University of Basel Psychiatric Hospital, Center for Psychotic Disorders, University of Basel, Switzerland; University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Basel, Switzerland.
University of Basel, Department of Psychology, Division of Personality and Developmental Psychology, Basel, Switzerland.
J Behav Ther Exp Psychiatry. 2020 Sep;68:101547. doi: 10.1016/j.jbtep.2020.101547. Epub 2020 Jan 7.
Individualized Metacognitive Training (MCT+) is a manualized intervention designed to improve delusional severity by reducing delusion-associated cognitive biases such as jumping-to-conclusions. Increased interest in personalized medicine stipulates the identification of patients who are more likely to benefit from specialized interventions. The present study aimed to explore baseline moderators of MCT+ efficacy on delusions and overall positive symptoms in psychosis.
We analyzed data from a randomized rater-blind controlled trial, in which 92 patients with psychotic disorders and current or past delusions were randomly assigned to either MCT+ or CogPack®, a cognitive remediation software. Baseline moderator variables consisted of jumping-to-conclusions, cognitive insight, quality of life, self-esteem, selective attention, and patients' attitudes towards their symptoms. Linear mixed-effects models were applied to investigate specific moderators of MCT+ efficacy.
In MCT+ relative to CogPack, presence of a jumping-to-conclusions bias, a lowered decision threshold, and low self-esteem were associated with larger improvements in delusional severity and/or overall positive symptoms over time. Subjective reasoning style and insight, as well as subjective attitudes towards psychosis, did not moderate the treatment efficacy of MCT+ relative to CogPack.
Participation of both treatment groups in group MCT as a part of standard care, possibly leading to additional effects on delusional severity.
Patients with low self-esteem and those who are prone to jumping-to-conclusions seem to particularly benefit from MCT+. Our results can help inform clinical practice as they provide specific criteria for selecting patients for whom MCT+ is most appropriate.
个体化元认知训练（MCT+）是一种旨在通过减少与妄想相关的认知偏差（如草率结论）来降低妄想严重程度的规范化干预措施。对个性化医学的日益关注规定了需要确定哪些患者更有可能从专门干预中受益。本研究旨在探讨 MCT+对精神分裂症患者妄想和总体阳性症状疗效的基线调节因素。
我们分析了一项随机评分者盲法对照试验的数据，其中 92 名患有精神障碍且目前或过去有妄想的患者被随机分配至 MCT+或认知矫正软件 CogPack®。基线调节变量包括草率结论、认知洞察力、生活质量、自尊、选择性注意以及患者对自身症状的态度。线性混合效应模型用于研究 MCT+疗效的具体调节因素。
与 CogPack 相比，在 MCT+中，存在草率结论偏差、决策阈值降低和自尊心低与妄想严重程度和/或总体阳性症状随时间的改善相关更大。主观推理风格和洞察力，以及对精神病的主观态度，并没有调节 MCT+相对于 CogPack 的治疗效果。
两组患者都参加了 MCT 组作为标准护理的一部分，这可能会对妄想严重程度产生额外的影响。
自尊心较低和易产生草率结论的患者似乎特别受益于 MCT+。我们的研究结果可以帮助指导临床实践，因为它们为选择最适合接受 MCT+的患者提供了具体标准。
