Efficacy of Individual Metacognitive Training in Patients with Schizophrenia: A Case Study

Several cognitive biases may be involved in the pathogenesis and continuation of symptoms in schizophrenia. Metacognitive Training (MCT) is a treatment program that targets cognitive bias in schizophrenia. The current work aimed to evaluate the influence of MCT on schizophrenia using a single-subject design.

Five patients with schizophrenia received metacognitive training. The treatments were done for at least four weeks, two sessions per week (number of sessions ranged from 8 to 18 sessions). The MCT consists of two sets of eight modules that target common cognitive biases and problem-solving difficulties in schizophrenia. Baseline assessment was performed using the Birchwood Insight Scale (BIS), the Positive and Negative Syndrome Scale (PANSS), the Psychotic Symptom Rating Scales (PSYRATS), the Global Assessment of Functioning (GAF), WHOQOL-BREF and the Peters et al, Delusions Inventory (PDI). The post intervention assessments included the afore-mentioned measures as well as treatment satisfaction. The follow-up assessments were conducted three and six months later. Data analysis was administered employing visual analysis diagrams, percentage of recovery and the Reliable Change Index (RCI). 

MCT was associated with a reduction in positive and negative symptoms (up to 18.7, 100 and 100% on the PANSS, PSYRATS and PDI, respectively) in individuals with schizophrenia, and its effects diminish over time. Insight showed significant improvement, but it was mainly the insight into symptoms. In patients with low baseline score of Quality of Life (QOL), an improvement was reported. The GAF did not change significantly.

MCT can be suggested as an adjunct therapy to decrease the symptoms of schizophrenia and improve the patients’ insight. Patients with more symptoms and lower levels of insight, performance and QOL seem to respond better to MCT. Randomized clinical trials are required.