Randomized Controlled Trial on the Effects of Metacognitive Training (MCT) in a Sample of Patients With Recent Onset Psychosis: Study of the Impact on the Severity and Dimensions of Delusions, Self-Esteem and Depression.

Abstract

Introduction: The purpose of this study was to assess the efficacy of metacognitive training for psychosis (MCT). The primary goal was to study the severity and the different dimensions of delusions. The secondary goal was to study its impact on self-esteem and depressive symptoms.

Methods: This study was planned as a multicentre randomized controlled clinical trial. A sample of 122 patients with a recent-onset diagnosis of schizophrenia spectrum disorders was randomized to receive an MCT intervention (N = 65) or a psychoeducational intervention (N = 57). Patients were assessed at three different time points (baseline, post-treatment and 6 months follow-up) with the following measures: the Psychotic Symptoms Rating Scale-Delusion subscale (PSYRATS-Del), the Beck Depression Inventory (BDI-II) and the Rosenberg Self-Esteem Scale (RSE). A generalized linear model comparing the MCT group and psychoeducational group in the main measures across all three assessment moments was constructed, controlling for the number of sessions they attended.

Results: In comparison with the psychoeducational group, MCT improved in several dimensions of delusions at the follow-up: amount of preoccupation about delusions (p = 0.048), duration of preoccupation about delusions (p = 0.048) and conviction (p = 0.048). No differences between groups were found in self-esteem or depression at any time-point, but both interventions improved self-esteem-in the follow-up.

Conclusions: In recent-onset psychosis patients, MCT demonstrated the expected benefits in conviction, as 'sowing seeds of doubt' is the core MCT mechanism of change. Despite functioning differently, both interventions improved patients' self-esteem. No superiority of MCT was discovered in self-esteem or depression in the short-term follow-up studied.