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Metacognitive Training for Psychosis (MCT) [1] is a novel psychotherapeutic approach for the treatment of positive symptoms of schizophrenia, especially delusions [2], developed by Steffen Moritz and Todd Woodward. The intervention is based on the theoretical principles of cognitive behavioral therapy, but focuses in particular on problematic thinking styles (cognitive biases) that are associated with the development and maintenance of positive symptoms; e.g. overconfidence in errors and jumping to conclusions.[3] Metacognitive training exists as a group training (MCT) and as an individualized intervention (MCT+).[4]

Background[edit]

Metacognition [5] can be defined as "thinking about thinking". Over the course of the training, cognitive biases subserving positive symptoms are identified and corrected. The current empirical evidence assumes a connection between certain cognitive biases, such as jumping to conclusions, and the development and maintenance of psychosis [3]. Accordingly, correcting these problematic/unhelpful thinking styles should lead to a reduction of symptoms.

Intervention[edit]

In eight training units (modules) and two additional modules, examples of "cognitive traps", which can promote the development and maintenance of the positive symptoms of schizophrenia, are presented to patients in a playful way. Patients are instructed to critically reflect on their previous problem behavior, to change it and to implement the contents of the training in everyday life. MCT deals with the following problematic styles of thinking: monocausal attributions, jumping to conclusions, inflexibility, problems in social cognition, overconfidence for memory errors and depressive thought patterns. The additional modules deal with stigma and low self-esteem. Individualized metacognitive training (MCT+) targets the same symptoms and cognitive biases as the group training, but is more flexible in that it allows discussion of individualized topics. The treatment materials for the group training can be obtained free of charge in over 30 languages from the website [6].

Efficacy[edit]

A recent meta-analysis found significant improvements for positive symptoms and delusions, as well as the acceptance of the training [7]. These findings have been replicated in 2018 [8]. An older meta-analysis based on a smaller number of studies found a small effect [9], which, reached significance when newer studies were considered [10]. Individual studies provide evidence for the long-term effectiveness of the approach beyond the immediate treatment period.[8][11]. MCT is recommended as an evidence-based treatment by the Royal Australian and New Zealand College of Psychiatrists [12].

References[edit]

  1. ^ Moritz, S.; Bohn, F.; Veckenstedt, R.; Hottenrott, B.; Woodward, T. (2016). Metacognition Study Group: Metacognitive Training for schizophrenic patients (MKT). Manual. Hamburg: VanHam Campus Publishing House.
  2. ^ Moritz, Steffen; Andreou, Christina; Schneider, Brooke C.; Wittekind, Charlotte E.; Menon, Mahesh; Balzan, Ryan P.; Woodward, Todd S. (2014-06). "Sowing the seeds of doubt: a narrative review on metacognitive training in schizophrenia". Clinical Psychology Review. 34 (4): 358–366. doi:10.1016/j.cpr.2014.04.004. ISSN 0272-7358. {{cite journal}}: Check date values in: |date= (help)
  3. ^ a b Garety, P. A.; Freeman, D. (2013/11). "The past and future of delusions research: from the inexplicable to the treatable". The British Journal of Psychiatry. 203 (5): 327–333. doi:10.1192/bjp.bp.113.126953. ISSN 0007-1250. {{cite journal}}: Check date values in: |date= (help)
  4. ^ Moritz, Steffen; Krieger, Eva; Bohn, Francesca; Veckenstedt, Ruth (2017). MKT+. doi:10.1007/978-3-662-52998-0.
  5. ^ Flavell, John H. (1979). "Metacognition and cognitive monitoring: A new area of cognitive-developmental inquiry". American Psychologist. 34 (10): 906–911. doi:10.1037/0003-066x.34.10.906. ISSN 0003-066X.
  6. ^ Moritz, Steffen; Veckenstedt, Ruth; Andreou, Christina; Bohn, Francesca; Hottenrott, Birgit; Leighton, Lucy; Köther, Ulf; Woodward, Todd S.; Treszl, András (2014-10-01). "Sustained and "Sleeper" Effects of Group Metacognitive Training for Schizophrenia". JAMA Psychiatry. 71 (10): 1103. doi:10.1001/jamapsychiatry.2014.1038. ISSN 2168-622X.
  7. ^ Eichner, Carolin; Berna, Fabrice (2016-07-01). "Acceptance and Efficacy of Metacognitive Training (MCT) on Positive Symptoms and Delusions in Patients With Schizophrenia: A Meta-analysis Taking Into Account Important Moderators". Schizophrenia Bulletin. 42 (4): 952–962. doi:10.1093/schbul/sbv225. ISSN 0586-7614. PMC 4903058. PMID 26748396.{{cite journal}}: CS1 maint: PMC format (link)
  8. ^ a b Liu, Yu-Chen; Tang, Chia-Chun; Hung, Tsai-Tzu; Tsai, Pei-Ching; Lin, Mei-Feng (2018-02-28). "The Efficacy of Metacognitive Training for Delusions in Patients With Schizophrenia: A Meta-Analysis of Randomized Controlled Trials Informs Evidence-Based Practice". Worldviews on Evidence-Based Nursing. 15 (2): 130–139. doi:10.1111/wvn.12282. ISSN 1545-102X.
  9. ^ Oosterhout, B. van; Smit, F.; Krabbendam, L.; Castelein, S.; Staring, A. B. P.; Gaag, M. van der (2016/01). "Metacognitive training for schizophrenia spectrum patients: a meta-analysis on outcome studies". Psychological Medicine. 46 (1): 47–57. doi:10.1017/S0033291715001105. ISSN 0033-2917. {{cite journal}}: Check date values in: |date= (help)
  10. ^ Oosterhout, B. van; Smit, F.; Krabbendam, L.; Castelein, S.; Staring, A. B. P.; Gaag, M. van der (2016/07). "Letter to the Editor: Should we focus on quality or quantity in meta-analyses?". Psychological Medicine. 46 (9): 2003–2005. doi:10.1017/S003329171600009X. ISSN 0033-2917. {{cite journal}}: Check date values in: |date= (help)
  11. ^ Favrod, J.; Rexhaj, S.; Bardy, S.; Ferrari, P.; Hayoz, C.; Moritz, S.; Conus, P.; Bonsack, C. (2014-06). "Sustained antipsychotic effect of metacognitive training in psychosis: A randomized-controlled study". European Psychiatry. 29 (5): 275–281. doi:10.1016/j.eurpsy.2013.08.003. ISSN 0924-9338. {{cite journal}}: Check date values in: |date= (help)
  12. ^ Galletly, C.; Castle, D.; Dark, F.; Humberstone, V.; Jablensky, A.; Killackey, E.; Kulkarni, J.; McGorry, P.; Nielssen, O.; Tran, N. (April 22, 2016). "Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders". Australian and New Zealand Journal of Psychiatry. 50: 410–472. doi:10.1177/0004867416641195.

External links[edit]

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