title: Sowing the seeds of doubt: a narrative review on metacognitive training in schizophrenia.
abstract: The present article provides a narrative review of empirical studies on metacognitive training in psychosis (MCT). MCT represents an amalgam of cognitive-behavioral therapy (CBT), cognitive remediation (CRT) and psychoeducation. The intervention is available in either a group (MCT) or an individualized (MCT+) format. By sowing the seeds of doubt in a playful and entertaining fashion, the program targets positive symptoms, particularly delusions. It aims to raise patients' awareness for common cognitive traps or biases (e.g., jumping to conclusions, overconfidence in errors, bias against disconfirmatory evidence) that are implicated in the formation and maintenance of psychosis. The majority of studies confirm that MCT meets its core aim, the reduction of delusions. Problems (e.g., potential allegiance effects) and knowledge gaps (i.e., outcome predictors) are highlighted. The preliminary data suggest that the individual MCT format is especially effective in addressing symptoms, cognitive biases and insight. We conclude that MCT appears to be a worthwhile complement to pharmacotherapy.
authors.affiliation: University Medical Center Hamburg-Eppendorf Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany. Electronic address: moritz@uke.uni-hamburg.de.
authors.forename: Steffen
authors.initials: S
authors.lastname: Moritz
authors.affiliation: University Medical Center Hamburg-Eppendorf Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Andreou
authors.affiliation: University Medical Center Hamburg-Eppendorf Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Brooke C
authors.initials: BC
authors.lastname: Schneider
authors.affiliation: University Medical Center Hamburg-Eppendorf Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Wittekind
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; BC Mental Health and Addictions Research Institute, Vancouver, BC, Canada.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Menon
authors.affiliation: School of Psychology, Flinders University, Adelaide, SA, Australia.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Balzan
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; BC Mental Health and Addictions Research Institute, Vancouver, BC, Canada.
authors.forename: Todd S
authors.initials: TS
authors.lastname: Woodward
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004644:Emotions / Q000502:physiology; D006801:Humans; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D012649:Self Concept
keywords: cognitive biases; delusions; metacognitive training; paranoia; psychosis; schizophrenia