SA123. Metacognitive Training to Improve Insight and Work Outcome in Schizophrenia

Abstract

Background: Metacognitive capacity is the awareness and understanding of one’s own thought processes and how they influence behaviors (Lysaker et al., 2005). Deficits in metacognition in psychosis represent a significant barrier to benefiting from psychosocial treatments such as work therapy (Lysaker et al., 2010). Therapies that target features of metacognition, such as insight into cognitive biases or overconfidence in errors, seem to exert some beneficial effects on symptomatic parameters and psychosocial outcome (Moritz et al., 2011). In an exploratory pilot, we sought to study if metacognitive training would lead to improvements in work therapy outcome as well as illness insight and symptoms. Methods: Twenty-four adult outpatients with schizophrenia enrolled in a work therapy program were randomized to either treatment as usual or 2 months of metacognitive training (MCT; Moritz & Woodward, 2007), a group-based therapy aimed at enhancing insight into cognitive biases underlying paranoia and delusions. Work therapy consisted of 2 to 6 supervised/structured hours/week at sites around the Institute (gift shop, cafeteria, greenhouse, or janitorial services). Assessments of insight (SUMD), work behavior (WBI), and symptoms (BPRS) were administered at baseline, post (2 months), and follow-up (4 months). Results: While both groups improved in work behavior, the MCT group demonstrated better work behavior at post (t = 4.13, P = .027). Although there were no significant changes in insight or positive symptoms in either group at post, interestingly, the MCT group demonstrated more insight (P = .032) and fewer positive symptoms at 2-month follow-up (P = .040). Conclusion: Improving metacognitive capacity was found to enhance work therapy benefits. Similar to other studies that combined psychotherapy and work therapy, effects on insight and symptoms needed time to consolidate and only became evident after the intervention ended (Mervis et al., 2016). While we did not tease out the potential impact of the overall outpatient milieu, our findings suggest that MCT may have an important role in vocational rehabilitation programs for schizophrenia.