Clinical Efficacy of Metacognitive vs Conventional Social Skills Training in Schizophrenia Spectrum Disorders

illustration of adult that seems frazzled
Metacognition-oriented social skills training may be promising for people with schizophrenia spectrum disorders.

Metacognition-oriented social skills training is more efficacious than conventional social skills training in terms of psychosocial functioning and symptom relief for patients affected by schizophrenia spectrum disorders, according to research published in Schizophrenia Bulletin.

Spanish investigators conducted a single-blind, randomized controlled trial pilot study between July 2014 and December 2016. They were encouraged by the results and the implication of short- and long-term benefits within this population.

Participants 18 to 65 years of age (mean: 37.69±12.62) were randomly assigned to 16 group sessions of either metacognition-oriented social skills training (n=36) or conventional social skills training (n=33), in addition to treatment as usual. 

Treatment was carried out over a 4-month period, with follow-up at 6 months. Participants receiving metacognition-oriented social skills training averaged 13.50 sessions, and participants receiving conventional social skills training averaged 14.20 sessions. Targeted social skills included conversation, assertiveness, and conflict management.

At the conclusion of treatment and follow-up, there were significant between-group differences favoring metacognition-oriented social skills training for total scores on the Social and Occupational Functioning Assessment Scale and the Personal and Social Performance Scale, both of which were used as measures of primary outcomes. The superiority of metacognition-oriented social skills training was evident when applied to both rating scales (between-group differences: 1.63 and 1.03, respectively; P <.01 for both). This trend continued during follow-up analysis (between-group differences, 1.43 and 0.88, respectively; P <.01 for both). Personal and Social Performance subscales also favored metacognition-oriented social skills training in terms of personal relationships, social activities, and aggressive behavior (P <.01).

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Secondary outcomes included psychotic symptoms, which were measured using the Positive and Negative Syndrome Scale. There was no significant difference between groups in either partial or total scores (P >.01).

There are several limitations of this study, including no control for baseline neuropsychological capacity. Additionally, the study was not designed to determine whether metacognition was the actual change mechanism, and replication of results in future research among diverse populations is needed.

Positive results associated with metacognition-oriented social skills training is consistent with previous reports and results involving metacognitive strategies. The authors concluded, “[Metacognition-oriented social skills training] may help patients to discover that they can still live a meaningful life instead of being passive and fearful of social interactions.”


Inchausti F, García-Poveda NV, Ballesteros-Prados A, et al. The effects of metacognition-oriented social skills training on psychosocial outcome in schizophrenia-spectrum disorders: a randomized controlled trial [published online December 16, 2017]. Schizophr Bull. doi:10.1093/schbul/sbx168.