Metacognitive training modified for negative symptoms: A feasibility study

Abstract

Objective: Although patients often prioritize the treatment of negative symptoms, few psychological interventions targeting negative symptoms exist. This study attempts to fill this gap by piloting a modified metacognitive training programme, specifically targeted at negative symptoms (MCT-N), with a group of patients with prominent negative symptoms.Method: We adopted a mixed methods case series design, providing detailed quantitative data on changes over time, to focus on potential mechanisms underlying the intervention, in combination with qualitative interviews. Results:The intervention showed good feasibility as demonstrated by the attendance rate, the positive feedback from participants and the multidisciplinary team, and the improvements on negative symptoms observed following the intervention. Multilevel modelling showed that depression, internalized stigma and reflective functioning explained the variance in negative symptoms.Discussion: The pilot study indicated that the intervention has high feasibility and that improvements in negative symptoms can be partially explained by improvements on depression, stigma and reflective functioning.

Metacognitive training for negative symptoms: Support for the cognitive model

“…This would be in line with previous research as ostracism (i.e., being T A B L E 2 Wilcoxon signed rank for completers at pre-analysis, post-analysis and follow-up analysis Session 8 Stigma (taken from the additional modules from original MCT) Psychoeducation on how stigma may lead to/maintain negative symptoms; strategies such as educating others about mental illness socially excluded and ignored) has been found to predict negative symptoms as well as to be increased by negative symptoms (Jaya et al, 2022). A change in social behaviour driven by metacognitive processes was also reported in the qualitative feedback in the original article (Swanson et al, 2021) (e.g., 'I learned that I can actually do things together with other people, it is all in my head, that I need to do things just on my own …' [P4] and 'I am trying a bit harder to socialise … It's helping with my social confidence. That makes me feel good' [P5]).…”

“…Although the chosen tool for the main outcome measurement represents best practice in the assessment of negative symptoms, it would have been preferable if an independent researcher had performed the assessment. As mentioned in the original study (Swanson et al, 2021), we cannot conclude that change over time occurred as a result of MCT as there was no control and all participants received treatment as usual during the intervention. The study is also limited in regards to its small sample size which means that the risk of Types I and II error should be acknowledged.…”

“…For detailed information about participants and study protocol, see Swanson et al (2021). In brief, a total of 15 individuals (mean age 42.6 years, 13 male) diagnosed with a psychotic disorder (majority with schizophrenia ( N = 13) of a presumably treatment resistant nature due to their Clozapine medication) took part in a study with a mixed methods case series design where detailed quantitative data on changes over time were combined with qualitative exit interviews to allow a focus on potential mechanisms underlying changes.…”

“…Evidence-based treatment options for negative symptoms are limited (Correll & Schooler, 2020). To target this treatment gap, a modified version of metacognitive training (MCT) for psychosis (Moritz et al, 2014) was developed by Swanson et al (2021) to address the defeatist and asocial beliefs thought to be involved in the development and maintenance of negative symptoms according to the cognitive model (see Beck et al, 2019). The cognitive model proposes that negative symptoms might be caused and maintained by dysfunctional beliefs arising as a consequence of repeated failures and setbacks.…”

“…Although it was found in a recent meta‐analysis (Penney et al, 2022) that MCT showed benefits up to 1 year postintervention, only a small effect size was found for negative symptoms. We therefore adapted MCT for negative symptoms to assess the acceptability and feasibility of the intervention and to identify mechanisms of change (Swanson et al, 2021). We found in the initial evaluation study that after eight sessions, participants ( N = 10) had fewer negative symptoms (as measured by the Brief Negative Symptom Scale (BNSS) (Kirkpatrick et al, 2010)), with large effect sizes.…”