Is MCT useful for psychosis?
The study by Ishikawa and colleagues (2020) assessed the effectiveness of a metacognitive training (MCT) in 50 Japanese patients with schizophrenia, schizotypal disorder and delusional disorders (ICD-10), proposing a randomized controlled trial to test the effectiveness of positive symptoms of the most recent and extended version of the MCT.
Schizophrenia-related disorders are a common form of psychosis. In acute episodes, delusions and hallucinations can cause disconnection from reality, as well as representing a risk for life span, 14.5 years lower than the average (Hjorthøj et al., 2017).
For the treatment of this spectrum of ailments, the use of antipsychotic drugs is common, although their effectiveness has been debated, as even the second generation (or atypical) antipsychotics have not fully met the initial high expectations (Kendall, 2011 ); as regards positive symptoms (delusions and hallucinations), atypical antipsychotic pharmacotherapy appears to be just better than placebo, and relapses occur in about a quarter of all patients (Leucht et al., 2003, 2009).
Various psychological approaches, particularly cognitive-behavioral (CBT), have been increasingly adopted as complementary strategies to antipsychotic drugs (Sivec & Montesano, 2012; Wykes et al., 2008).
A recent study (Ishikawa et al., 2020) assessed the effectiveness of a 10-module metacognitive training (MCT) recently developed by the University Medical Center Hamburg-Eppendorf in 50 Japanese patients with schizophrenia, schizotypal disorder and delusional disorders (ICD -10), proposing a randomized controlled trial to test the efficacy on positive symptoms of the most recent and extended version of MCT – which also includes two modules on self-esteem and stigma, two critical points of this disorder (Sundag et al. , 2015; Świtaj et al., 2015). The 50 patients were randomly assigned to routine treatment (TAU) (n = 26) or TAU + MCT treatment (n = 24), lasting ten weeks.
Patients were tested at four different times: at the baseline, six weeks after starting treatment, immediately after treatment and one month after the end of treatment.
The Positive and Negative Syndrome Scale (PANSS) (Kay et al., 1987) has been used to measure positive psychotic symptoms; the General Assessment of Functioning (GAF) (American Psychiatric Association, 2000) for the evaluation of the general functioning of the patient; the Cognitive Biases Questionnaire for psychosis (CBQp) (Peters et al., 2014) for the evaluation of cognitive distortions; the Beck Cognitive Insight Scale (BCIS) (Beck et al. 2004) for the measurement of insight; the Beck Depression Inventory version 2 (BDI-II) (Beck et al., 1996) for the evaluation of depressive symptoms; the 5-Level EQ-5D (EQ-5D-5 L) (van Hout et al., 2012) for the assessment of the quality of life.
The results of the research showed that participants in the TAU + MCT group showed greater benefit than those in the TAU group with regards to positive symptoms (especially delusions) after treatment, which remained in the follow-up to a month later.
Greater benefit was also observed with regard to general functioning and, partially, on cognitive bias. No significant difference regarding insight levels, depressive symptoms and quality of life.
These results are important not only for research at the service of clinical practice, which must never stop looking for more effective solutions for psychopathological problems, but also because they support the hypothesis that a western (meta) cognitive model can also be effective for a non-western culture (Ishikawa et al., 2017).