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Metacognitive training for schizophrenia spectrum patients: a meta-analysis on outcome studies

Published online by Cambridge University Press:  20 July 2015

B. van Oosterhout ,
F. Smit ,
L. Krabbendam ,
S. Castelein ,
A. B. P. Staring  and
M. van der Gaag
B. van Oosterhout*
Affiliation:
GGzE, De Woenselse Poort, PO Box 909, Eindhoven, The Netherlands
F. Smit
Affiliation:
Trimbos Institute (Netherlands Institute of Mental Health and Addiction), PO Box 725, Utrecht, The Netherlands Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, PO Box 7057, Amsterdam, The Netherlands Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University, PO Box 7057, Amsterdam, The Netherlands
L. Krabbendam
Affiliation:
Department of Educational Neuroscience and Research Institute Learn!, Faculty of Psychology and Education, VU University, Van der Boechorststraat 1, Amsterdam, The Netherlands
S. Castelein
Affiliation:
Lentis Psychiatric Institute, Lentis Research, PO Box 86, Groningen, The Netherlands University of Groningen, University Medical Center Groningen, Rob Giel Research Center, PO Box 30.001, Groningen, The Netherlands
A. B. P. Staring
Affiliation:
Altrecht Psychiatric Institute, Mimosastraat 2–4, Utrecht, The Netherlands
M. van der Gaag
Affiliation:
Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University, PO Box 7057, Amsterdam, The Netherlands Department of Psychosis Research, Parnassia Psychiatric Institute, Zoutkeetsingel 40, The Hague, The Netherlands
*
*Address for correspondence: B. van Oosterhout, GGzE, PO Box 909, 5600 AX, Eindhoven, The Netherlands. (Email: [email protected])
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Abstract

Background.

Metacognitive training (MCT) for schizophrenia spectrum is widely implemented. It is timely to systematically review the literature and to conduct a meta-analysis.

Method.

Eligible studies were selected from several sources (databases and expert suggestions). Criteria included comparative studies with a MCT condition measuring positive symptoms and/or delusions and/or data-gathering bias. Three meta-analyses were conducted on data gathering (three studies; 219 participants), delusions (seven studies; 500 participants) and positive symptoms (nine studies; 436 participants). Hedges’ g is reported as the effect size of interest. Statistical power was sufficient to detect small to moderate effects.

Results.

All analyses yielded small non-significant effect sizes (0.26 for positive symptoms; 0.22 for delusions; 0.31 for data-gathering bias). Corrections for publication bias further reduced the effect sizes to 0.21 for positive symptoms and to 0.03 for delusions. In blinded studies, the corrected effect sizes were 0.22 for positive symptoms and 0.03 for delusions. In studies using proper intention-to-treat statistics the effect sizes were 0.10 for positive symptoms and −0.02 for delusions. The moderate to high heterogeneity in most analyses suggests that processes other than MCT alone have an impact on the results.

Conclusions.

The studies so far do not support a positive effect for MCT on positive symptoms, delusions and data gathering. The methodology of most studies was poor and sensitivity analyses to control for methodological flaws reduced the effect sizes considerably. More rigorous research would be helpful in order to create enough statistical power to detect small effect sizes and to reduce heterogeneity. Limitations and strengths are discussed.

Keywords

Cognitive biasesmetacognitive trainingpsychosisschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 1 , January 2016 , pp. 47 - 57
Copyright
Copyright © Cambridge University Press 2015 

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References

Abdel-Hamid, M, Lehmkamper, C, Sonntag, C, Juckel, G, Daum, I, Brune, M (2009). Theory of mind in schizophrenia: the role of clinical symptomatology and neurocognition in understanding other people's thoughts and intentions. Psychiatry Research 165, 19–26.Google Scholar
Aghotor, J, Pfueller, U, Moritz, S, Weisbrod, M, Roesch-Ely, D (2010). Metacognitive training for patients with schizophrenia (MCT): feasibility and preliminary evidence for its efficacy. Journal of Behavior Therapy and Experimental Psychiatry 41, 207–211.Google Scholar
Balzan, RP, Delfabbro, PH, Galletly, CA, Woodward, TS (2014). Metacognitive training for patients with schizophrenia: preliminary evidence for a targeted, single-module programme. Australian and New Zealand Journal of Psychiatry 48, 1126–1136.Google Scholar
Bennett, K, Corcoran, R (2010). Biases in everyday reasoning: associations with subclinical anxiety, depression and paranoia. Psychosis 2, 227–237.Google Scholar
Bentall, RP, Rowse, G, Shryane, N, Kinderman, P, Howard, R, Blackwood, N, Moore, R, Corcoran, R (2009). The cognitive and affective structure of paranoid delusions: a transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression. Archives of General Psychiatry 66, 236–247.Google Scholar
Briki, M, Monnin, J, Haffen, E, Sechter, D, Favrod, J, Netillard, C, Cheraitia, E, Marin, K, Govyadovskaya, S, Tio, G, Bonin, B, Chauvet-Gelinier, JC, Leclerc, S, Hode, Y, Vidailhet, P, Berna, F, Bertschy, AZ, Vandel, P (2014). Metacognitive training for schizophrenia: a multicentre randomised controlled trial. Schizophrenia Research 157, 99–106.Google Scholar
Burns, AM, Erickson, DH, Brenner, CA (2014). Cognitive–behavioral therapy for medication-resistant psychosis: a meta-analytic review. Psychiatric Services 65, 874–880.Google Scholar
Colbert, SM, Peters, ER (2002). Need for closure and jumping-to-conclusions in delusion-prone individuals. Journal of Nervous and Mental Disease 190, 27–31.Google Scholar
Colbert, SM, Peters, ER, Garety, PA (2010). Delusions and belief flexibility in psychosis. Psychology and Psychotherapy: Theory, Research and Practice 83, 45–57.CrossRefGoogle ScholarPubMed
Craig, JS, Hatton, C, Craig, FB, Bentall, RP (2004). Persecutory beliefs, attributions and theory of mind: comparison of patients with paranoid delusions, Asperger's syndrome and healthy controls. Schizophrenia Research 69, 29–33.CrossRefGoogle ScholarPubMed
Cuijpers, P, Driessen, E, Hollon, SD, van Oppen, P, Barth, J, Andersson, G (2012). The efficacy of non-directive supportive therapy for adult depression: a meta-analysis. Clinical Psychology Review 32, 280–291.CrossRefGoogle ScholarPubMed
Duval, S, Tweedie, R (2000). Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455–463.CrossRefGoogle ScholarPubMed
Erawati, E, Keliat, BA, Helena, N, Hamid, A (2014). The influence of metacognitive training on delusion severity and metacognitive ability in schizophrenia. Journal of Psychiatric and Mental Health Nursing 21, 841–847.CrossRefGoogle ScholarPubMed
Favrod, J, Maire, A, Bardy, S, Pernier, S, Bonsack, C (2011). Improving insight into delusions: a pilot study of metacognitive training for patients with schizophrenia. Journal of Advanced Nursing 67, 401–407.Google Scholar
Favrod, J, Rexhaj, S, Bardy, S, Ferrari, P, Hayoz, C, Moritz, S, Conus, P, Bonsack, C (2014). Sustained antipsychotic effect of metacognitive training in psychosis: a randomized-controlled study. European Psychiatry 29, 275–281.Google Scholar
Fernyhough, C, Jones, SR, Whittle, C, Waterhouse, J, Bentall, RP (2008). Theory of mind, schizotypy, and persecutory ideation in young adults. Cognitive Neuropsychiatry 13, 233–249.CrossRefGoogle ScholarPubMed
Ferwerda, J, de Boer, K, van der Gaag, M (2010). Metacognitive training for patients with psychotic vulnerability [in Dutch]. Directieve Therapie 30, 263–279.Google Scholar
Fine, C, Gardner, M, Craigie, J, Gold, I (2007). Hopping, skipping or jumping to conclusions? Clarifying the role of the JTC bias in delusions. Cognitive Neuropsychiatry 12, 46–77.Google Scholar
Freeman, D (2007). Suspicious minds: the psychology of persecutory delusions. Clinical Psychological Review 27, 425–457.CrossRefGoogle ScholarPubMed
Freeman, D, Startup, H, Dunn, G, Cernis, E, Wingham, G, Pugh, K, Cordwell, J, Mander, H, Kingdon, D (2014). Understanding jumping to conclusions in patients with persecutory delusions: working memory and intolerance of uncertainty. Psychological Medicine 44, 3017–3024.Google Scholar
Garety, PA, Freeman, D, Jolley, S, Dunn, G, Bebbington, PE, Fowler, DG, Kuipers, E, Dudley, R (2005). Reasoning, emotions, and delusional conviction in psychosis. Journal of Abnormal Psychology 114, 373–384.CrossRefGoogle ScholarPubMed
Garety, PA, Hemsley, DR, Wessely, S (1991). Reasoning in deluded schizophrenic and paranoid patients. Biases in performance on a probabilistic inference task. Journal of Nervous and Mental Disease 179, 194–201.CrossRefGoogle ScholarPubMed
Garety, PA, Kuipers, E, Fowler, D, Freeman, D, Bebbington, PE (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine 31, 189–195.Google Scholar
Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal 327, 557–560.Google Scholar
Janssen, I, Versmissen, D, Campo, JA, Myin-Germeys, I, van Os, J, Krabbendam, L (2006). Attribution style and psychosis: evidence for an externalizing bias in patients but not in individuals at high risk. Psychological Medicine 36, 771–778.Google Scholar
Jauhar, S, McKenna, PJ, Radua, J, Fung, E, Salvador, R, Laws, KR (2014). Cognitive–behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. British Journal of Psychiatry 204, 20–29.Google Scholar
Kaney, S, Bentall, RP (1989). Persecutory delusions and attributional style. British Journal of Medical Psychology 62, 191–198.Google Scholar
Kinderman, P, Bentall, RP (1997). Causal attributions in paranoia and depression: internal, personal, and situational attributions for negative events. Journal of Abnormal Psychology 106, 341–345.Google Scholar
Kumar, D, Zia Ul Haq, M, Dubey, I, Dotivala, KN, Veqar Siddiqui, S, Prakash, R, Abhishek, P, Nizamie, SH (2010). Effect of meta-cognitive training in the reduction of positive symptoms in schizophrenia. European Journal of Psychotherapy and Counselling 12, 149–158.Google Scholar
Kuokkanen, R, Lappalainen, R, Repo-Tiihonen, E, Tiihonen, J (2014). Metacognitive group training for forensic and dangerous non-forensic patients with schizophrenia: a randomised controlled feasibility trial. Criminal Behaviour and Mental Health 24, 345–357.CrossRefGoogle ScholarPubMed
Langdon, R, Still, M, Connors, MH, Ward, PB, Catts, SV (2013). Attributional biases, paranoia, and depression in early psychosis. British Journal of Clinical Psychology 52, 408–423.Google Scholar
Liberati, A, Altman, DG, Tetzlaff, J, Mulrow, C, Gotzsche, PC, Ioannidis, JP, Moher, D (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Medicine 6, e1000100.Google Scholar
McKay, R, Langdon, R, Coltheart, M (2007). Jumping to delusions? Paranoia, probabilistic reasoning, and need for closure. Cognitive Neuropsychiatry 12, 362–376.Google Scholar
Moritz, S, Kerstan, A, Veckenstedt, R, Randjbar, S, Vitzthum, F, Schmidt, C, Heise, M, Woodward, TS (2011 a). Further evidence for the efficacy of a metacognitive group training in schizophrenia. Behaviour Research and Therapy 49, 151–157.Google Scholar
Moritz, S, Veckenstedt, R, Andreou, C, Bohn, F, Hottenrott, B, Leighton, L, Kother, U, Woodward, TS, Treszl, A, Menon, M, Schneider, BC, Pfueller, U, Roesch-Ely, D (2014). Sustained and “sleeper” effects of group metacognitive training for schizophrenia: a randomized clinical trial. JAMA Psychiatry 71, 1103–1111.Google Scholar
Moritz, S, Veckenstedt, R, Bohn, F, Hottenrott, B, Scheu, F, Randjbar, S, Aghotor, J, Kother, U, Woodward, TS, Treszl, A, Andreou, C, Pfueller, U, Roesch-Ely, D (2013). Complementary group metacognitive training (MCT) reduces delusional ideation in schizophrenia. Schizophrenia Research 151, 61–69.Google Scholar
Moritz, S, Veckenstedt, R, Randjbar, S, Vitzthum, F, Woodward, TS (2011 b). Antipsychotic treatment beyond antipsychotics: metacognitive intervention for schizophrenia patients improves delusional symptoms. Psychological Medicine 41, 1823–1832.CrossRefGoogle ScholarPubMed
Moritz, S, Woodward, TS (2005). Jumping to conclusions in delusional and non-delusional schizophrenic patients. British Journal of Clinical Psychology 44, 193–207.CrossRefGoogle ScholarPubMed
Moritz, S, Woodward, TS (2007). Metacognitive training in schizophrenia: from basic research to knowledge translation and intervention. Current Opinion in Psychiatry 20, 619–625.Google Scholar
Morrison, AP (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy 29, 257–276.CrossRefGoogle Scholar
National Institute of Clinical Excellence (2009). Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care (Update). National Institute of Clinical Excellence: London, UK.Google Scholar
Naughton, M, Nulty, A, Abidin, Z, Davoren, M, O'Dwyer, S, Kennedy, HG (2012). Effects of group metacognitive training (MCT) on mental capacity and functioning in patients with psychosis in a secure forensic psychiatric hospital: a prospective-cohort waiting list controlled study. BMC Research Notes 5, 302.CrossRefGoogle Scholar
Rocha, NB, Queiros, C (2013). Metacognitive and social cognition training (MSCT) in schizophrenia: a preliminary efficacy study. Schizophrenia Research 150, 64–68.CrossRefGoogle ScholarPubMed
Ross, K, Freeman, D, Dunn, G, Garety, P (2011). A randomized experimental investigation of reasoning training for people with delusions. Schizophrenia Bulletin 37, 324–333.Google Scholar
So, SH, Garety, PA, Peters, ER, Kapur, S (2010). Do antipsychotics improve reasoning biases? A review. Psychosomatic Medicine 72, 681–693.Google Scholar
Tarrier, N, Wykes, T (2004). Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale? Behaviour Research and Therapy 42, 1377–1401.CrossRefGoogle ScholarPubMed
Turner, DT, van der Gaag, M, Karyotaki, E, Cuijpers, P (2014). Psychological interventions for psychosis: a meta-analysis of comparative outcome studies. American Journal of Psychiatry 171, 523–538.Google Scholar
Van Dael, F, Versmissen, D, Janssen, I, Myin-Germeys, I, van Os, J, Krabbendam, L (2006). Data gathering: biased in psychosis? Schizophrenia Bulletin 32, 341–351.Google Scholar
van der Gaag, M (2006). A neuropsychiatric model of biological and psychological processes in the remission of delusions and auditory hallucinations. Schizophrenia Bulletin 32 (Suppl. 1), S113–S122.Google Scholar
van der Gaag, M, Hoffman, T, Remijsen, M, Hijman, R, de Haan, L, van Meijel, B, van Harten, PN, Valmaggia, L, de Hert, M, Cuijpers, A, Wiersma, D (2006). The five-factor model of the Positive and Negative Syndrome Scale II: a ten-fold cross-validation of a revised model. Schizophrenia Research 85, 280–287.Google Scholar
van der Gaag, M, Valmaggia, LR, Smit, F (2014). The effects of individually tailored formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: a meta-analysis. Schizophrenia Research 156, 30–37.Google Scholar
van Oosterhout, B, Krabbendam, L, de Boer, K, Ferwerda, J, van der Helm, M, Stant, AD, van der Gaag, M (2014). Metacognitive group training for schizophrenia spectrum patients with delusions: a randomized controlled trial. Psychological Medicine 44, 3025–3035.CrossRefGoogle ScholarPubMed
Versmissen, D, Janssen, I, Myin-Germeys, I, Mengelers, R, Campo, JA, van Os, J, Krabbendam, L (2008). Evidence for a relationship between mentalising deficits and paranoia over the psychosis continuum. Schizophrenia Research 99, 103–110.Google Scholar
Walston, F, Blennerhassett, RC, Charlton, BG (2000). “Theory of mind”, persecutory delusions and the somatic marker mechanism. Cognitive Neuropsychiatry 5, 161–174.Google Scholar
Woodward, TS, Moritz, S, Menon, M, Klinge, R (2008). Belief inflexibility in schizophrenia. Cognitive Neuropsychiatry 13, 267–277.Google Scholar
Wykes, T, Steel, C, Everitt, B, Tarrier, N (2008). Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin 34, 523–537.CrossRefGoogle ScholarPubMed
Young, HF, Bentall, RP (1997). Probabilistic reasoning in deluded, depressed and normal subjects: effects of task difficulty and meaningful versus non-meaningful material. Psychological Medicine 27, 455–465.Google Scholar
Zimmermann, G, Favrod, J, Trieu, VH, Pomini, V (2005). The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophrenia Research 77, 1–9.Google Scholar
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