Metacognitive therapy in treatment-resistant psychosis: a multiple-baseline study.
Open accessAbstract
BACKGROUND: More effective psychological treatments for psychosis are required. Case series data and pilot trials suggest metacognitive therapy (MCT) is a promising treatment for anxiety and depression. Other research has found negative metacognitive beliefs and thought-control strategies may be involved in the development and maintenance of hallucinations and delusions. The potential of MCT in treating psychosis has yet to be investigated. AIMS: Our aim was to find out whether a short number of MCT sessions would be associated with clinically significant and sustained improvements in delusions, hallucinations, anxiety, depression and subjective recovery in patients with treatment-resistant long-standing psychosis. METHOD: Three consecutively referred patients, each with a diagnosis of paranoid schizophrenia and continuing symptoms, completed a series of multiple baseline assessments. Each then received between 11 and 13 sessions of MCT and completed regular assessments of progress, during therapy, post-therapy and at 3-month follow-up. RESULTS: Two out of 3 participants achieved clinically significant reductions across a range of symptom-based outcomes at end-of-therapy. Improvement was sustained at 3-month follow-up for one participant. CONCLUSIONS: Our study demonstrates the feasibility of using MCT with people with medication-resistant psychosis. MCT was acceptable to the participants and associated with meaningful change. Some modifications may be required for this population, after which a controlled trial may be warranted.
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Wells's Metacognitive Therapy aims to reduce toxic thinking styles such as worry and threat monitoring believed to maintain paranoid thoughts and hallucinations by changing dysfunctional metacognitive beliefs and practicing metacognitive strategies like detached mindfulness.
“Similar to defusion techniques, Well’s Metacognitive Therapy aims to reduce toxic thinking styles such as worry and threat monitoring believed to maintain paranoid thoughts and hallucinations by changing dysfunctional metacognitive beliefs and practicing metacognitive strategies like detached mindfulness (124).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [124]
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“We also administered other measures of metacognition, namely the Metacognitions Questionnaire (MCQ-30) (Wells and Cartwright-Hatton, 2004), the Interpretation of Voices Inventory (IVI) (Morrison, Wells and Nothard, 2002) and the Beliefs about Paranoia Scale (BAPS) (Gumley, Gillan, Morrison and…”
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“Given that use of non-blinded assessors is associated with inflated estimates of effect size in clinical trials of CBT for psychosis (Wykes et al., 2008), future studies of MCT for psychosis should, if the design allows, employ independent and blinded raters.”
Background(2008) · Research Explorer (The University of Manchester) · Cited by 988 · see citing works
Meta-Cognition and worry: A cognitive model of generalized anxiety disorder
Wells, A. (1995) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465800015897 · Cited by 866 · cited 11× · see citing works
“Treatment followed the general principles of MCT for GAD, as outlined in Wells (2009) (Wells, 2009).”
BackgroundMethodInfluentialSensky, T., Turkington, D., Kingdon, D., Scott, J. L., Scott, J., Siddle, R., O'Carroll, M., & Barnes, T. R. E. (2000) · Archives of General Psychiatry · doi:10.1001/archpsyc.57.2.165 · Cited by 691 · cited 1× · see citing works
“In the largest, longest and best-designed study of CBT, some 40-50% of participants receiving befriending demonstrated at least a 50% improvement in symptoms (Sensky et al., 2000).”
BackgroundMorrison, A. P. (2001) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465801003010 · Cited by 673 · cited 4× · see citing works
“…has also been linked to the development of psychotic symptoms, specifically hallucinations (Baker and Morrison, 1998) and delusions (Freeman and Garety, 1999; Laroi and van der Linden, 2005; Morrison, 2001; Morrison, French and Wells, 2007; Morrison et al., 2010; Startup, Freeman and Garety, 2007).”
BackgroundInfluentialLeucht, S., Arbter, D., Engel, R. R., Kissling, W., & Davis, J. M. (2009) · Molecular Psychiatry · doi:10.1038/sj.mp.4002136 · Cited by 489 · cited 4× · see citing works
“As discussed, a reduction of 25% in PANSS total scores indicates clinically significant change in a group of patients whose symptoms are refractory to long-term antipsychotic treatment, while a 50% reduction reflects ‘much improvement’ in this group (Leucht et al., 2009b).”
BackgroundMethodInfluentialMetacognitive beliefs about rumination in recurrent major depression
Papageorgiou, C., & Adrian Wells, A. (2001) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(01)80021-3 · Cited by 401 · cited 2× · see citing works
“…1995), social anxiety (Clark and Wells, 1995), post-traumatic stress disorder (PTSD) (Wells and Sembi, 2004), obsessive-compulsive disorder (OCD) (Fisher and Wells, 2005), health anxiety (Bouman and Meijer, 1999), depression (Papageorgiou and Wells, 2001) and anger (Simpson and Papageorgiou, 2003).”
BackgroundNeil, S. T., Kilbride, M., Pitt, L., Nothard, S., Welford, M., Sellwood, W., & Morrison, A. P. (2009) · Psychosis · doi:10.1080/17522430902913450 · Cited by 362 · cited 4× · see citing works
“Questionnaire about the Process of Recovery (QPR) (Neil et al., 2009) The QPR is 22-item self-report measure of recovery from psychosis developed in close collaboration with service-users.”
BackgroundInfluentialLynch, D., Laws, K. R., & McKenna, P. J. (2010) · Psychological Medicine · doi:10.1017/s003329170900590x · Cited by 317 · cited 1× · see citing works
“…behavioural therapy (CBT), found it was moderately effective at reducing positive and negative symptoms, improving functioning and improving mood (Wykes, Steel, Everitt and Tarrier, 2008), although there is not complete consensus on this (Lynch, Laws and McKenna, 2010; Newton-Howes and Wood, 2011).”
BackgroundAttention and emotion: a clinical perspective
Eysenck, M. W. (1995) · Personality and Individual Differences · doi:10.1016/0191-8869(95)90043-8 · Cited by 301 · see citing works
Detached Mindfulness In Cognitive Therapy: A Metacognitive Analysis And Ten Techniques
Wells, A. (2005) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-005-0018-6 · Cited by 291 · cited 3× · see citing works
“A variety of exercises were used within and between sessions to help participants grasp the idea of detached mindfulness, which involved them developing a decentred awareness of their thoughts and letting them come and go without engaging with them (Wells, 2005).”
Backgroundvan der Heiden, C., Muris, P., & van der Molen, H. T. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.12.005 · Cited by 265 · cited 7× · see citing works
“Treatment followed the general principles of MCT for GAD, as outlined in Wells (2009) (Wells, 2009).”
MethodInfluentialMetacognitive therapy for generalized anxiety disorder: An open trial
Wells, A., & King, P. (2006) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2005.07.002 · Cited by 254 · cited 9× · see citing works
“Treatment followed the general principles of MCT for GAD, as outlined in Wells (2009) (Wells, 2009).”
BackgroundInfluentialMetacognitive therapy for obsessive–compulsive disorder: A case series
Fisher, P. L., & Wells, A. (2008) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2006.12.001 · Cited by 240 · cited 4× · see citing works
“and case studies suggest MCT (or components of MCT) is a promising treatment for OCD (Fisher and Wells, 2008), PTSD (Wells et al.”
BackgroundInfluentialLeucht, S., Davis, J. M., Engel, R. R., Kissling, W., & Kane, J. M. (2008) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2008.01308.x · Cited by 236 · cited 4× · see citing works
“As discussed, a reduction of 25% in PANSS total scores indicates clinically significant change in a group of patients whose symptoms are refractory to long-term antipsychotic treatment, while a 50% reduction reflects ‘much improvement’ in this group (Leucht et al., 2009b).”
BackgroundMethodInfluentialFreeman, D. H., & Garety, P. A. (1999) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246589927107x · Cited by 218 · cited 2× · see citing works
“Metacognition has also been linked to the development of psychotic symptoms, specifically hallucinations (Baker and Morrison, 1998) and delusions (Freeman and Garety, 1999; Laroi and van der Linden, 2005; Morrison, 2001; Morrison, French and Wells, 2007; Morrison et al., 2010; Startup, Freeman and…”
BackgroundStartup, H. M., Freeman, D. H., & Garety, P. A. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.04.006 · Cited by 205 · cited 1× · see citing works
“…has also been linked to the development of psychotic symptoms, specifically hallucinations (Baker and Morrison, 1998) and delusions (Freeman and Garety, 1999; Laroi and van der Linden, 2005; Morrison, 2001; Morrison, French and Wells, 2007; Morrison et al., 2010; Startup, Freeman and Garety, 2007).”
BackgroundCognitive processes in auditory hallucinations: attributional biases and metacognition
BAKER, C. A., & Morrison, A. P. (1998) · Psychological Medicine · doi:10.1017/s0033291798007314 · Cited by 199 · cited 2× · see citing works
“Metacognition has also been linked to the development of psychotic symptoms, specifically hallucinations (Baker and Morrison, 1998) and delusions (Freeman and Garety, 1999; Laroi and van der Linden, 2005; Morrison, 2001; Morrison, French and Wells, 2007; Morrison et al., 2010; Startup, Freeman and…”
BackgroundWells, A., Welford, M., King, P., Papageorgiou, C., Wisely, J., & Mendel, E. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.11.013 · Cited by 195 · cited 8× · see citing works
“Treatment followed the general principles of MCT for GAD, as outlined in Wells (2009) (Wells, 2009).”
MethodInfluentialWells, A., Fisher, P., Myers, S., Wheatley, J., Patel, T., & Brewin, C. R. (2009) · Cognitive Therapy and Research · doi:10.1007/s10608-007-9178-2 · Cited by 189 · cited 7× · see citing works
“The PSYRATS, BDI-2, BAI and CAS-1 were completed during every assessment and treatment session.”
BackgroundResultInfluentialLysaker, P. H., Buck, K. D., Carcione, A., Procacci, M., Salvatore, G., Nicolò, G., & Dimaggio, G. (2010) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608310x520436 · Cited by 186 · cited 2× · see citing works
“Perhaps it would be easier for patients to detach from their thoughts if they are able to contemplate that they might not be entirely realistic? Another important issue is whether all people with psychosis have the requisite capacity to think about their thoughts and feelings and, if not, whether this is something MCT…”
BackgroundCognitive and emotional predictors of predisposition to hallucinations in non‐patients
Morrison, A. P., Adrian Wells, A., & Nothard, S. (2002) · British Journal of Clinical Psychology · doi:10.1348/014466502760379127 · Cited by 174 · cited 2× · see citing works
“We also administered other measures of metacognition, namely the Metacognitions Questionnaire (MCQ-30) (Wells and Cartwright-Hatton, 2004), the Interpretation of Voices Inventory (IVI) (Morrison, Wells and Nothard, 2002) and the Beliefs about Paranoia Scale (BAPS) (Gumley, Gillan, Morrison and Schwannauer, 2009), as w…”
Durham, R. C., Guthrie, M., Morton, R. V., Reid, D. A., Treliving, L. R., Fowler, D. G., & Macdonald, R. R. (2003) · The British Journal of Psychiatry · doi:10.1192/bjp.182.4.303 · Cited by 156 · cited 2× · see citing works
“Following previous clinical trials (Durham et al., 2003) we defined a clinically significant reduction as at least a 25% reduction in either PSYRATS auditory hallucination or delusions scores from baseline assessment to end-of-treatment.”
MethodTai, S., & Turkington, D. (2009) · Schizophrenia Bulletin · doi:10.1093/schbul/sbp080 · Cited by 154 · cited 1× · see citing works
“However, as outlined elsewhere (Tai and Turkington, 2009), CBT for psychosis is evolving and new treatments are in development.”
BackgroundFisher, P. L., & Wells, A. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.09.002 · Cited by 140 · cited 4× · see citing works
“Negative ‘metacognitive’ beliefs (e.g., “My worry is uncontrollable” ) are thought to play a central role in the onset and maintenance of many different emotional disorders and problems, including generalised anxiety (GAD) (Wells, 1995), social anxiety (Clark and Wells, 1995), post-traumatic stress disorder (PTSD) (We…”
BackgroundInfluentialFoster, C., Startup, H. M., Potts, L. C., & Freeman, D. H. (2009) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2009.09.001 · Cited by 139 · cited 1× · see citing works
“In psychosis, a 4-session MCT-informed intervention, focused on reducing worry and challenging metacognitions, was found to be superior to treatment as usual in reducing persecutory delusions (Foster, Startup, Potts and Freeman, 2010).”
MethodNajmi, S., Riemann, B. C., & Wegner, D. M. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.02.015 · Cited by 133 · cited 1× · see citing works
“Thought suppression, a typical thought-control strategy in psychosis (Morrison and Wells, 2000), can lead to a paradoxical increase in the frequency of intrusive thoughts and / or associated distress (Lin and Wicker, 2007; Najmi, Riemann and Wegner, 2009; Wegner, Schneider, Carter and White, 1987).”
BackgroundMetacognitions in proneness towards hallucinations and delusions
Larøi, F., & der Linden, M. V. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.10.008 · Cited by 122 · cited 1× · see citing works
“…has also been linked to the development of psychotic symptoms, specifically hallucinations (Baker and Morrison, 1998) and delusions (Freeman and Garety, 1999; Laroi and van der Linden, 2005; Morrison, 2001; Morrison, French and Wells, 2007; Morrison et al., 2010; Startup, Freeman and Garety, 2007).”
BackgroundVilleneuve, K., Potvin, S., LESAGE, A. D., & Nicole, L. (2010) · Schizophrenia Research · doi:10.1016/j.schres.2010.04.003 · Cited by 110 · cited 1× · see citing works
“Psychosocial interventions appear to be highly acceptable to most service-users with psychosis (Villeneuve, Potvin, Lesage and Nicole, 2010; Warner, Mariathasan, Lawton-Smith and Samele, 2006).”
BackgroundMorrison, A. P., French, P., & Adrian Wells, A. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.01.002 · Cited by 107 · cited 1× · see citing works
“…has also been linked to the development of psychotic symptoms, specifically hallucinations (Baker and Morrison, 1998) and delusions (Freeman and Garety, 1999; Laroi and van der Linden, 2005; Morrison, 2001; Morrison, French and Wells, 2007; Morrison et al., 2010; Startup, Freeman and Garety, 2007).”
BackgroundMetacognitive therapy for PTSD: A core treatment manual
Adrian Wells, A., & Sembi, S. (2004) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(04)80053-1 · Cited by 99 · cited 5× · see citing works
“Negative ‘metacognitive’ beliefs (e.g., “My worry is uncontrollable” ) are thought to play a central role in the onset and maintenance of many different emotional disorders and problems, including generalised anxiety (GAD) (Wells, 1995), social anxiety (Clark and Wells, 1995), post-traumatic stress disorder (PTSD) (We…”
BackgroundInfluentialVarese, F., & Bentall, R. P. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.12.001 · Cited by 82 · cited 1× · see citing works
“Recent work has suggested metacognitive beliefs may be more important in understanding the distress associated with hallucinations, rather than hallucination occurrence per se (Varese and Bentall, 2011).”
BackgroundAttention Training With Auditory Hallucinations: A Case Study
Valmaggia, L., Bouman, T. K., & Schuurman, L. (2007) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2006.01.009 · Cited by 80 · cited 1× · see citing works
“…MCT) is a promising treatment for OCD (Fisher and Wells, 2008), PTSD (Wells et al., 2008), GAD (Wells and King, 2006) treatment-resistant depression (Wells et al., 2009) and auditory and visual hallucinations in psychosis (Hutton, Morrison and Taylor, 2012; Valmaggia, Bouman and Schuurman, 2007).”
BackgroundClinical relevance of findings in trials of antipsychotics: systematic review
Lepping, P., Sambhi, R. S., Whittington, R., Lane, S., & Poole, R. (2011) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.109.075366 · Cited by 79 · cited 1× · see citing works
“…main pharmacological intervention, antipsychotic medication, provides a clinically meaningful benefit above placebo has recently been questioned (Lepping, Sambhi, Whittington, Lane and Poole, 2011; Leucht, Arbter, Engel, Kissling and Davis, 2009a; Rattehalli, Jayaram and Smith, 2010), while…”
BackgroundLeucht, S., Kissling, W., & Davis, J. M. (2010) · Schizophrenia Bulletin · doi:10.1093/schbul/sbq016 · Cited by 75 · cited 1× · see citing works
“Following recent recommendations (Leucht, Kissling and Davis, 2010), we have changed this to a 0-6 scale.”
MethodThe Prevalence of Delusion-Like Beliefs Relative to Sociocultural Beliefs in the General Population
Pechey, R., & Halligan, P. W. (2010) · Psychopathology · doi:10.1159/000319788 · Cited by 67 · cited 1× · see citing works
“This reflects the fact that many people have psychotic-like experiences but are not distressed by them, and are not receiving help from services (Pechey and Halligan, 2011, in press).”
BackgroundMetacognitive beliefs about rumination in anger
Simpson, C., & Papageorgiou, C. (2003) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(03)80012-3 · Cited by 64 · cited 2× · see citing works
“…1995), social anxiety (Clark and Wells, 1995), post-traumatic stress disorder (PTSD) (Wells and Sembi, 2004), obsessive-compulsive disorder (OCD) (Fisher and Wells, 2005), health anxiety (Bouman and Meijer, 1999), depression (Papageorgiou and Wells, 2001) and anger (Simpson and Papageorgiou, 2003).”
BackgroundChronic PTSD Treated With Metacognitive Therapy: An Open Trial
Adrian Wells, A., Welford, M., Fraser, J., King, P., Mendel, E., Wisely, J. A., Knight, A., & Rees, D. (2008) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2006.11.005 · Cited by 63 · cited 5× · see citing works
“Negative ‘metacognitive’ beliefs (e.g., “My worry is uncontrollable” ) are thought to play a central role in the onset and maintenance of many different emotional disorders and problems, including generalised anxiety (GAD) (Wells, 1995), social anxiety (Clark and Wells, 1995), post-traumatic stress disorder (PTSD) (We…”
BackgroundInfluentialRisperidone versus placebo for schizophrenia
Rattehalli, R. D., Zhao, S., Li, B. G., Jayaram, M., Xia, J., & Sampson, S. J. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006918.pub3 · Cited by 63 · see citing works
Morrison, A. P., Gumley, A. I., Ashcroft, K., Manousos, I. R., White, R. G., Gillan, K., Adrian Wells, A., & Kingdon, D. (2010) · British Journal of Clinical Psychology · doi:10.1348/014466510x511141 · Cited by 48 · cited 2× · see citing works
“Metacognition has also been linked to the development of psychotic symptoms, specifically hallucinations (Baker and Morrison, 1998) and delusions (Freeman and Garety, 1999; Laroi and van der Linden, 2005; Morrison, 2001; Morrison, French and Wells, 2007; Morrison et al., 2011; Startup, Freeman and Garety, 2007).”
BackgroundMethodPrevalence and correlates of anomalous experiences in a large non‐clinical sample
Pechey, R., & Halligan, P. W. (2011) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/j.2044-8341.2011.02024.x · Cited by 48 · see citing works
A comparison of the effects of thought suppression, distraction and concentration
Lin, Y.-J., & Wicker, F. W. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.08.004 · Cited by 47 · cited 2× · see citing works
“Thought suppression, a typical thought-control strategy in psychosis (Morrison and Wells, 2000), can lead to a paradoxical increase in the frequency of intrusive thoughts and / or associated distress (Lin and Wicker, 2007; Najmi, Riemann and Wegner, 2009; Wegner, Schneider, Carter and White, 1987).”
BackgroundThought control strategies in schizophrenia: a comparison with non-patients
Morrison, A. P., & Adrian Wells, A. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00153-9 · Cited by 42 · cited 3× · see citing works
“Thought suppression, a typical thought-control strategy in psychosis (Morrison and Wells, 2000), can lead to a paradoxical increase in the frequency of intrusive thoughts and / or associated distress (Lin and Wicker, 2007; Najmi, Riemann and Wegner, 2009; Wegner, Schneider, Carter and White, 1987).”
BackgroundThe Development and Validation of the Beliefs about Paranoia Scale (Short Form)
Gumley, A. I., Gillan, K., Morrison, A. P., & Schwannauer, M. (2010) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246581000055x · Cited by 29 · cited 2× · see citing works
“…2004), the Interpretation of Voices Inventory (IVI) (Morrison, Wells and Nothard, 2002) and the Beliefs about Paranoia Scale (BAPS) (Gumley, Gillan, Morrison and Schwannauer, 2009), as well as a measure of social functioning, the Personal and Social Performance Scale (PSP)…”
Newton‐Howes, G., & Wood, R. (2011) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/j.2044-8341.2011.02048.x · Cited by 28 · cited 1× · see citing works
“…behavioural therapy (CBT), found it was moderately effective at reducing positive and negative symptoms, improving functioning and improving mood (Wykes, Steel, Everitt and Tarrier, 2008), although there is not complete consensus on this (Lynch, Laws and McKenna, 2010; Newton-Howes and Wood, 2011).”
BackgroundHutton, P., Morrison, A. P., & Taylor, H. E. (2011) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246581100035x · Cited by 25 · cited 1× · see citing works
“…MCT) is a promising treatment for OCD (Fisher and Wells, 2008), PTSD (Wells et al., 2008), GAD (Wells and King, 2006) treatment-resistant depression (Wells et al., 2009) and auditory and visual hallucinations in psychosis (Hutton, Morrison and Taylor, 2012; Valmaggia, Bouman and Schuurman, 2007).”
BackgroundPeuskens, J., Kaufman, L., & Vleymen, B. V. (2007) · Schizophrenia Research · doi:10.1016/j.schres.2007.05.035 · Cited by 17 · cited 1× · see citing works
“Following Peuskens et al., (2007), we defined ‘resolution’ of symptoms as a score of less than 3 on 8 selected PANSS remission items at post-treatment (Peuskens, Kaufman and Van Vleymen, 2007).”
BackgroundRisperidone Versus Placebo for Schizophrenia
Rattehalli, R., Jayaram, M., & Smith, M. (2010) · Schizophrenia Bulletin · doi:10.1093/schbul/sbq030 · Cited by 10 · cited 1× · see citing works
“…above placebo has recently been questioned (Lepping, Sambhi, Whittington, Lane and Poole, 2011; Leucht, Arbter, Engel, Kissling and Davis, 2009a; Rattehalli, Jayaram and Smith, 2010), while very high rates of drop-out from short and long-term clinical trials suggest low acceptability (Leucht et…”
BackgroundA metacognitive model and therapy for generalized anxiety disorder
Wells, A. (1999) · Clinical Psychology & Psychotherapy · doi:10.1002/(sici)1099-0879(199905)6:2
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Advances in metacognitive therapy
Wells, A. (2013) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2013.6.2.186 · Cited by 204 · see citing works
Thomas, N., Hayward, M., PETERS, E. R., van der Gaag, M., Bentall, R. P., Jenner, J. A., Strauss, C., Sommer, I. E., Johns, L., Varese, F., et al. (2014) · Schizophrenia Bulletin · doi:10.1093/schbul/sbu037 · Cited by 196 · see citing works
“May also arise from cognitive restructuring of content in CBT,(69) and addressing beliefs which promote engagement with voices.(70) Mindfulness and acceptance are correlated with indices of better adaptation to voices.”
BackgroundImmediate and Sustained Outcomes and Moderators Associated With Metacognitive Training for Psychosis
Penney, D., Sauvé, G., Mendelson, D., Thibaudeau, É., Moritz, S., & Lepage, M. (2022) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2022.0277 · Cited by 126 · see citing works
Metacognitive and cognitive-behavioral interventions for psychosis: new developments.
Moritz, S., Klein, J. P., Lysaker, P. H., & Mehl, S. (2019) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2019.21.3/smoritz · Cited by 101 · see citing works
Wilson, R. S., Yung, A. R., & Morrison, A. P. (2019) · Schizophrenia Research · doi:10.1016/j.schres.2019.11.035 · Cited by 96 · see citing works
Morrison, A. P., Pyle, M., Chapman, N., French, P., Parker, S. K., & Wells, A. (2014) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2013.11.003 · Cited by 82 · see citing works
“Our ten participants include the pre- and post-treatment and follow-up data from the 3 cases previously reported in a multiple baseline case series (Hutton et al., 2013).”
BackgroundSelf-citationPolese, D., Fornaro, M., Palermo, M., Luca, V. D., & de Bartolomeis, A. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00210 · Cited by 70 · see citing works
Metacognitive approaches to the treatment of psychosis: a comparison of four approaches.
Lysaker, P. H., Gagen, E., Moritz, S., & Schweitzer, R. (2018) · Psychology Research and Behavior Management · doi:10.2147/prbm.s146446 · Cited by 70 · see citing works
“In psychosis, negative thoughts are conceptualized by Hutton et al 32 as the trigger for distress rather than psychotic experiences themselves.”
Metacognitive beliefs in the at-risk mental state: A systematic review and meta-analysis
Cotter, J., Yung, A. R., Carney, R., & Drake, R. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.12.004 · Cited by 57 · see citing works
Fond, G. B., Boyer, L., Berna, F. S., Godin, O., Bulzacka, E., Andrianarisoa, M., Brunel, L., Aouizerate, B., Capdevielle, D., Chéreau, I., et al. (2018) · The British Journal of Psychiatry · doi:10.1192/bjp.2018.87 · Cited by 51 · see citing works
Nordahl, H., & Adrian Wells, A. (2019) · International Journal of Cognitive Therapy · doi:10.1007/s41811-019-00056-4 · Cited by 49 · see citing works
Experiential avoidance and appraisals of voices as predictors of voice‐related distress
Varese, F., Morrison, A. P., Beck, R., Heffernan, S., Law, H., & Bentall, R. P. (2016) · British Journal of Clinical Psychology · doi:10.1111/bjc.12102 · Cited by 47 · see citing works
Grealish, A., Tai, S., Hunter, A., Emsley, R., Murrells, T., & Morrison, A. P. (2016) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12111 · Cited by 51 · see citing works
Worry processes in patients with persecutory delusions.
Startup, H., Pugh, K., Dunn, G., Cordwell, J., Mander, H., Černis, E., Wingham, G., Shirvell, K., Kingdon, D., & Freeman, D. (2016) · British Journal of Clinical Psychology · doi:10.1111/bjc.12109 · Cited by 42 · see citing works
Metacognitive Therapy in Major Depression: An Open Trial of Comorbid Cases
Hjemdal, O., Hagen, R., Solem, S., Nordahl, H., Kennair, L. E. O., Ryum, T., Nordahl, H. M., & Adrian Wells, A. (2016) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2016.06.006 · Cited by 40 · see citing works
Austin, S. F., Lysaker, P. H., Jansen, J. E., Trauelsen, A. M., Nielsen, H. L., Pedersen, M. B., Haahr, U., & Simonsen, E. H. (2019) · Journal of Experimental Psychopathology · doi:10.1177/2043808718821572 · Cited by 38 · see citing works
Efficacy of metacognitive therapy in improving mental health: A meta‐analysis of single‐case studies
Rochat, L., Manolov, R., & Billieux, J. (2017) · Journal of Clinical Psychology · doi:10.1002/jclp.22567 · Cited by 34 · see citing works
“, 2012; Fitt & Rees, 2012; and eight studies in which Adrian Wells contributed [Bevan et al., 2013; Callesen, Jensen, & Wells, 2014; Fisher & Wells, 2008; Hutton et al., 2014; Papageorgiou & Wells, 1998, 2000; Wells & Sembi, 2004; Wells et al., 2009]; and Andouz et al.”
BackgroundResultInfluentialAustin, S. F., Mors, O. N., Nordentoft, M., Hjorthøj, C. R., Secher, R. G., Hesse, M., Hagen, R., Spada, M. M., & Adrian Wells, A. (2014) · Cognitive Therapy and Research · doi:10.1007/s10608-014-9633-9 · Cited by 35 · see citing works
“and meaningful change within a small group of people with treatment resistant psychosis after a brief course of metacognitive therapy (Hutton et al. 2014).”
BackgroundHayward, M., Berry, K., McCarthy‐Jones, S., Strauss, C., & Thomas, N. (2013) · Psychosis · doi:10.1080/17522439.2013.839735 · Cited by 26 · see citing works
Hutton, P., Rienzo, F. D., Turkington, D., Spencer, H. M., & Taylor, P. J. (2018) · Schizophrenia Bulletin · doi:10.1093/schbul/sby153 · Cited by 22 · see citing works
Hartley, S., Haddock, G., Sa, D. V. E., Emsley, R., & Barrowclough, C. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.12.002 · Cited by 21 · see citing works
Ricarte, J. J., Rey, F. D., Ros, L., Latorre, J. M., & Berna, F. S. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.04.007 · Cited by 16 · see citing works
“Metacognitive Therapy has thus been developed in order to challenge beliefs that worry and rumination are uncontrollable or dangerous (Hutton et al., 2014).”
BackgroundMetacognitive Therapy for Individuals at High Risk of Developing Psychosis: A Pilot Study
Parker, S., Mulligan, L. D., Milner, P., Bowe, S. E., & Palmier‐Claus, J. E. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02741 · Cited by 14 · see citing works
“We adapted the metacognitive model of generalized anxiety disorder (Wells, 1995) for use with UHR individuals, in a similar way to the therapy previously described for people with a diagnosis of schizophrenia (Hutton et al., 2014; Morrison et al., 2014).”
MethodMetacognitive therapy for binge eating disorder: A case series study
Robertson, S., & Strodl, E. S. (2020) · Clinical Psychologist · doi:10.1111/cp.12213 · Cited by 15 · see citing works
Wolfenden, L., Calam, R. M., Drake, R., & Gregg, L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.791294 · Cited by 14 · see citing works
Dysfunctional Metacognitive Beliefs in Body Dysmorphic Disorder
Zeinodini, Z., Sedighi, S., Rahimi, M. B., Noorbakhsh, S., & Esfahani, S. R. (2015) · Global Journal of Health Science · doi:10.5539/gjhs.v8n3p10 · Cited by 14 · see citing works
“These include depression [4], GAD [3], PTSD [8], obsessive-compulsive disorder, eating disorders [9], and psychosis [10].”
BackgroundEfficacy of metacognitive therapy for hypoactive sexual desire disorder among Iranian couples
Ramezani, M. A., Ahmadi, K., Besharat, M., Noohi, S., & Ghaemmaghami, A. (2017) · Psychotherapy Research · doi:10.1080/10503307.2017.1301690 · Cited by 13 · see citing works
The Scope of Metacognitive Therapy in the Treatment of Psychiatric Disorders
Sharma, V., Sagar, R., Kaloiya, G., & Mehta, M. (2022) · Cureus · doi:10.7759/cureus.23424 · Cited by 15 · see citing works
“, 2014 [57] Treatmentresistant psychosis 11–13 3 2 F, 1 M Multiple baseline case series PSYRATS, PANSS, BDI-II, BAI, QPR, CAS-1 Large reductions in delusion symptoms, depressive symptoms, and anxiety symptoms for 2/3 participants at posttreatment compared to baseline.”
BackgroundØstefjells, T., Melle, I. S., Hagen, R., Romm, K. L., Sönmez, N., Andreassen, O. A., & Røssberg, J. I. (2015) · Schizophrenia Research · doi:10.1016/j.schres.2015.10.026 · Cited by 11 · see citing works
“Therapy interventions targeting unhelpful metacognitive beliefs are available, and have shown promising results in early trials with psychosis patients (Hutton et al., 2014; Morrison et al., 2014).”
BackgroundFazio, L., Raio, A., Banaschewski, T., Bokde, A. L. W., Desriviéres, S., Flor, H., Garavan, H., Gowland, P., Grigis, A., Heinz, A., et al. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1434470 · Cited by 11 · see citing works
Mentalizing in individuals with state and trait risk for psychosis: a systematic review
Salve, F. D., Rossi, C., & Oasi, O. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1214385 · Cited by 9 · see citing works
“Moreover, the results obtained from the review suggest that the application of strategies to attenuate maladaptive metacognitive beliefs may be equally effective in improving psychotic symptoms in CHR (19, 58–61).”
BackgroundTully, S., Wells, A., & Morrison, A. P. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.07.052 · Cited by 9 · see citing works
Self-citationYousefi, M., Barzegar, M., Kouroshnia, M., & Khayyer, M. (2021) · Iranian Evolutionary Educational Psychology Journal · doi:10.52547/ieepj.3.3.256 · Cited by 9 · see citing works
Carter, K. E. P., & Adrian Wells, A. (2018) · Case Reports in Psychiatry · doi:10.1155/2018/1537237 · Cited by 8 · see citing works
Psychotherapy on an Acute Psychiatric Ward: Preliminary Findings From a Controlled Study
Cohen‐Chazani, Y., Igra, L., Hamm, J. A., Leonhardt, B. L., Klion, R. E., Cheli, S., & Hasson‐Ohayon, I. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.3002 · Cited by 7 · see citing works
Kumar, D., & Venkatasubramanian, G. (2018) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.32.3.192 · Cited by 7 · see citing works
“Hutton et al. (2014) used metacognitive therapy on three patients with treatment resistant psychosis and found that two patients showed clinically significant reductions in symptoms which was sustained when a follow-up assessment was done after 3 months.”
MethodSzczepanowski, R., Cichoń, E., Pasieczna, A. H., Gawęda, Ł., & Rosińćzuk, J. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00725 · Cited by 6 · see citing works
Early Intervention for Better Mental Health Services
Rosen, A., Byrne, P., Goldstone, S. D., & McGorry, P. D. (2015) · Wiley eBooks · doi:10.1002/9781118753378.ch99 · Cited by 6 · see citing works
The Assessment of Metacognition in Psychosis: Systematic Review and Future Lines of Research
Díaz-Cutraro, L., Verdaguer-Rodríguez, M., Ferrer-Quintero, M., Montserrat, R., Moritz, S., Lysaker, P. H., Dimaggio, G., Palma‐Sevillano, C., Lamarca, M., Espinosa, V., et al. (2026) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70223 · Cited by 4 · see citing works
“It aims to reduce the cognitive attentional syndrome by promoting more adaptive metacognitive strategies (Hutton et al. 2014; Morrison et al. 2014).”
Assessment of the cognitive attentional syndrome in children: an adaptation of the CAS-1
Normann, N., Reinholdt‐Dunne, M. L., Andersen, M. S., & Esbjørn, B. H. (2020) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246582000082x · Cited by 4 · see citing works
Metacognition in psychosis: What and how do we assess it?
Díaz-Cutraro, L., García‐Mieres, H., Dimaggio, G., Lysaker, P. H., Moritz, S., & Ochoa, S. (2022) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2022.09.003 · Cited by 4 · see citing works
Zhuo, C., Zhou, C., Cai, Z., Chen, J., Yang, L. X., Li, Q., Zhang, Q., Fang, T., Tian, H., Lin, C., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.09.037 · Cited by 4 · see citing works
Metacognitive change as a predictor of outcome in cognitive therapy for psychosis.
Parker, S., Adrian Wells, A., & Morrison, A. P. (2014) · PubMed · Cited by 3 · see citing works
Gussmann, E., Lucae, S., Falkai, P., Padberg, F., Egli, S., & Kopf-Beck, J. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1160075 · Cited by 2 · see citing works
Paranoid Thinking and Wellbeing. The Role of Doubt in Pharmacological and Metacognitive Therapies
Aguerri, L. A., Beato‐Fernández, L., Stavraki, M., Rodríguez‐Cano, T., Bajo, M., & Díaz, D. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02099 · Cited by 3 · see citing works
Kajka, N., & Kulik, A. (2024) · Psychiatria Polska · doi:10.12740/pp/onlinefirst/168298 · Cited by 2 · see citing works
Venzalá, M. B., Morgado, M. Á. R., Sánchez, M. A. J. R., & Rivero, M. I. (2014) · Revista de la Asociación Española de Neuropsiquiatría · doi:10.4321/s0211-57352014000200002 · Cited by 1 · see citing works
Dysfunctional Metacogntive Beliefs in Body Dysmorphic Disorder
Zeinodini, Z. (2015) · Journal of Psychology & Clinical Psychiatry · doi:10.15406/jpcpy.2015.04.00233 · Cited by 1 · see citing works
“These include depression [4], GAD [3], PTSD [8], obsessive-compulsive disorder, eating disorders [9], and psychosis [10].”
BackgroundMetacognitive therapy for rumination
Borders, A. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-812545-8.00012-7 · Cited by 1 · see citing works
Venzalá, M. B., Morgado, Á. R., Sánchez, J. R., & Rivero, I. (2014)
The cognitive and behavioural consequences of psychotic experiences
Tully, S. (2017) · Research Explorer (The University of Manchester)
Metacognition, stress & recovery
Capobianco, L. (2017) · Research Explorer (The University of Manchester)
فاعلیة العلاج المیتامعرفی فی خفض توهم المرض (قلق الصحة) لدى طلاب الجامعة
الحميد, ه. ج. ع. (2018) · مجلة الإرشاد النفسی · doi:10.21608/cpc.2018.42494
Mixed methods investigation of distress related to psychosis experiences
Akoral, M. (2019) · Queen Margaret University Publications Repository (Queen Margaret University)
The complex interplay between schizotypy and emotional, cognitive and psychological factors
Webster, L. (2019) · Nottingham Trent University's Institutional Repository (Nottingham Trent Repository)
فعالية الإرشاد الميتامعرفي في تخفيف أعراض اضطراب التشوه الجسمي لدى طالبات الجامعة
الشافعي, ن. ف. ع. (2023) · مجلة كلية التربية جامعة بنها · doi:10.21608/jfeb.2023.232731.1750
Blagov, P. S., Conner, J., & Singer, J. A. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-33040-7.00008-7
- Authors
- Hutton, P., Morrison, A. P., Wardle, M., & Wells, A.
- Affiliations
- University of Manchester (GB)
- Corresponding author
- Hutton, Paul
- Venue
- Behavioural and Cognitive Psychotherapy
- Publisher
- Cambridge University Press (CUP)
- Published
- 2013-01-03
- Volume
- 42
- Issue
- 2
- Pages
- 166-185
- ISSN
- 1352-4658 (ISSN-L)
- 1469-1833
- OpenAlex
- W1995613446
- Cited by
- 58
- References
- 65
- Citations by year
- 2026: 2 · 2024: 3 · 2023: 3 · 2022: 5 · 2021: 1 · 2020: 5 · 2019: 9 · 2018: 6 · 2017: 6 · 2016: 5 · 2015: 4 · 2014: 6 · 2013: 3
- FWCI
- 4.25
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Behavioural and Cognitive Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- Research Output (Edinburgh Napier University) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- metacognitive therapy, treatment-resistant psychosis, paranoid schizophrenia, delusions, hallucinations, anxiety, depression, metacognitive beliefs, thought control strategies, subjective recovery, feasibility
- MeSH terms
- Adult, Anxiety Disorders, Delusions, Depressive Disorder, Drug Resistance, Female, Follow-Up Studies, Hallucinations, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Surveys and Questionnaires, Schizophrenia, Paranoid, Antipsychotic Agents, Cognitive Behavioral Therapy
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