Metacognitive training for psychosis
Metacognitive Training (MCT) for psychosis is a psychological treatment approach aimed at improving the positive symptoms of psychosis. MCT uses a backdoor approach to not target symptoms directly but to reduce the cognitive biases associated with the development and maintenance of symptoms, particularly delusions, through improving participants’ metacognitive abilities. It is a strictly evidence-based approach, relying on more than 30 years of research in cognitive science and psychology. Recent meta-analyses have proven the lasting effectiveness of MCT for improving positive symptoms, cognitive biases, and insight (Moritz et al., 2022; Penney et al., 2022).
Comprised of 10 modules, MCT targets cognitive errors and biases, as well as emotional challenges associated with schizophrenia, such as mood problems. These biases may, independently or in combination, result in the development of false beliefs and even delusions (Freemann, 2007; Moritz &Woodward, 2007). Therefore, the aim of MCT is to increase the awareness for said biases and encourage a critical examination and modification of currently present problem-solving skills and beliefs.
MCT takes places in a group setting and each module possesses psychoeducational components that aim to “normalize” through the use of examples and exercises. Different biases are addressed, and the fallibility of human cognition is discussed. Subsequently, exaggerations of (normal) cognitive distortions are introduced and how they can lead to challenges in daily life and potentially result in delusions. Moreover, case examples of people with psychosis are used to illustrate this point and, if they feel inclined to do so, participants are presented with the opportunity to share their own experiences. The training guides participants to recognize and mitigate cognitive pitfalls. Additionally dysfunctional coping mechanisms, such as avoidance, are brought to attention and alternative and more constructive strategies are introduced.
Among the cognitive biases that are recognized to potentially contribute to the development of delusions are attributional style bias, jumping to conclusions, bias against disconformity evidence, deficits in theory of mind, and overconfidence in memory errors. Furthermore, the important topics of mood difficulties, self-esteem and how to handle stigmatization are also discussed. During the training the associations between thinking styles, delusions and psychosis are stressed as well as a change in the “cognitive infrastructure” underlying the delusional ideation. Throughout the training it is stressed that it is human to make mistakes and that most people have cognitive biases. The goal of MCT is it to assist participants in the comprehension and betterment of these biases, especially the ones that are prominently present in psychosis.
For more information on MCT training, visit: https://clinical-