Randomized control trial to assess the efficacy of metacognitive training compared with a psycho-educational group in people with a recent-onset psychosis.
BACKGROUND
Aims were to assess the efficacy of metacognitive training (MCT) in people with a recent onset of psychosis in terms of symptoms as a primary outcome and metacognitive variables as a secondary outcome.


METHODS
A multicenter, randomized, controlled clinical trial was performed. A total of 126 patients were randomized to an MCT or a psycho-educational intervention with cognitive-behavioral elements. The sample was composed of people with a recent onset of psychosis, recruited from nine public centers in Spain. The treatment consisted of eight weekly sessions for both groups. Patients were assessed at three time-points: baseline, post-treatment, and at 6 months follow-up. The evaluator was blinded to the condition of the patient. Symptoms were assessed with the PANSS and metacognition was assessed with a battery of questionnaires of cognitive biases and social cognition.


RESULTS
Both MCT and psycho-educational groups had improved symptoms post-treatment and at follow-up, with greater improvements in the MCT group. The MCT group was superior to the psycho-educational group on the Beck Cognitive Insight Scale (BCIS) total (p = 0.026) and self-certainty (p = 0.035) and dependence self-subscale of irrational beliefs, comparing baseline and post-treatment. Moreover, comparing baseline and follow-up, the MCT group was better than the psycho-educational group in self-reflectiveness on the BCIS (p = 0.047), total BCIS (p = 0.045), and intolerance to frustration (p = 0.014). Jumping to Conclusions (JTC) improved more in the MCT group than the psycho-educational group (p = 0.021). Regarding the comparison within each group, Theory of Mind (ToM), Personalizing Bias, and other subscales of irrational beliefs improved in the MCT group but not the psycho-educational group (p < 0.001-0.032).


CONCLUSIONS
MCT could be an effective psychological intervention for people with recent onset of psychosis in order to improve cognitive insight, JTC, and tolerance to frustration. It seems that MCT could be useful to improve symptoms, ToM, and personalizing bias.
Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Barcelona,Spain.
S
S
Ochoa
Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Barcelona,Spain.
R
R
López-Carrilero
Department of Psychiatry,IIS-Fundación Jiménez Díaz Hospital,Madrid,Spain.
M L
ML
Barrigón
Investigación Biomédica en Red de Salud Mental, CIBERSAM,Madrid,Spain.
E
E
Pousa
Centre d'Higiene Mental Les Corts,Barcelona,Spain.
A
A
Barajas
Investigación Biomédica en Red de Salud Mental, CIBERSAM,Madrid,Spain.
E
E
Lorente-Rovira
Comunidad Terapéutica Jaén Servicio Andaluz de Salud,Jaén,Spain.
F
F
González-Higueras
Investigación Biomédica en Red de Salud Mental, CIBERSAM,Madrid,Spain.
E
E
Grasa
Unidad de Salud Mental Comunitaria Malaga Norte, UGC Salud Mental Carlos Haya,Servicio Andaluz de Salud Málaga,Spain.
I
I
Ruiz-Delgado
Mental Health & Addiction Research Group, IdiBGi. Institut d'Assistencia Sanitària,Girona,Spain.
J
J
Cid
Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Barcelona,Spain.
I
I
Birulés
Psychiatry Service, Area de Gestión Sanitaria Sur Granada,Motril,Granada,Spain.
I
I
Esteban-Pinos
Centre d'Higiene Mental Les Corts,Barcelona,Spain.
R
R
Casañas
Investigación Biomédica en Red de Salud Mental, CIBERSAM,Madrid,Spain.
A
A
Luengo
Comunidad Terapéutica Jaén Servicio Andaluz de Salud,Jaén,Spain.
P
P
Torres-Hernández
Investigación Biomédica en Red de Salud Mental, CIBERSAM,Madrid,Spain.
I
I
Corripio
Unidad de Salud Mental Comunitaria Malaga Norte, UGC Salud Mental Carlos Haya,Servicio Andaluz de Salud Málaga,Spain.
M
M
Montes-Gámez
Mental Health & Addiction Research Group, IdiBGi. Institut d'Assistencia Sanitària,Girona,Spain.
M
M
Beltran
Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Barcelona,Spain.
A
A
De Apraiz
Psychiatry Service, Area de Gestión Sanitaria Norte de Málaga,Antequera,Málaga,Spain.
L
L
Domínguez-Sánchez
Centre d'Higiene Mental Les Corts,Barcelona,Spain.
E
E
Sánchez
Investigación Biomédica en Red de Salud Mental, CIBERSAM,Madrid,Spain.
B
B
Llacer
Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Barcelona,Spain.
T
T
Pélaez
Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Barcelona,Spain.
J L
JL
Bogas
Department of Psychiatry and Psychotherapy,University Medical Center Hamburg,Hamburg,Germany.
S
S
Moritz
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D000072466:Cognitive Remediation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D000067489:Metacognition / Q000502:physiology*; D017063:Outcome Assessment, Health Care; D011618:Psychotic Disorders / Q000503:physiopathology* / Q000628:therapy*; D016037:Single-Blind Method; D056345:Theory of Mind / Q000502:physiology*; D013850:Thinking / Q000502:physiology*; D055815:Young Adult
Metacognition; metacognitive training; psychological intervention; psychosis; recent onset of psychosis; schizophrenia