Metacognitive therapy in people with a schizophrenia spectrum diagnosis and medication resistant symptoms: A feasibility study
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.
Available from: Til Wykes
- "The prominence of metacognitive problems in people with schizophrenia prompted the proliferation of psychological interventions focussed on this domain (e.g., Bargenquast & Schweitzer, 2014; Moritz et al., 2013; Morrison et al., 2014). As part of this 'new wave' of metacognitive-informed psychological interventions, different authors have produced models of how metacognition may contribute to schizophrenia. "
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ABSTRACT: Cognitive remediation (CR) is a therapy targeting cognitive difficulties in psychiatric disorders. We recently develop a novel CR program for people with psychosis with a focus on metacognitive skills individually supported by a therapist. This study aims to assess the acceptability and feasibility of implementing CR in small groups where therapist support is shared amongst service users.
Control group design with non-randomized group allocation.
Twenty-five service users with a diagnosis of schizophrenia participated. Ten received group CR and 15 individual CR (i.e., one therapist for each service user). Both therapy formats were supported by one therapist. Participants were assessed before and after therapy with neuropsychological tests assessing different cognitive domains, self-assessed cognitive complaints, and psychotic symptoms. Treatment satisfaction questionnaires and therapist's session ratings were also collected for group CR.
Dropout rate was 20% for both methods. Session attendance was 74% for group CR and 86% for individual CR. Service users evaluated positively group CR and considered it helpful; therapists rated this delivery format feasible. Exploratory analysis suggested that the two methods have similar effects on cognition. After therapy, service users showed improvements in recall memory, reduced negative symptoms, and reported fewer cognitive complains.
It is feasible and acceptable for people with schizophrenia to take part in small CR therapy groups. The reduced therapist contact compared to individual therapy was well tolerated and may help sustain independent work. The small group format allows therapists to spend sufficient time to support the use of metacognitive strategies.
CR small groups are feasible and acceptable for service users and therapists. Therapist support can be shared. Metacognitive-based CR can improve cognition and may benefit awareness and negative symptoms.
© 2015 The British Psychological Society.
Available from: Andrew Gumley
- "The provision of normalizing information about the common nature of paranoid beliefs (Freeman et al. 2006) may help patients to re-evaluate their negative beliefs about their paranoid thoughts being uncontrollable and dangerous. Similarly, it is possible that metacognitive therapies based on the S-REF model may be helpful for people with psychosis and those at high risk, and there is preliminary evidence to support this suggestion (Morrison et al. 2014). "
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ABSTRACT: Paranoia is one of the commonest symptoms of psychosis but has rarely been studied in a population at risk of developing psychosis. Based on existing theoretical models, including the proposed distinction between 'poor me' and 'bad me' paranoia, we aimed to test specific predictions about associations between negative cognition, metacognitive beliefs and negative emotions and paranoid ideation and the belief that persecution is deserved (deservedness).
We used data from 117 participants from the Early Detection and Intervention Evaluation for people at risk of psychosis (EDIE-2) trial of cognitive-behaviour therapy, comparing them with samples of psychiatric in-patients and healthy students from a previous study. Multi-level modelling was utilized to examine predictors of both paranoia and deservedness, with post-hoc planned comparisons conducted to test whether person-level predictor variables were associated differentially with paranoia or with deservedness.
Our sample of at-risk mental state participants was not as paranoid, but reported higher levels of 'bad-me' deservedness, compared with psychiatric in-patients. We found several predictors of paranoia and deservedness. Negative beliefs about self were related to deservedness but not paranoia, whereas negative beliefs about others were positively related to paranoia but negatively with deservedness. Both depression and negative metacognitive beliefs about paranoid thinking were specifically related to paranoia but not deservedness.
This study provides evidence for the role of negative cognition, metacognition and negative affect in the development of paranoid beliefs, which has implications for psychological interventions and our understanding of psychosis.
Available from: Kenneth Connelly
- "Intervention is aimed towards establishing new ways of relating to negative thoughts and beliefs, by modifying metacognitive beliefs that give rise to obstructive patterns of thinking (Wells 2011). It has recently been shown as an effective therapy in disorders such as; psychosis (Morrison et al. 2014), GAD (Hjemdal, Hagen & Nordahl 2013), body dysmorphic disorder (Rabiei et al. 2011) and the reduction of student anxiety (Valizade et al. 2013). MCT may be a more effective form of treatment for those with SAD, as it would directly focus on modifying the mechanisms for maintaining this disorder. "
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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.
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