Metacognitive training (MCT) is an approach for treating the symptoms of

psychosis In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or inco ...

schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...

, especially

delusion A delusion is a fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other m ...

s, which has been adapted for other disorders such as depression,

obsessive–compulsive disorder Obsessive–compulsive disorder (OCD) is a mental disorder in which an individual has intrusive thoughts (an ''obsession'') and feels the need to perform certain routines (''Compulsive behavior, compulsions'') repeatedly to relieve the dis ...

and borderline over the years (see below). It was developed by Steffen Moritz and Todd Woodward. The intervention is based on the theoretical principles of

cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders. Cognitive behavioral therapy focuses on challenging and chang ...

, but focuses in particular on problematic thinking styles (

cognitive biases A cognitive bias is a systematic pattern of deviation from norm or rationality in judgment. Individuals create their own "subjective reality" from their perception of the input. An individual's construction of reality, not the objective input, ...

) that are associated with the development and maintenance of positive symptoms, e.g. overconfidence in errors and

jumping to conclusions Jumping to conclusions (officially the jumping conclusion bias, often abbreviated as JTC, and also referred to as the inference-observation confusion) is a psychological term referring to a communication obstacle where one "judge or decide somethin ...

. Metacognitive training exists as a group training (MCT) and as an individualized intervention (MCT+).

Background

Metacognition Metacognition is an awareness of one's thought processes and an understanding of the patterns behind them. The term comes from the root word ''Meta (prefix), meta'', meaning "beyond", or "on top of".Metcalfe, J., & Shimamura, A. P. (1994). ''Metac ...

can be defined as "thinking about thinking". Over the course of the training, cognitive biases subserving positive symptoms are identified and corrected. The current empirical evidence assumes a connection between certain cognitive biases, such as jumping to conclusions, and the development and maintenance of psychosis. Accordingly, correcting these problematic/unhelpful thinking styles should lead to a reduction of symptoms.

Intervention

In eight training units (modules) and two additional modules, examples of "cognitive traps", which can promote the development and maintenance of the positive symptoms of schizophrenia, are presented to patients in a playful way. Patients are instructed to critically reflect on their thought patterns, which may contribute to problematic behaviors, and to implement the contents of the training in everyday life. MCT deals with the following problematic styles of thinking: monocausal attributions, jumping to conclusions, inflexibility, problems in social cognition, overconfidence for memory errors and depressive thought patterns. The additional modules deal with stigma and low

self-esteem Self-esteem is confidence in one's own worth, abilities, or morals. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Macki ...

. Individualized metacognitive training (MCT+) targets the same symptoms and cognitive biases as the group training, but is more flexible in that it allows discussion of individualized topics. The treatment materials for the group training can be obtained free of charge in over 30 languages from the website.

Efficacy

A recent

meta-analysis Meta-analysis is a method of synthesis of quantitative data from multiple independent studies addressing a common research question. An important part of this method involves computing a combined effect size across all of the studies. As such, th ...

found significant improvements for positive symptoms and delusions, as well as the acceptance of the training. These findings have been replicated in 2018 and 2019. An older meta-analysis based on a smaller number of studies found a small effect, which reached significance when newer studies were considered. Individual studies provide evidence for the long-term effectiveness of the approach beyond the immediate treatment period. A meta-analysis based on 43 studies (''N'' = 1,816 individuals) showed that MCT improved delusions, hallucinations, cognitive biases, negative symptoms and functioning. MCT is recommended as an evidence-based treatment by the Royal Australian and New Zealand College of Psychiatrists as well as the German Association for Psychiatry, Psychotherapy and Psychosomatics.

Adaptations to other disorders

Since its introduction, MCT has been adapted to other mental disorders. Empirical studies have been carried out for borderline personality disorder, obsessive–compulsive disorder (self-help approach), depression, bipolar disorders, and problem gambling. MCT has also been modified to target the difficult-to-treat negative symptoms in schizophrenia, a recent feasibility study found good feasibility and improved negative symptoms.

References

External links

Metacognitive Training for Psychosis
Link to training material and manual.
Metacognitive Training for Psychosis, Individualized (MCT+)
Link to training material and manual.
Metacognitive Training for Obsessive-Compulsive Disorder (myMCT)
Link to training material and self-help manual.
Metacognitive Training for Depression
Link to training material and manual.
Metacognitive Training for Borderline Personality Disorder
Link to training material and manual. {{Psychotherapy Psychotherapy by type Cognitive behavioral therapy Schizophrenia