Can metacognitive interventions improve insight in schizophrenia spectrum disorders? A systematic review and meta-analysis

Abstract

Background Patients with schizophrenia spectrum disorders (SSD) tend to lack insight, which is linked to poor outcomes. The effect size of previous treatments on insight changes in SSD has been small. Metacognitive interventions may improve insight in SSD, although this remains unproved. Methods We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effects of metacognitive interventions designed for SSD, namely Metacognitive Training (MCT) and Metacognitive Reflection and Insight Therapy (MERIT), on changes in cognitive and clinical insight at post-treatment and at follow-up. Results Twelve RCTs, including 10 MCT RCTs (n = 717 participants) and two MERIT trials (n = 90), were selected, totalling N = 807 participants. Regarding cognitive insight six RCTs (n = 443) highlighted a medium effect of MCT on self-reflectiveness at post-treatment, d = 0.46, p < 0.01, and at follow-up, d = 0.30, p < 0.01. There was a small effect of MCT on self-certainty at post-treatment, d = −0.23, p = 0.03, but not at follow-up. MCT was superior to controls on an overall Composite Index of cognitive insight at post-treatment, d = 1.11, p < 0.01, and at follow-up, d = 0.86, p = 0.03, although we found evidence of heterogeneity. Of five MCT trials on clinical insight (n = 244 participants), which could not be meta-analysed, four of them favoured MCT compared v. control. The two MERIT trials reported conflicting results. Conclusions Metacognitive interventions, particularly Metacognitive Training, appear to improve insight in patients with SSD, especially cognitive insight shortly after treatment. Further long-term RCTs are needed to establish whether these metacognitive interventions-related insight changes are sustained over a longer time period and result in better outcomes.

Understanding the Influence of Personality Traits on Risk of Suicidal Behaviour in Schizophrenia Spectrum Disorders: A Systematic Review

“…This may lead to speculation that, in contrast to the commonly held view among clinicians, insight may prevent SB in psychosis [ 22 , 58 ]. Early intervention services should therefore prioritise treatments for improving some insight dimensions, namely, illness awareness and symptom relabelling [ 58 ], such as metacognitive training [ 61 ]. However, some difficulties should be acknowledged when restoring insight, which is likely to require gaining mastery over them [ 62 ].…”

Co-occurring Deficits in Clinical and Cognitive Insight in Prolonged Schizophrenia-Spectrum Disorders: Relationship to Metacognitive Deficits

“… 82 These interventions have been found to be acceptable by patients with schizophrenia spectrum disorders, with MERIT and MCT linked to significant improvements in clinical and cognitive insight. 83 , 84 …”

Peculiarities of Psychotic Insight and Its Presentation in Patient’s Diary

“…В психоаналитических подходах критичность рассматривается, с одной стороны, как одна из функций Эго (способность к тестированию реальности, способность различать Я и не-Я, отличать внутрипсихическое, например фантазии, мысли, галлюцинации, от внешнего), с другой -как некий компромисс между защитными механизмами личности [7]. Без появления критичности к психопатологическим переживаниям нельзя говорить о ремиссии при шизофрении [4,8].…”

“…Вместе с тем недостаток критичности при шизофрении в русле психоаналитических работ связывают с защитным механизмом отрицания и рассматривают как вполне понятную защиту человека от резкого снижения самооценки, неминуемого в случае осознания и принятия психического заболевания и необходимости лечения [7,8].…”

“…Обращение к продукции пациента, спонтанно появляющейся в ходе лечения, субъективные критерии выздоровления вкупе с исследованиями качества жизни и проявлений «нейрокогнитивного дефицита» -все это получило Неврология Психиатрия. Том 20, № 5 (2021) | | 69 ПСИХИАТРИЯ широкое распространение в психиатрии [8]. В настоящее время инсайт не укладывается в бинарную систему («есть» или «нет»), а представляет собой континуальное понятие, где осознание болезни -лишь один из его аспектов [11].…”