Psychotherapy for Disordered Thinking in Schizophrenia

Steven Dubovsky, MD

Not only does metacognitive training yield immediate benefits, but others emerge only after time.

Psychotherapeutic approaches to patients with schizophrenia are receiving renewed attention, but how long do the improvements endure? Researchers in Germany randomized 150 patients with schizophrenia spectrum diagnoses (mean age, 35) who were taking antipsychotics to one of two 16-session therapies. Metacognitive training (MCT) is a manual-based group treatment addressing attributional style, jumping to conclusions, flexible beliefs, theory of mind/social cognition, avoiding overconfidence in false memories, and mood/self-esteem. The control treatment, COGPACK, is an individualized, computer-based program, conducted in a group setting, to improve memory. Assessors were blinded as to treatment group.

Overall, 86% of patients stayed in the study for 6 months, and 61% stayed for 3 years of planned follow-up. Positive symptoms, especially delusions, decreased significantly more with MCT than with COGPACK at 6 months' follow-up, and this difference was maintained at 3 years. In addition, self-esteem and quality of life were significantly more improved in the MCT group at 3 years although not earlier. Attention improved more in the COGPACK group. Jumping to conclusions improved in both groups.

Citation(s):

Moritz S et al. Sustained and “sleeper” effects of group metacognitive training for schizophrenia: A randomized clinical trial. JAMA Psychiatry 2014 Oct; 71:1103.