Can Metacognitive Interventions Improve Insight in Schizophrenia Spectrum Disorders? A Systematic Review and Meta-analysis

Overview

Journal Psychol Med

Publisher Cambridge University Press

Specialty Psychology

Date 2020 Oct 14

PMID 33050956

Citations 14

Authors

Javier-David Lopez-Morinigo

Olesya Ajnakina

Adela Sanchez-Escribano Martinez

Paula-Jhoana Escobedo-Aedo

Veronica Gonzalez Ruiz-Ruano

Sergio Sanchez-Alonso

Laura Mata-Iturralde

Laura Munoz-Lorenzo

Susana Ochoa

Enrique Baca-Garcia

Anthony S David

Affiliations

Soon will be listed here.

Abstract

Background: Patients with schizophrenia spectrum disorders (SSD) tend to lack insight, which is linked to poor outcomes. The effect size of previous treatments on insight changes in SSD has been small. Metacognitive interventions may improve insight in SSD, although this remains unproved.

Methods: We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effects of metacognitive interventions designed for SSD, namely Metacognitive Training (MCT) and Metacognitive Reflection and Insight Therapy (MERIT), on changes in cognitive and clinical insight at post-treatment and at follow-up.

Results: Twelve RCTs, including 10 MCT RCTs (n = 717 participants) and two MERIT trials (n = 90), were selected, totalling N = 807 participants. Regarding cognitive insight six RCTs (n = 443) highlighted a medium effect of MCT on self-reflectiveness at post-treatment, d = 0.46, p < 0.01, and at follow-up, d = 0.30, p < 0.01. There was a small effect of MCT on self-certainty at post-treatment, d = -0.23, p = 0.03, but not at follow-up. MCT was superior to controls on an overall Composite Index of cognitive insight at post-treatment, d = 1.11, p < 0.01, and at follow-up, d = 0.86, p = 0.03, although we found evidence of heterogeneity. Of five MCT trials on clinical insight (n = 244 participants), which could not be meta-analysed, four of them favoured MCT compared v. control. The two MERIT trials reported conflicting results.

Conclusions: Metacognitive interventions, particularly Metacognitive Training, appear to improve insight in patients with SSD, especially cognitive insight shortly after treatment. Further long-term RCTs are needed to establish whether these metacognitive interventions-related insight changes are sustained over a longer time period and result in better outcomes.

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References

Moritz S, Veckenstedt R, Bohn F, Hottenrott B, Scheu F, Randjbar S . Complementary group Metacognitive Training (MCT) reduces delusional ideation in schizophrenia. Schizophr Res. 2013; 151(1-3):61-9. DOI: 10.1016/j.schres.2013.10.007. View

Van Camp L, Sabbe B, Oldenburg J . Cognitive insight: A systematic review. Clin Psychol Rev. 2017; 55:12-24. DOI: 10.1016/j.cpr.2017.04.011. View

Kokoszka A, Telichowska-Lesna A, Radzio R . [A questionnaire of insight into schizophrenia--"my thoughts and feelings"]. Psychiatr Pol. 2009; 42(4):491-502. View

van Oosterhout B, Smit F, Krabbendam L, Castelein S, Staring A, Van der Gaag M . Letter to the Editor: Should we focus on quality or quantity in meta-analyses?. Psychol Med. 2016; 46(9):2003-5. DOI: 10.1017/S003329171600009X. View

Duval S, Tweedie R . Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000; 56(2):455-63. DOI: 10.1111/j.0006-341x.2000.00455.x. View

Moritz S, Lysaker P . Metacognition - What did James H. Flavell really say and the implications for the conceptualization and design of metacognitive interventions. Schizophr Res. 2018; 201:20-26. DOI: 10.1016/j.schres.2018.06.001. View

David A . Insight and psychosis: the next 30 years. Br J Psychiatry. 2019; 217(3):521-523. DOI: 10.1192/bjp.2019.217. View

Beck A, Baruch E, Balter J, Steer R, Warman D . A new instrument for measuring insight: the Beck Cognitive Insight Scale. Schizophr Res. 2004; 68(2-3):319-29. DOI: 10.1016/S0920-9964(03)00189-0. View

Baron-Cohen S, Wheelwright S, Hill J, Raste Y, Plumb I . The "Reading the Mind in the Eyes" Test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. J Child Psychol Psychiatry. 2001; 42(2):241-51. View

10.

Favrod J, Rexhaj S, Bardy S, Ferrari P, Hayoz C, Moritz S . Sustained antipsychotic effect of metacognitive training in psychosis: a randomized-controlled study. Eur Psychiatry. 2013; 29(5):275-81. DOI: 10.1016/j.eurpsy.2013.08.003. View

11.

Kother U, Veckenstedt R, Vitzthum F, Roesch-Ely D, Pfueller U, Scheu F . "Don't give me that look" - overconfidence in false mental state perception in schizophrenia. Psychiatry Res. 2012; 196(1):1-8. DOI: 10.1016/j.psychres.2012.03.004. View

12.

Morgan C, Lappin J, Heslin M, Donoghue K, Lomas B, Reininghaus U . Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 study. Psychol Med. 2014; 44(13):2713-26. PMC: 4134320. DOI: 10.1017/S0033291714000282. View

13.

Sheehan D, Lecrubier Y, Sheehan K, Amorim P, Janavs J, Weiller E . The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1999; 59 Suppl 20:22-33;quiz 34-57. View

14.

van Oosterhout B, Krabbendam L, de Boer K, Ferwerda J, van der Helm M, Stant A . Metacognitive group training for schizophrenia spectrum patients with delusions: a randomized controlled trial. Psychol Med. 2014; 44(14):3025-35. DOI: 10.1017/S0033291714000555. View

15.

McEvoy J, Freter S, Everett G, Geller J, Appelbaum P, Apperson L . Insight and the clinical outcome of schizophrenic patients. J Nerv Ment Dis. 1989; 177(1):48-51. DOI: 10.1097/00005053-198901000-00008. View

16.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

17.

Pijnenborg G, de Vos A, Timmerman M, Van der Gaag M, Sportel B, Arends J . Social cognitive group treatment for impaired insight in psychosis: A multicenter randomized controlled trial. Schizophr Res. 2018; 206:362-369. DOI: 10.1016/j.schres.2018.10.018. View

18.

Moritz S, Kerstan A, Veckenstedt R, Randjbar S, Vitzthum F, Schmidt C . Further evidence for the efficacy of a metacognitive group training in schizophrenia. Behav Res Ther. 2011; 49(3):151-7. DOI: 10.1016/j.brat.2010.11.010. View

19.

Lysaker P, Pattison M, Leonhardt B, Phelps S, Vohs J . Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry. 2018; 17(1):12-23. PMC: 5775127. DOI: 10.1002/wps.20508. View

20.

Ludtke T, Pult L, Schroder J, Moritz S, Bucker L . A randomized controlled trial on a smartphone self-help application (Be Good to Yourself) to reduce depressive symptoms. Psychiatry Res. 2018; 269:753-762. DOI: 10.1016/j.psychres.2018.08.113. View