title: Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study.
abstract: BACKGROUND
  Theory-driven interventions targeting specific factors that contribute to delusions are receiving increased interest. The present study aimed to assess the efficacy of individualized metacognitive therapy (MCT+), a short manualized intervention that addresses delusion-associated cognitive biases.
  
  
  METHODS
  92 patients with current or past delusions were randomized to receive 12 twice-weekly sessions of either MCT+ or a control intervention within a randomized controlled rater-blind design. Psychopathology and cognitive biases were assessed at baseline, 6 weeks and 6 months. ANCOVAs adjusted for baseline scores were used to assess differences between groups regarding outcome variables. Both per-protocol and intention-to-treat analyses were conducted.
  
  
  RESULTS
  At 6 weeks, there was a significant difference in favor of MCT+ regarding decrease in delusion severity and improvement of self-reflectiveness (medium effect size), and a trend-wise difference regarding probability thresholds to decision. These effects increased, when only patients attending a minimum of 4 therapy sessions were considered. Control group patients subsequently showed further improvement while patients in the MCT+ group remained stable, such that there were no differences between groups at the 6-month follow-up.
  
  
  CONCLUSIONS
  Lower attendance rates in the control group possibly leading to unequal therapeutic effort; lower baseline delusion severity in the MCT+ group.
  
  
  CONCLUSIONS
  The result pattern suggests that MCT+ led to earlier improvement in delusions and cognitive biases compared to the control intervention. The absence of a long-term effect might reflect floor effects in the MCT+ group, but may also indicate the need for further measures to promote sustainability of MCT+ effects.
authors.affiliation: Center for Gender Research and Early Detection, University Psychiatric Clinics Basel, Switzerland; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany. Electronic address: Christina.Andreou@upkbs.ch.
authors.forename: Christina
authors.initials: C
authors.lastname: Andreou
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Wittekind
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Fieker
authors.affiliation: Center for Gender Research and Early Detection, University Psychiatric Clinics Basel, Switzerland.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Heitz
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Ruth
authors.initials: R
authors.lastname: Veckenstedt
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bohn
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Moritz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015982:Bias; D003071:Cognition; D003702:Delusions / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D000067489:Metacognition; D008875:Middle Aged; D011614:Psychotherapy, Brief / Q000379:methods*; D011618:Psychotic Disorders / Q000150:complications / Q000628:therapy*; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cognitive biases; Cognitive-Behavioral therapy; Jumping-to-conclusions; Metacognition; Psychotherapy; Schizophrenia