Metacognitive Training for Psychosis

What Is Metacognitive Training?

Metacognitive training (MCT) is an intervention generally framed to modify metacognitive beliefs in people. Here and now, it is inclined to treat the symptoms of schizophrenia (periods of psychosis) and psychosis. Stephen Moritz and Todd Woodward developed this training. Metacognitive training is based on the theories of cognitive behavioral therapy (a psychosocial approach for mental disorders to reduce depression, anxiety, and cognitive thoughts). This intervention chiefly focuses on and withdraws the cognitive biases, which could be the first positive sign of psychosis.

What Are Psychosis and Its Cognitive Bias?

Psychosis is a mental health disorder in which a person gets detached from reality. Psychosis may occur underlying psychotic illness like schizophrenia, drug abuse, or any medication. Common symptoms of psychosis:

• Delusion-false belief.

• Hallucination.

• Impairment in talking and learning.

• Disturbed thoughts.

• Hyperactivity.

• Aggression.

• Anxiety.

• Nervousness.

Cognitive thoughts or delusion is the prevalent stuff in psychosis that makes one disconnect from reality. Cognitive bias is the systematic thought process in which an individual forms a subject reality with their perception. This might result in impairment and distorted behavior. Here, the brain simplifies the information on their input, personalized experiences, and preferences. An example of cognitive thoughts is ‘jumping to conclusions.

What Is ‘Jumping to Conclusion’?

It is a psychological term known for communication obstacles in which one decides or presumes the situation without knowing the facts, thus resulting in an unwarranted conclusion. In simple words, one does not see things clearly and makes their own undesirable decisions. An example of the ‘jumping to conclusion’ phrase is if one is not talking to a person passing by, then the person ends up thinking that they are angry. However, the actual reason is not based on that fact or conclusion.

What Is the Aim of Metacognitive Training?

Metacognition is thinking about thinking. Metacognitive training aims at identifying one's insights or perceptions and recovering them. Also, aims to give awareness about cognitive thoughts and bias. Over time of metacognitive training, the positive symptoms of psychosis are diminished, particularly paranoid ideas. It also aims to dwindle one’s confidence in false belief in reality and also show the possible effects of "jumping to conclusions."

What Are the Types of Metacognitive Training?

The training is available in two forms-

1. Group format metacognitive training (MCT).

2. Individualized metacognitive training (MCT+).

Both individualized and group training target positive symptoms, cognitive thoughts, and jumping to conclusions. However, Individualized metacognitive training would be even more effective as it cares about individualized topics.

How Does Metacognitive Intervention Work?

The metacognitive intervention comprises eight MCT modules(training units) and four additional modules. They joyfully present these modules to patients experiencing psychosis or schizophrenia. So that the patients watch over the sessions and observe in a group or person, then they ask them to reflect on their thoughts and prompt them, which leads to distorted behavior. They are also informed to implement this training in their day-to-day life. End of the day, assignments will be given to each patient. One group cycle represents eight modules within four weeks, and another cycle would be optional based on the patient's cooperation.

Steps in the Training: Every module begins with psychoeducational elements with examples and exercises. All domains are explained one at a time. The drawback of being cognition is also illustrated. The next step is defining the pathological extremes of each bias. Then, they are taught how to overcome the exaggeration of thinking bias in life with case examples of psychotic patients. The group's metacognitive training allows them to share their own delusion experiences.

Eight modules of MCT,

1. Attributional distortions or monocausal (single-handed) attributions.

2. Jumping to conclusion bias.

3. Bias against conformational evidence.

4. Shortfalls in the theory of mind.

5. Overconfidence in memory errors.

6. Shortfalls in the theory of mind.

7. Jumping to conclusion bias.

8. Depressive cognition.

While the additional modules are for,

• Stigma.

• Low self-esteem.

Correction of these problematic or impractical thinking styles would eventually reduce the symptoms.

How Is Metacognitive Training Administered?

MCT is usually delivered through a set of sessions that comprise elements considered crucial to help the targeted individuals become more aware and gain better control over the cognitive processes they experience. Here is how it is generally administered:

• Group Sessions: This treatment approach is usually implemented in a group format so that people can learn and assist one another. These sessions are usually conducted by peer leaders or under the supervision of a counselor or a therapist.

• Modules: The training is in phases, and each phase contains specific content regarding various aspects of cognition like memory, perception, biases, and even problem-solving.

• Psychoeducation: Members are given information on the four general cognitive biases and cognitive distortions and are supposed to identify them in their reasoning.

• Exercises and Activities: Applying and engaging are employed while teaching to demonstrate the ideas and concepts. These could be, for instance, thought experiments, roleplays, and cognitive exercises.

• Discussion and Reflection: Encouraging participants to talk and share their ideas as well as their real-life experiences helps them think critically about the patterns of their minds.

• Homework Assignments: It is possible to assign specific tasks to participants for the use of metacognitive skills in their daily routine between the sessions.

• Feedback and Support: Periodic feedback and reinforcement by the facilitator assist the participants in enhancing their metacognition skills and solving difficulties.

• Follow-up: Some patients may require periodic check-ups or review sessions to ensure adherence to the prescribed regimen and mastery of the techniques learned in treatment.

Is Metacognitive Training Effective?

After fulfilling diagnostic criteria and baseline assessments, patients were categorized for pharmacological therapies and psychotherapy. They are examined with Psychotic Symptoms Rating Scales (PSYRATS) and are then treated accordingly. The results are evident that metacognitive training has surplus effects on psychosis, even with the patients showing partial response to antipsychotic drugs. An older analysis of metacognitive training with patients showed less effect. At the same time, the new meta-analysis proved enough efficacious findings on the improvement of symptoms and delusions. Royal Australian and New Zealand College of Psychiatrists and the German Association for Psychiatry, Psychosomatics, and Psychotherapy suggested metacognitive training as evidence-based training for psychosis and psycho-related disorders.

Metacognitive Training for Other Disorders- Metacognitive training has been practiced in other psycho-related disorders since its founding. Those disorders include depression, bipolar disorders, schizophrenia, obsessive-compulsive disorder (OCD), and borderline personality disorder.

How Does Cognitive Behavioral Therapy (CBT) Differ From Metacognitive Training (MCT)?

Cognitive behavioral therapy is a psychosocial intervention to treat mental health disorders that primarily aids in depression and anxiety disorders. Like metacognition training, this relieves cognizant thinking bias and their associated distorted behaviors. Both therapies are goal-directed, brief, well-oriented, and structured, but CBC focuses only on cognition, and MCT focuses on the meta-level of cognition (cognition over cognition).

Conclusion

Although persistent positive symptoms and cognition bias are the major challenges of psychiatric care, the training demotes the symptoms and induces a bias-free person. However, further studies are going on to elucidate the mechanism and efficiency of metacognitive training.