Complementary group Metacognitive Training (MCT) reduces delusional ideation in schizophrenia

Moritz, Steffen; Veckenstedt, Ruth; Bohn, Francesca; Hottenrott, Birgit; Scheu, Florian; Randjbar, Sarah; Aghotor, Julia; Köther, Ulf; Woodward, Todd S.; Treszl, András; Andreou, Christina; Pfueller, Ute; Roesch-Ely, Daniela

doi:10.1016/j.schres.2013.10.007

Cited by 121 publications

(126 citation statements)

References 52 publications

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“…Other, more low-threshold, possibilities include online or mobile-phone based exercises; our group is currently working on the development of respective applications. Surprisingly, we did not observe a significant effect on the number of draws to decision in the Fish Task, inconsistent with our previous findings regarding group MCT (Moritz et al, 2013a). Table 1 indicates a possible reason for this negative finding: The number of draws to decision in the present patient sample was much higher at baseline compared to previous studies by our group and others (Moritz et al, 2013a;Moritz et al, 2011;So et al, 2015) on MCT.…”

Section: Discussioncontrasting

confidence: 99%

“…It is probable that this inconsistency is due to selective floor effects in the MCT+ group: As shown in Tables 1 and 2, the randomization process resulted in differences between the two groups regarding baseline symptoms, which were lower in MCT+ patients -and, in fact, lower than in previous studies by our group (Moritz et al, 2013a;Moritz et al, 2011) and others (Favrod et al, 2014;So et al, 2015). This, in combination with the rapid improvement, led to very low symptom levels in these patients post-intervention, while the control group may have benefited from greater margins for change.…”

Section: Discussionmentioning

confidence: 55%

“…Patients were randomized according to a computerized randomization plan [pseudorandom fixed procedure, analogous to a previous group MTC trial by our group (Moritz et al, 2014b;Moritz et al, 2013a)] to one of two interventions: MCT+ or CogPack® (Marker, 2003) (see below for details regarding the interventions). Treatment arm allocation was performed observerblind and communicated to patients by a person who was neither involved in the assessments nor in intervention delivery.…”

Section: Methodsmentioning

confidence: 99%

“…All assessments were carried out by raters blind to treatment allocation. Rater training was performed according to the same procedure used in our recent group MCT study (Moritz et al, 2013a). In order to further enhance reliability, assessments for each individual patient were carried out by the same rater throughout the trial period.…”

Section: Methodsmentioning

confidence: 99%

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Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study

Andreou

Wittekind

Fieker

et al. 2017

Journal of Behavior Therapy and Experimental Psychiatry

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Background & Objectives: Theory-driven interventions targeting specific factors that contribute to delusions are receiving increased interest. The present study aimed to assess the efficacy of individualized metacognitive therapy (MCT+), a short manualized intervention that addresses delusion-associated cognitive biases.Methods: 92 patients with current or past delusions were randomized to receive 12 twiceweekly sessions of either MCT+ or a control intervention within a randomized controlled raterblind design. Psychopathology and cognitive biases were assessed at baseline, 6 weeks and 6 months. ANCOVAs adjusted for baseline scores were used to assess differences between groups regarding outcome variables. Both per-protocol and intention-to-treat analyses were conducted.Results: At 6 weeks, there was a significant difference in favor of MCT+ regarding decrease in delusion severity and improvement of self-reflectiveness (medium effect size), and a trend-wise difference regarding probability threshold to decision. These effects increased, when only patients attending a minimum of 4 therapy sessions were considered. Control group patients subsequently showed further improvement while patients in the MCT+ group remained stable, such that there were no differences between groups at the 6-month follow-up.Limitations: Lower attendance rates in the control group possibly leading to unequal therapeutic effort; lower baseline delusion severity in the MCT+ group. Conclusions:The result pattern suggests that MCT+ led to an earlier improvement in delusions and cognitive biases compared to the control intervention. The absence of a long-term effect might reflect floor effects in the MCT+ group, but may also indicate the need for further measures to promote sustainability of MCT+ effects.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 55%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study

Andreou

Wittekind

Fieker

et al. 2017

Journal of Behavior Therapy and Experimental Psychiatry

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“…The three studies with the highest baseline delusion scores were So et al (2015), and van Oosterhout et al (2014). Taking these three studies, the effect size is 0.49, while studies with the lowest delusion scores at baseline (Moritz et al 2011a(Moritz et al ,b, 2013Briki et al 2014;Gaweda et al 2015) have a pooled effect size of 0.25 on delusions. So the empirical evidence rather suggests that patients with highest baseline scores of paranoia in general benefit most from therapy.…”

Section: Evolution Of Mctmentioning

confidence: 99%

Letter to the Editor: Should we focus on quality or quantity in meta-analyses?

Oosterhout¹,

Smit

Krabbendam³

et al. 2016

Psychol. Med.

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Sustained and “Sleeper” Effects of Group Metacognitive Training for Schizophrenia

et al. 2014

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IMPORTANCE Cognitive interventions increasingly complement psychopharmacological treatment to enhance symptomatic and functional outcome in schizophrenia. Metacognitive training (MCT) is targeted at cognitive biases involved in the pathogenesis of delusions.OBJECTIVE To examine the long-term efficacy of group MCT for schizophrenia in order to explore whether previously established effects were sustained. DESIGN, SETTING, AND PARTICIPANTSA 2-center, randomized, controlled, assessor-blind, parallel group trial was conducted. A total of 150 inpatients or outpatients with DSM-IV diagnoses of schizophrenia spectrum disorders were enrolled. All patients were prescribed antipsychotic medication. The second follow-up assessment took place 3 years later after the intervention phase was terminated. INTERVENTIONS Group MCT targeting cognitive biases vs neuropsychological training (COGPACK).Patients received a maximum of 16 sessions. MAIN OUTCOMES AND MEASURESThe primary outcome measure was a delusion score derived from the Positive and Negative Syndrome Scale (PANSS). The PANSS positive syndrome and total scores, the Psychotic Symptom Rating Scales, the jumping to conclusions bias, self-esteem, and quality of life served as secondary outcome measures. RESULTSThe intention-to-treat analyses demonstrated that patients in the MCT group had significantly greater reductions in the core PANSS delusion score, after 3 years compared with the control group (η 2 partial = .037; P = .05). Among the secondary outcomes, the intention-to-treat analyses also demonstrated that patients in the MCT group had significantly greater reductions in the PANSS positive syndrome score (η 2 partial = .055; P = .02) and the Psychotic Symptom Rating Scales delusion score (η 2 partial = .109; P = .001). Significant group differences at the 3-year follow-up were also found on measures of self-esteem and quality of life, which did not distinguish groups at earlier assessment points. Attention was improved in the neuropsychological training group relative to the MCT group. The completion rate was 61.3% after 3 years. CONCLUSIONS AND RELEVANCEMetacognitive training demonstrated sustained effects in the reduction of delusions, which were over and above the effects of antipsychotic medication. Moreover, there were some unanticipated ("sleeper") effects as both self-esteem and quality of life were improved after 3 years. Effects on self-esteem and well-being were found even in the absence of an improvement on the jumping to conclusions bias.

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Complementary group Metacognitive Training (MCT) reduces delusional ideation in schizophrenia

Cited by 121 publications

References 52 publications

Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study

Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study

Letter to the Editor: Should we focus on quality or quantity in meta-analyses?

Sustained and “Sleeper” Effects of Group Metacognitive Training for Schizophrenia

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