Wednesday, October 31, 2018

Specialized Psychotherapy Found to Reduce Severity of Delusions in Patients With Schizophrenia

Participating in a brief course of individualized metacognitive training—a psychotherapy designed to specifically target delusional beliefs—can reduce the severity of delusions and positive symptoms in patients with schizophrenia, according to a study published Tuesday in Schizophrenia Bulletin.

The study found that patients who received metacognitive training had significant reductions in delusional thinking compared with patients who received cognitive remediation, a program designed to improve cognitive abilities. These improvements were maintained at six months.

The findings “suggest that even brief psychotherapy can help to ameliorate the symptoms of psychosis,” Ryan P. Balzan, Ph.D., of Findlers University in Adelaide, Australia, and colleagues wrote.

Patients aged 18 to 65 with a schizophrenia spectrum diagnosis and delusional beliefs were recruited for the study. Of the 54 patients included in the trial, 52 were taking antipsychotic medications; these patients continued to receive their medication throughout the study.

The patients were randomly assigned to metacognitive training or cognitive remediation. Patients in the metacognitive training group completed four two-hour sessions with a therapist over one month, where they learned techniques for increasing awareness of their own cognitive biases that may contribute to the formation and maintenance of their delusional beliefs (for example, overconfidence and belief inflexibility). Patients in the cognitive remediation group completed four therapist-led, 90-minute to two-hour sessions over the same timeframe, during which they focused on improving working and verbal memory, processing speed, problem-solving, and attention—cognitive domains commonly impaired in patients with schizophrenia.

The researchers assessed the patients’ delusions, positive symptoms, performance in several cognitive domains, and clinical insight (awareness of and attitudes toward mental illness) at the start of the trial, following the completion of the four therapy sessions, and six months later. Two patients did not complete the six-month assessment.

Patients in the metacognitive training group showed significant reductions in delusional and overall positive symptom severity and improved clinical insight relative to patients in the cognitive remediation group. In contrast, compared with those in the metacognitive training group, patients in the cognitive remediation group showed moderate improvement in problem-solving ability but in no other cognitive domains. The authors wrote that this suggests “more CR [cognitive remediation] might be required to be effective in these domains.”

In conclusion, the authors wrote, “While larger multisite trials investigating MCT+ [metacognitive training] are warranted, the present study adds to the growing literature that psychological interventions can be effective in people with psychosis.”

For related information, see the American Journal of Psychotherapy article “Application of Integrative Metacognitive Psychotherapy for Serious Mental Illness.”

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