Improving insight into delusions: a pilot study of metacognitive training for patients with schizophrenia

The paper is a report of a study conducted to test the implementation of the French version of the metacognitive training programme and its effects on psychotic symptoms and awareness of the disorder.

Understanding of the mechanisms underlying the psychotic experience has considerably improved in recent years. Psychotic symptoms are associated with cognitive biases that trigger, worsen or maintain them. Metacognitive training aims to make patients aware of their cognitive biases, train them to see these distortions in a critical way, and help them complete or change their problem-solving repertoire.

A small, uncontrolled pilot study was carried out. Patients suffering from schizophrenia or schizoaffective disorder with persistent psychotic symptoms were recruited in an outpatient rehabilitation unit. They were assessed at pre- and post-test with the Psychotic Symptom Rating Scales, Positive and Negative Syndrome Scale and Scale to Assess Unawareness of Mental Disorder. The metacognitive training was administered every week in group sessions during an 8 months period in 2008.

Twenty-five patients consented to participate. Eighteen patients completed 8 to 16 one-hour weekly sessions of metacognitive training. Participants reduced substantially the severity of their delusions and improved their awareness of delusions, attribution of the delusions to the disease and awareness of the disorder. The improvements were accompanied by a reduction in depression.

Metacognitive training appears to be a promising new technology which requires further research. It can be easily used by nurses to help patients with delusions to take into account their cognitive biases.