Complementary group Metacognitive Training (MCT) reduces delusional ideation in schizophrenia.
Abstract
Background Symptom reduction under antipsychotic agents is incomplete for most schizophrenia patients. In order to enhance outcome, cognitive approaches are increasingly adopted as add-on interventions. The present study aimed to determine the efficacy of group Metacognitive Training (MCT), which targets cognitive biases putatively involved in the pathogenesis of delusions.Methods A two-center, randomized, assessor-blind, controlled trial between MCT group training and cognitive training was carried out (ISRCTN95205723). A total of 150 in- and outpatients with DSM diagnoses of schizophrenia spectrum disorders were enrolled. All patients were concurrently prescribed antipsychotic medication. Assessments were made at baseline, four weeks and six months later. The primary outcome was a delusion score derived from the Positive and Negative Syndrome Scale (PANSS). The Psychotic Symptom Rating Scales (PSYRATS) as well as cognitive measures served as secondary outcomes.Results Completion at follow-up was 86%. According to intention-to-treat (ITT) analyses, patients in the MCT group showed significantly greater symptom reduction on the PANSS delusion subscore (follow-up), PANSS positive score (post-treatment) and PSYRATS delusion score (post-treatment and follow-up). Improvement on the PANSS positive scale at post-treatment and follow-up was positively correlated with the number of attended MCT sessions. No changes were seen for other psychopathological syndromes.Discussion MCT, a low-intensity training aimed at enhancing patients' awareness of cognitive biases subserving paranoia, led to improvement in delusion symptoms relative to the control condition and over and above the effects of antipsychotic medication. This improvement was sustained at follow-up.
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MCT promotes cognitive flexibility by raising metacognitive awareness and knowledge for cognitive biases and reduces positive symptoms.
“MCT on the other hand aims to promote patients’ cognitive flexibility by raising metacognitive awareness and knowledge for cognitive biases (21) and showed significant effects on reducing positive symptoms (8, 22, 23).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [23]
Cites
Society and the Adolescent Self-Image
Rosenberg, M. (1965) · doi:10.1515/9781400876136 · Cited by 30,126 · see citing works
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139 · see citing works
The mini international neuropsychiatric interview
Lecrubier, Y., Sheehan, D. V., Hergueta, T., & Weiller, E. (1998) · European Psychiatry · doi:10.1016/s0924-9338(99)80239-9 · Cited by 5,882 · see citing works
GPOWER: A general power analysis program
Erdfelder, E., Faul, F., & Buchner, A. (1996) · Behavior Research Methods, Instruments, & Computers · doi:10.3758/bf03203630 · Cited by 4,864 · see citing works
Small sample inference for fixed effects from restricted maximum likelihood
Kenward, M. G., & Roger, J. H. (1997) · Biometrics · doi:10.2307/2533558 · Cited by 4,552 · see citing works
Analysing controlled trials with baseline and follow up measurements
Vickers, A. J., & Altman, D. G. (2001) · BMJ · doi:10.1136/bmj.323.7321.1123 · Cited by 2,116 · see citing works
A Meta-Analysis of Cognitive Remediation for Schizophrenia: Methodology and Effect Sizes
Wykes, T., Huddy, V., Cellard, C., McGurk, S. R., & Czobor, P. (2011) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.10060855 · Cited by 1,693 · see citing works
HADDOCK, G., McCARRON, J., TARRIER, N., & FARAGHER, E. B. (1999) · Psychological Medicine · doi:10.1017/s0033291799008661 · Cited by 1,461 · see citing works
Wykes, T., Steel, C., Everitt, B., & Tarrier, N. (2007) · Schizophrenia Bulletin · doi:10.1093/schbul/sbm114 · Cited by 1,029 · see citing works
The Positive and Negative Syndrome Scale (PANSS): rationale and standardisation
Kay, S. R., Opler, L. A., & Lindenmayer, J.-P. (1989) · British Journal of Psychiatry · doi:10.1192/s0007125000291514 · Cited by 1,016 · see citing works
Rivermead Behavioural Memory Test
la Cour, P., & GALLAGHER, K. (1990) · Nordisk Psykologi · doi:10.1080/00291463.1990.10636996 · Cited by 992 · see citing works
Suspicious minds: The psychology of persecutory delusions
Freeman, D. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2006.10.004 · Cited by 814 · see citing works
Cognitive approaches to delusions: a critical review of theories and evidence.
Garety, P. A., & Freeman, D. (1999) · British Journal of Clinical Psychology · doi:10.1348/014466599162700 · Cited by 794 · see citing works
The Brown assessment of beliefs scale: Reliability and validity
Eisen, J. L., Phillips, K. A., Baer, L., Beer, D. A., Atala, K. D., & Rasmussen, S. A. (1998) · American Journal of Psychiatry · doi:10.1176/ajp.155.1.102 · Cited by 705 · see citing works
Psychometric properties of the Positive and Negative Syndrome Scale (PANSS) in schizophrenia
Peralta, V., & Cuesta, M. J. (1994) · Psychiatry Research · doi:10.1016/0165-1781(94)90093-0 · Cited by 583 · see citing works
A simple sample size formula for analysis of covariance in randomized clinical trials
Borm, G. F., Fransen, J., & Lemmens, W. A. J. G. (2007) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2007.02.006 · Cited by 579 · see citing works
Wilson, B., Cockburn, J., Baddeley, A., & Hiorns, R. (1989) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/01688638908400940 · Cited by 530 · see citing works
Moritz, S., & Woodward, T. S. (2007) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e3282f0b8ed · Cited by 525 · see citing works
Leucht, S., Barnes, T. R. E., Kissling, W., Engel, R. R., Correll, C. U., & Kane, J. M. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.7.1209 · Cited by 518 · see citing works
Leucht, S., Arbter, D., Engel, R. R., Kissling, W., & Davis, J. M. (2009) · Molecular Psychiatry · doi:10.1038/sj.mp.4002136 · Cited by 489 · see citing works
Lincoln, T. M., Lullmann, E., & Rief, W. (2006) · Schizophrenia Bulletin · doi:10.1093/schbul/sbm002 · Cited by 486 · see citing works
Jumping to conclusions in delusional and non‐delusional schizophrenic patients
Moritz, S., & Woodward, T. S. (2005) · British Journal of Clinical Psychology · doi:10.1348/014466505x35678 · Cited by 372 · see citing works
Self-citationZimmermann, G., Favrod, J., Trieu, V. H., & Pomini, V. (2005) · Schizophrenia Research · doi:10.1016/j.schres.2005.02.018 · Cited by 371 · see citing works
Combs, D. R., Adams, S. D., Penn, D. L., Roberts, D., Tiegreen, J., & Stem, P. (2007) · Schizophrenia Research · doi:10.1016/j.schres.2006.12.010 · Cited by 340 · see citing works
Garety, P. A., Fowler, D. G., Freeman, D., Bebbington, P., Dunn, G., & Kuipers, E. (2008) · British Journal of Psychiatry · doi:10.1192/bjp.bp.107.043570 · Cited by 296 · see citing works
Roberts, D. L., & Penn, D. L. (2009) · Psychiatry Research · doi:10.1016/j.psychres.2008.02.007 · Cited by 288 · see citing works
Liu, G. F., Lu, K., Mogg, R., Mallick, M., & Mehrotra, D. V. (2009) · Statistics in Medicine · doi:10.1002/sim.3639 · Cited by 254 · see citing works
Quality of life of people with schizophrenia, bipolar disorder and other psychotic disorders
Saarni, S. I., Viertiö, S., Perälä, J., Koskinen, S., Lönnqvist, J., & Suvisaari, J. (2010) · British Journal of Psychiatry · doi:10.1192/bjp.bp.109.076489 · Cited by 251 · see citing works
Explaining delusions: a cognitive perspective
Bell, V., Halligan, P. W., & Ellis, H. D. (2006) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2006.03.004 · Cited by 213 · see citing works
Missing data in randomised controlled trials: a practical guide
Carpenter, J. R., & Kenward, M. (2007) · LSHTM Research Online (London School of Hygiene and Tropical Medicine) · Cited by 204 · see citing works
Speechley, W. J., Whitman, J. C., & Woodward, T. S. (2010) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.090025 · Cited by 202 · see citing works
Self-citationFurther evidence for the efficacy of a metacognitive group training in schizophrenia
Moritz, S., Kerstan, A., Veckenstedt, R., Randjbar, S., Vitzthum, F., Schmidt, C. S., Heise, M., & Woodward, T. S. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.11.010 · Cited by 194 · see citing works
Self-citationDrake, R., Haddock, G., Tarrier, N., Bentall, R., & Lewis, S. (2007) · Schizophrenia Research · doi:10.1016/j.schres.2006.04.024 · Cited by 194 · see citing works
Detecting and defusing cognitive traps: metacognitive intervention in schizophrenia
Moritz, S., Vitzthum, F., Randjbar, S., Veckenstedt, R., & Woodward, T. S. (2010) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e32833d16a8 · Cited by 182 · see citing works
Self-citationCognitive functioning in delusions: A longitudinal analysis
PETERS, E. R., & Garety, P. A. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.03.008 · Cited by 176 · see citing works
Dimensionality and norms of the Rosenberg Self-Esteem Scale in a German general population sample
Roth, M., Decker, O., Herzberg, P. Y., & Brähler, E. (2008) · European Journal of Psychological Assessment · doi:10.1027/1015-5759.24.3.190 · Cited by 166 · see citing works
Moritz, S., Veckenstedt, R., Randjbar, S., Vitzthum, F., & Woodward, T. S. (2011) · Psychological Medicine · doi:10.1017/s0033291710002618 · Cited by 158 · see citing works
Self-citationAghotor, J., Pfueller, U., Moritz, S., Weisbrod, M., & Roesch-Ely, D. (2010) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2010.01.004 · Cited by 156 · see citing works
Self-citationA Randomized Experimental Investigation of Reasoning Training for People With Delusions
Ross, K., Freeman, D., Dunn, G., & Garety, P. (2009) · Schizophrenia bulletin · doi:10.1093/schbul/sbn165 · Cited by 155 · see citing works
Symptom rating scales and outcome in schizophrenia
Mortimer, A. M. (2007) · The British Journal of Psychiatry · doi:10.1192/bjp.191.50.s7 · Cited by 147 · see citing works
van der Gaag, M. (2006) · Schizophrenia Bulletin · doi:10.1093/schbul/sbl027 · Cited by 127 · see citing works
Moritz, S., & Woodward, T. S. (2014) · Cited by 125 · see citing works
Self-citationMcEvoy, J. P. (2007) · PubMed · Cited by 122 · see citing works
Waller, H., Freeman, D., Jolley, S., Dunn, G., & Garety, P. (2011) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2011.03.001 · Cited by 120 · see citing works
Item response analysis of the Positive and Negative Syndrome Scale
Santor, D. A., Ascher‐Svanum, H., Lindenmayer, J., & Obenchain, R. L. (2007) · BMC Psychiatry · doi:10.1186/1471-244x-7-66 · Cited by 107 · see citing works
Moritz, S., Woodward, T. S., & Lambert, M. (2006) · British Journal of Clinical Psychology · doi:10.1348/014466506x129862 · Cited by 105 · see citing works
Self-citationInsight and quality of life in schizophrenia: recent findings and treatment implications
Karow, A., & Pajonk, F. G. (2006) · Current Opinion in Psychiatry · doi:10.1097/01.yco.0000245754.21621.c9 · Cited by 104 · see citing works
Fisher, P., & Wells, A. (2009) · Routledge eBooks · doi:10.4324/9780203881477 · Cited by 103 · see citing works
Sustained antipsychotic effect of metacognitive training in psychosis: A randomized-controlled study
Favrod, J., Rexhaj, S., Bardy, S., Ferrari, P., Hayoz, C., Moritz, S., Conus, P., & Bonsack, C. (2013) · European Psychiatry · doi:10.1016/j.eurpsy.2013.08.003 · Cited by 101 · see citing works
Self-citationKinnear, P. R., & Gray, C. D. (2009) · Cited by 99 · see citing works
Different sides of the same coin? Intercorrelations of cognitive biases in schizophrenia
Moritz, S., Veckenstedt, R., Hottenrott, B., Woodward, T. S., Randjbar, S., & Lincoln, T. M. (2010) · Cognitive Neuropsychiatry · doi:10.1080/13546800903399993 · Cited by 97 · see citing works
Self-citationKurtz, M. M. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.02.008 · Cited by 81 · see citing works
Reavley, N. J., & Jorm, A. F. (2011) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048674.2011.614216 · Cited by 80 · see citing works
Woodward, T. S., Mizrahi, R., Menon, M., & Christensen, B. K. (2009) · Psychiatry Research · doi:10.1016/j.psychres.2008.10.018 · Cited by 74 · see citing works
Self-citationVerheij, B. (2012) · Lecture notes in computer science · doi:10.1007/978-3-642-33353-8_32 · Cited by 72 · see citing works
Effect of meta-cognitive training in the reduction of positive symptoms in schizophrenia
Kumar, D., Haq, M. Z. U., Dubey, I., Dotivala, K. N., Siddiqui, S. V., Prakash, R., Abhishek, P., & Nizamie, S. H. (2010) · European Journal of Psychotherapy & Counselling · doi:10.1080/13642537.2010.488875 · Cited by 67 · see citing works
Favrod, J., Maire, A., Bardy, S., Pernier, S., & Bonsack, C. (2010) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2010.05470.x · Cited by 61 · see citing works
Assessment of subjective cognitive and emotional effects of antipsychotic drugs. Effect by defect?
Moritz, S., Andreou, C., Klingberg, S., Thoering, T., & Peters, M. J. V. (2013) · Neuropharmacology · doi:10.1016/j.neuropharm.2013.04.039 · Cited by 49 · see citing works
Self-citationThe rise and fall of the atypical antipsychotics
Kendall, T. (2011) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.110.083766 · Cited by 48 · see citing works
Schneider, S., Jelinek, L., Lincoln, T. M., & Moritz, S. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2010.12.013 · Cited by 46 · see citing works
Self-citationSuzuki, T. (2011) · Europe PMC (PubMed Central) · doi:10.64719/pb.4069 · Cited by 44 · see citing works
Wirksamkeit kognitiver Interventionen für Schizophrenie
Lincoln, T. M., Suttner, C., & Nestoriuc, Y. (2008) · Psychologische Rundschau · doi:10.1026/0033-3042.59.4.217 · Cited by 39 · see citing works
Are Randomized Controlled Trials Relevant to Clinical Practice?
Hollon, S. D., & Wampold, B. E. (2009) · The Canadian Journal of Psychiatry · doi:10.1177/070674370905400909 · Cited by 23 · see citing works
Saarni, S. I., Viertiö, S., Perälä, J., et al. (2010) · Schizophrenia Research · doi:10.1016/j.schres.2010.02.996 · Cited by 4 · see citing works
So, S. H., Garety, P. A., PETERS, E. R., et al. (2012) · Schizophrenia Research · doi:10.1016/s0920-9964(12)71014-9 · Cited by 2 · see citing works
Are people with schizophrenia more rational than normal controls
Owen, G. S., Cutting, J., & David, A. S. (2006) · Research Portal (King's College London) · Cited by 2 · see citing works
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BackgroundMethod
- Authors
- Moritz, S., Veckenstedt, R., Bohn, F., Hottenrott, B., Scheu, F., Randjbar, S., Aghotor, J., Köther, U., Woodward, T. S., Treszl, A., Andreou, C., Pfueller, U., & Roesch-Ely, D.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- Heidelberg University (DE)
- University of British Columbia (CA)
- Corresponding author
- Moritz, Steffen
- ORCID
- Venue
- Schizophrenia Research
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 151
- Issue
- 1-3
- Pages
- 61-69
- ISSN
- 0920-9964 (ISSN-L)
- OpenAlex
- W2105131865
- Cited by
- 146
- References
- 66
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 7 · 2023: 9 · 2022: 13 · 2021: 9 · 2020: 8 · 2019: 12 · 2018: 12 · 2017: 21 · 2016: 8 · 2015: 16 · 2014: 16 · 2013: 1
- FWCI
- 9.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Schizophrenia Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Universität Heidelberg
- Bundesministerium für Bildung und Forschung
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- metacognitive training, delusional ideation
- MeSH terms
- Adult, Analysis of Variance, Awareness, Delusions, Female, Humans, Longitudinal Studies, Male, Middle Aged, Neuropsychological Tests, Psychiatric Status Rating Scales, Psychometrics, Schizophrenia, Schizophrenic Psychology, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome
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