Sustained and "sleeper" effects of group metacognitive training for schizophrenia:a randomized clinical trial

TY - JOUR

T1 - Sustained and "sleeper" effects of group metacognitive training for schizophrenia:a randomized clinical trial

AU - Moritz, Steffen

AU - Veckenstedt, Ruth

AU - Andreou, Christina

AU - Bohn, Francesca

AU - Hottenrott, Birgit

AU - Leighton, Lucy

AU - Köther, Ulf

AU - Woodward, Todd S

AU - Treszl, András

AU - Menon, Mahesh

AU - Schneider, Brooke C

AU - Pfueller, Ute

AU - Roesch-Ely, Daniela

N1 - Lucy Leighton INTERN

PY - 2014/10

Y1 - 2014/10

N2 - IMPORTANCE: Cognitive interventions increasingly complement psychopharmacological treatment to enhance symptomatic and functional outcome in schizophrenia. Metacognitive training (MCT) is targeted at cognitive biases involved in the pathogenesis of delusions.OBJECTIVE: To examine the long-term efficacy of group MCT for schizophrenia in order to explore whether previously established effects were sustained.DESIGN, SETTING, AND PARTICIPANTS: A 2-center, randomized, controlled, assessor-blind, parallel group trial was conducted. A total of 150 inpatients or outpatients with DSM-IV diagnoses of schizophrenia spectrum disorders were enrolled. All patients were prescribed antipsychotic medication. The second follow-up assessment took place 3 years later after the intervention phase was terminated.INTERVENTIONS: Group MCT targeting cognitive biases vs neuropsychological training (COGPACK). Patients received a maximum of 16 sessions.MAIN OUTCOMES AND MEASURES: The primary outcome measure was a delusion score derived from the Positive and Negative Syndrome Scale (PANSS). The PANSS positive syndrome and total scores, the Psychotic Symptom Rating Scales, the jumping to conclusions bias, self-esteem, and quality of life served as secondary outcome measures.RESULTS: The intention-to-treat analyses demonstrated that patients in the MCT group had significantly greater reductions in the core PANSS delusion score, after 3 years compared with the control group (η2partial = .037; P = .05). Among the secondary outcomes, the intention-to-treat analyses also demonstrated that patients in the MCT group had significantly greater reductions in the PANSS positive syndrome score (η2partial = .055; P = .02) and the Psychotic Symptom Rating Scales delusion score (η2partial = .109; P = .001). Significant group differences at the 3-year follow-up were also found on measures of self-esteem and quality of life, which did not distinguish groups at earlier assessment points. Attention was improved in the neuropsychological training group relative to the MCT group. The completion rate was 61.3% after 3 years.CONCLUSIONS AND RELEVANCE: Metacognitive training demonstrated sustained effects in the reduction of delusions, which were over and above the effects of antipsychotic medication. Moreover, there were some unanticipated ("sleeper") effects as both self-esteem and quality of life were improved after 3 years. Effects on self-esteem and well-being were found even in the absence of an improvement on the jumping to conclusions bias.TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN95205723.

AB - IMPORTANCE: Cognitive interventions increasingly complement psychopharmacological treatment to enhance symptomatic and functional outcome in schizophrenia. Metacognitive training (MCT) is targeted at cognitive biases involved in the pathogenesis of delusions.OBJECTIVE: To examine the long-term efficacy of group MCT for schizophrenia in order to explore whether previously established effects were sustained.DESIGN, SETTING, AND PARTICIPANTS: A 2-center, randomized, controlled, assessor-blind, parallel group trial was conducted. A total of 150 inpatients or outpatients with DSM-IV diagnoses of schizophrenia spectrum disorders were enrolled. All patients were prescribed antipsychotic medication. The second follow-up assessment took place 3 years later after the intervention phase was terminated.INTERVENTIONS: Group MCT targeting cognitive biases vs neuropsychological training (COGPACK). Patients received a maximum of 16 sessions.MAIN OUTCOMES AND MEASURES: The primary outcome measure was a delusion score derived from the Positive and Negative Syndrome Scale (PANSS). The PANSS positive syndrome and total scores, the Psychotic Symptom Rating Scales, the jumping to conclusions bias, self-esteem, and quality of life served as secondary outcome measures.RESULTS: The intention-to-treat analyses demonstrated that patients in the MCT group had significantly greater reductions in the core PANSS delusion score, after 3 years compared with the control group (η2partial = .037; P = .05). Among the secondary outcomes, the intention-to-treat analyses also demonstrated that patients in the MCT group had significantly greater reductions in the PANSS positive syndrome score (η2partial = .055; P = .02) and the Psychotic Symptom Rating Scales delusion score (η2partial = .109; P = .001). Significant group differences at the 3-year follow-up were also found on measures of self-esteem and quality of life, which did not distinguish groups at earlier assessment points. Attention was improved in the neuropsychological training group relative to the MCT group. The completion rate was 61.3% after 3 years.CONCLUSIONS AND RELEVANCE: Metacognitive training demonstrated sustained effects in the reduction of delusions, which were over and above the effects of antipsychotic medication. Moreover, there were some unanticipated ("sleeper") effects as both self-esteem and quality of life were improved after 3 years. Effects on self-esteem and well-being were found even in the absence of an improvement on the jumping to conclusions bias.TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN95205723.

KW - Adult

KW - Antipsychotic Agents

KW - Cognition

KW - Cognitive Therapy

KW - Combined Modality Therapy

KW - Female

KW - Humans

KW - Interview, Psychological

KW - Male

KW - Neuropsychological Tests

KW - Psychiatric Status Rating Scales

KW - Quality of Life

KW - Schizophrenia

KW - Schizophrenic Psychology

KW - Self Concept

KW - Single-Blind Method

U2 - 10.1001/jamapsychiatry.2014.1038

DO - 10.1001/jamapsychiatry.2014.1038

M3 - SCORING: Journal article

C2 - 25103718

VL - 71

SP - 1103

EP - 1111

JO - JAMA PSYCHIAT

JF - JAMA PSYCHIAT

SN - 2168-622X

IS - 10

ER -