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Moderators of Symptomatic Outcome in Metacognitive Training for Psychosis (MCT). Who Benefits and Who Does Not?

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Abstract

Metacognitive training (MCT) for psychosis is a group intervention targeted at reducing positive symptoms in schizophrenia through an improvement of cognitive biases in these patients. Despite evidence for its feasibility and efficacy, the recommendations for including or excluding patients from MCT have so far been largely based on anecdotal clinical wisdom rather than empirical evidence. Predictors and moderators of outcome are presently unknown. We reanalyzed data from a large randomized controlled trial, for which 150 patients were randomly assigned to either MCT or CogPack® (neurocognitive training) and followed up for up to 3 years. We explored which demographic variables, baseline symptoms, and cognitive biases would predict overall outcome and specific treatment benefits in MCT. Low self-esteem and social anxiety at baseline as well as positive appraisal of the intervention were consistently associated with improved outcome in MCT relative to CogPack®. Among other variables, improvement of cognitive biases and selective attention during the intervention period as well as number of sessions attended were general predictors of positive outcome, irrespective of the type of intervention. Patients with cognitive biases and psychological strain (e.g., low self-esteem and quality of life) paired with social problems may represent an ideal target group for MCT. The present findings await replication in independent samples and may not generalise to other forms of metacognitive training (e.g., MCT for depression) or individualized metacognitive intervention for psychosis (MCT+).

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Notes

  1. We also have to acknowledge that our social anxiety measure was a novel subscale, which needs further validation. Future studies should employ more specialized measures of social anxiety.

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Funding

The study was funded by the German Research Foundation (DFG; Mo 969/6-1 and 6-2).

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Steffen Moritz & Jürgen Gallinat

  2. Department of Psychiatry, University of British Columbia, Vancouver, Canada

    Mahesh Menon, Devon Andersen & Todd S. Woodward

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  1. Steffen Moritz
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  2. Mahesh Menon
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Correspondence to Steffen Moritz.

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Conflict of Interest

The study was funded by the German Research Foundation (DFG), awarded to SM (DFG Mo 969/6-1 and 6-2). SM and TSW are developers of metacognitive training for psychosis (MCT). SM has received a honorarium from Janssen and Lilly for speaking about MCT. Steffen Moritz, Mahesh Menon, Devon Andersen, Todd S. Woodward and Jürgen Gallinat declares that they no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional as well as national research committee and with the 1964 Helsinki declaration and its later amendments. We received ethical approval by the Medical Board Hamburg.

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Informed consent was obtained from all individual participants included in the study.

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This article does not contain any studies with animals performed by any of the authors.

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Moritz, S., Menon, M., Andersen, D. et al. Moderators of Symptomatic Outcome in Metacognitive Training for Psychosis (MCT). Who Benefits and Who Does Not?. Cogn Ther Res 42, 80–91 (2018). https://doi.org/10.1007/s10608-017-9868-3

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