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

J Behav Ther Exp Psychiatry. 2020 Sep;68:101547. doi: 10.1016/j.jbtep.2020.101547. Epub 2020 Jan 7.


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.

Keywords: Efficacy; Jumping-to-conclusions; Metacognition; Moderation; Schizophrenia; Self-esteem.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cognitive Behavioral Therapy*
  • Delusions / psychology*
  • Delusions / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Psychotic Disorders / psychology*
  • Psychotic Disorders / therapy*
  • Quality of Life
  • Treatment Outcome
  • Young Adult