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Metacognitive Therapy in Treatment-Resistant Psychosis: A Multiple-Baseline Study

Published online by Cambridge University Press:  03 January 2013

Paul Hutton ,
Anthony P. Morrison ,
Melissa Wardle  and
Adrian Wells
Paul Hutton*
Affiliation:
Greater Manchester West Mental Health Foundation NHS Trust, and University of Manchester, UK
Anthony P. Morrison
Affiliation:
Greater Manchester West Mental Health Foundation NHS Trust, and University of Manchester, UK
Melissa Wardle
Affiliation:
Greater Manchester West Mental Health Foundation NHS Trust, and University of Manchester, UK
Adrian Wells
Affiliation:
University of Manchester, UK, and NTNU, Trondheim, Norway
*
Reprint requests to Paul Hutton, Psychosis Research Unit, Department of Psychology, Greater Manchester West Mental Health NHS Foundation Trust, Bury New Road, Prestwich M25 3BL, UK. E-mail: [email protected]
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Abstract

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.

Keywords

Metacognitive therapypsychosisschizophreniahallucinationsdelusions
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 42 , Issue 2 , March 2014 , pp. 166 - 185
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

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References

Baker, C. A. and Morrison, A. P. (1998). Cognitive processes in auditory hallucinations: attributional biases and metacognition. Psychological Medicine, 28, 1199–1208.Google Scholar
Beck, A. T. (1976). Cognitive Therapy and the Emotional Disorders. New York: International Universities Press.Google Scholar
Beck, A. T., Epstein, N. and Brown, G. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.CrossRefGoogle ScholarPubMed
Beck, A. T., Steer, R. A. and Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
Bouman, T. K. and Meijer, K. J. (1999). A preliminary study of worry and metacognitions in hypochondriasis. Clinical Psychology and Psychotherapy, 6, 96–101.Google Scholar
Clark, D. M., and Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G. and Liebowitz, M. R. (Eds.), Social Phobia: diagnosis, assessment, and treatment (pp. 69–93). New York: Guilford Press.Google Scholar
Durham, R. C., Guthrie, M., Morton, R. V., Reid, D. A., Treliving, L. R., Fowler, D., et al. (2003). Tayside-Fife clinical trial of cognitive-behavioural therapy for medication-resistant psychotic symptoms: results to 3-month follow-up. British Journal of Psychiatry, 182, 303–311.CrossRefGoogle Scholar
Fisher, P. L. and Wells, A. (2005). Experimental modification of beliefs in obsessive-compulsive disorder: a test of the metacognitive model. Behaviour Research and Therapy, 43, 821–829.Google Scholar
Fisher, P. L. and Wells, A. (2008). Metacognitive therapy for obsessive-compulsive disorder: a case series. Journal of Behavior Therapy and Experimental Psychiatry, 39, 117–132.CrossRefGoogle ScholarPubMed
Foster, C., Startup, H., Potts, L. and Freeman, D. (2010). A randomized controlled trial of a worry intervention for individuals with persistent persecutory delusions. Journal of Behavior Therapy and Experimental Psychiatry, 41, 45–51.Google Scholar
Freeman, D. and Garety, P. A. (1999). Worry, worry processes and dimensions of delusions: an exploratory investigation of a role for anxiety processes in the maintenance of delusional distress. Behavioural and Cognitive Psychotherapy, 27, 47–62.Google Scholar
Garety, P. A., Kuipers, E., Fowler, D., Freeman, D. and Bebbington, P. E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189–195.CrossRefGoogle ScholarPubMed
Gumley, A. I., Gillan, K., Morrison, A. P. and Schwannauer, M. (2010). The development and validation of the Beliefs about Paranoia Scale (Short Form). Behavioural and Cognitive Psychotherapy, 39, 35–53.CrossRefGoogle ScholarPubMed
Haddock, G., McCarron, J., Tarrier, N. and Faragher, E. B. (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptoms rating scales (PSYRATS). Psychological Medicine, 29, 879–889.Google Scholar
Hutton, P., Morrison, A. P. and Taylor, H. (2012). Brief cognitive-behavioural therapy for hallucinations: can it help people who decide not to take antipsychotic medication? A case report. Behavioural and Cognitive Psychotherapy, 40, 111–116.Google Scholar
Kay, S. R., Fiszbein, A. and Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.Google Scholar
Laroi, F. and van der Linden, M. (2005). Metacognitions in proneness towards hallucinations and delusions Behaviour Research and Therapy, 43, 1425–1441.Google Scholar
Lepping, P., Sambhi, R. S., Whittington, R., Lane, S. and Poole, R. (2011). Clinical relevance of findings in trials of antipsychotics: systematic review. British Journal of Psychiatry, 198, 341–345.CrossRefGoogle ScholarPubMed
Leucht, S., Arbter, D., Engel, R. R., Kissling, W. and Davis, J. M. (2009). How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials. Molecular Psychiatry, 14, 429–447.Google Scholar
Leucht, S., Davis, J. M., Engel, R. R., Kissling, W. and Kane, J. M. (2009). Definitions of response and remission in schizophrenia: recommendations for their use and their presentation. Acta Psychiatrica Scandinavica Suppl., 438, 7–14.Google Scholar
Leucht, S., Kissling, W. and Davis, J. M. (2010). The PANSS should be rescaled. Schizophrenia Bulletin, 36, 461–462.CrossRefGoogle ScholarPubMed
Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M., Rosenheck, R., Perkins, D., et al. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353, 1209–1223.Google Scholar
Lin, Y. J. and Wicker, F. W. (2007). A comparison of the effects of thought suppression, distraction and concentration. Behavior Research and Therapy, 45, 2924–2937.Google Scholar
Lynch, D., Laws, K. R. and McKenna, P. J. (2010). Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials. Psychological Medicine, 40, 9–24.Google Scholar
Lysaker, P. H., Buck, K. D., Carcione, A., Procacci, M., Salvatore, G., Nicolo, G., et al. (2011). Addressing metacognitive capacity for self reflection in the psychotherapy for schizophrenia: a conceptual model of the key tasks and processes. Psychology and Psychotherapy: Theory Research and Practice, 84, 58–69.Google Scholar
Morosini, P. L., Magliano, L., Brambilla, L., Ugolini, S. and Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica, 101, 323–329.Google Scholar
Morrison, A. P. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy, 29, 257–276.CrossRefGoogle Scholar
Morrison, A. P., French, P. and Wells, A. (2007). Metacognitive beliefs across the continuum of psychosis: comparisons between patients with psychotic disorders, patients at ultra-high risk and non-patients. Behaviour Research and Therapy, 45, 2241–2246.Google Scholar
Morrison, A. P., Gumley, A. I., Ashcroft, K., Manousos, R., White, R., Gillan, K., et al. (2011). Metacognition and persecutory delusions: tests of a metacognitive model in a clinical population and comparisons with non-patients. British Journal of Clinical Psychology, 50, 223–233.CrossRefGoogle Scholar
Morrison, A. P. and Wells, A. (2000). Thought control strategies in schizophrenia: a comparison with non-patients. Behaviour Research and Therapy, 38, 1205–1209.Google Scholar
Morrison, A. P., Wells, A. and Nothard, S. (2002). Cognitive and emotional predictors of predisposition to hallucinations in non-patients. British Journal of Clinical Psychology, 41, 259–270.Google Scholar
Najmi, S., Riemann, B. C. and Wegner, D. M. (2009). Managing unwanted intrusive thoughts in obsessive-compulsive disorder: relative effectiveness of suppression, focused distraction, and acceptance. Behavior Research and Therapy, 47, 494–503.Google Scholar
Neil, S. T., Kilbride, M., Pitt, L., Welford, M., Nothard, S., Sellwood, W., et al. (2009). The Questionnaire about the Process of Recovery (QPR): a research instrument developed in collaboration with service users. Psychosis, 1, 145–155.Google Scholar
Newton-Howes, G. and Wood, R. (2011). Cognitive behavioural therapy and the psychopathology of schizophrenia: systematic review and meta-analysis. Psychology and Psychotherapy: Theory, Research and Practice. doi: 10.1111/j.2044-8341.2011.02048.x Google Scholar
NICE (2009). Schizophrenia: core interventions in the treatment and management of schizophrenia in adults in primary care and secondary care (update): London: National Institute for Health and Clinical Excellence.Google Scholar
Papageorgiou, C. and Wells, A. (2001). Metacognitive beliefs about rumination in recurrent major depression Cognitive and Behavioral Practice, 8, 160–164.CrossRefGoogle Scholar
Pechey, R. and Halligan, P. (2011). The prevalence of delusion-like beliefs relative to sociocultural beliefs in the general population. Psychopathology, 44, 106–115.Google Scholar
Pechey, R. and Halligan, P. (in press). Prevalence and correlates of anomalous experiences in a large non-clinical sample. Psychology and Psychotherapy: Theory, Research and Practice.Google Scholar
Peuskens, J., Kaufman, L. and Van Vleymen, B. (2007). Analysis of resolution criteria in patients with schizophrenia treated with olanzapine for an acute psychotic episode. Schizophrenia Research, 95 (1–3), 169–173.CrossRefGoogle ScholarPubMed
Proctor, D. (2008). A Randomized Controlled Trial of Metacognitive Therapy versus Exposure Therapy for Posttraumatic Stress Disorder. Thesis submitted to the University of Manchester for the degree of Doctor of Clinical Psychology in the Faculty of Medical and Human Sciences.Google Scholar
Rattehalli, R. D., Jayaram, M. B. and Smith, M. (2010). Risperidone versus placebo for schizophrenia. Cochrane Database System Review, 1, CD006918.Google Scholar
Sensky, T., Turkington, D., Kingdon, D., Scott, J. L., Scott, J., Siddle, R., et al. (2000). A randomized controlled trial of cognitive-behaviour therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry, 57, 165–172.Google Scholar
Simpson, C. and Papageorgiou, C. (2003). Metacognitive beliefs about rumination in anger. Cognitive and Behavioral Practice, 10, 91–94.Google Scholar
Startup, H., Freeman, D. and Garety, P. A. (2007). Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence. Behavior Research and Therapy, 45, 523–537.CrossRefGoogle ScholarPubMed
Tai, S. and Turkington, D. (2009). The evolution of cognitive behavior therapy for schizophrenia: current practice and recent developments. Schizophrenia Bulletin, 35, 865–873.Google Scholar
Valmaggia, L., Bouman, T. and Schuurman, L. (2007). Attention training with auditory hallucinations: a case study. Cognitive and Behavioral Practice, 14, 127–133.Google Scholar
van der Heiden, C., Muris, P. and van der Molen, H. T. (2011). Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder. Behavior Research and Therapy, 50, 100–109.Google Scholar
Varese, F. and Bentall, R. P. (2011). The metacognitive beliefs account of hallucinatory experiences: a literature review and meta-analysis. Clinical Psychology Review, 31, 850–864.Google Scholar
Villeneuve, K., Potvin, S., Lesage, A. and Nicole, L. (2010). Meta-analysis of rates of drop-out from psychosocial treatment among persons with schizophrenia spectrum disorder. Schizophrenia Research, 121 (1–3), 266–270.Google Scholar
Warner, L., Mariathasan, J., Lawton-Smith, S. and Samele, C. (2006). A Review of the Literature and Consultation on Choice and Decision-making for Users and Carers of Mental Health and Social Care Services. London: King's Fund/Sainsbury Centre for Mental Health.Google Scholar
Wegner, D. M., Schneider, D. J., Carter, S. R. III and White, T. L. (1987). Paradoxical effects of thought suppression. Journal of Personality and Social Psychology, 53, 5–13.Google Scholar
Wells, A. (1995). Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301–320.Google Scholar
Wells, A. (2005). Detached mindfulness in cognitive therapy: a metacognitive analysis and ten techniques. Journal of Rational-Emotive and Cognitive-Behavioral Therapy, 23, 337–355.Google Scholar
Wells, A. (2008). Metacognitive Therapy for Anxiety and Depression. New York: Guilford Press.Google Scholar
Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. New York: Guilford Press.Google Scholar
Wells, A. and Cartwright-Hatton, S. (2004). A short form of the metacognitions questionnaire: properties of the MCQ-30. Behaviour Research and Therapy, 42 385–396.Google Scholar
Wells, A., Fisher, P., Myers, S., Wheatley, J., Patel, T. and Brewin, C. R. (2009). Metacognitive therapy in recurrent and persistent depression: a multiple-baseline study of a new treatment. Cognitive Therapy and Research, 33, 291–300.CrossRefGoogle Scholar
Wells, A. and King, P. (2006). Metacognitive therapy for generalized anxiety disorder: an open trial. Journal of Behavior Therapy and Experimental Psychiatry, 37, 206–212.Google Scholar
Wells, A. and Matthews, G. (1994). Attention and Emotion: a clinical perspective. Hillsdale NJ: Lawrence Erlbaum Associates.Google Scholar
Wells, A. and Sembi, S. (2004). Metacognitive therapy for PTSD: a core treatment manual. Cognitive and Behavioral Practice, 11, 365–377.CrossRefGoogle Scholar
Wells, A., Welford, M., Fraser, J., King, P., Mendel, E., Wisely, J., et al. (2008). Chronic PTSD treated with metacognitive therapy: an open trial. Cognitive and Behavioral Practice, 15, 85–92.Google Scholar
Wells, A., Welford, M., King, P., Papageorgiou, C., Wisely, J. and Mendel, E. (2010). A pilot randomized trial of metacognitive therapy vs applied relaxation in the treatment of adults with generalized anxiety disorder. Behaviour Research and Therapy, 48, 429–434.Google Scholar
Wykes, T., Steel, C., Everitt, B. and Tarrier, N. (2008). Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin, 34, 523–537.CrossRefGoogle ScholarPubMed
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