Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-08T09:23:07.938Z Has data issue: false hasContentIssue false
  • English
  • Français

Sustained antipsychotic effect of metacognitive training in psychosis: A randomized-controlled study

Published online by Cambridge University Press:  15 April 2020

J. Favrod ,
S. Rexhaj ,
S. Bardy ,
P. Ferrari ,
C. Hayoz ,
S. Moritz ,
P. Conus  and
C. Bonsack
J. Favrod*
Affiliation:
La Source, School of Nursing Sciences, University of Applied Sciences of Western Switzerland, avenue Vinet 30, 1004Lausanne, Switzerland Community Psychiatry Service, Department of psychiatry, University Hospital Center of Lausanne, site de Cery, 1008Prilly, Switzerland
S. Rexhaj
Affiliation:
La Source, School of Nursing Sciences, University of Applied Sciences of Western Switzerland, avenue Vinet 30, 1004Lausanne, Switzerland Community Psychiatry Service, Department of psychiatry, University Hospital Center of Lausanne, site de Cery, 1008Prilly, Switzerland
S. Bardy
Affiliation:
Community Psychiatry Service, Department of psychiatry, University Hospital Center of Lausanne, site de Cery, 1008Prilly, Switzerland
P. Ferrari
Affiliation:
La Source, School of Nursing Sciences, University of Applied Sciences of Western Switzerland, avenue Vinet 30, 1004Lausanne, Switzerland Community Psychiatry Service, Department of psychiatry, University Hospital Center of Lausanne, site de Cery, 1008Prilly, Switzerland
C. Hayoz
Affiliation:
HorizonSud, case postale 41, 1633Marsens, Switzerland
S. Moritz
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center in Hamburg-Eppendorf, Martinistraße 52, 20246Hamburg, Germany
P. Conus
Affiliation:
General Psychiatry Service, Department of psychiatry, University Hospital Center of Lausanne, site de Cery, 1008Prilly, Switzerland
C. Bonsack
Affiliation:
Community Psychiatry Service, Department of psychiatry, University Hospital Center of Lausanne, site de Cery, 1008Prilly, Switzerland
*
*Corresponding author. Tel.: +41 79 447 31 57. E-mail addresses:[email protected] (J. Favrod).
Get access

Abstract

Persistent psychotic symptoms represent a major challenge for psychiatric care. Basic research has shown that psychotic symptoms are associated with cognitive biases. Metacognitive training (MCT) aims at helping patients to become aware of these biases and to improve problem-solving. Fifty-two participants fulfilling diagnostic criteria of schizophrenia or schizoaffective disorders and persistent delusions and stabilized antipsychotic medication were enrolled in this study. Following baseline assessment patients were randomized either to treatment as usual (TAU) conditions or TAU + MCT. The intervention consisted of eight weekly 1-hour sessions (maximum: 8 hours). Participants were assessed at 8 weeks and 6-months later by blind assessors. Participants were assessed with the Psychotic Symptoms Rating Scales (PSYRATS) and the positive subscale of the PANSS. Between-group differences in post- and pre-test values were significant at a medium effect size in favor of the MCT for the PSYRATS delusion scale and the positive scale of the PANSS both at post and follow-up. The results of this study indicate that MCT training has a surplus antipsychotic effect for patients suffering from schizophrenia-related disorders who demonstrate only a partial response to antipsychotic treatment and that the effect of the intervention persists for at least 6 months after the intervention.

Keywords

PsychosisSchizophreniaCognitive biasesRandomized studyMetacognitive training
Type
Original articles
Information
European Psychiatry , Volume 29 , Issue 5 , June 2014 , pp. 275 - 281
Copyright
Copyright © Elsevier Masson SAS 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1

Equal contributors.

References

Aghotor, J., Pfueller, U., Moritz, S., Weisbrod, M., Roesch-Ely, D.Metacognitive training for patients with schizophrenia (MCT): feasibility and preliminary evidence for its efficacy. J Behav Ther Exp Psychiatry 2010;41:207–211.CrossRefGoogle ScholarPubMed
Agid, O., Kapur, S., Arenovich, T., Zipursky, R.B.Delayed-onset hypothesis of antipsychotic action: a hypothesis tested and rejected. Arch Gen Psychiatry 2003;60:1228–1235.CrossRefGoogle ScholarPubMed
Amador, X.F., Flaum, M., Andreasen, N.C., Strauss, D.H., Yale, S.A., Clark, S.C.et al.Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry 1994;51:826–836.CrossRefGoogle ScholarPubMed
Andreasen, N.C., Pressler, M., Nopoulos, P., Miller, D., Ho, B.C.Antipsychotic dose equivalents and dose-years: a standardized method for comparing exposure to different drugs. Biol Psychiatry 2010;67:255–262.CrossRefGoogle ScholarPubMed
Bentall, R.P., Corcoran, R., Howard, R., Blackwood, N., Kinderman, P.Persecutory delusions: a review and theoretical integration. Clin Psychol Rev 2001;21:1143–1192.CrossRefGoogle ScholarPubMed
Brune, M.Emotion recognition, ‘theory of mind’, and social behavior in schizophrenia. Psychiatry Res 2005;133:135–147.CrossRefGoogle Scholar
Buckley, P.F., Miller, B.J., Lehrer, D.S., Castle, D.J.Psychiatric comorbidities and schizophrenia. Schizophr Bull 2009;35:383–402.CrossRefGoogle Scholar
Chisholm, D., Knapp, M.R., Knudsen, H.C., Amaddeo, F., Gaite, L., van Wijngaarden, B.Client Socio-Demographic and Service Receipt Inventory--European Version: development of an instrument for international research. EPSILON Study 5. European Psychiatric Services: inputs linked to outcome domains and needs. Br J Psychiatry Suppl 2000;8:s28–s33.CrossRefGoogle Scholar
Cohen, J.Statistical power analysis for the behavioral sciences. 2nd ed.Hillsdale, NJ: Lawrence Earlbaum Associates; 1988.Google Scholar
Colbert, S.M., Peters, E.R., Garety, P.A.Delusions and belief flexibility in psychosis. Psychol Psychother 2010;83:45–57.CrossRefGoogle ScholarPubMed
Favrod, J., Grasset, F., Spreng, S., Grossenbacher, B., Hode, Y.Benevolent voices are not so kind: the functional significance of auditory hallucinations. Psychopathology 2004;37:304–308.CrossRefGoogle Scholar
Favrod, J., Maire, A., Bardy, S., Pernier, S., Bonsack, C.Improving insight into delusions: a pilot study of metacognitive training for patients with schizophrenia. J Adv Nurs 2011;67:401–407.CrossRefGoogle ScholarPubMed
Favrod, J., Rexhaj, S., Ferrari, P., Bardy, S., Hayoz, C., Morandi, S.et al.French version validation of the psychotic symptom rating scales (PSYRATS) for outpatients with persistent psychotic symptoms. BMC Psychiatry 2012;12:161.CrossRefGoogle ScholarPubMed
Fine, C., Gardner, M., Craigie, J., Gold, I.Hopping, skipping or jumping to conclusions? Clarifying the role of the JTC bias in delusions. Cogn Neuropsychiatry 2007;12:46–77.CrossRefGoogle ScholarPubMed
Freeman, D., Garety, P., Kuipers, E., Colbert, S., Jolley, S., Fowler, D.et al.Delusions and decision-making style: use of the Need for Closure Scale. Behav Res Ther 2006;44:1147–1158.CrossRefGoogle ScholarPubMed
Freeman, D., Garety, P.A., Kuipers, E., Fowler, D., Bebbington, P.E., Dunn, G.Acting on persecutory delusions: the importance of safety seeking. Behav Res Ther 2007;45:89–99.CrossRefGoogle ScholarPubMed
Gaweda, L., Moritz, S., Kokoszka, A.Trening metapoznawczy dla chorych na schizofrenie. Opis metody i doswiadczen klinicznych. Psychiatr Pol 2009;43:683–692.Google Scholar
Haddock, G., McCarron, J., Tarrier, N., Faragher, E.B.Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychol Med 1999;29:879–889.CrossRefGoogle Scholar
Harrow, M., Jobe, T.H.How frequent is chronic multiyear delusional activity and recovery in schizophrenia: a 20-year multi-follow-up. Schizophr Bull 2010;36:192–204.CrossRefGoogle ScholarPubMed
Helldin, L., Kane, J.M., Hjarthag, F., Norlander, T.The importance of cross-sectional remission in schizophrenia for long-term outcome: a clinical prospective study. Schizophr Res 2009;115:67–73.CrossRefGoogle ScholarPubMed
Jeste, D.V., Palmer, B.W., Appelbaum, P.S., Golshan, S., Glorioso, D., Dunn, L.B.et al.A new brief instrument for assessing decisional capacity for clinical research. Arch Gen Psychiatry 2007;64:966–974.CrossRefGoogle ScholarPubMed
Kay, S.R., Fiszbein, A., Opler, L.A.The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261–276.CrossRefGoogle Scholar
Kumar, D., Zia Ul Haq, M., Dubey, I., Dotivala, K.N., Veqar Siddiqui, S., Prakash, R.et al.Effect of meta-cognitive training in the reduction of positive symptoms in schizophrenia. Eur J Psychother Counsel 2010;12:149–158.CrossRefGoogle Scholar
Lancon, C., Auquier, P., Llorca, P.M., Martinez, J.L., Bougerol, T., Scotto, J.C.Psychometric properties of PANSS (Positive and Negative Syndrome Scale) in the French version in a sample of schizophrenic patients. Encephale 1997;23:1–9.Google Scholar
Lincoln, T., Mehl, S., Exner, C., Lindenmeyer, J., Rief, W.Attributional style and persecutory delusions. Evidence for an event independent and state specific external-personal attribution bias for social situations. Cogn Ther Res 2010;34:297–302.CrossRefGoogle Scholar
Lysaker, P.H., Olesek, K.L., Warman, D.M., Martin, J.M., Salzman, A.K., Nicolo, G.et al.Metacognition in schizophrenia: correlates and stability of deficits in theory of mind and self-reflectivity. Psychiatry Res 2011;190:18–22.CrossRefGoogle ScholarPubMed
Lysaker, P.H., Gumley, A., Luedtke, B., Buck, K.D., Ringer, J.M., Olesek, K.et al.Social cognition and metacognition in schizophrenia: evidence of their independence and linkage with outcomes. Acta Psychiatr Scand 2013;127:239–247.CrossRefGoogle ScholarPubMed
Miller, L.J.Qualitative changes in hallucinations. Am J Psychiatry 1996;153:265–267.Google ScholarPubMed
Mizrahi, R., Kiang, M., Mamo, D.C., Arenovich, T., Bagby, R.M., Zipursky, R.B.et al.The selective effect of antipsychotics on the different dimensions of the experience of psychosis in schizophrenia spectrum disorders. Schizophr Res 2006;88:111–118.CrossRefGoogle ScholarPubMed
Moritz, S., Woodward, T.S.Memory confidence and false memories in schizophrenia. J Nerv Ment Dis 2002;190:641–643.CrossRefGoogle Scholar
Moritz, S., Woodward, T.S.Metacognitive control over false memories: a key determinant of delusional thinking. Curr Psychiatry Rep 2006;8:184–190.CrossRefGoogle ScholarPubMed
Moritz, S., Woodward, T.S.Metacognitive training for schizophrenia patients (MCT): a pilot study of feasability, treatment adherence and subjective efficacy. German J Psychiatry 2007;10:69–78.Google Scholar
Moritz, S., Woodward, T.S.Metacognitive training in schizophrenia: from basic research to knowledge translation and intervention. Curr Opin Psychiatry 2007;20:619–625.CrossRefGoogle ScholarPubMed
Moritz, S., Woodward, T., Burlon, M., Braus, D., Andresen, B.Attributional style in schizophrenia: evidence for a decreased sense of self-causation in currently paranoid patients. Cogn Ther Res 2007;31:371–383.CrossRefGoogle Scholar
Moritz, S., Woodward, T.S.Metacognition Study Group Favrod, J.Entraînement des habiletés métacognitives pour les personnes atteintes de schizophrénie (EMC). Hamburg: VanHam Campus Verlag; 2007.Google Scholar
Moritz, S., Veckenstedt, R., Hottenrott, B., Woodward, T.S., Randjbar, S., Lincoln, T.M.Different sides of the same coin? Intercorrelations of cognitive biases in schizophrenia. Cogn Neuropsychiatry 2010;15:406–421.CrossRefGoogle Scholar
Moritz, S., Veckenstedt, R., Randjbar, S., Vitzthum, F., Karow, A., Lincoln, T.M.Course and determinants of self-esteem in people diagnosed with schizophrenia during psychiatric treatment. Psychosis 2010;2:144–153.CrossRefGoogle Scholar
Moritz, S., Kerstan, A., Veckenstedt, R., Randjbar, S., Vitzthum, F., Schmidt, C.et al.Further evidence for the efficacy of a metacognitive group training in schizophrenia. Behav Res Ther 2011;49:151–157.CrossRefGoogle Scholar
Moritz, S., Veckenstedt, R., Randjbar, S., Vitzthum, F., Woodward, T.S.Antipsychotic treatment beyond antipsychotics: metacognitive intervention for schizophrenia patients improves delusional symptoms. Psychol Med 2011;41:1823–1832.CrossRefGoogle ScholarPubMed
Morris, S.B., DeShon, R.P.Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol Methods 2002;7:105–125.CrossRefGoogle ScholarPubMed
Raffard, S., Trouillet, R., Capdevielle, D., Gely-Nargeot, M.C., Bayard, S., Laroi, F.et al.[French adaptation and validation of the scale to assess unawareness of mental disorder]. Can J Psychiatry 2010;55:523–531.CrossRefGoogle Scholar
Randjbar, S., Veckenstedt, R., Vitzthum, F., Hottenrott, B., Moritz, S.Attributional biases in paranoid schizophrenia: further evidence for a decreased sense of self-causation in paranoia. Psychosis 2010;3:74–85.CrossRefGoogle Scholar
Rietdijk, J., Dragt, S., Klaassen, R., Ising, H., Nieman, D., Wunderink, L.et al.A single blind randomized controlled trial of cognitive behavioural therapy in a help-seeking population with an at risk mental state for psychosis: the Dutch Early Detection and Intervention Evaluation (EDIE-NL) trial. Trials 2010;11:30.CrossRefGoogle Scholar
Riutort, M., Cuervo, C., Danion, J.M., Peretti, C.S., Salame, P.Reduced levels of specific autobiographical memories in schizophrenia. Psychiatry Res 2003;117:35–45.CrossRefGoogle Scholar
Roberts, D.L., Penn, D.L.Social cognition and interaction training (SCIT) for outpatients with schizophrenia: a preliminary study. Psychiatry Res 2009;166:141–147.CrossRefGoogle ScholarPubMed
Salvatore, G., Lysaker, P.H., Popolo, R., Procacci, M., Carcione, A., Dimaggio, G.Vulnerable self, poor understanding of others’ minds, threat anticipation and cognitive biases as triggers for delusional experience in schizophrenia: a theoretical model. Clin Psychol Psychother 2012;19:247–259.CrossRefGoogle ScholarPubMed
Savla, G.N., Vella, L., Armstrong, C.C., Penn, D.L., Twamley, E.W.Deficits in domains of social cognition in schizophrenia: a meta-analysis of the empirical evidence. Schizophr Bull 2013;39:979–992.CrossRefGoogle ScholarPubMed
Stone, J.M., Pilowsky, L.S.Antipsychotic drug action: targets for drug discovery with neurochemical imaging. Expert Rev Neurother 2006;6:57–64.CrossRefGoogle ScholarPubMed
Tarrier, N., Barrowclough, C., Bamrah, J.S.Prodromal signs of relapse in schizophrenia. Soc Psychiatry Psychiatr Epidemiol 1991;26:157–161.Google Scholar
Tas, C., Brown, E.C., Esen-Danaci, A., Lysaker, P.H., Brune, M.Intrinsic motivation and metacognition as predictors of learning potential in patients with remitted schizophrenia. J Psychiatr Res 2012;46:1086–1092.CrossRefGoogle ScholarPubMed
Villeneuve, K., Potvin, S., Lesage, A., Nicole, L.Meta-analysis of rates of drop-out from psychosocial treatment among persons with schizophrenia spectrum disorder. Schizophr Res 2010;121:266–270.CrossRefGoogle ScholarPubMed
Wiffen, B.D., Rabinowitz, J., Lex, A., David, A.S.Correlates, change and ‘state or trait’ properties of insight in schizophrenia. Schizophr Res 2010;122:94–103.CrossRefGoogle ScholarPubMed
Woodward, T.S., Moritz, S., Cuttler, C., Whitman, J.C.The contribution of a cognitive bias against disconfirmatory evidence (BADE) to delusions in schizophrenia. J Clin Exp Neuropsychol 2006;28:605–617.CrossRefGoogle Scholar
Wykes, T., Steel, C., Everitt, B., Tarrier, N.Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophr Bull 2008;34:523–537.CrossRefGoogle ScholarPubMed
Wykes, T., Huddy, V., Cellard, C., McGurk, S.R., Czobor, P.A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatry 2011;168:472–485.CrossRefGoogle ScholarPubMed
Zimmermann, G., Favrod, J., Trieu, V.H., Pomini, V.The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophr Res 2005;77:1–9.CrossRefGoogle ScholarPubMed
Zink, M., Englisch, S., Meyer-Lindenberg, A.Polypharmacy in schizophrenia. Curr Opin Psychiatry 2010;23:103–111.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.