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

TY - JOUR

T1 - Moderators of treatment efficacy in individualized metacognitive training for psychosis (MCT+)

AU - Leanza, Letizia

AU - Studerus, Erich

AU - Bozikas, Vasilis P

AU - Moritz, Steffen

AU - Andreou, Christina

N1 - Copyright © 2020 Elsevier Ltd. All rights reserved.

PY - 2020/9

Y1 - 2020/9

N2 - 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.

AB - 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.

U2 - 10.1016/j.jbtep.2020.101547

DO - 10.1016/j.jbtep.2020.101547

M3 - SCORING: Journal article

C2 - 31980132

VL - 68

SP - 101547

JO - J BEHAV THER EXP PSY

JF - J BEHAV THER EXP PSY

SN - 0005-7916

ER -