Metacognitive training benefits accumulate over time for schizophrenia patients

The benefits of metacognitive training to target cognitive biases persist for at least 3 years, with late additional benefits appearing more than 6 months after the intervention, shows research.

Patients’ self-esteem and quality of life showed improvements long after they underwent training, report Steffen Moritz (University Medical Center Hamburg-Eppendorf, Germany) and co-workers in JAMA Psychiatry.

The findings come from a long-term follow-up of a randomised trial comparing the effects of metacognitive training and neuropsychological training in patients with schizophrenia. The metacognitive training targeted jumping to conclusions and overconfidence in errors (ie, cognitive biases), aiming to reduce the severity of delusions.

Of the 150 patients who underwent randomisation, 61.3% were available for follow-up at 3 years. Over this time, the average core delusion score on the Positive and Negative Syndrome Scale (PANSS) in patients assigned to metacognitive training fell from 6.58 to 4.79. This change was significantly greater than the reduction in patients who underwent neuropsychological training (the COGPACK programme), from 6.26 to 5.73 points.

Patients who undertook metacognitive training also had significantly larger improvements in Psychosis Rating Scales delusion subscale scores and PANSS positive symptom scores.

In addition, they had larger gains on the Rosenberg Self-Esteem Scale than the patients who received neuropsychological training (32.07 to 36.66 vs 33.87 to 34.70) and a greater improvement in global quality-of-life scores at 3 years, despite no differences having emerged between the groups in these measures at earlier follow-up points (4 weeks and 6 months).

“The destigmatizing/normalizing approach of the program, which highlights similarities to normal behavior while not downplaying psychotic symptoms, may have contributed to the improvement by reducing feelings of stress, guilt, and stigmatization”, the team suggests.

These late improvements occurred despite the metacognitive training not producing a larger reduction in jumping to conclusions relative to COGPACK; this decreased in both groups of patients.

The researchers say this “unexpected” finding could be caused by learning or practice effects, by patients in the COGPACK group becoming aware of the training goals of the metacognitive training, or by metacognitive training exerting its influence via different or multiple effects.

Nevertheless, Moritz et al speculate that patients who underwent metacognitive training “were perhaps more alert to their cognitive biases, which over time positively impacted behavior, social relationships, and self-esteem.”

Supporting this, significantly more patients in the metacognitive versus neuropsychological training groups reported their training had proved directly applicable to real-life situations “and that they would think more about alternative explanations before judging a situation.”

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