Effects of a Korean version of the metacognitive training program for outpatients with schizophrenia on theory of mind, positive symptoms, and interpersonal relationships

Abstract

Background:Since the significance of metacognition as the theoretical basis of a psychological intervention for schizophrenia first emerged, there have been ongoing attempts to restore or strengthen patients’ metacognitive abilities.Aim:A Korean version of the metacognitive training (MCT) program was developed, and its effects on theory of mind, positive and negative symptoms, and interpersonal relationships were examined in stable outpatients with schizophrenia.Method:A pre-test–post-test design with a control group was used. The participants were 59 outpatients (30 in experimental group, 29 in control group) registered at five mental health facilities in a city in South Korea. The developed MCT program was applied for a total of 18 sessions, 60 min per session, over a period of 14 weeks. The hinting task, false belief task, Scale for the Assessment of Positive and Negative Symptoms, and Relationship Change Scale were used to verify the effects of this program. Data were analysed by the chi-square test, t-test, and Mann–Whitney U-test using the SPSS/PASW 18.0 statistics program.Results:The general characteristics, intelligence, and outcome variables of the two groups were homogeneous. After the intervention, the experimental group showed significant improvements in theory of mind, positive and negative symptoms and interpersonal relationships compared with the control group.Conclusion:These results suggest that the MCT program can be a complementary psychotherapy that contributes to symptom relief and interpersonal functioning in patients with schizophrenia, and is effective in the Korean culture, beyond the Western context.

Immediate and Sustained Outcomes and Moderators Associated With Metacognitive Training for Psychosis

“…Table 1 presents the main characteristics of included studies and reports (Z. Fekete, MA, personal communication, September 2021; J.M. Lopez, PhD, personal communication, July 2021; and D. Raucher-Chéné, MD, personal communication, August 2021) and Table 2 displays participant characteristics. Table 3 and eAppendix 1 in the Supplement present the narrative review results of the 6 nonincluded studies and reports (eg, did not report ES values, secondary analyses).…”

What areas of everyday functioning are affected by theory of mind deficits in recent‐onset schizophrenia spectrum disorders?

“…This approach closely corresponds to the two component of the metacognitive framework proposed by Cella et al (2015) in order to mitigate the impact of cognitive deficits, namely, metacognitive knowledge (making the patient aware of their difficulties and of the situations in which these difficulties can have a negative impact) and metacognitive regulation (using strategies to improve performance and monitor their efficacy). Relatedly, a recent study reported improvements in ToM performance following metacognitive training (Park et al, 2020), a treatment known to improve positive symptoms in schizophrenia (Moritz et al, 2011; Moritz et al, 2013; Moritz & Woodward, 2007; van Oosterhout et al, 2016). While these approaches focus mainly on the patient, in the case of social cognition deficits, the metacognitive approach could further capitalize on the interactive nature of social interactions; raise the other person's knowledge of the patient's difficulties ( second‐person metacognitive knowledge ) and get them involved in applying strategies to mitigate the impact of the patient's difficulties ( second‐person metacognitive regulation ).…”