Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands.
Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
Schizophr Bull. 2019 Jun 18;45(4):784-793. doi: 10.1093/schbul/sby136.
Evidence-based psychological interventions to support treatment decision-making capacity (capacity) in psychosis do not currently exist. This study sought to establish whether reducing the extent to which this group form conclusions based on limited evidence, also known as the "jumping-to-conclusions" (JTC) bias, could improve capacity.
In a randomized controlled open trial, 37 patients aged 16-65 years diagnosed with schizophrenia-spectrum disorders were randomly assigned (1:1) to receive a single-session intervention designed to reduce the JTC bias (MCT-JTC; adapted from Metacognitive Training [MCT]) or an attention control (AC) condition designed to control for therapist attention, duration, modality, and face validity. Primary outcomes were treatment decision-making capacity measured by the MacArthur Competency Assessment Tool for Treatment (MacCAT-T) and the jumping-to-conclusions reasoning bias measured by draws to decision on the beads task, each of which were administered by the psychologist delivering the intervention.
Those receiving MCT-JTC had large improvements in overall capacity (d = 0.96, P < .05) and appreciation (d = 0.87, P < .05) compared to those receiving AC. Reduction in JTC mediated a large proportion of the effect of group allocation on understanding, appreciation, reasoning, and overall MacCAT-T scores.
This is the first experimental investigation of the effect of a psychological intervention on treatment decision-making capacity in psychosis. It provides early evidence that reducing the JTC bias is associated with large and rapid improvements in capacity. Due to limited resources, assessments were administered by the researchers delivering the intervention. Results should therefore be considered preliminary and a larger, definitive trial addressing methodological limitations is warranted.
目前尚无支持精神病患者治疗决策能力（能力）的基于证据的心理干预措施。本研究旨在确定是否可以减少该群体基于有限证据形成结论的程度，也称为“跳跃结论”（JTC）偏差，从而提高能力。
在一项随机对照开放试验中，37 名年龄在 16-65 岁之间被诊断为精神分裂症谱系障碍的患者被随机分配（1：1）接受单次干预，旨在减少 JTC 偏差（MCT-JTC；改编自元认知训练[MCT]）或注意力控制（AC）条件，旨在控制治疗师的注意力、持续时间、方式和表面效度。主要结局是由治疗决策能力评估工具（MacCAT-T）测量的治疗决策能力和由珠子任务中的决策绘制测量的跳跃结论推理偏差，每个评估均由提供干预措施的心理学家进行。
与接受 AC 治疗的患者相比，接受 MCT-JTC 治疗的患者的整体能力（d = 0.96，P <.05）和欣赏能力（d = 0.87，P <.05）有很大提高。JTC 的减少部分解释了组分配对理解、欣赏、推理和整体 MacCAT-T 分数的影响。
这是第一项关于心理干预对精神病治疗决策能力影响的实验研究。它提供了早期证据，表明减少 JTC 偏差与能力的大幅快速提高有关。由于资源有限，评估由提供干预措施的研究人员进行。因此，结果应被视为初步结果，需要进行更大、更明确的试验来解决方法学限制。
