title: Metacognitive training for patients with schizophrenia: preliminary evidence for a targeted, single-module programme.
abstract: OBJECTIVE
  Metacognitive training is an eight-module, group-based treatment programme for people with schizophrenia that targets the cognitive biases (i.e. problematic thinking styles) thought to contribute to the genesis and maintenance of delusions. The present article is an investigation into the efficacy of a shorter, more targeted, single-module metacognitive training programme, administered individually, which focuses specifically on improving cognitive biases that are thought to be driven by a 'hypersalience of evidence-hypothesis matches' mechanism (e.g. jumping to conclusions, belief inflexibility, reasoning heuristics, illusions of control). It was hypothesised that a more targeted metacognitive training module could still improve performance on these bias tasks and reduce delusional ideation, while improving insight and quality of life.
  
  
  METHODS
  A sample of 28 patients diagnosed with schizophrenia and mild delusions either participated in the hour-long, single-session, targeted metacognitive training programme (n = 14), or continued treatment as usual (n = 14). All patients were assessed using clinical measures gauging overall positive symptomology, delusional ideation, quality of life and insight, and completed two cognitive bias tasks designed to elucidate the representativeness and illusion of control biases.
  
  
  RESULTS
  After a 2-week, post-treatment interval, targeted metacognitive training patients exhibited significant decreases in delusional severity and conviction, significantly improved clinical insight, and significant improvements on the cognitive bias tasks, relative to the treatment-as-usual controls. Performance improvements on the cognitive bias tasks significantly correlated with the observed reductions in overall positive symptomology. Patients also evaluated the training positively.
  
  
  CONCLUSIONS
  Although interpretations of these results are limited due to the lack of an optimally designed, randomised controlled trial and a small sample size, the results are promising and warrant further investigation into targeted versions of the metacognitive training programme.
authors.affiliation: School of Psychology, Flinders University, Australia School of Psychology, University of Adelaide, Australia Discipline of Psychiatry, University of Adelaide, Australia drbalzan@gmail.com.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Balzan
authors.affiliation: School of Psychology, University of Adelaide, Australia.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Delfabbro
authors.affiliation: Discipline of Psychiatry, University of Adelaide, Australia.
authors.forename: Cherrie A
authors.initials: CA
authors.lastname: Galletly
authors.affiliation: Department of Psychiatry, University of British Columbia, Canada.
authors.forename: Todd S
authors.initials: TS
authors.lastname: Woodward
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003702:Delusions / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012189:Retrospective Studies; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D016896:Treatment Outcome
keywords: Metacognitive training; cognitive bias; delusions; schizophrenia