Can metacognitive interventions improve insight in schizophrenia spectrum disorders? A systematic review and meta-analysis.
Por:
Lopez-Morinigo JD, Ajnakina O, Martínez AS, Escobedo-Aedo PJ, Ruiz-Ruano VG, Sánchez-Alonso S, Mata-Iturralde L, Muñoz-Lorenzo L, Ochoa S, Baca-García E and David AS
Publicada:
14 oct 2020
Ahead of Print:
14 oct 2020
Resumen:
BACKGROUND: Patients with schizophrenia spectrum disorders (SSD) tend to lack insight, which is linked to poor outcomes. The effect size of previous treatments on insight changes in SSD has been small. Metacognitive interventions may improve insight in SSD, although this remains unproved. METHODS: We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effects of metacognitive interventions designed for SSD, namely Metacognitive Training (MCT) and Metacognitive Reflection and Insight Therapy (MERIT), on changes in cognitive and clinical insight at post-treatment and at follow-up. RESULTS: Twelve RCTs, including 10 MCT RCTs (n = 717 participants) and two MERIT trials (n = 90), were selected, totalling N = 807 participants. Regarding cognitive insight six RCTs (n = 443) highlighted a medium effect of MCT on self-reflectiveness at post-treatment, d = 0.46, p < 0.01, and at follow-up, d = 0.30, p < 0.01. There was a small effect of MCT on self-certainty at post-treatment, d = -0.23, p = 0.03, but not at follow-up. MCT was superior to controls on an overall Composite Index of cognitive insight at post-treatment, d = 1.11, p < 0.01, and at follow-up, d = 0.86, p = 0.03, although we found evidence of heterogeneity. Of five MCT trials on clinical insight (n = 244 participants), which could not be meta-analysed, four of them favoured MCT compared v. control. The two MERIT trials reported conflicting results. CONCLUSIONS: Metacognitive interventions, particularly Metacognitive Training, appear to improve insight in patients with SSD, especially cognitive insight shortly after treatment. Further long-term RCTs are needed to establish whether these metacognitive interventions-related insight changes are sustained over a longer time period and result in better outcomes.
Filiaciones:
Lopez-Morinigo JD:
Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
Ajnakina O:
Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
Martínez AS:
Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
Escobedo-Aedo PJ:
Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
Ruiz-Ruano VG:
Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
Sánchez-Alonso S:
Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
Mata-Iturralde L:
Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
Muñoz-Lorenzo L:
Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
Ochoa S:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
Baca-García E:
Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
Departamento de Psicología, Psychology Clinical and Health, Universidad Católica del Maule, Talca, Chile
David AS:
Institute of Mental Health, University College London, London, UK
Green Published, hybrid
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