None listed
Conditions
Brief summary
Background Aggressive behaviour in forensic psychiatric settings is “frequent and problematic; its impact on patients, staff, unit functioning and mental health services is profound” (Daffern, 2007, p.117). Positive symptoms of schizophrenia, particularly delusions, have been found to be associated with aggressive behaviour. Central features underlying delusions include cognitive biases such as the jumping to conclusions bias, an other attributional style, theory of mind deficits and poor emotion recognition. With a greater understanding of cognitive biases and processes underlying delusions, new targeted psychotherapies have emerged such as Metacognitive Training for Psychosis (MCT), with promising findings in psychiatric settings. However, the use of MCT in forensic settings has only recently begun to be examined, with beneficial effects for individuals with schizophrenia in MCT groups showing a greater capacity to consent to treatment, improved global functioning, and a greater reduction in symptoms of schizophrenia and suspiciousness than for those in the control group. It has been suggested that decreased delusional severity and reduced suspiciousness, for example, may in turn decrease aggression in a forensic psychiatric setting. Therefore, future research involving the use of MCT for delusions on reducing aggression in schizophrenia patients in a forensic psychiatric setting appears warranted. Aims of the Project First Aim: To test the effects of a psychological intervention for delusions on reducing aggression in patients with schizophrenia in a forensic psychiatric setting. This intervention incorporates MCT in a forensic psychiatric setting. Furthermore, Module Four of the MCT contains a brief emotion recognition component, which is expanded to incorporate further Emotion Recognition Training, with this psychological intervention in a forensic psychiatric setting being endorsed by Professor Moritz as MCT-Forensic (MCT-F). Second Aim: To identify the best predictors of: 1) aggression at baseline; and 2) change in aggression following treatment. Proposal Research Design The first aim will employ an ANCOVA model, with the pretest scores as the covariate, the posttest scores as the dependent variable, and the two groups (MCT-F treatment group and waitlist control group) as the independent variable. The second aim will be investigated by linear multiple regression. Methods The study aims to recruit 48 participants in total from the State Forensic Mental Health Service based on the inclusion criteria. An Information Sheet will be discussed with the participant, and informed consent will be obtained. This will be followed by pre-treatment assessment (T1). Participants will be randomly allocated to either a treatment group (MCT-F) of six weeks training or the waitlist control group. A post-assessment (T2) will then be conducted after training completion. The wait-list group will then be offered the program and then the next cohort will be enlisted.
Interventions
The Metacognitive Training Program for Psychosis (MCT) is a cost free download (http://www.uke.de). The MCT is designed to assist people in changing their thinking patterns that contribute to delusions, which subsequently avoids relapse or reduces the impact of delusions. Each module begins with psychoeducational elements and “normalising “through examples and exercises. Pathological extremes for each cognitive bias are then highlighted and their implications for daily life discussed with cas
The Metacognitive Training Program for Psychosis (MCT) is a cost free download (http://www.uke.de). The MCT is designed to assist people in changing their thinking patterns that contribute to delusions, which subsequently avoids relapse or reduces the impact of delusions. Each module begins with psychoeducational elements and “normalising “through examples and exercises. Pathological extremes for each cognitive bias are then highlighted and their implications for daily life discussed with case examples of people with psychosis. Dysfunctional coping strategies such as avoidance are also highlighted. The sessions are interactive and entertaining and aim to capture participants’ attention, with a move away from the drill and practice approaches often incorporated with traditional Cognitive Behaviour Therapy group programs. Participants are also required to complete homework between sessions. Module Four of the MCT program contains a brief section on emotion perception, which will be enhanced further with Emotion Recognition Training (ERT) (Marsh et al., 2013). The aim is to enhance the effects of Module Four’s brief section on emotion perception, which sensitises participants to the ambivalence of social situations. This MCT program will be incorporated in a forensic psychiatric setting and for clarity will be called the Metacognitive Training for Psychosis – Forensic (MCT-F), which is endorsed by Professor Steffen Moritz. The MCT-F program will run for six weeks, twice a week for one hour per session. No more than 10 participants will be recruited into each group.
Sponsors
Macquarie University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
Inclusion criteria is a DSM-IV-TR (American Psychiatric Association, 2000) of schizophrenia or schizoaffective disorder, be aged between 18-55 years, have English as a first language (or educated from primary school age in English) and have a history of aggressive behaviour.
Exclusion criteria
Exclusion criteria include current alcohol/drug abuse, a comorbid acquired or developmental brain disorder, as assessed by the treating Psychiatrist, or documented head trauma (unconscious for more than one hour).
Outcome results
None listed