Metacognitive change as a predictor of outcome in cognitive therapy for psychosis

There is little known about predictors of response to cognitive therapy (CT) for psychosis. This study tests the hypothesis that metacognitive change at both end of treatment and follow-up is associated with positive outcomes in people with psychosis receiving CT.

Patients referred for CT for psychosis were offered CT over a maximum of 30 sessions. Assessments, including interview-based measures of psychotic symptoms and a questionnaire assessing metacognitive worry, were performed at pre-CT, post-CT and one-year follow-up. Data from 32 patients were analyzed.

Significant positive relationships were found between metacognitive worry change scores at one-year follow-up and both positive symptoms of psychosis and particular dimensions of hallucinations. No significant relationships were found between metacognitive change and delusional symptoms.

These results suggest that metacognitive change is associated with symptom change at followup. In particular, these benefits seem most evident in those people experiencing hallucinations. Methodological limitations and clinical implications are discussed.