Cognitive Insight in First-Episode Psychosis: Changes during Metacognitive Training

Irene Birulés,Maria Barrigón,Ana De Apraiz,Esther Pousa,Raquel López-Carrilero,Isabel Ruiz-Delgado,Jordi Cid,Ester Lorente-Rovira,Trinidad Pélaez,Ana Barajas,The Spanish Metacognition Study Group ,Eva Grasa,Daniel Cuadras,Susana Ochoa,Fermín González-Higueras,Roger Montserrat,Steffen Moritz

doi:10.3390/jpm10040253

Abstract

Background: Metacognitive training (MCT) has demonstrated its efficacy in psychosis. However, the effect of each MCT session has not been studied. The aim of the study was to assess changes in cognitive insight after MCT: (a) between baseline, post-treatment, and follow-up; (b) after each session of the MCT controlled for intellectual quotient (IQ) and educational level. Method: A total of 65 patients with first-episode psychosis were included in the MCT group from nine centers of Spain. Patients were assessed at baseline, post-treatment, and 6 months follow-up, as well as after each session of MCT with the Beck Cognitive Insight Scale (BCIS). The BCIS contains two subscales: self-reflectiveness and self-certainty, and the Composite Index. Statistical analysis was performed using linear mixed models with repeated measures at different time points. Results: Self-certainty decreased significantly (p = 0.03) over time and the effect of IQ was negative and significant (p = 0.02). From session 4 to session 8, all sessions improved cognitive insight by significantly reducing self-certainty and the Composite Index. Conclusions: MCT intervention appears to have beneficial effects on cognitive insight by reducing self-certainty, especially after four sessions. Moreover, a minimum IQ is required to ensure benefits from MCT group intervention.

Highlights

Schizophrenia and first-episode psychosis represent one of the most invalidating disorders
The results revealed that cognitive insight improved with the Metacognitive training (MCT), in particular regarding the self-certainty subscale
Regarding the effect of each session in changing cognitive insight, the results indicated that, after the fourth session, there was an improvement in cognitive insight, in the self-certainty subscale and in the Composite Index

Summary

Introduction

Schizophrenia and first-episode psychosis represent one of the most invalidating disorders It concurs with high psychosocial disability and is associated with stigma and discrimination. It has a strong genetic basis, psychosocial protective aspects must always be considered to ensure their acceptance and integration in the community [1,2]. Patients were assessed at baseline, post-treatment, and 6 months follow-up, as well as after each session of MCT with the Beck Cognitive Insight Scale (BCIS). From session 4 to session 8, all sessions improved cognitive insight by significantly reducing self-certainty and the Composite Index. Conclusions: MCT intervention appears to have beneficial effects on cognitive insight by reducing self-certainty, especially after four sessions. A minimum IQ is required to ensure benefits from MCT group intervention

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