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Metacognitive training

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Treatment for psychosis in schizophrenia

Metacognitive training (MCT) is an approach for treating the symptoms of psychosis in schizophrenia, especially delusions, which has been adapted for other disorders such as depression, obsessive–compulsive disorder and borderline over the years (see below). It was 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. Metacognitive training exists as a group training (MCT) and as an individualized intervention (MCT+).

Background

Metacognition 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. Accordingly, correcting these problematic/unhelpful thinking styles should lead to a reduction of symptoms.

Intervention

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 thought patterns, which may contribute to problematic behaviors, 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.

Efficacy

A recent meta-analysis found significant improvements for positive symptoms and delusions, as well as the acceptance of the training. These findings have been replicated in 2018 and 2019. An older meta-analysis based on a smaller number of studies found a small effect, which reached significance when newer studies were considered. Individual studies provide evidence for the long-term effectiveness of the approach beyond the immediate treatment period. A meta-analysis based on 43 studies (N = 1,816 individuals) showed that MCT improved delusions, hallucinations, cognitive biases, negative symptoms and functioning. MCT is recommended as an evidence-based treatment by the Royal Australian and New Zealand College of Psychiatrists as well as the German Association for Psychiatry, Psychotherapy and Psychosomatics.

Adaptations to other disorders

Since its introduction, MCT has been adapted to other mental disorders. Empirical studies have been carried out for borderline personality disorder, obsessive–compulsive disorder (self-help approach), depression, bipolar disorders, and problem gambling.

References

  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. (June 2014). "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. hdl:2440/96875. ISSN 0272-7358. PMID 24866025.
  3. ^ Garety, P. A.; Freeman, D. (November 2013). "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. PMID 24187067.
  4. Moritz, Steffen; Krieger, Eva; Bohn, Francesca; Veckenstedt, Ruth (2017). MKT+. doi:10.1007/978-3-662-52998-0. ISBN 978-3-662-52997-3.
  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): 1103–11. doi:10.1001/jamapsychiatry.2014.1038. ISSN 2168-622X. PMID 25103718.
  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. PMC 4903058. PMID 26748396.
  8. ^ 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. PMID 29489070.
  9. ^ Philipp, Rebecca; Kriston, Levente; Lanio, Jana; Kühne, Franziska; Härter, Martin; Moritz, Steffen; Meister, Ramona (2019). "Effectiveness of metacognitive interventions for mental disorders in adults—A systematic review and meta-analysis (METACOG)". Clinical Psychology & Psychotherapy. 26 (2): 227–240. doi:10.1002/cpp.2345. ISSN 1063-3995. PMID 30456821.
  10. Oosterhout, B. van; Smit, F.; Krabbendam, L.; Castelein, S.; Staring, A. B. P.; Gaag, M. van der (January 2016). "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. PMID 26190517. S2CID 25707116.
  11. Oosterhout, B. van; Smit, F.; Krabbendam, L.; Castelein, S.; Staring, A. B. P.; Gaag, M. van der (July 2016). "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. PMID 26888290.
  12. Favrod, J.; Rexhaj, S.; Bardy, S.; Ferrari, P.; Hayoz, C.; Moritz, S.; Conus, P.; Bonsack, C. (June 2014). "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. PMID 24176646.
  13. Penney, Danielle; Sauvé, Geneviève; Mendelson, Daniel; Thibaudeau, Élisabeth; Moritz, Steffen; Lepage, Martin (2022-05-01). "Immediate and Sustained Outcomes and Moderators Associated With Metacognitive Training for Psychosis: A Systematic Review and Meta-analysis". JAMA Psychiatry. 79 (5): 417–429. doi:10.1001/jamapsychiatry.2022.0277. ISSN 2168-622X. PMC 8943641. PMID 35320347.
  14. 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 (5): 410–472. doi:10.1177/0004867416641195. PMID 27106681.
  15. Gaebel, Wolfgang (2019). S3-Leitlinie Schizophrenie . Berlin: Springer. ISBN 978-3-662-59380-6.
  16. Schilling, Lisa; Moritz, Steffen; Kriston, Levente; Krieger, Maria; Nagel, Matthias (2018). "Efficacy of metacognitive training for patients with borderline personality disorder: Preliminary results". Psychiatry Research. 262: 459–464. doi:10.1016/j.psychres.2017.09.024. PMID 28927866.
  17. Jelinek, Lena; Faissner, Mirjam; Moritz, Steffen; Kriston, Levente (2018-12-16). "Long-term efficacy of Metacognitive Training for Depression (D- MCT ): A randomized controlled trial". British Journal of Clinical Psychology. 58 (3): 245–259. doi:10.1111/bjc.12213. ISSN 0144-6657. PMID 30556583.
  18. Haffner, Paula; Quinlivan, Esther; Fiebig, Jana; Sondergeld, Lene-Marie; Strasser, Elisa Sophie; Adli, Mazda; Moritz, Steffen; Stamm, Thomas Josef (2018). "Improving functional outcome in bipolar disorder: A pilot study on metacognitive training". Clinical Psychology & Psychotherapy. 25 (1): 50–58. doi:10.1002/cpp.2124. PMID 28857347.
  19. Gehlenborg, Josefine; Bücker, Lara; Berthold, Mira; Miegel, Franziska; Moritz, Steffen (2020-09-21). "Feasibility, Acceptance, and Safety of Metacognitive Training for Problem and Pathological Gamblers (Gambling-MCT): A Pilot Study". Journal of Gambling Studies. 37 (2): 663–687. doi:10.1007/s10899-020-09975-w. ISSN 1573-3602. PMC 8144133. PMID 32955694.

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