Steffen Moritz1, Ruth Veckenstedt1, Christina Andreou1, Francesca Bohn1, Birgit Hottenrott1, Lucy Leighton1, Ulf Köther1, Todd S Woodward2, András Treszl3, Mahesh Menon4, Brooke C Schneider1, Ute Pfueller5, Daniela Roesch-Ely5. 1. Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada3BC Mental Health and Addictions Research Institute, Vancouver, British Columbia, Canada. 3. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada. 5. Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg, Germany6Department of Experimental Psychopathology and Neurophysiology, Center for Psychosocial Medicine, Heidelberg, Germany.
Abstract
IMPORTANCE: Cognitive interventions increasingly complement psychopharmacological treatment to enhance symptomatic and functional outcome in schizophrenia. Metacognitive training (MCT) is targeted at cognitive biases involved in the pathogenesis of delusions. OBJECTIVE: To examine the long-term efficacy of group MCT for schizophrenia in order to explore whether previously established effects were sustained. DESIGN, SETTING, AND PARTICIPANTS: A 2-center, randomized, controlled, assessor-blind, parallel group trial was conducted. A total of 150 inpatients or outpatients with DSM-IV diagnoses of schizophrenia spectrum disorders were enrolled. All patients were prescribed antipsychotic medication. The second follow-up assessment took place 3 years later after the intervention phase was terminated. INTERVENTIONS: Group MCT targeting cognitive biases vs neuropsychological training (COGPACK). Patients received a maximum of 16 sessions. MAIN OUTCOMES AND MEASURES: The primary outcome measure was a delusion score derived from the Positive and Negative Syndrome Scale (PANSS). The PANSS positive syndrome and total scores, the Psychotic Symptom Rating Scales, the jumping to conclusions bias, self-esteem, and quality of life served as secondary outcome measures. RESULTS: The intention-to-treat analyses demonstrated that patients in the MCT group had significantly greater reductions in the core PANSS delusion score, after 3 years compared with the control group (η2partial = .037; P = .05). Among the secondary outcomes, the intention-to-treat analyses also demonstrated that patients in the MCT group had significantly greater reductions in the PANSS positive syndrome score (η2partial = .055; P = .02) and the Psychotic Symptom Rating Scales delusion score (η2partial = .109; P = .001). Significant group differences at the 3-year follow-up were also found on measures of self-esteem and quality of life, which did not distinguish groups at earlier assessment points. Attention was improved in the neuropsychological training group relative to the MCT group. The completion rate was 61.3% after 3 years. CONCLUSIONS AND RELEVANCE: Metacognitive training demonstrated sustained effects in the reduction of delusions, which were over and above the effects of antipsychotic medication. Moreover, there were some unanticipated ("sleeper") effects as both self-esteem and quality of life were improved after 3 years. Effects on self-esteem and well-being were found even in the absence of an improvement on the jumping to conclusions bias. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN95205723.
RCT Entities:
IMPORTANCE: Cognitive interventions increasingly complement psychopharmacological treatment to enhance symptomatic and functional outcome in schizophrenia. Metacognitive training (MCT) is targeted at cognitive biases involved in the pathogenesis of delusions. OBJECTIVE: To examine the long-term efficacy of group MCT for schizophrenia in order to explore whether previously established effects were sustained. DESIGN, SETTING, AND PARTICIPANTS: A 2-center, randomized, controlled, assessor-blind, parallel group trial was conducted. A total of 150 inpatients or outpatients with DSM-IV diagnoses of schizophrenia spectrum disorders were enrolled. All patients were prescribed antipsychotic medication. The second follow-up assessment took place 3 years later after the intervention phase was terminated. INTERVENTIONS: Group MCT targeting cognitive biases vs neuropsychological training (COGPACK). Patients received a maximum of 16 sessions. MAIN OUTCOMES AND MEASURES: The primary outcome measure was a delusion score derived from the Positive and Negative Syndrome Scale (PANSS). The PANSS positive syndrome and total scores, the Psychotic Symptom Rating Scales, the jumping to conclusions bias, self-esteem, and quality of life served as secondary outcome measures. RESULTS: The intention-to-treat analyses demonstrated that patients in the MCT group had significantly greater reductions in the core PANSS delusion score, after 3 years compared with the control group (η2partial = .037; P = .05). Among the secondary outcomes, the intention-to-treat analyses also demonstrated that patients in the MCT group had significantly greater reductions in the PANSS positive syndrome score (η2partial = .055; P = .02) and the Psychotic Symptom Rating Scales delusion score (η2partial = .109; P = .001). Significant group differences at the 3-year follow-up were also found on measures of self-esteem and quality of life, which did not distinguish groups at earlier assessment points. Attention was improved in the neuropsychological training group relative to the MCT group. The completion rate was 61.3% after 3 years. CONCLUSIONS AND RELEVANCE: Metacognitive training demonstrated sustained effects in the reduction of delusions, which were over and above the effects of antipsychotic medication. Moreover, there were some unanticipated ("sleeper") effects as both self-esteem and quality of life were improved after 3 years. Effects on self-esteem and well-being were found even in the absence of an improvement on the jumping to conclusions bias. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN95205723.
Authors: Alkomiet Hasan; Birgit Guse; Joachim Cordes; Wolfgang Wölwer; Georg Winterer; Wolfgang Gaebel; Berthold Langguth; Michael Landgrebe; Peter Eichhammer; Elmar Frank; Göran Hajak; Christian Ohmann; Pablo E Verde; Marcella Rietschel; Raees Ahmed; William G Honer; Berend Malchow; Susanne Karch; Thomas Schneider-Axmann; Peter Falkai; Thomas Wobrock Journal: Schizophr Bull Date: 2015-10-03 Impact factor: 9.306
Authors: Anne Katrin Külz; Sarah Landmann; Barbara Cludius; Nina Rose; Thomas Heidenreich; Lena Jelinek; Heike Alsleben; Karina Wahl; Alexandra Philipsen; Ulrich Voderholzer; Jonathan G Maier; Steffen Moritz Journal: Eur Arch Psychiatry Clin Neurosci Date: 2018-11-16 Impact factor: 5.270
Authors: Steffen Moritz; Candelaria I Mahlke; Stefan Westermann; Friederike Ruppelt; Paul H Lysaker; Thomas Bock; Christina Andreou Journal: Schizophr Bull Date: 2018-02-15 Impact factor: 9.306