Diagnosis of Schizophrenia Spectrum Disorders
Conditions
Keywords
Schizophrenia, Psychotherapy, Metacognitive abilities, Session by session assessment, Outcome
Brief summary
People with schizophrenia spectrum disorders are faced with significant metacognitive impairments that include difficulties in their ability to form complex representations of the self and others. These impairments are associated with increased symptoms, impaired subjective self-experiences, and lower social functioning. As a result, interventions that enhance metacognitive capacity have been recently developed and explored. One of these interventions is Metacognitive Reflection and Insight Therapy (MERIT; Lysaker et al., 2014). MERIT is an integrative model of psychotherapy that seeks to promote holistic metacognitive capacity and consequently increase a positive sense of agency and sense of meaning in life among clients with schizophrenia. Several case studies (including in Bar-Ilan's community clinic), as well as a recent pilot study, showed increased metacognitive abilities and a decrease in symptoms following MERIT. The current study will explore both the effectiveness and the change mechanisms that underlie MERIT interventon among clients diagnosed with schizophrenia spectrum disorders, via both pre- and post-measures of the intervention's outcome and session-by-session estimations of the therapeutic process.
Interventions
BEHAVIORALMERIT
Metacognitive Reflection and Insight Therapy
Sponsors
Bar-Ilan University, Israel
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of schizophrenia spectrum disorders * Ability to provide informed consent * Ability to read and write in Hebrew
Exclusion criteria
* No co-morbid nuerological condition * No hospitalization in the last 6 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Metacognition Assessment Scale-Abbreviated (MAS-A) | Prior to the begining of the therapy (baseline, pre-treatment), and again at the end of the therapy (six months later, post-treatment) | The Metacognition Assessment Scale-Abbreviated (MAS-A) is a rating scale used to assess metacognitive abilities in individuals, particularly those with psychiatric conditions. The scale consists of four domains that reflect one's ability to understand different mental phenomena and use this understanding in order to cope with psychological challenges. Higher scores indicate a higher complexity of functions and ideas in each domain, i.e. higher values represent a better outcome. The four scales/domains: 1. self-reflectivity (min 1 to max 9) ; 2. understanding of the other's mind (min 1 to max 7) ; 3. decentration (min 1 to max 3) ; 4. mastery (min 1 to max 9). The total score is the sum of the ratings in each subscale. Thus, the total score can be ranged from 4 (min) to 28 (max), when higher values represent a better outcome. |
Countries
Israel
Participant flow
Recruitment details
Participants were 35 adults diagnosed with of schizophrenia /schizoaffective disorder. Exclusion criteria: intellectual disability, neurological disorders, substance use problems, acute psychosis, and risk for suicidal behavior, based on the intake interview. The study used a delayed randomized controlled trial design to examine the therapeutic benefits of MERIT delivered in a community clinic at Bar-Ilan University.
Participants by arm
| Arm | Count |
|---|---|
| Treatment Group MERIT: Metacognitive Reflection and Insight Therapy | 31 |
| Delayed Treatment Control Group MERIT: Metacognitive Reflection and Insight Therapy | 23 |
| Total | 54 |
Baseline characteristics
| Characteristic | Delayed Treatment Control Group | Total | Treatment Group |
|---|---|---|---|
| Age, Continuous | 40.5 years STANDARD_DEVIATION 8.71 | 39.6 years STANDARD_DEVIATION 9.74 | 39 years STANDARD_DEVIATION 10.63 |
| Race and Ethnicity Not Collected | — | 0 Participants | — |
| Region of Enrollment Israel | 14 participants | 35 participants | 21 participants |
| Sex: Female, Male Female | 14 Participants | 32 Participants | 18 Participants |
| Sex: Female, Male Male | 9 Participants | 22 Participants | 13 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 31 | 0 / 23 |
| other Total, other adverse events | 0 / 31 | 0 / 23 |
| serious Total, serious adverse events | 0 / 31 | 0 / 23 |
Outcome results
Primary
Metacognition Assessment Scale-Abbreviated (MAS-A)
The Metacognition Assessment Scale-Abbreviated (MAS-A) is a rating scale used to assess metacognitive abilities in individuals, particularly those with psychiatric conditions. The scale consists of four domains that reflect one's ability to understand different mental phenomena and use this understanding in order to cope with psychological challenges. Higher scores indicate a higher complexity of functions and ideas in each domain, i.e. higher values represent a better outcome. The four scales/domains: 1. self-reflectivity (min 1 to max 9) ; 2. understanding of the other's mind (min 1 to max 7) ; 3. decentration (min 1 to max 3) ; 4. mastery (min 1 to max 9). The total score is the sum of the ratings in each subscale. Thus, the total score can be ranged from 4 (min) to 28 (max), when higher values represent a better outcome.
Time frame: Prior to the begining of the therapy (baseline, pre-treatment), and again at the end of the therapy (six months later, post-treatment)
Population: The N in the POST row is following dropouts.~Treatment Group Arm: Baseline/pre-treatment and post-treatment at 24 weeks; For Delayed Treatment Control Group Arm: Baseline/pre-waiting period and 6 months post-waiting period prior to starting treatment.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Delayed Treatment Control Group | Metacognition Assessment Scale-Abbreviated (MAS-A) | Pre (treatment/waiting period) | 11.53 score on a scale | Standard Deviation 3.7 |
| Delayed Treatment Control Group | Metacognition Assessment Scale-Abbreviated (MAS-A) | Post (treatment/waiting period) | 14.22 score on a scale | Standard Deviation 3.4 |
| Treatment Group | Metacognition Assessment Scale-Abbreviated (MAS-A) | Pre (treatment/waiting period) | 14.22 score on a scale | Standard Deviation 2.75 |
| Treatment Group | Metacognition Assessment Scale-Abbreviated (MAS-A) | Post (treatment/waiting period) | 14.25 score on a scale | Standard Deviation 4.2 |