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Randomized control trial to assess the efficacy of metacognitive training compared with a psycho-educational group in people with a recent-onset psychosis

Published online by Cambridge University Press:  07 February 2017

S. Ochoa ,
R. López-Carrilero ,
M. L. Barrigón ,
E. Pousa ,
A. Barajas ,
E. Lorente-Rovira ,
F. González-Higueras ,
E. Grasa ,
I. Ruiz-Delgado  and
J. Cid
...Show all authors
S. Ochoa*
Affiliation:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
R. López-Carrilero
Affiliation:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
M. L. Barrigón
Affiliation:
Department of Psychiatry, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain Psychiatry Service, Area de Gestión Sanitaria Sur Granada, Motril, Granada, Spain
E. Pousa
Affiliation:
Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain Salut Mental Parc Taulí, Sabadell (Barcelona), Hospital Universitari – UAB Universitat Autònoma de Barcelona, Neuropsiquiatria i Addicions, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
A. Barajas
Affiliation:
Centre d'Higiene Mental Les Corts, Barcelona, Spain Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
E. Lorente-Rovira
Affiliation:
Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain Psychiatry Service, Hospital Clínico Universitario de Valencia, Spain
F. González-Higueras
Affiliation:
Comunidad Terapéutica Jaén Servicio Andaluz de Salud, Jaén, Spain
E. Grasa
Affiliation:
Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Spain
I. Ruiz-Delgado
Affiliation:
Unidad de Salud Mental Comunitaria Malaga Norte, UGC Salud Mental Carlos Haya, Servicio Andaluz de Salud Málaga, Spain
J. Cid
Affiliation:
Mental Health & Addiction Research Group, IdiBGi. Institut d'Assistencia Sanitària, Girona, Spain
I. Birulés
Affiliation:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
I. Esteban-Pinos
Affiliation:
Psychiatry Service, Area de Gestión Sanitaria Sur Granada, Motril, Granada, Spain
R. Casañas
Affiliation:
Centre d'Higiene Mental Les Corts, Barcelona, Spain
A. Luengo
Affiliation:
Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain Psychiatry Service, Hospital Clínico Universitario de Valencia, Spain
P. Torres-Hernández
Affiliation:
Comunidad Terapéutica Jaén Servicio Andaluz de Salud, Jaén, Spain
I. Corripio
Affiliation:
Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Spain
M. Montes-Gámez
Affiliation:
Unidad de Salud Mental Comunitaria Malaga Norte, UGC Salud Mental Carlos Haya, Servicio Andaluz de Salud Málaga, Spain
M. Beltran
Affiliation:
Mental Health & Addiction Research Group, IdiBGi. Institut d'Assistencia Sanitària, Girona, Spain
A. De Apraiz
Affiliation:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
L. Domínguez-Sánchez
Affiliation:
Psychiatry Service, Area de Gestión Sanitaria Norte de Málaga, Antequera, Málaga, Spain
E. Sánchez
Affiliation:
Centre d'Higiene Mental Les Corts, Barcelona, Spain
B. Llacer
Affiliation:
Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain Psychiatry Service, Hospital Clínico Universitario de Valencia, Spain
T. Pélaez
Affiliation:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
J. L. Bogas
Affiliation:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
S. Moritz
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
*
*Address for correspondence: S. Ochoa, Research and Development Unit of Parc Sanitari Sant Joan de Déu, CIBERSAM, C/Dr Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain (Email: sochoa@pssjd.org)
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Abstract

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.

Method

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.

Keywords

Metacognitionmetacognitive trainingpsychological interventionpsychosisrecent onset of psychosisschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 9 , July 2017 , pp. 1573 - 1584
Copyright
Copyright © Cambridge University Press 2017 

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Footnotes

†

Members of the Spanish Metacognition Study Group are given in the Appendix.

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