Francesca Vitzthum

Further evidence for the efficacy of a metacognitive group training in schizophrenia.

Metacognitive training (MCT) for patients with schizophrenia is a novel psychological group treatment targeting cognitive biases putatively involved in the pathogenesis of schizophrenia (e.g. jumping to conclusions, overconfidence in errors). Its eight modules are available cost-free online in many languages. In the present study, 36 subacute or remitted patients were randomly allocated to either the MCT or a wait-list group who received treatment-as-usual (TAU). Baseline and post assessments were 8 weeks apart and were performed blind to group status. MCT showed significantly greater improvement on the following parameters relative to the TAU group: delusion distress (PSYRATS), memory and social quality of life. In the MCT group, the rate of jumping to conclusions bias was reduced after training. No differences occurred on the PANSS. The present study confirms prior reports that MCT exerts beneficial effects on some cognitive and symptomatic parameters.

Antipsychotic treatment beyond antipsychotics: metacognitive intervention for schizophrenia patients improves delusional symptoms.

BACKGROUND Although antipsychotic medication still represents the treatment of choice for schizophrenia, its objective impact on symptoms is only in the medium-effect size range and at least 50% of patients discontinue medication in the course of treatment. Hence, clinical researchers are intensively looking for complementary therapeutic options. Metacognitive training for schizophrenia patients (MCT) is a group intervention that seeks to sharpen the awareness of schizophrenia patients on cognitive biases (e.g. jumping to conclusions) that seem to underlie delusion formation and maintenance. The present trial combined group MCT with an individualized cognitive-behavioural therapy-oriented approach entitled individualized metacognitive therapy for psychosis (MCT+) and compared it against an active control. METHOD A total of 48 patients fulfilling criteria of schizophrenia were randomly allocated to either MCT+ or cognitive remediation (clinical trial NCT01029067). Blind to intervention, both groups were assessed at baseline and 4 weeks later. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scales (PSYRATS). Jumping to conclusions was measured using a variant of the beads task. RESULTS PANSS delusion severity declined significantly in the combined MCT treatment compared with the control condition. PSYRATS delusion conviction as well as jumping to conclusions showed significantly greater improvement in the MCT group. In line with prior studies, treatment adherence and subjective efficacy was excellent for the MCT. CONCLUSIONS The results suggest that the combination of a cognition-oriented and a symptom-oriented approach ameliorate psychotic symptoms and cognitive biases and represents a promising complementary treatment for schizophrenia.

“Don't give me that look” — Overconfidence in false mental state perception in schizophrenia

Dysfunctions in social cognition are implicated in the pathogenesis of schizophrenia and have been extensively replicated over the years. For memory research, the administration of cognitive tasks with metacognitive aspects like confidence ratings has deepened our insight into how impairments contribute to symptoms of the disorder. A total of 76 patients with schizophrenia or schizoaffective disorder and a sample of 30 healthy participants were tested with the Reading the Mind in the Eyes test (Eyes-test). The Eyes-test was complemented with a rating scale requesting response confidence and was administered along with paradigms tapping neuropsychological parameters and cognitive insight. Schizophrenia patients showed impaired abilities on mental state perception. In addition, they committed more high-confidence errors and at the same time made fewer high-confidence correct responses. Impairments were most pronounced in patients with formal thought disorder. The patients displayed a decreased metacognitive awareness for their deficits. The results suggest that adding confidence ratings to the investigation of social cognition promises to advance our understanding of social cognition in schizophrenia. Patients not only show severe impairments in social cognition, but are overconfident in their judgments and lack cognitive insight into their deficits. The results highlight the need for metacognitive therapeutic approaches for the treatment of this population.

Attributional biases in paranoid schizophrenia: Further evidence for a decreased sense of self‐causation in paranoia

Attributional biases are assumed to be part of the pathogenesis of persecutory delusions. The aim of the present study was to explore whether such biases are confined to current paranoid delusions or related to other positive symptoms as well. Another goal was to investigate whether current paranoid schizophrenia patients only show an exaggerated personalizing bias for negative events (i.e. personalizing blame) or also tend to externalize responsibility for positive events (i.e. decreased sense of self‐causation). The Internal, Personal and Situational Attributions Questionnaire (IPSAQ) was administered to 29 schizophrenia patients (10 with current paranoia), 26 psychiatric patients (OCD) and 33 healthy controls. Acutely paranoid patients made fewer internal attributions for positive and negative events, thus replicating a previously reported decreased sense of self‐causation. This kind of attributional style was related to acute positive symptomatology, but not to persecutory beliefs in particular. No evidence was found for a relationship between personalizing blame and the severity of current persecutory beliefs. An analysis of the narrative causal statements of the IPSAQ revealed that paranoid patients more often made external‐situational attributions particularly for positive events. Both psychiatric groups gave significantly more mono‐causal explanations for events than healthy controls.

Incorrigibility, jumping to conclusions, and decision threshold in schizophrenia

Introduction. Previous studies confirmed a bias against disconfirmatory evidence (BADE) for both delusional and delusion-neutral events in paranoid schizophrenia. In the present study, we examined a potential relationship between the BADE and delusional ideation. Methods. Fifty-five patients with schizophrenia (32 with current delusions), 20 patients with obsessive-compulsive disorder and 30 healthy participants were presented written scenarios composed of three successive sentences which increasingly disambiguated the situation. Participants were asked to rate interpretations presented along with the sentences. After each new sentence, participants could adjust their judgements in view of the new information. One interpretation (“true”) did not seem to fit the first statement but became increasingly plausible, whereas “lure” interpretations appeared very likely initially but were eventually incorrect. Patients were given the option to decide for one of the statements. Results. Patients with schizophrenia, irrespective of delusion severity, attenuated their ratings significantly less for lure interpretations in face of disconfirmatory evidence (BADE) compared to both control groups. We found no impairment regarding the integration of confirmatory evidence. Patients with schizophrenia made more incorrect decisions after the first sentence indicating jumping to conclusions relative to healthy controls. Participants with schizophrenia showed a lowered decision threshold compared to the controls. Conclusions. The findings lend further evidence to the claim that patients with schizophrenia are hastier and rather inflexible in their decision making. This response pattern may represent a trait-like vulnerability factor for the emergence of delusional incorrigibility, a hallmark symptom of schizophrenia.

Course and determinants of self-esteem in people diagnosed with schizophrenia during psychiatric treatment

Background: Opposing predictions have been formulated with regard to the causal relationship between paranoia and self‐esteem, either assuming a protective role of paranoia for explicit self‐esteem or a linear decrease of self‐esteem upon symptom deterioration. The primary purpose of the present study was to provide estimates for the prevalence of low self‐esteem in people diagnosed with schizophrenia during psychiatric treatment. Method: Self‐esteem was assessed in a cohort of 58 schizophrenia patients at the beginning of psychiatric treatment and 44 healthy controls. A subgroup of 45 patients and 24 controls was reassessed 4 weeks later. Results: At baseline, 42% of the patients displayed low self‐esteem (i.e. one standard deviation below the norm; re‐assessment: 49%). Baseline depression and antipsychotic dosage were the strongest predictors for low self‐esteem after 4 weeks. While paranoid ideas were not related to self‐esteem, neither cross‐sectionally nor longitudinally, grandiose delusions were modestly associated to higher self‐esteem. Conclusions: Symptom improvement over time did not translate into altered explicit self‐esteem. The results are inconsistent with a strong formulation of the hypothesis that paranoid ideas act as a defence. However, before dismissing this hypothesis, future investigations should look at qualitative aspects of delusional beliefs along with potential functional benefits of paranoia other than self‐esteem that may moderate the relationship.

Individualized Metacognitive Therapy Program for Patients with Psychosis (MCT+): Introduction of a Novel Approach for Psychotic Symptoms

BACKGROUND Metacognitive Group Training for Schizophrenia Patients (MCTg) focuses on dysfunctional thinking styles (e.g. cognitive biases) putatively involved in the formation and maintenance of delusions. Recently, the Individualized Metacognitive Therapy Program for Patients with Psychosis (MCT+), an extension of the group training, was released. MCT+ sessions aim to correct false metacognitive beliefs, which in turn should challenge a patients personal delusional convictions. AIMS The present study demonstrates how MCT and MCT+ can be combined and how the contents are conveyed to the patient. METHOD We present a single case study of a patient undergoing a combined treatment of MCT and MCT+. Before intervention and 4 weeks later the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scales (PSYRATS) were administered. RESULTS The patient showed a substantial symptom reduction after 4 weeks of combined therapy of MCTg and MCT+ as measured with PANSS and PSYRATS. CONCLUSIONS The present case history lends preliminary evidence for the feasibility of this new treatment approach in psychosis.

Religiosity, magical ideation, and paranormal beliefs in anxiety disorders and obsessive-compulsive disorder: a cross-sectional study.

Abstract The relation between religiosity/spirituality (R/S), personal beliefs, and mental health has been extensively studied. However, concerning anxiety disorders (ADs), empirical evidence is scarce. This study investigated the differences in R/S and magical/paranormal ideation among obsessive-compulsive disorder patients (OCD; n = 49), patients with other ADs (n = 36), and healthy controls (HCs; n = 35). Our results suggest negative religious coping as being the only parameter showing significantly higher scores in OCD and AD participants in comparison with HCs. Negative religious coping reflects negative functional expressions of R/S in stressful situations. Logistic regression also suggested negative religious coping as the strongest predictor of group affiliation to the nonhealthy group. Further results show no significant differences between other R/S, magical, and paranormal ideation traits among groups. This study underlines an important role of negative religious coping in ADs yet does not clearly indicate a specific causality. Religious-sensitive treatment targeting cognitive aspects of negative religious coping are discussed.

Theoretische Annahmen: Kognitive Verzerrungen bei Wahn

Eine psychologische, verstandnisbasierte Auseinandersetzung mit Wahn und Schizophrenie hat erst in jungster Zeit an wissenschaftlicher Akzeptanz und klinischem Einfluss gewonnen. Fur diese verzogerte Entwicklung scheint, wie bereits erwahnt, ein historischer Vorbehalt bezuglich der Durchfuhrbarkeit und des Erfolgs psychotherapeutischer Masnahmen bei psychotischen Storungen seitens der grosen psychotherapeutischen Schulen, der Psychoanalyse und teilweise auch der Verhaltenstherapie, verantwortlich zu sein. Unter dem Jaspersschen Postulat der Unverstehbarkeit von Psychosen und Freuds Annahme der fehlenden Gegenubertragung galten Schizophrenie und Wahn lange Zeit auch unter Psychologen als rein biologisch begrundet und damit als »Sache des Arztes bzw. Apothekers«. Diese Vorstellungen sind nicht zuletzt durch zahlreiche Befunde der Grundlagenforschung und erfolgreiche verhaltenstherapeutische Ansatze korrigiert worden.