Letizia Leanza1, Erich Studerus2, Vasilis P Bozikas3, Steffen Moritz4, Christina Andreou5. 1. University of Basel Psychiatric Hospital, Center for Psychotic Disorders, University of Basel, Switzerland; University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Basel, Switzerland. Electronic address: letizia.leanza@unibas.ch. 2. University of Basel, Department of Psychology, Division of Personality and Developmental Psychology, Basel, Switzerland. 3. 2nd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece. 4. Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 5. University of Basel Psychiatric Hospital, Center for Psychotic Disorders, University of Basel, Switzerland.
Abstract
BACKGROUND AND OBJECTIVES:Individualized Metacognitive Training (MCT+) is a manualized intervention designed to improve delusional severity by reducing delusion-associated cognitive biases such as jumping-to-conclusions. Increased interest in personalized medicine stipulates the identification of patients who are more likely to benefit from specialized interventions. The present study aimed to explore baseline moderators of MCT+ efficacy on delusions and overall positive symptoms in psychosis. METHODS: We analyzed data from a randomized rater-blind controlled trial, in which 92 patients with psychotic disorders and current or past delusions were randomly assigned to either MCT+ or CogPack®, a cognitive remediation software. Baseline moderator variables consisted of jumping-to-conclusions, cognitive insight, quality of life, self-esteem, selective attention, and patients' attitudes towards their symptoms. Linear mixed-effects models were applied to investigate specific moderators of MCT+ efficacy. RESULTS: In MCT+ relative to CogPack, presence of a jumping-to-conclusions bias, a lowered decision threshold, and low self-esteem were associated with larger improvements in delusional severity and/or overall positive symptoms over time. Subjective reasoning style and insight, as well as subjective attitudes towards psychosis, did not moderate the treatment efficacy of MCT+ relative to CogPack. LIMITATIONS: Participation of both treatment groups in group MCT as a part of standard care, possibly leading to additional effects on delusional severity. CONCLUSIONS: Patients with low self-esteem and those who are prone to jumping-to-conclusions seem to particularly benefit from MCT+. Our results can help inform clinical practice as they provide specific criteria for selecting patients for whom MCT+ is most appropriate.
RCT Entities:
BACKGROUND AND OBJECTIVES: Individualized Metacognitive Training (MCT+) is a manualized intervention designed to improve delusional severity by reducing delusion-associated cognitive biases such as jumping-to-conclusions. Increased interest in personalized medicine stipulates the identification of patients who are more likely to benefit from specialized interventions. The present study aimed to explore baseline moderators of MCT+ efficacy on delusions and overall positive symptoms in psychosis. METHODS: We analyzed data from a randomized rater-blind controlled trial, in which 92 patients with psychotic disorders and current or past delusions were randomly assigned to either MCT+ or CogPack®, a cognitive remediation software. Baseline moderator variables consisted of jumping-to-conclusions, cognitive insight, quality of life, self-esteem, selective attention, and patients' attitudes towards their symptoms. Linear mixed-effects models were applied to investigate specific moderators of MCT+ efficacy. RESULTS: In MCT+ relative to CogPack, presence of a jumping-to-conclusions bias, a lowered decision threshold, and low self-esteem were associated with larger improvements in delusional severity and/or overall positive symptoms over time. Subjective reasoning style and insight, as well as subjective attitudes towards psychosis, did not moderate the treatment efficacy of MCT+ relative to CogPack. LIMITATIONS: Participation of both treatment groups in group MCT as a part of standard care, possibly leading to additional effects on delusional severity. CONCLUSIONS:Patients with low self-esteem and those who are prone to jumping-to-conclusions seem to particularly benefit from MCT+. Our results can help inform clinical practice as they provide specific criteria for selecting patients for whom MCT+ is most appropriate.
Authors: D J Hauke; V Roth; P Karvelis; R A Adams; S Moritz; S Borgwardt; A O Diaconescu; C Andreou Journal: Schizophr Bull Date: 2022-06-21 Impact factor: 7.348