Metacognitive training for psychosis (MCT): a systematic meta-review of its effectiveness
Antonia Meinhart, Geneviève Sauvé, Annika Schmueser, Danielle Penney, Fabrice Berna, Łukasz Gawęda, María Lamarca, Steffen Moritz, Susana Ochoa, Caroline König, Vanessa Acuña, Rabea Fischer
Abstract
Abstract Objective Metacognitive training for psychosis (MCT) targets cognitive biases implicated in the pathogenesis of psychosis, e.g., jumping to conclusions, overconfidence in errors, and inflexibility. This systematic meta-review investigated the current meta-analytic evidence for the effectiveness of MCT with respect to core symptom features in schizophrenia (i.e., positive symptoms, delusions and hallucinations, negative symptoms, and overall psychotic symptoms). Data sources This meta-review was registered with PROSPERO (CRD42023447442) on July 28, 2023. Articles were searched across five electronic databases from January 1, 2007 to September 1, 2023. Study selection Meta-analyses addressing metacognitive interventions targeting psychotic symptoms were eligible for meta-review. Data extraction and synthesis PRISMA guidelines were followed when applicable. Data extraction was done independently by two authors (AM, AS). A random-effects model was used to pool data within meta-analyses. Main outcomes and measures Main outcomes were levels/severity of positive symptoms, delusions and hallucinations, negative symptoms, and overall psychotic symptoms after intervention. Results Eight meta-analyses and two re-analyses were included for meta-review. A total of eight analyses provided sufficient data for analysis. Significant evidence was found in favor of MCT for positive symptoms (85.71%; N = 35, g = 0.473 [0.295, 0.651], I 2 = 74.64), delusions (60%; N = 24, g = 0.639 [0.389, 0.889], I 2 = 80.01), hallucinations (100%; N = 9, g = 0.265 [0.098, 0.432], I 2 = 6.1), negative symptoms (100%; N = 17, g = 0.233 [0.1, 0.366], I 2 = 34.78), and overall symptoms (50%; N = 37, g = 0.392 [0.245, 0.538], I 2 = 65.73). None of the meta-analyses included a large enough sample size to meet the criteria for ‘suggestive’, ‘convincing’, or ‘highly convincing’ evidence according to metaumbrella.org guidelines (required sample size > 1000 cases). None of the meta-analyses scored ‘moderate’ or ‘high’ on methodological quality. Meta-analyses with significant results were more recent and/or considered more primary studies. Conclusions and relevance There is consistent evidence that MCT ameliorates positive symptoms and delusions in schizophrenia.