Metacognitive training (MCT) for psychosis: a systematic review and grade recommendations.
Por:
Goncalves A, Ochoa S, Moritz S, Gaweda L, Cavieres A, König C, Fischer R, Meinhart A, Lamarca M, Ayesa-Arriola R, Balzan R, Böge K, Lecomte T, Raffard S and Berna F
Publicada:
26 may 2025
Ahead of Print:
26 may 2025
Resumen:
BACKGROUND: Recent meta-analyses support the inclusion of cognitive behavioral therapy (CBT) in schizophrenia treatment. Metacognitive Training (MCT) for psychosis is a psychoeducational program derived from CBT, with most meta-analyses showing favorable results. Although meta-analyses are commonly used in clinical practice to guide evidence-based decision-making, the grading system provides complementary results by offering a structured approach for assessing the strength and reliability of evidence and deriving grades of recommendations accordingly. METHODS: Our research applies the guidelines from the World Federation of Societies of Biological Psychiatry (WFSBP) to propose grades of recommendation for MCT for psychosis, analyzing 38 randomized controlled trials (RCTs) (n = 1942) and 10 meta-analyses. The primary outcome was positive symptoms, with secondary measures including negative symptoms, general psychopathology, self-esteem, functioning, insight, and cognitive function. RESULTS: Our findings are primarily based on the risks of bias attributed to RCTs (11 high, 19 moderate, 6 low) and, when necessary, on the overall confidence attributed to meta-analyses (3 low, 7 critically low). According to the WFSBP guidelines, strong recommendations should be made for using MCT for psychosis to improve post-treatment positive symptoms, delusions, and total psychotic symptoms (WFSBP-grade 1). Limited recommendations (WFSBP-grade 2) could be made for using MCT to improve post-treatment visuospatial abilities and to maintain benefits over time in psychopathology, functioning, self-esteem, episodic memory, and attention. CONCLUSIONS: MCT for psychosis is an evidence-based program, especially for positive symptoms, with long-lasting clinical benefits. These recommendations should be interpreted with caution given potential residual biases and heterogeneity among studies.
Filiaciones:
Goncalves A:
University of Strasbourg, Inserm U1329, 67091 Strasbourg, France (A Goncalves, PhD candidate
F Berna MD, PhD)
Ochoa S:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830, Barcelona, Spain (M Lamarca, PhD candidate
S Ochoa, PhD)
Grup MERITT, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950, Barcelona, Spain (M Lamarca, PhD candidate
S Ochoa PhD)
Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (M Lamarca, PhD candidate
Moritz S:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany (Prof S Moritz
A Meinhart, MSc
R Fischer, MSc)
Gaweda L:
Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland (Prof L Gaweda, PhD)
Cavieres A:
Departamento de Psiquiatría, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Chile (A Cavieres, MD)
König C:
Soft Computing Research Group at Intelligent Data Science and Artificial Intelligence Research Center, Universitat Politècnica de Catalunya, Barcelona, Spain (C König, PhD)
Fischer R:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany (Prof S Moritz
A Meinhart, MSc
R Fischer, MSc)
Meinhart A:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany (Prof S Moritz
A Meinhart, MSc
R Fischer, MSc)
:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830, Barcelona, Spain (M Lamarca, PhD candidate
S Ochoa, PhD)
Grup MERITT, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950, Barcelona, Spain (M Lamarca, PhD candidate
S Ochoa PhD)
Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (M Lamarca, PhD candidate
Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, 08193 Barcelona, Spain (M Lamarca, PhD candidate)
Ayesa-Arriola R:
Unidad de Investigación en Psiquiatría (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, España (R Ayesa-Arriola, PhD)
Balzan R:
Psychology Clinic, Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, Australia (R Balzan, PhD)
Böge K:
Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Germany (K Böge, PhD)
Medical University of Brandenburg, Brandenburg, Germany (K Böge, PhD)
German Mental Health Center (DZPG), Germany (K Böge, PhD)
Lecomte T:
Psychology department, University of Montréal, CRIUSMM, CRIPCAS, Montreal, Canada (Prof T Lecomte)
Réseau Canadien pour la Recherche en Schizophrénie et Psychoses, Montreal, Canada (Prof T Lecomte)
Raffard S:
Epsylon laboratory, EA 4556, University of Montpellier 3, 34090 Montpellier, France (Prof S Raffard, PhD)
University Department of Adult Psychiatry, Montpellier University Hospital, 34090 Montpellier, France (Prof S Raffard)
Berna F:
University of Strasbourg, Inserm U1329, 67091 Strasbourg, France (A Goncalves, PhD candidate
F Berna MD, PhD)
University Hospitals of Strasbourg, Inserm U1329, 67091 Strasbourg, France (Prof F Berna MD, PhD)
Green Submitted, gold
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