Influencing schizophrenia treatment worldwide
Reprinted from the "CBT" issue of Visions Journal, 2009, 6 (1), p. 20
What is metacognition?
“Meta” means above and “cognition” refers to thinking or perceiving. Thus, metacognition is being aware of one’s thoughts—or, thinking about one’s thinking.
About metacognitive training
Metacognitive training (MCT) is a program developed directly from current cognitive neuropsychiatry research findings on schizophrenia and psychosis. MCT shares knowledge gained in research labs to help individuals experiencing psychosis become more aware of the thinking patterns involved in their illness.
The training was developed (and continues to be developed) by Steffen Moritz at the University Medical Centre Hamburg-Eppendorf in Germany and myself. My research, some of which is shared through the MCT, has been carried out through the BC Mental Health and Addictions Research Institute and the University of British Columbia. The first MCT manual was published in 2005. MCT is currently used in more than 40 centres worldwide and has been translated into 14 languages.
The main purpose of the metacognitive training is to help people change the thinking patterns that cause delusions, thereby avoiding relapse into illness or reducing the impact of delusions.
How does MCT work?
Research shows that people with schizophrenia or psychosis tend to think and reason in ways that can help establish delusions.1 Delusions are false beliefs that aren’t shared by others in the community. For example, the belief that one is being spied on by the CIA is (almost always) an example of a delusion
Psychosis (delusions and hallucinations) is not a sudden and instantaneous incident. It often begins with a gradual change in one’s thinking and social environment. Learning to be aware of one’s thoughts can help prevent psychotic breakdown.
The MCT is a group-based program that teaches participants about common thinking patterns to which they may be prone. The program also suggests ways to counter these potentially problematic thought patterns.
Erroneous or distorted thinking patterns may—on their own or in combination with other factors—help establish delusions. Processing emotionally charged information through distorted thinking styles may trigger delusional thoughts.
Common thinking distortions include:
making strong judgments based on little evidence
blaming other people rather than circumstances
being unable to fully consider and accept information provided by other people
being unable to let go of strongly held positions
being overconfident that inaccurate memories are in fact accurate
The MCT program aims to raise clients’ awareness of these distortions and to prompt them to critically reflect on, complement and change their current problem-solving tools.
MCT never addresses participants’ specific delusions. However, individual delusional themes can be addressed in one-to-one therapeutic sessions, such as cognitive-behavioural therapy (CBT). Also, our new MCT+ program,* though based on our group MCT, is more individualized and can be used to supplement CBT (www.uke.de/mkt_plus).
The program is provided in a group program structure because the generation of ideas that results from participant interaction is key to the learning process.
Each cycle of the program is made up of eight modules. Presenting two modules per week, one module each session, is helpful because a full cycle can be completed in one month. There are also two cycles of the program available. They cover the same topics, but the instructional content is different. This is so participants can repeat the training and have a fresh learning experience.
Each session emphasizes the learning objective of the module (“Why are we doing this?”) and the practical relevance to the individual’s experiences (“What does this have to do with psychosis?”).
The module topics are: Attribution—Blaming and Taking Credit; Jumping to Conclusions I; Changing Beliefs; To Empathize I; Memory; To Empathize II; Jumping to Conclusions II; and Self-esteem and Mood.
The sessions are entertaining and designed to capture participants’ attention (see sidebar). Although the exercises are fun, they also challenge problem thinking patterns.
Though MCT is an interactive program, participants are not pressured to be involved. They are asked to participate at their own comfort level.
Discussion about what type of thinking underlies delusions is encouraged—but participants are not required to discuss their individual (possibly delusional) beliefs.
How can you benefit from MCT?
Early research suggests that MCT produces a reduction in the severity of delusions.2 And in a feasibility study, the MCT program was rated as more fun and more useful in daily life than an alternative cognitive program administered to a control group.3 Voluntary participation has been excellent, and the participants tend to recommend the program to others.
How can you participate in a session?
The MCT program is not offered publically to a general audience. Members of your care team are encouraged to access all the resources they would need to administer the program themselves. A number of care teams in the Lower Mainland are currently offering this program to their clients.
MCT is available free of charge to any health professional running support groups for people with schizophrenia and psychosis. Information, materials and program modules can be accessed through the University Medical Centre Hamburg-Eppendorf (www.uke.de/mkt).
About the authorTodd is an Assistant Professor in Psychiatry at UBC and a research scientist at the BC Mental Health and Addiction Research Institute. He is the co-creator of metacognitive training (MCT) with primary developer Steffen Moritz of the University Medical Centre Hamburg-Eppendorf in Germany. Todd researches the neural and cognitive underpinnings of psychosis and schizophrenia.
Garety, P.A. & Freeman, D. (1999). Cognitive approaches to delusions: A critical review of the evidence. British Journal of Clinical Psychology, 38(), 113-154.
Moritz, S. & Woodward, T.S. (2007b). Metacognitive training in schizophrenia: From basic research to knowledge translation and intervention. Current Opinion in Psychiatry, 20(6), 619-625.
Moritz, S. & Woodward, T.S. (2007a). Metacognitive training for schizophrenia patients (MCT): A pilot study on feasibility, treatment adherence, and subjective efficacy. German Journal of Psychiatry, 10(3), 69-78.