Metacognitive training (MCT) for psychosis—which helps patients learn to question unfounded assumptions known as cognitive biases that contribute to their symptoms—was associated with reduced delusions and hallucinations and improved self-esteem and functioning, according to a report in JAMA Psychiatry. Common cognitive biases in people with psychosis include jumping to conclusions, inflexibility about one’s beliefs, and overconfidence in one’s judgments.
“[T]he benefits of MCT were maintained up to one year after the intervention,” said lead author Danielle Penney, a Ph.D. candidate at Douglas Research Center of McGill University, in a press release. “More generally, these findings support the utility of MCT as an effective tool that can be offered by mental health care workers across health care settings … .”
The researchers analyzed 43 studies of MCT involving 1,816 participants. Of the 43 studies, 30 were randomized, controlled trials (RCTs); 11 were non-RCTs; and two were quantitative descriptive studies. The researchers examined the effect of MCT on global symptoms, delusions, hallucinations, and cognitive biases. They also looked at the effect of MCT on self-esteem, negative symptoms, quality of life, well-being, and functioning.
MCT reduced all symptoms examined, with effect sizes that ranged from small (0.16 for cognitive biases, 0.17 for self-esteem, 0.23 for negative symptoms, and 0.26 for hallucinations) to medium (0.41 for functioning and 0.50 for positive symptoms) and large (0.69 for delusions). Moreover, analysis of RCTs found that both treatment and control groups maintained the therapeutic level reached at the end of treatment for all outcomes at the one-year follow-up.
The effects of MCT on symptoms in people with psychosis were similar to the effects reported in studies of cognitive-behavioral therapy for psychosis and cognitive remediation. Previous analyses of cognitive-behavioral therapy for psychosis found small to moderate effects on delusions and small effects on hallucinations, negative symptoms, and functioning. Similarly, prior meta-analyses of cognitive remediation have reported small to moderate effects for negative symptoms, global symptoms, and functioning.
The researchers concluded: “These findings provide some evidence to consider MCT in international treatment guidelines, and the focus may now shift toward implementation and cost-effectiveness trials in real-world clinical settings.”
For related information, see the Psychiatric News article “Therapy Targeting Cognitive Biases Reduces Delusions in Psychosis.”
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