Metacognitive training (MCT) for psychosis was associated with improvement in hallucinations, delusions, and conceptual disorganization for up to 1 year after intervention according to a recent study published in JAMA Psychiatry.

Despite more effective medication, many people with schizophrenic spectrum disorders experience ongoing “positive symptoms,” including hallucinations, delusions, and conceptual disorganization, the researchers state. Metacognitive training and therapy may help mitigate some of these symptoms. It addresses maladaptive thinking styles and helps people with schizophrenic spectrum disorders become more aware of cognitive biases. It is available to groups as well as individuals.

To date, 8 meta-analyses have analyzed MCT since 2007. Given the lack of study data, the researchers wanted to compile an update. The researchers looked at outcomes both directly and indirectly targeted by MCT. They searched 11 databases to identify MCT studies published from 2007 through June 3, 2021. They included 43 studies in the analysis.


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The researchers found a small-to-moderate effect size for outcomes directly targeted by MCT (g=0.39; 95% CI, 0.25-0.53; P <.001; 38 reports). Positive symptoms reached moderate effect size (g=0.50; 95% CI, 0.34-0.67; P <.001; 36 reports). The greatest benefit was noted in the improvement of delusions, with small benefits for hallucinations and cognitive bias. The researchers also noticed small improvements in self-esteem and functioning. The participants maintained benefits from MCT until their 1 year follow-up.

While the study synthesized 14 years of evidence, the researchers observed heterogeneity of effect-size values for many of the studies, although it was not noticed at follow-up. The researchers also noted publication bias.

“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,” the researchers conclude.

“In addition, the COVID-19 pandemic has exacerbated the need for virtual evidence-based psychological intervention delivery, especially among vulnerable populations. It may be useful for future work to also assess the feasibility, acceptability, and effectiveness of MCT as a virtually delivered intervention.”

Reference

Penney D, Sauvé G, Mendelson D, Thibaudeau É, Moritz S, Lepage M. Immediate and sustained outcomes and moderators associated with metacognitive training for psychosis: a systematic review and meta-analysis. JAMA Psychiatry. Published online March 23, 2022. doi:10.1001/jamapsychiatry.2022.0277