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Metacognitive group training for schizophrenia spectrum patients with delusions: a randomized controlled trial

Published online by Cambridge University Press:  26 March 2014

B. van Oosterhout ,
L. Krabbendam ,
K. de Boer ,
J. Ferwerda ,
M. van der Helm ,
A. D. Stant  and
M. van der Gaag
B. van Oosterhout*
Affiliation:
GGzE, De Woenselse Poort, Eindhoven, The Netherlands
L. Krabbendam
Affiliation:
Department of Educational Neuroscience, VU University Amsterdam, The Netherlands
K. de Boer
Affiliation:
Retired clinical psychologist, Heiloo, The Netherlands
J. Ferwerda
Affiliation:
GGZ Noord-Holland-Noord, Heiloo, The Netherlands
M. van der Helm
Affiliation:
Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
A. D. Stant
Affiliation:
Department of Epidemiology, University Medical Centre Groningen, The Netherlands
M. van der Gaag
Affiliation:
Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
*
* Address for correspondence: B. van Oosterhout, M.Sc., GGzE, PO Box 909, 5600 AX, Eindhoven, The Netherlands. (Email: [email protected])
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Abstract

Background

Metacognitive training (MCT) for patients with psychosis is a psychological group intervention that aims to educate patients about common cognitive biases underlying delusion formation and maintenance, and to highlight their negative consequences in daily functioning.

Method

In this randomized controlled trial, 154 schizophrenia spectrum patients with delusions were randomly assigned to either MCT + treatment as usual (TAU) or TAU alone. Both groups were assessed at baseline, and again after 8 and 24 weeks. The trial was completed fully by 111 patients. Efficacy was measured with the Psychotic Symptom Rating Scales (PSYRATS) Delusions Rating Scale (DRS), and with specific secondary measures referring to persecutory ideas and ideas of social reference (the Green Paranoid Thoughts Scale, GPTS), cognitive insight (the Beck Cognitive Insight Scale, BCIS), subjective experiences of cognitive biases (the Davos Assessment of Cognitive Biases Scale, DACOBS) and metacognitive beliefs (the 30-item Metacognitions Questionnaire, MCQ-30). Economic analysis focused on the balance between societal costs and health outcomes (quality-adjusted life years, QALYs).

Results

Both conditions showed a decrease of delusions. MCT was not more efficacious in terms of reducing delusions, nor did it change subjective paranoid thinking and ideas of social reference, cognitive insight or subjective experience of cognitive biases and metacognitive beliefs. The results of the economic analysis were not in favour of MCT + TAU.

Conclusions

In the present study, MCT did not affect delusion scores and self-reported cognitive insight, or subjective experience of cognitive biases and metacognitive beliefs. MCT was not cost-effective.

Keywords

Delusionsmetacognitivepsychosistherapytraining
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 14 , October 2014 , pp. 3025 - 3035
Copyright
Copyright © Cambridge University Press 2014 

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