Metacognitive therapy in people with a schizophrenia spectrum diagnosis and medication resistant symptoms: a feasibility study.
OBJECTIVE
Cognitive behaviour therapy (CBT) for psychosis has been shown to be effective, but there are recent suggestions that it is less efficacious than initially thought. Metacognitive therapy (MCT), which focuses on metacognitive mechanisms, has led to positive results in other disorders, but has yet to be evaluated in people with schizophrenia spectrum diagnoses. This study evaluates the feasibility of MCT for people with psychotic disorders.


METHODS
Ten participants with schizophrenia spectrum disorders received up to 12 sessions of MCT in an open trial. Outcomes included psychiatric symptoms measured using the PANSS, at baseline, 9 months (end of treatment) and at 12 months (follow-up), as well as dimensions of hallucinations and delusions, emotional dysfunction, self-rated recovery, social functioning and metacognitive beliefs.


RESULTS
T-tests and Wilcoxon's signed ranks tests revealed significant beneficial effects on several outcomes at end-of-treatment and follow-up. Cohen's d effect sizes were moderate to large (for PANSS total, d = 1.0 at end of treatment; d = 0.95 at follow-up). A response rate analysis found 50% and 40% of participants achieved at least a 25% reduction in PANSS total scores by end of therapy and follow-up, respectively. Exploratory analyses revealed that metacognitive beliefs significantly changed over treatment and follow-up periods.


CONCLUSIONS
This study had no control group and was not randomised; therefore, it is likely that effect sizes were inflated.


CONCLUSIONS
This study provides preliminary evidence that MCT is a feasible treatment for people with psychosis. An adequately powered randomised controlled trial is warranted.
School of Psychological Sciences, University of Manchester, Manchester, United Kingdom; Greater Manchester West NHS Mental Health Foundation Trust, Manchester, United Kingdom. Electronic address: anthony.p.morrison@manchester.ac.uk.
Anthony P
AP
Morrison
Greater Manchester West NHS Mental Health Foundation Trust, Manchester, United Kingdom.
Melissa
M
Pyle
Greater Manchester West NHS Mental Health Foundation Trust, Manchester, United Kingdom.
Nicola
N
Chapman
Greater Manchester West NHS Mental Health Foundation Trust, Manchester, United Kingdom.
Paul
P
French
Greater Manchester West NHS Mental Health Foundation Trust, Manchester, United Kingdom.
Sophie K
SK
Parker
School of Psychological Sciences, University of Manchester, Manchester, United Kingdom; Dept of Psychology, NTNU, Trondheim, Norway.
Adrian
A
Wells
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders; D012559:Schizophrenia / Q000188:drug therapy / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D014150:Antipsychotic Agents
Metacognitive therapy; Psychosis; Schizophrenia