Psychological Medicine

Original Articles

Antipsychotic treatment beyond antipsychotics: metacognitive intervention for schizophrenia patients improves delusional symptoms

S. Moritza1 c1, R. Veckenstedta1, S. Randjbara1, F. Vitzthuma1 and T. S. Woodwarda2a3

a1 University Hospital Hamburg-Eppendorf, Hospital for Psychiatry and Psychotherapy, Martinistraße 52, Hamburg, Germany

a2 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada

a3 BC Mental Health and Addictions Research Institute, Vancouver, British Columbia, Canada


Background Although antipsychotic medication still represents the treatment of choice for schizophrenia, its objective impact on symptoms is only in the medium-effect size range and at least 50% of patients discontinue medication in the course of treatment. Hence, clinical researchers are intensively looking for complementary therapeutic options. Metacognitive training for schizophrenia patients (MCT) is a group intervention that seeks to sharpen the awareness of schizophrenia patients on cognitive biases (e.g. jumping to conclusions) that seem to underlie delusion formation and maintenance. The present trial combined group MCT with an individualized cognitive-behavioural therapy-oriented approach entitled individualized metacognitive therapy for psychosis (MCT+) and compared it against an active control.

Method A total of 48 patients fulfilling criteria of schizophrenia were randomly allocated to either MCT+ or cognitive remediation (clinical trial NCT01029067). Blind to intervention, both groups were assessed at baseline and 4 weeks later. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scales (PSYRATS). Jumping to conclusions was measured using a variant of the beads task.

Results PANSS delusion severity declined significantly in the combined MCT treatment compared with the control condition. PSYRATS delusion conviction as well as jumping to conclusions showed significantly greater improvement in the MCT group. In line with prior studies, treatment adherence and subjective efficacy was excellent for the MCT.

Conclusions The results suggest that the combination of a cognition-oriented and a symptom-oriented approach ameliorate psychotic symptoms and cognitive biases and represents a promising complementary treatment for schizophrenia.

(Received April 26 2010)

(Revised November 11 2010)

(Accepted December 08 2010)

(Online publication January 28 2011)


c1 Address for correspondence: Prof. Dr. S. Moritz, University Hospital Hamburg-Eppendorf, Hospital for Psychiatry and Psychotherapy, Martinistraße 52, Hamburg, Germany. (Email: