Sowing the seeds of doubt: A narrative review on metacognitive training in schizophrenia

Steffen Moritz*, Christina Andreou, Brooke C. Schneider, Charlotte E. Wittekind, Mahesh Menon, Ryan P. Balzan, Todd S. Woodward

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

230 Citations (Scopus)


The present article provides a narrative review of empirical studies on metacognitive training in psychosis (MCT). MCT represents an amalgam of cognitive-behavioral therapy (CBT), cognitive remediation (CRT) and psychoeducation. The intervention is available in either a group (MCT) or an individualized (MCT. +) format. By sowing the seeds of doubt in a playful and entertaining fashion, the program targets positive symptoms, particularly delusions. It aims to raise patients' awareness for common cognitive traps or biases (e.g., jumping to conclusions, overconfidence in errors, bias against disconfirmatory evidence) that are implicated in the formation and maintenance of psychosis. The majority of studies confirm that MCT meets its core aim, the reduction of delusions. Problems (e.g., potential allegiance effects) and knowledge gaps (i.e., outcome predictors) are highlighted. The preliminary data suggest that the individual MCT format is especially effective in addressing symptoms, cognitive biases and insight. We conclude that MCT appears to be a worthwhile complement to pharmacotherapy.

Original languageEnglish
Pages (from-to)358-366
Number of pages9
JournalClinical Psychology Review
Issue number4
Publication statusPublished - Jun 2014
Externally publishedYes


  • Cognitive biases
  • Delusions
  • Metacognitive training
  • Paranoia
  • Psychosis
  • Schizophrenia


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