Can metacognitive interventions improve insight in schizophrenia spectrum disorders? A systematic review and meta-analysis

Javier-David Lopez-Morinigo, Olesya Ajnakina, Adela Sánchez-Escribano Martínez, Paula-Jhoana Escobedo-Aedo, Verónica González Ruiz-Ruano, Sergio Sánchez-Alonso, Laura Mata-Iturralde, Laura Muñoz-Lorenzo, Susana Ochoa, Enrique Baca-García, Anthony S David, Javier-David Lopez-Morinigo, Olesya Ajnakina, Adela Sánchez-Escribano Martínez, Paula-Jhoana Escobedo-Aedo, Verónica González Ruiz-Ruano, Sergio Sánchez-Alonso, Laura Mata-Iturralde, Laura Muñoz-Lorenzo, Susana Ochoa, Enrique Baca-García, Anthony S David

Abstract

Background: Patients with schizophrenia spectrum disorders (SSD) tend to lack insight, which is linked to poor outcomes. The effect size of previous treatments on insight changes in SSD has been small. Metacognitive interventions may improve insight in SSD, although this remains unproved.

Methods: We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effects of metacognitive interventions designed for SSD, namely Metacognitive Training (MCT) and Metacognitive Reflection and Insight Therapy (MERIT), on changes in cognitive and clinical insight at post-treatment and at follow-up.

Results: Twelve RCTs, including 10 MCT RCTs (n = 717 participants) and two MERIT trials (n = 90), were selected, totalling N = 807 participants. Regarding cognitive insight six RCTs (n = 443) highlighted a medium effect of MCT on self-reflectiveness at post-treatment, d = 0.46, p < 0.01, and at follow-up, d = 0.30, p < 0.01. There was a small effect of MCT on self-certainty at post-treatment, d = -0.23, p = 0.03, but not at follow-up. MCT was superior to controls on an overall Composite Index of cognitive insight at post-treatment, d = 1.11, p < 0.01, and at follow-up, d = 0.86, p = 0.03, although we found evidence of heterogeneity. Of five MCT trials on clinical insight (n = 244 participants), which could not be meta-analysed, four of them favoured MCT compared v. control. The two MERIT trials reported conflicting results.

Conclusions: Metacognitive interventions, particularly Metacognitive Training, appear to improve insight in patients with SSD, especially cognitive insight shortly after treatment. Further long-term RCTs are needed to establish whether these metacognitive interventions-related insight changes are sustained over a longer time period and result in better outcomes.

Keywords: Insight; metacognitive interventions; outcomes; schizophrenia spectrum disorders.

Figures

Fig. 1.
Fig. 1.
Flow chart of the studies selection process.
Fig. 2.
Fig. 2.
Meta-analysis of the effects of Metacognitive Training on cognitive insight - BCIS-Self-Reflectiveness -: at baseline, at post-treatment and at a follow-up.
Fig. 3.
Fig. 3.
Meta-analysis of the effects of Metacognitive Training on cognitive insight - BCIS-Self-Certainty -: at baseline, at post-treatment and at follow-up.
Fig. 4.
Fig. 4.
Meta-analysis of the effects of Metacognitive Training on cognitive insight - BCISComposite Index -: at baseline, at post-treatment and at follow-up.

References

    1. Aghotor, J., Pfueller, U., Moritz, S., Weisbrod, M., & Roesch-Ely, D. (2010). Metacognitive training for patients with schizophrenia (MCT): Feasibility and preliminary evidence for its efficacy. Journal of Behavior Therapy and Experimental Psychiatry, 41(3), 207–211. doi: 10.1016/j.jbtep.2010.01.004.
    1. Ahuir, M., Cabezas, Á, Miñano, M. J., Algora, M. J., Estrada, F., Solé, M., … Labad, J. (2018). Improvement in cognitive biases after group psychoeducation and metacognitive training in recent-onset psychosis: A randomized crossover clinical trial. Psychiatry Research, 270, 720–723. doi: 10.1016/j.psychres.2018.10.066.
    1. Amador, X.F., & David, A. S. (Eds.). (2004). Insight and psychosis (2nd ed.). New York: Oxford University Press.
    1. Amador, X. F., Flaum, M., Andreasen, N. C., Strauss, D. H., Yale, S. A., Clark, S. C., & Gorman, J. M. (1994). Awareness of illness in schizophrenia and schizoaffective and mood disorders. Archives of General Psychiatry, 51(10), 826–836. doi: 10.1001/archpsyc.1994.03950100074007.
    1. Amador, X. F., Strauss, D. H., Yale, S. A., Flaum, M. M., Endicott, J., & Gorman, J. M. (1993). Assessment of insight in psychosis. The American Journal of Psychiatry, 150(6), 873–879. doi: 10.1176/ajp.150.6.873.
    1. American Psychiatric Association. (Eds.). (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed., text revision). Washington, DC: Author.
    1. Andreou, C., Wittekind, C. E., Fieker, M., Heitz, U., Veckenstedt, R., Bohn, F., & Moritz, S. (2017). Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study. Journal of Behavior Therapy and Experimental Psychiatry, 56, 144–151. doi: 10.1016/j.jbtep.2016.11.013.
    1. Balzan, R. P., Delfabbro, P. H., Galletly, C. A., & Woodward, T. S. (2014). Metacognitive training for patients with schizophrenia: Preliminary evidence for a targeted, single-module programme. The Australian and New Zealand Journal of Psychiatry, 48(12), 1126–1136. doi: 10.1177/0004867413508451.
    1. Balzan, R. P., Mattiske, J. K., Delfabbro, P., Liu, D., & Galletly, C. (2019). Individualized metacognitive training (MCT + ) reduces delusional symptoms in psychosis: A randomized clinical trial. Schizophrenia Bulletin, 45(1), 27–36. doi: 10.1093/schbul/sby152.
    1. Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., & Plumb, I. (2001). The “reading the mind in the eyes” test revised version: A study with normal adults, and adults with asperger syndrome or high-functioning autism. Journal of Child Psychology and Psychiatry, 42, 241–251. doi: 10.1111/1469-7610.00715.
    1. Beck, A. T., Baruch, E., Balter, J. M., Steer, R. A., & Warman, D. M. (2004). A new instrument for measuring insight: The Beck Cognitive Insight Scale. Schizophrenia Research, 68(2–3), 319–329. doi: 10.1016/S0920-9964(03)00189-0.
    1. Birchwood, M., Smith, J., Drury, V., Healy, J., Macmillan, F., & Slade, M. (1994). A self-report Insight Scale for psychosis: Reliability, validity and sensitivity to change. Acta Psychiatrica Scandinavica, 89(1), 62–67. doi: 10.1111/j.1600-0447.1994.tb01487.x.
    1. Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2010). A basic introduction to fixed-effect and random-effects models for meta-analysis. Research Synthesis Methods, 1(2), 97–111. doi: 10.1002/jrsm.12.
    1. Briki, M., Monnin, J., Haffen, E., Sechter, D., Favrod, J., Netillard, C., … Vandel, P. (2014). Metacognitive training for schizophrenia: A multicentre randomised controlled trial. Schizophrenia Research, 157(1–3), 99–106. doi: 10.1016/j.schres.2014.06.005.
    1. Buonocore, M., Bosia, M., Riccaboni, R., Bechi, M., Spangaro, M., Piantanida, M., … Cavallaro, R. (2015). Combined neurocognitive and metacognitive rehabilitation in schizophrenia: Effects on bias against disconfirmatory evidence. European Psychiatry, 30(5), 615–621. doi: 10.1016/j.eurpsy.2015.02.006.
    1. Carpenter, W. T., Strauss, J. S., & Bartko, J. J. (1973). Flexible system for the diagnosis of schizophrenia: Report from the WHO International Pilot Study of Schizophrenia. Science (New York, N.Y.), 182(4118), 1275–1278. doi: 10.1126/science.182.4118.1275.
    1. David, A. S. (1990). Insight and psychosis. The British Journal of Psychiatry, 156, 798–808. doi: 10.1192/bjp.156.6.798.
    1. David, A. S. (2019). Insight and psychosis: The next 30 years. The British Journal of Psychiatry, 18, 1–3. doi: 10.1192/bjp.2019.217.
    1. de Jong, S., van Donkersgoed, R. J. M., Timmerman, M. E., Aan Het Rot, M., Wunderink, L., Arends, J., … Pijnenborg, G. H. M. (2019). Metacognitive reflection and insight therapy (MERIT) for patients with schizophrenia. Psychological Medicine, 49(2), 303–313. doi: 10.1017/S0033291718000855.
    1. Dimaggio, G., & Lysaker, P. H. (2010). Metacognition and severe adult mental disorders: From research to treatment. London: Routledge.
    1. Duval, S., & Tweedie, R. (2000a). A nonparametric ‘Trim and Fill’ method of accounting for publication bias in meta-analysis. Journal of the American Statistical Association, 95(449), 89–98. doi: 10.1080/01621459.2000.10473905.
    1. Duval, S., & Tweedie, R. (2000b). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56(2), 455–463. doi: 10.1111/j.0006-341x.2000.00455.x.
    1. Eichner, C., & Berna, F. (2016). Acceptance and efficacy of metacognitive training (MCT) on positive symptoms and delusions in patients with schizophrenia: A meta-analysis taking into account important moderators. Schizophrenia Bulletin, 42(4), 952–962. doi: 10.1093/schbul/sbv225.
    1. Erawati, E., Keliat, B. A., Helena, N., & Hamid, A. (2014). The influence of metacognitive training on delusion severity and metacognitive ability in schizophrenia. Journal of Psychiatric and Mental Health Nursing, 21(9), 841–847. doi: 10.1111/jpm.12130.
    1. Favrod, J., Maire, A., Bardy, S., Pernier, S., & Bonsack, C. (2011). Improving insight into delusions: A pilot study of metacognitive training for patients with schizophrenia. Journal of Advanced Nursing, 67(2), 401–407. doi: 10.1111/j.1365-2648.2010.05470.x.
    1. Favrod, J., Rexhaj, S., Bardy, S., Ferrari, P., Hayoz, C., Moritz, S., … Bonsack, C. (2014). Sustained antipsychotic effect of metacognitive training in psychosis: A randomized-controlled study. European Psychiatry, 29(5), 275–281. doi: 10.1001/jamapsychiatry.2014.1038.
    1. Fisher, P., & Wells, A. (2009). Metacognitive therapy. The CBT distinctive features series. Sussex, U.K: Routledge.
    1. Flavell, J. H. (1979). Metacognition and cognitive monitoring: A new area of cognitive-developmental inquiry. American Psychologist, 34(10), 906–911. doi: 10.1037/0003-066X.34.10.906.
    1. Gawęda, Ł, Krężołek, M., Olbryś, J., Turska, A., & Kokoszka, A. (2015). Decreasing self-reported cognitive biases and increasing clinical insight through meta-cognitive training in patients with chronic schizophrenia. Journal of Behavior Therapy and Experimental Psychiatry, 48, 98–104. doi: 10.1016/j.jbtep.2015.02.002.
    1. Henry, C., & Ghaemi, S. N. (2004). Insight in psychosis: A systematic review of treatment interventions. Psychopathology, 37(4), 194–199. doi: 10.1159/000080131.
    1. Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ, 327(7414), 557–560. doi: 10.1136/bmj.327.7414.557.
    1. Hjorthøj, C., Stürup, A. E., McGrath, J. J., & Nordentoft, M. (2017). Years of potential life lost and life expectancy in schizophrenia: A systematic review and meta-analysis. The Lancet Psychiatry, 4(4), 295–301. doi: 10.1016/S2215-0366(17)30078-0.
    1. Jiang, J., Zhang, L., Zhu, Z., Li, W., & Li, C. (2015). Metacognitive training for schizophrenia: A systematic review. Shanghai Archives of Psychiatry, 27(3), 149–157. doi: 10.11919/j.issn.1002-0829.215065.
    1. Jongsma, H. E., Gayer-Anderson, C., Lasalvia, A., Quattrone, D., Mulè, A., Szöke, A., ... European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2 (EU-GEI WP2) Group. (2018). Treated incidence of psychotic disorders in the multinational EU-GEI study. JAMA Psychiatry, 75(1), 36–46. doi:10.1001/jamapsychiatry.2017.3554.
    1. Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. doi: 10.1093/schbul/13.2.261.
    1. Kemp, R., & David, A.S. (1997). Insight and compliance In Blackwell B. (Ed.), Treatment compliance and the therapeutic alliance. The Netherlands: Harwood Academic Publishers.
    1. Kokoszka, A., Telichowska-Leśna, A., & Radzio, R. (2008). A questionnaire of insight into schizophrenia – ‘my thoughts and feelings’. Psychiatria Polska, 42(4), 491–502. Retrieved from: .
    1. Köther, U., Veckenstedt, R., Vitzthum, F., Roesch-Ely, D., Pfueller, U., Scheu, F., & Moritz, S. (2012). “Don´t give me that look” – overconfidence in false mental state perception in schizophrenia. Psychiatry Research, 196(1), 1–8. doi: 10.1016/j.psychres.2012.03.004.
    1. Kumar, D., Rao, M. G., Raveendranathan, D., Venkatasubramanian, G., Varambally, S., & Gangadhar, B. N. (2015). Metacognitive training for delusion in treatment-resistant schizophrenia. Clinical Schizophrenia & Related Psychoses, 9(1), 40–43. doi: 10.3371/CSRP.KURA.031513.
    1. Kuokkanen, R., Lappalainen, R., Repo-Tiihonen, E., & Tiihonen, J. (2014). Metacognitive group training for forensic and dangerous non-forensic patients with schizophrenia: A randomised controlled feasibility trial. Criminal Behaviour and Mental Health: CBMH, 24(5), 345–357.
    1. Lam, K. C. K., Ho, C. P. S., Wa, J. C., Chan, S. M. Y., Yam, K. K. N., Yeung, O., … Balzan, R. P. (2015). Metacognitive training (MCT) for schizophrenia improves cognitive insight: A randomized controlled trial in a Chinese sample with schizophrenia spectrum disorders. Behaviour Research and Therapy, 64, 38–42. doi: 10.1016/j.brat.2014.11.008.
    1. Lincoln, T. M., Lüllmann, E., & Rief, W. (2007). Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophrenia Bulletin, 33(6), 1324–1342. doi: 10.1093/schbul/sbm002.
    1. Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage Publications.
    1. Liu, Y.-C., Tang, C.-C., Hung, T.-T., Tsai, P.-C., & Lin, M.-F. (2018). The efficacy of metacognitive training for delusions in patients with schizophrenia: A meta-analysis of randomized controlled trials informs evidence-based practice. Worldviews on Evidence-Based Nursing, 15(2), 130–139. doi: 10.1111/wvn.12282.
    1. Lüdtke, T., Pult, L. K., Schröder, J., Moritz, S., & Bücker, L. (2018). A randomized controlled trial on a smartphone self-help application (Be Good to Yourself) to reduce depressive symptoms. Psychiatry Research, 269, 753–762. doi: 10.1016/j.psychres.2018.08.113.
    1. Lysaker, P. H., & Klion, R. E. (2018). Recovery, meaning-making, and severe mental illness: A comprehensive guide to metacognitive reflection and insight therapy (First edition). New York, NY: Routledge, Taylor & Francis Group.
    1. Lysaker, P. H., Pattison, M. L., Leonhardt, B. L., Phelps, S., & Vohs, J. L. (2018). Insight in schizophrenia spectrum disorders: Relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry, 17(1), 12–23. doi: 10.1002/wps.20508.
    1. McEvoy, J. P., Freter, S., Everett, G., Geller, J. L., Appelbaum, P., Apperson, L. J., & Roth, L. (1989). Insight and the clinical outcome of schizophrenic patients. The Journal of Nervous and Mental Disease, 177(1), 48–51. doi: 10.1097/00005053-198901000-00008.
    1. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. doi:10.1371/journal.pmed.1000097.
    1. Morgan, C., Lappin, J., Heslin, M., Donoghue, K., Lomas, B., Reininghaus, U., … Dazzan, P. (2014). Reappraising the long-term course and outcome of psychotic disorders: The AESOP-10 study. Psychological Medicine, 44(13), 2713–2726. doi: 10.1017/S0033291714000282.
    1. Moritz, S., Andreou, C., Schneider, B. C., Wittekind, C. E., Menon, M., Balzan, R. P., & Woodward, T. S. (2014a). Sowing the seeds of doubt: A narrative review on metacognitive training in schizophrenia. Clinical Psychology Review, 34(4), 358–366. doi: 10.1016/j.cpr.2014.04.004.
    1. Moritz, S., Kerstan, A., Veckenstedt, R., Randjbar, S., Vitzthum, F., Schmidt, C., … Woodward, T. S. (2011a). Further evidence for the efficacy of a metacognitive group training in schizophrenia. Behaviour Research and Therapy, 49(3), 151–157. doi: 10.1016/j.brat.2010.11.010.
    1. Moritz, S., & Lysaker, P. H. (2018a). Metacognition – What did James H. Flavell really say and the implications for the conceptualization and design of metacognitive interventions. Schizophrenia Research, 201, 20–26. doi: 10.1016/j.schres.2018.06.001.
    1. Moritz, S., Mahlke, C. I., Westermann, S., Ruppelt, F., Lysaker, P. H., Bock, T., & Andreou, C. (2018b). Embracing psychosis: A cognitive insight intervention improves personal narratives and meaning-making in patients with schizophrenia. Schizophrenia Bulletin, 44(2), 307–316. doi: 10.1093/schbul/sbx072.
    1. Moritz, S., Veckenstedt, R., Andreou, C., Bohn, F., Hottenrott, B., Leighton, L., … Roesch-Ely, D. (2014b). Sustained and “Sleeper” effects of group metacognitive training for schizophrenia: A randomized clinical trial. JAMA Psychiatry, 71(10), 1103. doi: 10.1001/jamapsychiatry.2014.1038.
    1. Moritz, S., Veckenstedt, R., Bohn, F., Hottenrott, B., Scheu, F., Randjbar, S., … Roesch-Ely, D. (2013). Complementary group Metacognitive Training (MCT) reduces delusional ideation in schizophrenia. Schizophrenia Research, 151(1–3), 61–69. doi: 10.1016/j.schres.2013.10.007.
    1. Moritz, S., Veckenstedt, R., Randjbar, S., Vitzthum, F., & Woodward, T. S. (2011b). Antipsychotic treatment beyond antipsychotics: Metacognitive intervention for schizophrenia patients improves delusional symptoms. Psychological Medicine, 41(9), 1823–1832.
    1. Moritz, S., & Woodward, T. S. (2007). Metacognitive training for schizophrenia patients (MCT): A pilot study on feasibility, treatment adherence, and subjective efficacy. German Journal of Psychiatry, 10(3), 69–78. Retrieved from: .
    1. Morris, S. B., & DeShon, R. P. (2002). Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychological Methods, 7(1), 105–125. doi: 10.1037/1082-989x.7.1.105.
    1. Nair, A., Palmer, E. C., Aleman, A., & David, A. S. (2014). Relationship between cognition, clinical and cognitive insight in psychotic disorders: A review and meta-analysis. Schizophrenia Research, 152(1), 191–200. doi: 10.1016/j.schres.2013.11.033.
    1. Naughton, M., Nulty, A., Abidin, Z., Davoren, M., O'Dwyer, S., & Kennedy, H. G. (2012). Effects of group metacognitive training (MCT) on mental capacity and functioning in patients with psychosis in a secure forensic psychiatric hospital: A prospective-cohort waiting list controlled study. BMC Research Notes, 5, 302. doi: 10.1186/1756-0500-5-302.
    1. Ochoa, S., López-Carrilero, R., Barrigón, M. L., Pousa, E., Barajas, A., Lorente-Rovira, E., … Spanish Metacognition Study Group. (2017). Randomized control trial to assess the efficacy of metacognitive training compared with a psycho-educational group in people with a recent-onset psychosis. Psychological Medicine, 47(9), 1573–1584. doi:10.1017/S0033291716003421.
    1. Phan, K., Xie, A., Di Eusanio, M., & Yan, T. D. (2014). A meta-analysis of minimally invasive versus conventional sternotomy for aortic valve replacement. The Annals of Thoracic Surgery, 98(4), 1499–1511. doi: 10.1016/j.athoracsur.2014.05.060.
    1. Philipp, R., Kriston, L., Lanio, J., Kühne, F., Härter, M., Moritz, S., & Meister, R. (2019). Effectiveness of metacognitive interventions for mental disorders in adults-A systematic review and meta-analysis (METACOG). Clinical Psychology & Psychotherapy, 26(2), 227–240. doi: 10.1002/cpp.2345.
    1. Pijnenborg, G. H. M., de Vos, A. E., Timmerman, M. E., Van der Gaag, M., Sportel, B. E., Arends, J., … Aleman, A. (2019). Social cognitive group treatment for impaired insight in psychosis: A multicenter randomized controlled trial. Schizophrenia Research, 206, 362–369. doi: 10.1016/j.schres.2018.10.018.
    1. Pijnenborg, G. H. M., van Donkersgoed, R. J. M., David, A. S., & Aleman, A. (2013). Changes in insight during treatment for psychotic disorders: A meta-analysis. Schizophrenia Research, 144(1–3), 109–117. doi: 10.1016/j.schres.2012.11.018.
    1. Rocha, N. B. F., & Queirós, C. (2013). Metacognitive and social cognition training (MSCT) in schizophrenia: A preliminary efficacy study. Schizophrenia Research, 150(1), 64–68. doi: 10.1016/j.schres.2013.07.057.
    1. Ross, K., Freeman, D., Dunn, G., & Garety, P. (2011). A randomized experimental investigation of reasoning training for people with delusions. Schizophrenia Bulletin, 37(2), 324–333. doi: 10.1093/schbul/sbn165.
    1. Sheehan, D. V., Lecrubier, Y., Sheehan, K., Amorim, P., Janavs, J., Weiller, E., …Dunbar, G. C. (1998). The MINI International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview. Journal of Clinical Psychiatry, 59(20), 22–23.
    1. So, S. H.-W., Chan, A. P., Chong, C. S.-Y., Wong, M. H.-M., Lo, W. T.-L., Chung, D. W.-S., & Chan, S. S. (2015). Metacognitive training for delusions (MCTd): Effectiveness on data-gathering and belief flexibility in a Chinese sample. Frontiers in Psychology, 6, 730. doi: 10.3389/fpsyg.2015.00730.
    1. Ussorio, D., Giusti, L., Wittekind, C. E., Bianchini, V., Malavolta, M., Pollice, R., … Roncone, R. (2016). Metacognitive training for young subjects (MCT young version) in the early stages of psychosis: Is the duration of untreated psychosis a limiting factor? Psychology and Psychotherapy, 89(1), 50–65. doi: 10.1111/papt.12059.
    1. Van Camp, L. S. C., Sabbe, B. G. C., & Oldenburg, J. F. E. (2017). Cognitive insight: A systematic review. Clinical Psychology Review, 55, 12–24. doi: 10.1016/j.cpr.2017.04.011.
    1. van Oosterhout, B., Krabbendam, L., de Boer, K., Ferwerda, J., van der Helm, M., Stant, A. D., & van der Gaag, M. (2014). Metacognitive group training for schizophrenia spectrum patients with delusions: A randomized controlled trial. Psychological Medicine, 44(14), 3025–3035. doi: 10.1017/S0033291714000555.
    1. van Oosterhout, B., Smit, F., Krabbendam, L., Castelein, S., Staring, A. B. P., & van der Gaag, M. (2016a). Metacognitive training for schizophrenia spectrum patients: A meta-analysis on outcome studies. Psychological Medicine, 46(1), 47–57. doi: 10.1017/S0033291715001105.
    1. van Oosterhout, B., Smit, F., Krabbendam, L., Castelein, S., Staring, A. B. P., & van der Gaag, M. (2016b). Psychological Medicine, 46, 2003–2005. doi: 10.1017/S003329171600009X.
    1. Vohs, J. L., Leonhardt, B. L., James, A. V., Francis, M. M., Breier, A., Mehdiyoun, N., … Lysaker, P. H. (2018). Metacognitive reflection and insight therapy for early psychosis: A preliminary study of a novel integrative psychotherapy. Schizophrenia Research, 195, 428–433. doi: 10.1016/j.schres.2017.10.041.
    1. Wells, A., & Purdon, C. (1999). Metacognition and cognitive-behaviour therapy: A special issue. Clinical Psychology & Psychotherapy, 6(2), 71–72. doi: 10.1002/(SICI)1099-0879(199905)6:;2-G.
    1. Wilson, D. B. (2010). Meta-analysis macros for SAS, SPSS, and Stata. Retrieved from: .
    1. World Health Organization. (Ed.). (1993). The ICD-10 classification of mental and behavioural disorders: Diagnostic criteria for research. Geneva: Author.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere