title: Metacognitive group training for forensic and dangerous non-forensic patients with schizophrenia: a randomised controlled feasibility trial.
abstract: BACKGROUND
  In schizophrenia, the presence of certain cognitive biases has been established. Informed by this, metacognitive training (MCT) has been developed for schizophrenia. There is increasing evidence of its effectiveness with some patients, but its applicability to dangerous patients has not yet been demonstrated.
  
  
  OBJECTIVE
  Our aim was to test the feasibility of a randomised controlled trial (RCT) of MCT for patients in a high-security hospital setting.
  
  
  METHODS
  Twenty of 33 eligible and selected male in-patients with schizophrenia and a history of violence were randomised pairwise to eight sessions of MCT or treatment as usual. Symptom severity and reasoning, according to the jumping to conclusions paradigm, were measured before, immediately after treatment, and 3 and 6 months later.
  
  
  RESULTS
  Men in both groups completed the trial, and those in the MCT arm, almost all of the group sessions. The MCT arm had a significant advantage in improvement of 'suspiciousness', greatest at 3 months, but then declining. No significant improvement in reasoning ability was achieved.
  
  
  CONCLUSIONS
  Metacognitive training showed sufficient promise in this group for a full trial to be worthwhile, and the feasibility of an RCT methodology, even in a secure hospital, was established. The fact that the improvements faded during follow-up suggests that a useful modification to the treatment would be lengthening the protocol, repeating it, or both.
authors.affiliation: Niuvanniemi Hospital, Kuopio, Finland; Department of Psychology, University of Jyväskylä, Finland.
authors.forename: Riitta
authors.initials: R
authors.lastname: Kuokkanen
authors.forename: Raimo
authors.initials: R
authors.lastname: Lappalainen
authors.forename: Eila
authors.initials: E
authors.lastname: Repo-Tiihonen
authors.forename: Jari
authors.initials: J
authors.lastname: Tiihonen
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005555:Forensic Psychiatry; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group / Q000379:methods*; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D013850:Thinking; D016896:Treatment Outcome