Antipsychotic treatment beyond antipsychotics: metacognitive intervention for schizophrenia patients improves delusional symptoms

2011 ◽  
Vol 41 (9) ◽  
pp. 1823-1832 ◽  
Author(s):  
S. Moritz ◽  
R. Veckenstedt ◽  
S. Randjbar ◽  
F. Vitzthum ◽  
T. S. Woodward
Keyword(s):  
Group Intervention ◽  
Rating Scales ◽  
Cognitive Biases ◽  
Cognitive Remediation ◽  
Behavioural Therapy ◽  
Medium Effect ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Jumping To Conclusions ◽  
Oriented Approach

BackgroundAlthough antipsychotic medication still represents the treatment of choice for schizophrenia, its objective impact on symptoms is only in the medium-effect size range and at least 50% of patients discontinue medication in the course of treatment. Hence, clinical researchers are intensively looking for complementary therapeutic options. Metacognitive training for schizophrenia patients (MCT) is a group intervention that seeks to sharpen the awareness of schizophrenia patients on cognitive biases (e.g. jumping to conclusions) that seem to underlie delusion formation and maintenance. The present trial combined group MCT with an individualized cognitive-behavioural therapy-oriented approach entitled individualized metacognitive therapy for psychosis (MCT+) and compared it against an active control.MethodA total of 48 patients fulfilling criteria of schizophrenia were randomly allocated to either MCT+ or cognitive remediation (clinical trial NCT01029067). Blind to intervention, both groups were assessed at baseline and 4 weeks later. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scales (PSYRATS). Jumping to conclusions was measured using a variant of the beads task.ResultsPANSS delusion severity declined significantly in the combined MCT treatment compared with the control condition. PSYRATS delusion conviction as well as jumping to conclusions showed significantly greater improvement in the MCT group. In line with prior studies, treatment adherence and subjective efficacy was excellent for the MCT.ConclusionsThe results suggest that the combination of a cognition-oriented and a symptom-oriented approach ameliorate psychotic symptoms and cognitive biases and represents a promising complementary treatment for schizophrenia.

Sustained antipsychotic effect of metacognitive training in psychosis: A randomized-controlled study

2014 ◽  
Vol 29 (5) ◽  
pp. 275-281 ◽  
Author(s):  
J. Favrod ◽  
S. Rexhaj ◽  
S. Bardy ◽  
P. Ferrari ◽  
C. Hayoz ◽  
...  
Keyword(s):  
Rating Scales ◽  
Cognitive Biases ◽  
Basic Research ◽  
Medium Effect ◽  
Controlled Study ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Treatment As Usual ◽  
Metacognitive Training ◽  
Antipsychotic Effect

AbstractPersistent psychotic symptoms represent a major challenge for psychiatric care. Basic research has shown that psychotic symptoms are associated with cognitive biases. Metacognitive training (MCT) aims at helping patients to become aware of these biases and to improve problem-solving. Fifty-two participants fulfilling diagnostic criteria of schizophrenia or schizoaffective disorders and persistent delusions and stabilized antipsychotic medication were enrolled in this study. Following baseline assessment patients were randomized either to treatment as usual (TAU) conditions or TAU + MCT. The intervention consisted of eight weekly 1-hour sessions (maximum: 8 hours). Participants were assessed at 8 weeks and 6-months later by blind assessors. Participants were assessed with the Psychotic Symptoms Rating Scales (PSYRATS) and the positive subscale of the PANSS. Between-group differences in post- and pre-test values were significant at a medium effect size in favor of the MCT for the PSYRATS delusion scale and the positive scale of the PANSS both at post and follow-up. The results of this study indicate that MCT training has a surplus antipsychotic effect for patients suffering from schizophrenia-related disorders who demonstrate only a partial response to antipsychotic treatment and that the effect of the intervention persists for at least 6 months after the intervention.

scholarly journals Cognitive Behavioural Therapy for Auditory Hallucinations: Effectiveness and Predictors of Outcome in a Specialist Clinic

2010 ◽  
Vol 39 (2) ◽  
pp. 129-138 ◽  
Author(s):  
Neil Thomas ◽  
Susan Rossell ◽  
John Farhall ◽  
Frances Shawyer ◽  
David Castle
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Negative Symptoms ◽  
Rating Scales ◽  
Behavioural Therapy ◽  
Auditory Hallucinations ◽  
Psychotic Symptoms ◽  
Predictors Of Outcome ◽  
Formal Thought Disorder ◽  
Behavioural Treatment ◽  
Cognitive Behavioural

Background: Cognitive behavioural therapy has been established as an effective treatment for residual psychotic symptoms but a substantial proportion of people do not benefit from this treatment. There has been little direct study of predictors of outcome, particularly in treatment targeting auditory hallucinations. Method: The Psychotic Symptom Rating Scales (PSYRATS) and Positive and Negative Syndrome Scale (PANSS) were administered pre- and post-therapy to 33 people with schizophrenia-related disorders receiving CBT for auditory hallucinations in a specialist clinic. Outcome was compared with pre-therapy measures of insight, beliefs about the origin of hallucinations, negative symptoms and cognitive disorganization. Results: There were significant improvements post-treatment on the PSYRATS and PANSS Positive and General Scales. Improvement on the PSYRATS was associated with lower levels of negative symptoms, but was unrelated to overall insight, delusional conviction regarding the origins of hallucinations, or levels of cognitive disorganization. Conclusions: Lack of insight and presence of formal thought disorder do not preclude effective cognitive-behavioural treatment of auditory hallucinations. There is a need to further understand why negative symptoms may present a barrier to therapy.

Misattributing speech and jumping to conclusions: A longitudinal study in people at high risk of psychosis

2015 ◽  
Vol 30 (1) ◽  
pp. 32-37 ◽  
Author(s):  
T.T. Winton-Brown ◽  
M.R. Broome ◽  
P. Allen ◽  
I. Valli ◽  
O. Howes ◽  
...  
Keyword(s):  
Psychotic Disorder ◽  
Symptom Severity ◽  
Cognitive Biases ◽  
Psychotic Symptoms ◽  
Self Monitoring ◽  
Level Of Functioning ◽  
Jumping To Conclusions ◽  
Over Time ◽  
At Risk Mental State

AbstractBiases in cognition such as Jumping to Conclusions (JTC) and Verbal Self-Monitoring (VSM) are thought to underlie the formation of psychotic symptoms. This prospective study in people with an At Risk Mental State (ARMS) for psychosis examined how these cognitive biases changed over time, and predicted clinical and functional outcomes. Twenty-three participants were assessed at clinical presentation and a mean of 31 months later. Performance on a JTC and VSM tasks were measured at both time points. Relationships to symptom severity, level of function and the incidence of psychotic disorder were then examined. The levels of symptoms, function and VSM all improved over time, while JTC was stable. Five participants (22%) developed a psychotic disorder during the follow-up period, but the risk of transition was not related to performance on either task at baseline, or to longitudinal changes in task performance. JTC performance correlated with symptom severity at baseline and follow-up. Similarly, performance on the two tasks was not related to the level of functioning at follow-up. Thus, while the ARMS is associated with both VSM and JTC biases, neither predict the onset of psychosis or the overall functional outcome.

scholarly journals M218. RELATIONSHIP BETWEEN JUMPING TO CONCLUSIONS AND OTHER COGNITIVE BIASES AND SOCIAL COGNITION IN PEOPLE WITH SCHIZOPHRENIA

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S218-S219
Author(s):  
Mar Garcia-Franco ◽  
Sonia Vilamala-Anton ◽  
Gemma Prat ◽  
Maria Jose EScandell ◽  
Jose Ramón Martínez ◽  
...  
Keyword(s):  
Social Cognition ◽  
Theory Of Mind ◽  
Attributional Style ◽  
Cognitive Biases ◽  
Psychotic Symptoms ◽  
Rehabilitation Services ◽  
Negative Events ◽  
Schizotypal Personality ◽  
Jumping To Conclusions ◽  
Borderline Disorder

Abstract Background Deficits in jumping to conclusions and social cognition have been described in people with schizophrenia. The aims of the study are to relate jumping to conclusions with social cognition and other cognitive biases in people with schizophrenia attended in rehabilitation services. Methods A descriptive study was performed. The subjects of our study were persons from 18 to 65 years old, attended in rehabilitation services, with schizophrenia diagnoses and other diagnoses with presence of psychotic symptoms (depression, bipolar disorder, borderline disorder, delusional disease, schizoaffective, and schizotypal personality). The variables included were JTC considered three beads tasks with different proportions: 85:15%, 60:40% and 60:40% salient task. Moreover, cognitive insight (BCIS), attributional style (IPSAQ), and Hinting Task -Theory of Mind (ToM) were assessed. A T student analysis was done in order to compare JTC with the rest of the quantitative variables. Results People who jump to conclusions in the salient task scored higher in self-certainty BCIS (p=0.028), in self attribution for negative events (p=0.036) and lower in attribution to other people of negative events (p=0.028). A tendency was found between the presence of JTC and ToM (p=0.051). In the task of 85-15 only a tendency was found between presence of JTC and higher scores in the personalizing bias (p=0.079). Moreover, in the task of 60:40 a tendency was found between presence of JTC and worse performance in the ToM test (p=0.051). Discussion We found a relationship between jumping to conclusions and self-certainty and self-attributions for negative events; as well as, it is a tendency that higher jumping to conclusions is related with worst ToM. There are important clinic implications of this, because we know that jumping to conclusions and theory of mind is related with the formation and maintenance of delusions.

An Investigation of Module-Specific Effects of Metacognitive Training for Psychosis

2018 ◽  
Vol 226 (3) ◽  
pp. 164-173 ◽  
Author(s):  
Brooke C. Schneider ◽  
Barbara Cludius ◽  
Wolfgang Lutz ◽  
Steffen Moritz ◽  
Julian A. Rubel
Keyword(s):  
Intervention Study ◽  
Cognitive Biases ◽  
Medium Effect ◽  
Psychotic Symptoms ◽  
Group Training ◽  
Positive Symptoms ◽  
Open Label ◽  
Metacognitive Training ◽  
Specific Effects ◽  
Before And After

Abstract. Metacognitive training for psychosis (MCT) is a group training program that targets cognitive biases, which play a role in the pathogenesis of delusions. It remains unclear to what extent individual MCT modules lead to within- or between-session changes in positive symptoms, sadness, cognitive biases, or theory of mind (ToM) distortions. A one-armed open-label intervention study was conducted with 176 psychiatric inpatients with psychotic symptoms. Patients were asked to fill out a questionnaire on cognitive biases, symptoms, and ToM distortions before and after each session. Multilevel (ML) modeling was used to assess associations between participation in a respective module and subsequent changes in self-reported symptoms. ML analyses indicated an overall improvement in all outcomes as well as within-session decreases in positive symptoms for a module addressing ToM distortions with a small effect. Two MCT modules addressing cognitive biases (jumping to conclusions, a bias against disconfirmatory evidence) were associated with reductions in the module-specific bias with a small and small to medium effect, respectively. The study provides initial evidence regarding module-specific associations with positive symptoms, cognitive biases, and ToM distortions in MCT.

scholarly journals Stress and cognitive biases in schizotypy: A two-site study of bias against disconfirmatory evidence and jumping to conclusions

2019 ◽  
Vol 62 ◽  
pp. 20-27 ◽  
Author(s):  
Thanh P. Le ◽  
Taylor L. Fedechko ◽  
Alex S. Cohen ◽  
Samantha Allred ◽  
Carrie Pham ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Biases ◽  
Information Gathering ◽  
Psychotic Symptoms ◽  
Jumping To Conclusions ◽  
Psychosis Continuum ◽  
The Us ◽  
As Stress ◽  
Reasoning Biases

Abstract The dysfunctional cognitive and reasoning biases which underpin psychotic symptoms are likely to present prior to the onset of a diagnosable disorder and should therefore be detectable along the psychosis continuum in individuals with schizotypal traits. Two reasoning biases, Bias Against Disconfirmatory Evidence (BADE) and Jumping to Conclusions (JTC), describe how information is selected and weighed under conditions of uncertainty during decision making. It is likely that states such as elevated stress exacerbates JTC and BADE in individuals with high schizotypal traits vulnerable to displaying these information gathering styles. Therefore, we evaluated whether stress and schizotypy interacted to predict these reasoning biases using separate samples from the US (JTC) and England (BADE). Generally speaking, schizotypal traits and stress were not independently associated with dysfunctional reasoning biases. However, across both studies, the interaction between schizotypy traits and stress significantly predicted reasoning biases such that increased stress was associated with increased reasoning biases, but only for individuals low in schizotypal traits. These patterns were observed for positive schizotypal traits (in both samples), for negative traits (in the England sample only), but not for disorganization traits. For both samples, our findings suggest that the presence of states such as stress is associated with, though not necessarily dysfunctional, reasoning biases in individuals with low schizotypy. These reasoning biases seemed, in some ways, relatively immutable to stress in individuals endorsing high levels of positive schizotypal traits.

Individualized Metacognitive Therapy Program for Patients with Psychosis (MCT+): Introduction of a Novel Approach for Psychotic Symptoms

2013 ◽  
Vol 42 (1) ◽  
pp. 105-110 ◽  
Author(s):  
Francesca Bohn Vitzthum ◽  
Ruth Veckenstedt ◽  
Steffen Moritz
Keyword(s):  
Rating Scales ◽  
Cognitive Biases ◽  
Single Case ◽  
Combined Therapy ◽  
Combined Treatment ◽  
Thinking Styles ◽  
Psychotic Symptoms ◽  
Group Training ◽  
Metacognitive Therapy ◽  
Therapy Program

Background: Metacognitive Group Training for Schizophrenia Patients (MCTg) focuses on dysfunctional thinking styles (e.g. cognitive biases) putatively involved in the formation and maintenance of delusions. Recently, the Individualized Metacognitive Therapy Program for Patients with Psychosis (MCT+), an extension of the group training, was released. MCT+ sessions aim to correct false metacognitive beliefs, which in turn should challenge a patient's personal delusional convictions. Aims: The present study demonstrates how MCT and MCT+ can be combined and how the contents are conveyed to the patient. Method: We present a single case study of a patient undergoing a combined treatment of MCT and MCT+. Before intervention and 4 weeks later the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scales (PSYRATS) were administered. Results: The patient showed a substantial symptom reduction after 4 weeks of combined therapy of MCTg and MCT+ as measured with PANSS and PSYRATS. Conclusions: The present case history lends preliminary evidence for the feasibility of this new treatment approach in psychosis.

A bias-oriented treatment approach: The metacognitive training for schizophrenia patients (MCT)

2011 ◽  
Vol 26 (S2) ◽  
pp. 2160-2160
Author(s):  
S. Moritz ◽  
T.S. Woodward
Keyword(s):  
Cognitive Biases ◽  
Cognitive Remediation ◽  
Cognitive Intervention ◽  
Behavioural Therapy ◽  
Controlled Study ◽  
Metacognitive Training ◽  
Psychological Understanding ◽  
Cognitive Behavioural ◽  
Meta Analyses ◽  
New Evidence

Until recently, psychological therapy for schizophrenia was considered inefficient or even harmful by many clinicians. The reservation against psychotherapy is partly rooted in the assumption that delusions are not amenable to psychological understanding. However, meta-analyses suggest that cognitive intervention is effective in ameliorating schizophrenia symptoms. In addition, evidence has accumulated that cognitive biases, such as jumping to conclusions (JTC), are involved in the pathogenesis of schizophrenia positive symptoms, particularly delusions. A recently developed group program, called metacognitive training (MCT), is presented targeting cognitive biases. The MCT is a hybrid of psychoeducation, cognitive remediation and cognitive-behavioural therapy. Patients are taught strategies how to identify and defuse “cognitive traps”. The program can be downloaded at no cost at www.uke.de/mkt and is currently available in more than 20 languages. New evidence on the feasibility and efficacy of the MCT is presented. At the end, a novel individualized variant entitled MCT+ is demonstrated targeting individual delusional ideas. A random-controlled study asserts the efficacy of the MCT+ to reduce JTC as well as delusion severity and conviction.

scholarly journals Unmet needs for treatment in 102 individuals with brief and limited intermittent psychotic symptoms (BLIPS): implications for current clinical recommendations

2019 ◽  
Vol 29 ◽  
Author(s):  
Paolo Fusar-Poli ◽  
Andrea De Micheli ◽  
Monica Chalambrides ◽  
Aoife Singh ◽  
Castagnini Augusto ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Outcomes ◽  
Cognitive Behavioural Therapy ◽  
Unmet Needs ◽  
Behavioural Therapy ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Poor Prognostic Factor ◽  
Cognitive Behavioural

Abstract Aims To investigate clinical outcomes and unmet needs in individuals at Clinical High Risk for Psychosis presenting with Brief and Limited Intermittent Psychotic Symptoms (BLIPS). Methods Prospective naturalistic long-term (up to 9 years) cohort study in individuals meeting BLIPS criteria at the Outreach And Support In South-London (OASIS) up to April 2016. Baseline sociodemographic and clinical characteristics, specific BLIPS features, preventive treatments received and clinical outcomes (psychotic and non-psychotic) were measured. Analyses included Kaplan Meier survival estimates and Cox regression methods. Results One hundred and two BLIPS individuals were followed up to 9 years. Across BLIPS cases, 35% had an abrupt onset; 32% were associated with acute stress, 45% with lifetime trauma and 20% with concurrent illicit substance use. The vast majority (80%) of BLIPS individuals, despite being systematically offered cognitive behavioural therapy for psychosis, did not fully engage with it and did not receive the minimum effective dose. Only 3% of BLIPS individuals received the appropriate dose of cognitive behavioural therapy. At 4-year follow-up, 52% of the BLIPS individuals developed a psychotic disorder, 34% were admitted to hospital and 16% received a compulsory admission. At 3-year follow-up, 52% of them received an antipsychotic treatment; at 4-year follow-up, 26% of them received an antidepressant treatment. The presence of seriously disorganising and dangerous features was a strong poor prognostic factor. Conclusions BLIPS individuals display severe clinical outcomes beyond their very high risk of developing psychosis and show poor compliance with preventive cognitive behavioural therapy. BLIPS individuals have severe needs for treatment that are not met by current preventive strategies.

A naturalistic, randomized, controlled trial combining cognitive remediation with cognitive–behavioural therapy after first-episode non-affective psychosis

2013 ◽  
Vol 44 (9) ◽  
pp. 1889-1899 ◽  
Author(s):  
R. J. Drake ◽  
C. J. Day ◽  
R. Picucci ◽  
J. Warburton ◽  
W. Larkin ◽  
...  
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Rating Scale ◽  
Cognitive Remediation ◽  
Behavioural Therapy ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Affective Psychosis ◽  
Cognitive Behavioural ◽  
Significant Difference ◽  
Group Time

BackgroundCognitive remediation (CR) preceding cognitive–behavioural therapy for psychosis (CBTp) was trialled within routine clinical services, with the hypothesis that following first-episode non-affective psychosis CR would enhance CBTp efficacy by improving neuropsychological performance.MethodA total of 61 patients with DSM-IV non-affective psychoses waiting for routine CBTp were randomized to computerized CR over 12 weeks, supported by a trained support worker, or time-matched social contact (SC). Primary outcome was the blind-rated Psychotic Symptoms Rating Scale (PSYRATS). Secondary outcomes included measures of CBTp progress, cognition, symptoms, insight and self-esteem: all at baseline, after CR (12 weeks) and after CBTp (42 weeks). PSYRATS and global neuropsychological efficacy were tested using mixed-effects models with a group × time interaction term. Measures of CBTp progress and some neuropsychological measures were modelled by regression.ResultsThere was no significant difference between the CR and SC groups in PSYRATS (group × time coefficient 0.3, 95% confidence interval −0.4 to 1.1, p = 0.39). However, after CR CBTp was shorter [median 7 sessions, interquartile range (IQR) 2–12 after CR; median 13, IQR 4–18 after SC; model p = 0.011] and linked to better insight (p = 0.02). Global cognition did not improve significantly more after CR (p = 0.20) but executive function did (Wisconsin Card Sort, p = 0.012).ConclusionsCBTp courses preceded by CR were far shorter but achieved the same outcome as CBTp preceded by an active control, consistent with neuropsychological improvement enhancing CBTp. CR was delivered by staff with minimal training, offering the potential to reduce the costs of CBTp considerably.

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