Department of Psychology, The Chinese University of Hong Kong, 3/F Wong Foo Yuan Building, Shatin, N.T., Hong Kong SAR.
Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, N.T., Hong Kong SAR.
J Affect Disord. 2021 Jan 15;279:388-397. doi: 10.1016/j.jad.2020.09.126. Epub 2020 Oct 6.
Metacognitive training (MCT) has been shown to be effective in reducing psychotic symptoms, including delusions. However, less is known on whether MCT, or its specific modules, are effective in ameliorating reasoning biases e.g. belief flexibility. As inflexibility in appraisal has been associated with psychosis and major depressive disorder (MDD), this study examined the efficacy of a 4-session MCT on delusions, depression, and belief flexibility, in two clinical groups (Psychosis and Depression).
This study adopted a single-blind randomised controlled design, with patients with schizophrenia spectrum disorders (and delusions) and patients with MDD being randomised, respectively, into the MCT condition or a treatment-as-usual (TAU) condition. The MCT intervention consisted of specific modules targeting belief flexibility. Participants were assessed before and after treatment, and at 1- and 6-month follow-ups.
Among the 113 participants, 27 patients with psychosis and 29 patients with MDD attended MCT. There were significant improvements in psychotic symptoms, especially delusions, for the Psychosis group, and in depressive symptoms for the MDD group. Symptom improvements following MCT were of large effect sizes, were significantly greater than TAU, and persisted at 6-month. Belief flexibility also improved in both groups, although changes were smaller in size and were not significantly greater than TAU.
An active control condition was not included.
This study demonstrated large and stable symptom reductions in delusions and depression, and smaller (yet stable) improvement in belief flexibility across groups, following a 4-session MCT, carrying implications for transdiagnostic process-based interventions and their mechanisms of change.
元认知训练（MCT）已被证明可有效减少精神病症状，包括妄想。然而，对于 MCT 或其特定模块是否能改善推理偏差，例如信念灵活性，了解较少。由于评估的不灵活性与精神病和重度抑郁症（MDD）有关，因此本研究考察了 4 节 MCT 对精神病和抑郁症两种临床群体（精神病和抑郁症）的妄想、抑郁和信念灵活性的疗效。
本研究采用单盲随机对照设计，将精神分裂症谱系障碍（伴有妄想）患者和 MDD 患者分别随机分配到 MCT 条件或常规治疗（TAU）条件。MCT 干预包括针对信念灵活性的特定模块。参与者在治疗前、治疗后以及 1 个月和 6 个月随访时进行评估。
在 113 名参与者中，27 名精神病患者和 29 名 MDD 患者参加了 MCT。精神病组的精神病症状，特别是妄想，以及 MDD 组的抑郁症状均有显著改善。MCT 后症状改善的效果显著，且明显大于 TAU，且在 6 个月时仍然存在。两组的信念灵活性也有所改善，尽管变化幅度较小，且与 TAU 相比无显著差异。
未包括活性对照条件。
本研究表明，4 节 MCT 可显著且稳定地减轻妄想和抑郁症状，并较小程度地（但稳定）改善信念灵活性，提示跨诊断基于过程的干预及其变化机制具有重要意义。
