Abstract
BackgroundMetacognitive Training (MCT) is a manualised cognitive intervention for psychosis aimed at transferring knowledge of cognitive biases and providing corrective experiences. The aim of MCT is to facilitate symptom reduction and protect against relapse. In a naturalistic audit of clinical effectiveness we examined what effect group MCT has on mental capacity, symptoms of psychosis and global function in patients with a psychotic illness, when compared with a waiting list comparison group.MethodsOf 93 patients detained in a forensic mental health hospital under both forensic and civil mental health legislation, 19 were assessed as suitable for MCT and 11 commenced. These were compared with 8 waiting list patients also deemed suitable for group MCT who did not receive it in the study timeframe. The PANSS, GAF, MacArthur Competence Assessment Tool- Treatment (MacCAT-T) and MacArthur Competence Assessment Tool-Fitness to Plead (MacCAT-FP) were recorded at baseline and repeated after group MCT or following treatment as usual in the waiting list group.ResultsWhen baseline functioning was accounted for, patients that attended MCT improved in capacity to consent to treatment as assessed by the MacCAT-T (p = 0.019). The more sessions attended, the greater the improvements in capacity to consent to treatment, mainly due to improvement in MacCAT-T understanding (p = 0.014) and reasoning . The GAF score improved in patients who attended the MCT group when compared to the waiting list group (p = 0.038) but there were no changes in PANSS scores.ConclusionMeasures of functional mental capacity and global function can be used as outcome measures for MCT. MCT can be used successfully even in psychotic patients detained in a forensic setting. The restoration of elements of decision making capacity such as understanding and reasoning may be a hither-to unrecognised advantage of such treatment. Because pharmacotherapy can be optimised and there is likely to be enough time to complete the course, there are clear opportunities to benefit from such treatment programmes in forensic settings.
Highlights
Metacognitive Training (MCT) is a manualised cognitive intervention for psychosis aimed at transferring knowledge of cognitive biases and providing corrective experiences
After adjustment for baseline, those undergoing metacognitive training (MCT) had an improvement in the Global Assessment of Functioning Scale (GAF) compared to the waiting list group (p = 0.024)
Correlating changes in outcome measures (T2-T1) with the number of treatment sessions attended for all 19 patients including the waiting list comparison group, for MacCAT-T change in understanding score, T2-T1, Spearman r = +0.644 p = 0.004, reasoning change, r = +0.540, p = 0.021, appreciation change r = +0.284 p > 0.3, change in total MacCAT-T score r = +0.556, p = 0.016; for MacCAT-FP change in understanding score r = +0.250, p > 0.3, reasoning r = +0.410 p > 0.05, appreciation r = +0.159 p > 0.5, total MacCAT-FP score r = 0.236 p > 0.3
Summary
Metacognitive Training (MCT) is a manualised cognitive intervention for psychosis aimed at transferring knowledge of cognitive biases and providing corrective experiences. In forensic settings, patients are often detained because of impaired functional mental capacities for example if found unfit to stand trial These functional cognitive deficits are likely to have the same basis in cognitive biases and distortions and may benefit from the same treatments. A number of problematic thinking styles or cognitive biases reported in schizophrenia are related to the formation and maintenance of positive symptoms of schizophrenia, delusions. Among these biases are attributional biases, the jumping to conclusion bias, bias against disconfirmatory evidence, deficits in theory of mind, over confidence in memory errors and depressive cognitive patterns [9,10,11]. There is a growing body of literature on the use of MCT in psychosis, to the authors’ knowledge there is no evidence of its use patients for with psychotic illness in the forensic population
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