Metacognitive Therapy Yields Unexpected Benefits in Schizophrenia

August 15, 2014

By Will Boggs MD

NEW YORK - Besides reducing delusions, metacognitive therapy (MCT) improves self-esteem and quality of life years after the treatment of people with schizophrenia, researchers from Germany report.

"Schizophrenia can be understood psychologically to some extent, and addressing cognitive biases improves symptoms beyond treatment with antipsychotics," Dr. Steffen Moritz from University Medical Center Hamburg-Eppendorf in Hamburg told Reuters Health by email.

Metacognitive training targets cognitive biases said to be involved in the formation and maintenance of psychotic symptoms, and a number of pilot studies have shown MCT to be feasible in patients with schizophrenia.

Dr. Moritz and colleagues recently reported significant improvements in delusion severity and a trend toward reduction of Positive and Negative Syndrome Scale (PANSS) positive symptoms at the six-month follow-up of their randomized trial (MCT versus neuropsychological training) of 150 patients with schizophrenia.

In their new report, online August 6 in JAMA Psychiatry, they provide three-year follow-up data on these patients.

Just over 60% of patients in both groups completed the follow-up. The PANSS core delusion score remained significantly better in the MCT group (though this difference lost significance in the per-protocol analysis), and the improvements in the PANSS positive score in the MCT group persisted at three years.

The researchers also found unexpected effects: self-esteem and quality of life improved to a significantly greater extent at three years in the MCT group compared with the neuropsychological control group.

On the other hand, the control group experienced greater improvement in selective attention than did the MCT group.

"The destigmatizing/normalizing approach of the program, which highlights similarities to normal behavior while not downplaying psychotic symptoms, may have contributed to the improvement by reducing feelings of stress, guilt, and stigmatization," the researchers conclude. "However, dismantling studies are needed to verify this hypothesis."

"Trials are now urgently needed to explore whether psychological treatment is beneficial for those patients that reject antipsychotic medication," Dr. Moritz said.

MCT is readily available in 31 languages online, according to Dr. Moritz, and he knows of more than 1,000 clinicians who have downloaded the program and affirmed that they are using it. The training program is freely available at

Dr. Moritz added that MCT is best suited for patients with "mild to moderate psychotic symptoms (i.e., delusions and/or hallucinations)."

Dr. Henry Gerard Kennedy from Trinity College Dublin in Ireland has used the MCT, but was not involved in the new research. He told Reuters Health by email, "We found that MCT improved mental capacity to consent to treatment, a vital goal for any intervention in psychosis. The best candidates are those who meet diagnostic criteria for schizophrenia and other psychoses."

Riitta Kuokkanen, a psychologist at Niuvanniemi Hospital in Kuopio, Finland, also has experience with MCT.

"MCT is a valuable complement to pharmacotherapy," she told Reuters Health by email. "It is highly accepted among patients and it may improve patients' quality of life in the long run. I would say that it is cost-effective."


JAMA Psychiatry 2014.

(c) Copyright Thomson Reuters 2014. Click For Restrictions -