Work

F121. Metacognitive Training (mct) to Improve Insight and Work Outcome in Schizophrenia

Year: 2019

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: Metacognitive capacity is the awareness and understanding of one’s own thought processes and how they influence behaviors (Lysaker et al., 2005). Deficits in metacognition in people with psychosis represent a significant barrier to benefiting from psychosocial treatments such as work therapy (Lysaker et al., 2010). Therapies that target features of metacognition, such as insight into cognitive biases or overconfidence in errors, have been shown to exert some beneficial effects on symptomatic parameters and psychosocial outcome (Moritz et al., 2011) Following meta-analyses that demonstrate its effectiveness, MCT has been incorporated into several national treatment guidelines. In an exploratory pilot, we sought to examine if metacognitive training would lead to improvements in illness insight and symptoms as well as work therapy and supported employment outcomes. Twenty-four adult outpatients with schizophrenia enrolled in a work therapy program were randomized to either treatment as usual or 2 months of Metacognitive Training (MCT; Moritz & Woodward, 2007), a group-based therapy aimed at enhancing insight into cognitive biases underlying paranoia and delusions. Work therapy consisted of 2–6 supervised/structured hours/week for 8–14 weeks at sites around The Institute of Living (gift shop, cafeteria, greenhouse, or janitorial services). Following work therapy, participants were enrolled in a SE program coordinated by Easter Seals Capital Region. Assessments of insight (SUMD), symptoms (BPRS), and work behavior (WBI) were administered at baseline, post (2mo), and follow-up 1 (4mo). Employment outcome was collected at follow-up 2 (12mo). At post, while both groups improved in work behavior, the MCT group demonstrated better work behavior than treatment as usual (F(1,22)=2.87, p=.030). Although there were no significant changes in insight or positive symptoms in either group at post, interestingly, the MCT group demonstrated greater insight (F=3.16, p=.026) and fewer positive symptoms at two-month follow-up (F=3.53, p=.018). Regarding employment outcome, a greater percentage of those who received MCT were employed in the community (chi square=13.79, p=.018). Results provide additional evidence that improvements in metacognitive capacity may contribute to increased insight into illness, reduction in symptomology, and improvements in vocational outcomes among individuals with schizophrenia. Differences found in work behavior and employment outcomes may be explained by an individual’s ability to think about and correct one’s thinking about work-related matters. Individuals who can recognize biases in their thinking may be better able to find new ways to think about and respond to workplace challenges. Conversely, limited capacity to identify these biases may serve as a barrier in work-performance over time. Delayed improvements in insight and symptomology suggest what is learned in cognitive and work therapy may need time to consolidate before an individual is able to identify benefits. The small sample size limits generalizability of these findings; however, the study’s exploratory nature may provide hypotheses for future research.

Source: Schizophrenia Bulletin

DOI: 10.1093/schbul/sbz018.533