Douglas Mental Health University Institute, Montréal, Québec, Canada.
Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada.
JAMA Psychiatry. 2022 May 1;79(5):417-429. doi: 10.1001/jamapsychiatry.2022.0277.
A substantial increase in the number of trials examining metacognitive training (MCT) for psychosis necessitates an updated examination of the outcomes associated with MCT.
To review the immediate and sustained associations of MCT with proximal (directly targeted) and distal (indirectly influenced) outcomes and assess treatment- and participant-related moderators to identify the potential factors associated with the expected heterogeneity of effect sizes.
Eleven electronic databases were searched from 2007 to June 3, 2021 (alert until September 10, 2021). Reference lists of earlier meta-analyses and included reports were screened.
Reports examined MCT and included participants with schizophrenia spectrum and related psychotic disorders (1045 reports identified; 281 assessed). There were no age, sex, gender, race and ethnicity, language, or study design restrictions. Two reviewers performed the selection of studies to be analyzed.
The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed. Data were extracted by 3 reviewers and pooled using random effects models. Hedges g effect sizes were computed. The Mixed-Methods Appraisal tool was used to assess study quality.
Proximal outcomes were global positive symptoms, delusions, hallucinations, and cognitive biases. Distal outcomes were self-esteem, negative symptoms, quality of life, well-being, and functioning. Immediate and sustained outcomes were examined. Meta-regressions, subgroup, and sensitivity analyses assessed moderators.
This systematic review and meta-analysis included 43 studies (46 reports). Forty reports were synthesized in meta-analysis (N=1816 participants) and 6 reports were included in narrative review. In the studies examined, MCT was associated with positive symptoms (g = 0.50; 95% CI, 0.34-0.67), delusions (g = 0.69; 95% CI, 0.45-0.93), hallucinations (g = 0.26; 95% CI, 0.11-0.40), cognitive biases (g = 0.16; 95% CI, 0.03-0.29), self-esteem (g = 0.17; 95% CI, 0.03-0.31), negative symptoms (g = 0.23; 95% CI, 0.10-0.37), and functioning (g = 0.41; 95% CI, 0.12-0.69). These associations were maintained up to 1 year. The quality of life effect size was nonsignificant (g = 0.20; 95% CI, -0.07 to 0.47); only 1 study assessed well-being. Publication year was associated with moderated hallucinations (β = 0.04; 95% CI, 0.00-0.07). Overall, narrative review results corroborated meta-analytic findings.
In this meta-analysis, MCT for psychosis was associated with benefits up to 1 year postintervention in several treatment contexts. These findings suggest that MCT may merit integration in treatment guidelines for schizophrenia.
大量研究检验了元认知训练（MCT）治疗精神病的效果，因此需要对与 MCT 相关的结果进行更新的评估。
回顾 MCT 与直接目标（直接针对）和间接影响（间接影响）结果的即时和持续关联，并评估治疗和参与者相关的调节因素，以确定与预期效应大小异质性相关的潜在因素。
从 2007 年至 2021 年 6 月 3 日（提醒截止到 2021 年 9 月 10 日），在 11 个电子数据库中进行了搜索。还筛选了早期荟萃分析和纳入报告的参考文献列表。
报告研究了 MCT，并纳入了精神分裂症谱系和相关精神病障碍的参与者（确定了 1045 份报告；评估了 281 份报告）。没有年龄、性别、性别、种族和民族、语言或研究设计限制。两名审查员选择了要分析的研究。
遵循系统评价和荟萃分析报告的首选报告项目。由 3 名审查员提取数据，并使用随机效应模型进行汇总。计算了 Hedges g 效应大小。使用混合方法评估工具评估研究质量。
近端结果是总体阳性症状、妄想、幻觉和认知偏差。远端结果是自尊、阴性症状、生活质量、幸福感和功能。检查了即时和持续的结果。进行了元回归、亚组和敏感性分析以评估调节因素。
本系统评价和荟萃分析包括 43 项研究（46 项报告）。40 项研究在荟萃分析中进行了综合（N=1816 名参与者），6 项研究在叙述性综述中进行了综合。在研究中，MCT 与阳性症状（g=0.50；95%置信区间，0.34-0.67）、妄想（g=0.69；95%置信区间，0.45-0.93）、幻觉（g=0.26；95%置信区间，0.11-0.40）、认知偏差（g=0.16；95%置信区间，0.03-0.29）、自尊（g=0.17；95%置信区间，0.03-0.31）、阴性症状（g=0.23；95%置信区间，0.10-0.37）和功能（g=0.41；95%置信区间，0.12-0.69）相关。这些关联在 1 年内得以维持。生活质量的效应大小无统计学意义（g=0.20；95%置信区间，-0.07 至 0.47）；只有 1 项研究评估了幸福感。出版年份与调节性幻觉有关（β=0.04；95%置信区间，0.00-0.07）。总体而言，叙述性综述结果证实了荟萃分析的发现。
在这项荟萃分析中，精神病的 MCT 在多个治疗环境中与 1 年的干预后益处相关。这些发现表明，MCT 可能值得纳入精神分裂症的治疗指南。
