Jeffrey Clayton, Penney Danielle, Sauvé Geneviève, Mendelson Daniel, Thibaudeau Élisabeth, Moritz Steffen, Hotte-Meunier Adèle, Lepage Martin
Douglas Research Centre, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
Douglas Research Centre, Montreal, Canada; Department of Psychology, Université du Québec à Montréal, Canada.
Schizophr Res. 2025 Jan;275:79-86. doi: 10.1016/j.schres.2024.12.004. Epub 2024 Dec 14.
Metacognitive training for psychosis (MCT) offers benefits for addressing hallmark deficits/symptoms in schizophrenia spectrum disorders including reductions in cognitive biases and positive/negative symptoms as well as improvements in social cognition and functioning. However, differing results exist regarding the relationship between MCT and neurocognition. A comprehensive understanding of the nature of this relationship would significantly contribute to the existing literature and our understanding of the potential added value of MCT as a cognitive intervention for psychosis.
Across eleven electronic databases, 1312 sources were identified, and 14 studies examining MCT and neurocognition in psychosis were included in this review. Measures of estimated effect sizes were calculated with Hedge's g, moderator analyses used Cochrane's Q statistic and significance tests to measure group differences according to control conditions.
Twelve studies, 11 randomized controlled trials (RCTs) and 1 non-RCT, were included in the main meta-analyses, consisting of 673 participants (n = 345, n = 328). When comparing MCT against control interventions, non-significant differences in estimated effect sizes were observed across all neurocognitive domains when evaluating pre-post changes (g ≤ 0.1, p > .05). Two additional studies corroborated these results in a narrative review.
These findings suggest that when compared against control conditions, MCT does not pose a statistically meaningful benefit to neurocognitive performance. General practice/learning effects are likely the main contributor that explains improvement in neurocognitive performance, and not a difference of intervention allocation when considering MCT against the included control comparators. These findings help establish the specificity of the effects of MCT.
精神病元认知训练（MCT）有助于解决精神分裂症谱系障碍的标志性缺陷/症状，包括减少认知偏差、阳性/阴性症状，以及改善社会认知和功能。然而，关于MCT与神经认知之间的关系，存在不同的研究结果。全面了解这种关系的本质将极大地丰富现有文献，并有助于我们理解MCT作为一种精神病认知干预手段的潜在附加价值。
通过11个电子数据库，共识别出1312个来源，本综述纳入了14项研究，这些研究考察了MCT与精神病患者神经认知的关系。使用Hedge's g计算估计效应量，通过Cochrane's Q统计量和显著性检验进行调节分析，以根据对照条件测量组间差异。
主要的荟萃分析纳入了12项研究，其中11项随机对照试验（RCT）和1项非RCT，共673名参与者（n = 345，n = 328）。在比较MCT与对照干预措施时，评估前后变化时，所有神经认知领域的估计效应量均无显著差异（g≤0.1，p>.05）。另外两项研究在叙述性综述中证实了这些结果。
这些发现表明，与对照条件相比，MCT对神经认知表现没有统计学上的显著益处。一般实践/学习效应可能是解释神经认知表现改善的主要因素，而不是在将MCT与纳入的对照比较时，干预分配的差异。这些发现有助于确定MCT效果的特异性。
