Metacognitive training for schizophrenia patients (MCT): A pilot study on feasibility, treatment adherence, and subjective efficacy

Objectives: The present study explored the safety, acceptance and subjective efficacy of a newly developed intervention program aimed at increasing awareness of, and possibly ameliorating, cognitive and behavioural biases in schizophrenia. Metacognitive training (MCT) builds upon inferences drawn from basic research on cognition and metacognition in schizophrenia: A plethora of studies has confirmed that several cognitive biases (e.g., attributional style, jumping to conclusions, bias against disconfirmatory evidence, theory of mind, over-confidence in errors, need for closure, and low self-esteem) may play a pathogenetic role in the emergence and/or maintenance of the disorder, particularly delusions. Methods: Forty outpatients were randomized to MCT and a control intervention (cognitive remediation, CogPack). Treatment in either group was performed twice weekly for an entire duration of 4 weeks (i.e., 8 sessions each lasting 45-60 minutes). At the end of the training, participants were asked to evaluate the subjective utility and efficacy of the program. In addition, treatment adherence and adverse events were documented. Results: MCT yielded superior scores relative to CogPack on several subjective parameters. Treatment adherence was comparable and no adverse events were noted during either intervention. Conclusions: The present study underscores the feasibility and acceptance of metacognitive training in psychosis. Future trials are warranted to verify the impact of MCT on the amelioration of metacognition assumed to exert a positive influence on symptomatology.