Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany.
Clin Psychol Psychother. 2019 Mar;26(2):227-240. doi: 10.1002/cpp.2345. Epub 2018 Dec 16.
We evaluated the effectiveness and acceptability of metacognitive interventions for mental disorders. We searched electronic databases and included randomized and nonrandomized controlled trials comparing metacognitive interventions with other treatments in adults with mental disorders. Primary effectiveness and acceptability outcomes were symptom severity and dropout, respectively. We performed random-effects meta-analyses. We identified Metacognitive Training (MCTrain), Metacognitive Therapy (MCTherap), and Metacognition Reflection and Insight Therapy (MERIT). We included 49 trials with 2,609 patients. In patients with schizophrenia, MCTrain was more effective than a psychological treatment (cognitive remediation, SMD = -0.39). It bordered significance when compared with standard or other psychological treatments. In a post hoc analysis, across all studies, the pooled effect was significant (SMD = -0.31). MCTrain was more effective than standard treatment in patients with obsessive-compulsive disorder (SMD = -0.40). MCTherap was more effective than a waitlist in patients with depression (SMD = -2.80), posttraumatic stress disorder (SMD = -2.36), and psychological treatments (cognitive-behavioural) in patients with anxiety (SMD = -0.46). In patients with depression, MCTherap was not superior to psychological treatment (cognitive-behavioural). For MERIT, the database was too small to allow solid conclusions. Acceptability of metacognitive interventions among patients was high on average. Methodological quality was mostly unclear or moderate. Metacognitive interventions are likely to be effective in alleviating symptom severity in mental disorders. Although their add-on value against existing psychological interventions awaits to be established, potential advantages are their low threshold and economy.
我们评估了元认知干预对精神障碍的有效性和可接受性。我们检索了电子数据库，并纳入了比较元认知干预与精神障碍成人其他治疗的随机和非随机对照试验。主要有效性和可接受性结果分别为症状严重程度和脱落率。我们进行了随机效应荟萃分析。我们确定了元认知训练（MCTrain）、元认知疗法（MCTherap）和元认知反思和洞察疗法（MERIT）。我们纳入了 49 项试验，共 2609 名患者。在精神分裂症患者中，MCTrain 比心理治疗（认知矫正）更有效（SMD=-0.39）。与标准或其他心理治疗相比，其效果接近显著。在事后分析中，所有研究的汇总效应均显著（SMD=-0.31）。在强迫症患者中，MCTrain 比标准治疗更有效（SMD=-0.40）。在抑郁症患者中，MCTherap 比等待治疗更有效（SMD=-2.80），在创伤后应激障碍患者中（SMD=-2.36），在焦虑症患者中（SMD=-0.46）比心理治疗（认知行为）更有效。在抑郁症患者中，MCTherap 并不优于心理治疗（认知行为）。对于 MERIT，数据库太小，无法得出明确结论。患者对元认知干预的接受度平均较高。方法学质量大多不明确或中等。元认知干预可能有效减轻精神障碍的症状严重程度。尽管它们相对于现有心理干预的附加价值有待确定，但潜在的优势是其低门槛和经济性。
