None listed
Conditions
Brief summary
Delusions are characteristic of people with psychosis. Many of these people do not respond well to current drug treatments and require additional psychological treatment. This project is an investigation into the efficacy of psychological treatments for delusions in psychosis, focusing on a new therapy (MCT+) which combines cognitive-behavioural therapy for psychosis and metacognitive training. Cognitive Behavioural Therapy for psychosis develops an awareness of the implausible content of a patient’s delusion, while metacognitive training targets the problematic thinking styles underlying delusional beliefs. It is expected that MCT+ will be one of the most effective psychological treatments for reducing delusional symptoms. The first aim of the proposed project is to determine the unique contribution of an individually-administered MCT+ program, combining the important facets of MCT and Cognitive Behavioural Therapy, over a standard cognitive remediation program (HAPPYneuron) targeting only neuropsychological cognitive deficits. The second aim is to determine the persistence of any improvements due to MCT+ by including a longitudinal follow-up. In sum, this project will provide the theory-driven evidence base that is needed to inform and influence clinicians to roll-out MCT+ to improve treatment for delusional people with psychosis. Primary Hypothesis: Participants who receive metacognitive training (MCT+) will show a reduction in delusional severity whilst improving clinical and cognitive insight (relative to participants in the cognitive remediation control condition). Participants randomised to the cognitive remediation control condition will show improvements to the “cognitive symptoms” of psychosis, including improved language and memory skills (relative to participants in the metacognitive training condition).
Interventions
Metacognitive therapy (MCT+) is a novel psychotherapeutic approach that builds on the concepts and goals of cognitive-behavioural therapy for psychosis. MCT+ targets the cognitive biases (i.e. distortions in the collection and processing of information) thought to underlie the formation and maintenance of delusional beliefs, and aims to bring to the attention of patients the cognitive dysfunctions that may be causing or maintaining their delusional symptoms (i.e. ‘metacognitive’ implies ‘thinkin
Metacognitive therapy (MCT+) is a novel psychotherapeutic approach that builds on the concepts and goals of cognitive-behavioural therapy for psychosis. MCT+ targets the cognitive biases (i.e. distortions in the collection and processing of information) thought to underlie the formation and maintenance of delusional beliefs, and aims to bring to the attention of patients the cognitive dysfunctions that may be causing or maintaining their delusional symptoms (i.e. ‘metacognitive’ implies ‘thinking about one’s thinking’). One of the three fundamental components of the programme is knowledge translation. The second component is a demonstration of the negative consequences of these cognitive biases via exercises that target each bias individually. Finally, patients are offered alternative thinking strategies, which may help them to arrive at more appropriate inferences and thereby avoid the ‘cognitive traps’ that otherwise lead to delusional beliefs. It consists of 8 modules covering (i) six cognitive biases common in psychosis (jumping-to-conclusions, attribution bias, belief inflexibility, theory of mind deficits, false memories, depressive thinking styles), (ii) an introductory and relapse prevention module. It is individually administered (face-to-face) by a psychologist (eligible or working towards eligibility for clinical endorsement) across 4 x 2 hour sessions, once/week for 4 weeks (plus 3 assessment sessions at baseline, 6-week follow-up, 6-month follow-up) at Lyell McEwin, Flinders and Noarlunga Hospitals. Attendance to the four individual therapy sessions will be recorded for each participant.
Sponsors
Flinders University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
a) Must have a DSM-5 diagnosis of a schizophrenia spectrum disorder (this will be confirmed by the ‘Psychotic Disorder’ subscale of the Mini-International Neuropsychiatric Interview or M.I.N.I). b) Must hold mild to moderate delusional beliefs as a minimum; this will be confirmed by a baseline ‘Delusions’ subscale score >3 of the Positive and Negative Syndrome Scale (PANSS). c) Must be able to speak, read and understand English and have the ability to respond to questions and follow instructions.
Exclusion criteria
a) primary diagnosis of substance use disorder b) IQ<70 c) severe organic brain disorders
Outcome results
None listed