Options
Metacognitive training (MCT) for psychosis: a systematic review and grade recommendations
Journal
European Psychiatry
Date Issued
2025
Author(s)
Adrien Goncalves
Susana Ochoa
Steffen Moritz
Łukasz Gawęda
Caroline König
Rabea Fischer
Antonia Meinhart
Maria Lamarca
Rosa Ayesa-Arriola
Ryan Balzan
Kerem Böge
Tania Lecomte
Stéphane Raffard
Fabrice Berna
Abstract
<jats:title>Abstract</jats:title>
<jats:sec id="S0924933825100278_sec1">
<jats:title>Background</jats:title>
<jats:p>Recent meta-analyses support the inclusion of cognitive behavioral therapy (CBT) in schizophrenia treatment. Metacognitive Training (MCT) for psychosis is a psychoeducational program derived from CBT, with most meta-analyses showing favorable results. Although meta-analyses are commonly used in clinical practice to guide evidence-based decision-making, the grading system provides complementary results by offering a structured approach for assessing the strength and reliability of evidence and deriving grades of recommendations accordingly.</jats:p>
</jats:sec>
<jats:sec id="S0924933825100278_sec2" sec-type="methods">
<jats:title>Methods</jats:title>
<jats:p>Our research applies the guidelines from the World Federation of Societies of Biological Psychiatry (WFSBP) to propose grades of recommendation for MCT for psychosis, analyzing 38 randomized controlled trials (RCTs) (<jats:italic>n</jats:italic> = 1942) and 10 meta-analyses. The primary outcome was positive symptoms, with secondary measures including negative symptoms, general psychopathology, self-esteem, functioning, insight, and cognitive function.</jats:p>
</jats:sec>
<jats:sec id="S0924933825100278_sec3" sec-type="results">
<jats:title>Results</jats:title>
<jats:p>Our findings are primarily based on the risks of bias attributed to RCTs (11 high, 19 moderate, 6 low) and, when necessary, on the overall confidence attributed to meta-analyses (3 low, 7 critically low). According to the WFSBP guidelines, strong recommendations should be made for using MCT for psychosis to improve post-treatment positive symptoms, delusions, and total psychotic symptoms (WFSBP-grade 1). Limited recommendations (WFSBP-grade 2) could be made for using MCT to improve post-treatment visuospatial abilities and to maintain benefits over time in psychopathology, functioning, self-esteem, episodic memory, and attention.</jats:p>
</jats:sec>
<jats:sec id="S0924933825100278_sec4" sec-type="conclusions">
<jats:title>Conclusions</jats:title>
<jats:p>MCT for psychosis is an evidence-based program, especially for positive symptoms, with long-lasting clinical benefits. These recommendations should be interpreted with caution given potential residual biases and heterogeneity among studies.</jats:p>
</jats:sec>
<jats:sec id="S0924933825100278_sec1">
<jats:title>Background</jats:title>
<jats:p>Recent meta-analyses support the inclusion of cognitive behavioral therapy (CBT) in schizophrenia treatment. Metacognitive Training (MCT) for psychosis is a psychoeducational program derived from CBT, with most meta-analyses showing favorable results. Although meta-analyses are commonly used in clinical practice to guide evidence-based decision-making, the grading system provides complementary results by offering a structured approach for assessing the strength and reliability of evidence and deriving grades of recommendations accordingly.</jats:p>
</jats:sec>
<jats:sec id="S0924933825100278_sec2" sec-type="methods">
<jats:title>Methods</jats:title>
<jats:p>Our research applies the guidelines from the World Federation of Societies of Biological Psychiatry (WFSBP) to propose grades of recommendation for MCT for psychosis, analyzing 38 randomized controlled trials (RCTs) (<jats:italic>n</jats:italic> = 1942) and 10 meta-analyses. The primary outcome was positive symptoms, with secondary measures including negative symptoms, general psychopathology, self-esteem, functioning, insight, and cognitive function.</jats:p>
</jats:sec>
<jats:sec id="S0924933825100278_sec3" sec-type="results">
<jats:title>Results</jats:title>
<jats:p>Our findings are primarily based on the risks of bias attributed to RCTs (11 high, 19 moderate, 6 low) and, when necessary, on the overall confidence attributed to meta-analyses (3 low, 7 critically low). According to the WFSBP guidelines, strong recommendations should be made for using MCT for psychosis to improve post-treatment positive symptoms, delusions, and total psychotic symptoms (WFSBP-grade 1). Limited recommendations (WFSBP-grade 2) could be made for using MCT to improve post-treatment visuospatial abilities and to maintain benefits over time in psychopathology, functioning, self-esteem, episodic memory, and attention.</jats:p>
</jats:sec>
<jats:sec id="S0924933825100278_sec4" sec-type="conclusions">
<jats:title>Conclusions</jats:title>
<jats:p>MCT for psychosis is an evidence-based program, especially for positive symptoms, with long-lasting clinical benefits. These recommendations should be interpreted with caution given potential residual biases and heterogeneity among studies.</jats:p>
</jats:sec>