Metacognitive training for patients with schizophrenia: Preliminary evidence for a targeted, single-module programme
Abstract
Objective: Metacognitive training is an eight-module, group-based treatment programme for people with schizophrenia that targets the cognitive biases (i.e. problematic thinking styles) thought to contribute to the genesis and maintenance of delusions. The present article is an investigation into the efficacy of a shorter, more targeted, single-module metacognitive training programme, administered individually, which focuses specifically on improving cognitive biases that are thought to be driven by a ‘hypersalience of evidence-hypothesis matches’ mechanism (e.g. jumping to conclusions, belief inflexibility, reasoning heuristics, illusions of control). It was hypothesised that a more targeted metacognitive training module could still improve performance on these bias tasks and reduce delusional ideation, while improving insight and quality of life. Method: A sample of 28 patients diagnosed with schizophrenia and mild delusions either participated in the hour-long, single-session, targeted metacognitive training programme ( n = 14), or continued treatment as usual ( n = 14). All patients were assessed using clinical measures gauging overall positive symptomology, delusional ideation, quality of life and insight, and completed two cognitive bias tasks designed to elucidate the representativeness and illusion of control biases. Results: After a 2-week, post-treatment interval, targeted metacognitive training patients exhibited significant decreases in delusional severity and conviction, significantly improved clinical insight, and significant improvements on the cognitive bias tasks, relative to the treatment-as-usual controls. Performance improvements on the cognitive bias tasks significantly correlated with the observed reductions in overall positive symptomology. Patients also evaluated the training positively. Conclusions: Although interpretations of these results are limited due to the lack of an optimally designed, randomised controlled trial and a small sample size, the results are promising and warrant further investigation into targeted versions of the metacognitive training programme.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In a sample with mild delusions, metacognitive training led to improvements in clinical insight relative to treatment as usual.
“Consistent with initial work reporting the acceptability and feasibility of MCT, Balzan et al 177 found that this treatment led to improvements in symptoms, cognitive biases and clinical insight relative to treatment as usual in a sample with mild delusions.”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [177]
In a sample with mild delusions, metacognitive training led to improvements in symptoms relative to treatment as usual.
“Consistent with initial work reporting the acceptability and feasibility of MCT, Balzan et al 177 found that this treatment led to improvements in symptoms, cognitive biases and clinical insight relative to treatment as usual in a sample with mild delusions.”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [177]
In a sample with mild delusions, metacognitive training led to improvements in cognitive biases relative to treatment as usual.
“Consistent with initial work reporting the acceptability and feasibility of MCT, Balzan et al 177 found that this treatment led to improvements in symptoms, cognitive biases and clinical insight relative to treatment as usual in a sample with mild delusions.”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [177]
Cites
The Positive and Negative Syndrome Scale (PANSS) for schizophrenia.
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987) · Schizophrenia Bulletin · doi:10.1093/schbul/13.2.261 · Cited by 21,378 · see citing works
On the psychology of prediction.
Kahneman, D., & Tversky, A. (1973) · Psychological Review · doi:10.1037/h0034747 · Cited by 6,202 · see citing works
Skevington, S. M., Lotfy, M., & O'Connell, K. A. (2004) · Quality of Life Research · doi:10.1023/b:qure.0000018486.91360.00 · Cited by 4,686 · see citing works
Comprehensive Textbook of Psychiatry
Freedman, A. M., & Kaplan, H. I. (1967) · The American Journal of the Medical Sciences · doi:10.1097/00000441-196712000-00052 · Cited by 3,825 · see citing works
Two Factor Index of Social Position
Hollingshead, A. B. (1957) · Cited by 3,757 · see citing works
Negative v Positive Schizophrenia
Andreasen, N. C. (1982) · Archives of General Psychiatry · doi:10.1001/archpsyc.1982.04290070025006 · Cited by 2,008 · see citing works
Judgment of contingency in depressed and nondepressed students: sadder but wiser?
Alloy, L., & Abramson, L. (1979) · Journal of experimental psychology. General · doi:10.1037//0096-3445.108.4.441 · Cited by 1,733 · see citing works
Judgment of contingency in depressed and nondepressed students: Sadder but wiser?
Alloy, L. B., & Abramson, L. Y. (1979) · Journal of Experimental Psychology: General · doi:10.1037/0096-3445.108.4.441 · Cited by 1,692 · see citing works
Comprehensive Textbook of Psychiatry
Stein, E. J., & Swiller, H. I. (1994) · International Journal of Group Psychotherapy · doi:10.1080/00207284.1994.11491261 · Cited by 1,321 · see citing works
David, A. S. (1990) · The British Journal of Psychiatry · doi:10.1192/bjp.156.6.798 · Cited by 1,164 · 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
A new instrument for measuring insight: the Beck Cognitive Insight Scale
Beck, A. T. (2003) · Schizophrenia Research · doi:10.1016/s0920-9964(03)00189-0 · Cited by 871 · 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
Measuring Delusional Ideation: The 21-Item Peters et al. Delusions Inventory (PDI)
Peters, E., Joseph, S., Day, S., & Garety, P. (2004) · Schizophrenia Bulletin · doi:10.1093/oxfordjournals.schbul.a007116 · Cited by 607 · 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., Komossa, K., Rummel‐Kluge, C., Corves, C., Hunger, H., Schmid, F., Lobos, C. A., Schwarz, S., & Davis, J. M. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.08030368 · Cited by 489 · see citing works
Zimmermann, 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
Woodward, T. S., Moritz, S., Cuttler, C., & Whitman, J. C. (2006) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803390590949511 · Cited by 239 · see citing works
Self-citationExplaining 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 216 · 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-citationCognitive behavioural therapy for drug‐resistant psychosis
Garety, P. A., Kuipers, L., Fowler, D. G., Chamberlain, F., & Dunn, G. (1994) · British Journal of Medical Psychology · doi:10.1111/j.2044-8341.1994.tb01795.x · Cited by 190 · 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
A 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
Group cognitive-behavioural therapy for schizophrenia
Barrowclough, C., Haddock, G., Lobban, F. A., Jones, S. H., Siddle, R., Roberts, C., & Gregg, L. (2006) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.106.021386 · Cited by 130 · see citing works
Moritz, S., & Woodward, T. S. (2014) · Cited by 125 · see citing works
Self-citationLecomte, T., Leclerc, C., Corbière, M., Wykes, T., Wallace, C. J., & Spidel, A. L. (2008) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e31818ee231 · Cited by 123 · see citing works
Over-adjustment or miscomprehension? A re-examination of the jumping to conclusions bias
Balzan, R. P., Delfabbro, P., Galletly, C. A., & Woodward, T. S. (2012) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867411435291 · Cited by 80 · see citing works
Self-citationImproving cognitive treatments for delusions
Freeman, D. H. (2011) · Schizophrenia Research · doi:10.1016/j.schres.2011.08.012 · Cited by 80 · see citing works
Do Antipsychotics Improve Reasoning Biases? A Review
So, S., Garety, P., Peters, E., & Kapur, S. (2010) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181e7cca6 · Cited by 75 · see citing works
Balzan, R. P., Delfabbro, P., Galletly, C. A., & Woodward, T. S. (2012) · British Journal of Clinical Psychology · doi:10.1111/bjc.12000 · Cited by 64 · see citing works
Self-citationBechdolf, A., Knost, B., Nelson, B., Schneider, N., Veith, V., Yung, A. R., & Pukrop, R. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048670903393571 · Cited by 58 · see citing works
Group Cognitive Behavioral Therapy for Delusions: Helping Patients Improve Reality Testing
Landa, Y., Silverstein, S. M., Schwartz, F., & Savitz, A. J. (2006) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-005-9001-x · Cited by 47 · see citing works
Impaired Evidence Integration and Delusions in Schizophrenia
Speechley, W. J., Ngan, E. T. C., Moritz, S., & Woodward, T. S. (2012) · Journal of Experimental Psychopathology · doi:10.5127/jep.018411 · Cited by 47 · see citing works
Self-citationGroup CBT for Clients With a First Episode of Schizophrenia
Lecomte, T., Leclerc, C., Wykes, T., & Lecomte, J. (2003) · Journal of Cognitive Psychotherapy · doi:10.1891/jcop.17.4.375.52538 · Cited by 38 · see citing works
Balzan, R. P., Delfabbro, P., Galletly, C. A., & Woodward, T. S. (2012) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2012.663901 · Cited by 37 · see citing works
Self-citationGranholm, E. L., Auslander, L. A., Gottlieb, J. D., McQuaid, J. R., & McClure, F. S. (2006) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-005-9004-7 · Cited by 36 · see citing works
Illusory Correlations and Control Across the Psychosis Continuum
Balzan, R. P., Delfabbro, P., Galletly, C. A., & Woodward, T. S. (2013) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e318288e229 · Cited by 25 · see citing works
Self-citationChange in jumping to conclusions linked to change in delusions in early psychosis
Sanford, N., Lecomte, T., Leclerc, C., Wykes, T., & Woodward, T. S. (2013) · Schizophrenia Research · doi:10.1016/j.schres.2013.02.042 · Cited by 24 · see citing works
Self-citationSpidel, A. L., Lecomte, T., & Leclerc, C. (2006) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-005-9006-5 · Cited by 18 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Galletly, C., Castle, D., Dark, F., Humberstone, V., Jablensky, A., Killackey, E., Kulkarni, J., McGorry, P., Nielssen, O., & Tran, N. (2016) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867416641195 · Cited by 877 · see citing works
Self-citationSowing the seeds of doubt: a narrative review on metacognitive training in schizophrenia
Moritz, S., Andreou, C., Schneider, B. C., Wittekind, C. E., Menon, M., Balzan, R. P., & Woodward, T. S. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.04.004 · Cited by 325 · see citing works
Self-citationLysaker, P. H., Pattison, M. L., Leonhardt, B. L., Phelps, S., & Vohs, J. L. (2018) · World Psychiatry · doi:10.1002/wps.20508 · Cited by 247 · see citing works
Eichner, C., & Berna, F. (2016) · Schizophrenia Bulletin · doi:10.1093/schbul/sbv225 · Cited by 218 · see citing works
Liu, Y., Tang, C., Hung, T., Tsai, P., & Lin, M. (2018) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12282 · Cited by 109 · see citing works
Cognitive insight: a systematic review.
Van Camp, L. S. C., Sabbe, B. G. C., & Oldenburg, J. F. E. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.04.011 · Cited by 99 · see citing works
Ochoa, S., López-Carrilero, R., Barrigón, M. L., Pousa, E., Barajas, A., Lorente-Rovira, E., González-Higueras, F., Grasa, E., Ruiz-Delgado, I., Cid, J., et al. (2017) · Psychological Medicine · doi:10.1017/s0033291716003421 · Cited by 97 · see citing works
Vohs, J. L., George, S., Leonhardt, B. L., & Lysaker, P. H. (2016) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2016.1199275 · Cited by 66 · see citing works
Lam, K. C. K., Ho, C. P. S., Wa, J. C., Chan, S. M. Y., Yam, K. K. N., Yeung, O. S. F., Wong, W. C. H., & Balzan, R. P. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.11.008 · Cited by 62 · see citing works
Self-citationGawęda, Ł., Krężołek, M., Olbryś, J., Turska, A., & Kokoszka, A. (2015) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2015.02.002 · Cited by 56 · see citing works
Is metacognitive training for psychosis effective?
Moritz, S., Woodward, T. S., & Balzan, R. (2016) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.2016.1135737 · Cited by 21 · see citing works
Self-citationUsing the back door: metacognitive training for psychosis.
Kumar, D., Menon, M., Moritz, S., & Woodward, T. S. (2015) · Psychosis · doi:10.1080/17522439.2014.913073 · Cited by 20 · see citing works
Self-citationBalzan, R. P., & Galletly, C. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00967 · Cited by 12 · see citing works
Self-citation
- Authors
- Balzan, R. P., Delfabbro, P. H., Galletly, C. A., & Woodward, T. S.
- Affiliations
- Flinders University (AU)
- The University of Adelaide (AU)
- University of British Columbia (CA)
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2013-10-24
- Volume
- 48
- Issue
- 12
- Pages
- 1126-1136
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- OpenAlex
- W2104601909
- Cited by
- 63
- References
- 42
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 6 · 2020: 7 · 2019: 2 · 2018: 5 · 2017: 6 · 2016: 8 · 2015: 11 · 2014: 7 · 2013: 1
- FWCI
- 6.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Australian & New Zealand Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- Universitätsklinikum Hamburg-Eppendorf
- 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, schizophrenia, delusions, cognitive biases, representativeness bias, illusion of control, jumping to conclusions, delusional conviction, insight, quality of life, positive symptoms
- MeSH terms
- Adult, Delusions, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Psychiatric Status Rating Scales, Quality of Life, Retrospective Studies, Schizophrenia, Schizophrenic Psychology, Cognitive Behavioral Therapy, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
