Cognitive behavior therapy (CBT) of psychotic symptoms is a useful adjunctive treatment to antipsychotic medication when patients do not respond fully to the medication. It is probably also a valuable way to help patients to integrate the psychotic experience in a more functional way. However, effect sizes of CBT stay moderate and there is a place for improvement.
Metacognitive training brings an essential complement to CBT since it helps patients to become aware of their cognitive biases through concrete exercises. I recommend actively reading this paper and connecting to the website.
Our first clinical experiences with the metacognitive skills training program show that it help patients to accept more easily that they are suffering from a mental illness. Indeed, the program has a powerful normalizing effect because it explains psychotic symptoms through experience and not only from a theoretical perspective.
Good reading and downloading.
Zimmermann G, Favrod J, Trieu VH, Pomini V. The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophrenia Research, 2005, 77:1-9. Abstract
Favrod J, Vianin P, Pomini V & Mast FW. A first step toward cognitive remediation of voices: a case study. Cognitive Behaviour Therapy. 2006, 35, 3:159-163. Abstract
View all comments by Jérôme Favrod
I think the MCT approach would work well in combination with CBT for the reasons outlined by Moritz and Woodward. In addition, MCT might potentially serve to make clients more aware of their own thought processes—and this metacognition can make transition to CBT much smoother.
And it's nice to see direct knowledge translation of cognitive research in schizophrenia—going from an interesting academic finding to something that can directly impact the lives of our clients/patients.
View all comments by Mahesh Menon
I greatly appreciated this paper. First, it provides a helpful summary of the findings on cognitive biases in psychosis. More importantly though, it introduces a treatment program that is directly derived from basic research. This is a necessary approach to take in developing and enhancing disorder-specific treatment and should have the potential to improve existing CBT-interventions for psychosis. While CBT already indirectly involves changing dysfunctional cognitive styles (e.g. in restructuring delusional interpretations of individual experiences) it does not focus on these styles or challenge them in a direct and global manner. Changes produced by the meta-cognitive training might thus be more likely to generalize to other situations. Also, so far it remains open whether the efficacy of CBT is due to changes in cognitive styles. Possibly a detailed evaluation of the meta-cognitive training could also shed some light on mechanisms of change in cognitive therapy of psychosis. View all comments by Tania Lincoln