Moderators of treatment efficacy in individualized metacognitive training for psychosis (MCT+). (September 2020)

• Record Type: Journal Article
• Authors: Leanza, Letizia; Studerus, Erich; Bozikas, Vasilis P.; Moritz, Steffen; Andreou, Christina
• Is Part Of: Journal of behavior therapy and experimental psychiatry. Volume 68(2020)
• Publication Date: 2020-09
• Subjects: Schizophrenia -- Metacognition -- Moderation -- Jumping-to-conclusions -- Self-esteem -- Efficacy; Behavior therapy -- Periodicals; 616.89142
• DOI: 10.1016/j.jbtep.2020.101547
• Languages: English
• ISSNs: 0005-7916

Abstract

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. Highlights: Individualized MCT+ is an intervention targeting delusions. We investigated moderators of MCT + efficacy compared to a control intervention. Patients prone to jumping-to-conclusions particularly benefited from MCT+. Higher MCT + response was also predicted by low baseline self-esteem. Cognitive insight and subjective attitudes did not moderate treatment response.