schemata). We provide illustrative examples of how each module attempts to demonstrate these biases “at work” and how they may be responsible for the development and maintenance of delusional beliefs. We will also cover a new individualized application of the program, labeled metacognitive therapy (MCT+). MCT+ combines the “process-oriented” approach of the MCT group-training with elements from individual CBTp, and works by relating information from the original MCT modules to the individual experiences, observations, and symptoms of the individual client. We end with a summary of the studies that have investigated the efficacy of MCT/MCT+ in treating the symptoms of psychosis, and conclude that MCT is a potentially valuable tool for clinical care teams interested in novel, evidence-based non-pharmacological interventions.
    01/2014: pages 154-170;
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    ABSTRACT: Verbal thoughts (such as negative cognitions) and sensory phenomena (such as visual mental imagery) are usually conceptualised as distinct mental experiences. The present study examined to what extent depressive thoughts are accompanied by sensory experiences and how this is associated with symptom severity, insight of illness and quality of life. A large sample of mildly to moderately depressed patients (N = 356) was recruited from multiple sources and asked about sensory properties of their depressive thoughts in an online study. Diagnostic status and symptom severity were established over a telephone interview with trained raters. Sensory properties of negative thoughts were reported by 56.5% of the sample (i.e., sensation in at least one sensory modality). The highest prevalence was seen for bodily (39.6%) followed by auditory (30.6%) and visual (27.2%) sensations. Patients reporting sensory properties of thoughts showed more severe psychopathological symptoms than those who did not. The degree of perceptuality was marginally associated with quality of life. The findings support the notion that depressive thoughts are not only verbal but commonly accompanied by sensory experiences. The perceptuality of depressive thoughts and the resulting sense of authenticity may contribute to the emotional impact and pervasiveness of such thoughts, making them difficult to dismiss for their holder.
    Cognition and Emotion 12/2013; · 2.52 Impact Factor
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    ABSTRACT: The investigation of veridical mood-congruent memory (MCM) in major depressive disorder (MDD) has been subject of many studies, whereas mood-congruent false memory has received comparatively little attention. The present study examined the influence of valence, personal relevance and the valence of the context of the learning material on true and false MCM in 20 inpatients with MDD and 20 healthy controls. Sixty positive, negative, neutral or personally relevant nouns were either combined with a positive, negative or neutral adjective. Word pairs were presented to participants in a learning trial. In a recognition task, participants had to identify the previously studied word pairs. A MCM effect could not be found for hits. However, in exploratory analyses, word pairs containing personally relevant nouns were more rated towards old by the patient relative to the control group. Furthermore, depressed patients tended to rate items more towards old than controls when the words were presented in a negative new context. Results are in line with previous findings in depression research emphasizing the role of mood-congruent false memories for mood disorders.
    Psychiatry research. 12/2013;

Publication Stats

4k Citations
675.56 Total Impact Points


  • 1998–2014
    • University of Hamburg
      • • Department of Psychiatry and Psychotherapy
      • • Department of Psychosomatic Medicine and Psychotherapy
      Hamburg, Hamburg, Germany
  • 1997–2014
    • University Medical Center Hamburg - Eppendorf
      • • Department of Psychiatry and Psychotherapy
      • • Department of Psychosomatic Medicine and Psychotherapy
      Hamburg, Hamburg, Germany
  • 2013
    • Charité Universitätsmedizin Berlin
      • Department of Psychiatry and Psychotherapy
      Berlin, Land Berlin, Germany
  • 2010–2013
    • Universität Heidelberg
      • Department of Geriatric Psychiatry
      Heidelberg, Baden-Wuerttemberg, Germany
  • 2009–2013
    • Medical University of Warsaw
      • Katedra i Klinika Psychiatryczna
      Warsaw, Masovian Voivodeship, Poland
    • Evangelisches Krankenhaus Alsterdorf
      Hamburg, Hamburg, Germany
  • 2011
    • Universitätsklinikum Freiburg
      • Department of Psychiatry and Psychotherapy
      Freiburg, Lower Saxony, Germany
  • 2008–2010
    • Philipps-Universität Marburg
      • Fachbereich Psychologie
      Marburg an der Lahn, Hesse, Germany
  • 2007
    • Simon Fraser University
      Burnaby, British Columbia, Canada
  • 2002
    • University of British Columbia - Vancouver
      • Department of Psychology
      Vancouver, British Columbia, Canada
  • 2000
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany