Sex differences in neurocognitive response to metacognitive training in first-episode psychosis: Implications for personalized interventions
Year: 2026
Type: article
Study design: Clinical Trial
Abstract: PURPOSE: Neurocognitive impairments are a core feature of psychosis and impact long-term outcomes. While sex differences in neurocognition have been observed in first-episode psychosis (FEP), findings remain mixed, and little is known about differential responses to metacognitive interventions. This study examined sex differences in the effectiveness of Metacognitive Training (MCT) on neurocognitive outcomes in FEP. METHODS: A total of 122 individuals with FEP were randomized to receive either MCT or psychoeducational intervention. Neurocognitive performance was assessed at baseline and at 6-month follow-up using a comprehensive battery (CPT-II, TMT, WCST, Stroop test, TAVEC, WAIS-III Digit Span). General Linear Models tested the effects of intervention, sex, and their interaction, both unadjusted and adjusted for covariates. RESULTS: MCT led to greater improvements than psychoeducation in immediate recall, processing speed, cognitive flexibility, inhibitory control, and attention. Improvements in immediate recall and Stroop Interference remained significant after adjustment, with Stroop performance also influenced by diagnosis. Across groups, men performed better in verbal memory, while women showed increased serial clustering in short-term recall, an effect that remained significant after adjustment. Notably, a group-by-sex interaction indicated that women receiving MCT experienced greater gains in short-term recall after controlling for covariates. CONCLUSIONS: MCT enhances specific neurocognitive functions in FEP and shows promising effects for women in verbal memory processes. These findings underscore the importance of incorporating sex and diagnostic factors when tailoring early interventions for psychosis and highlight the potential of MCT as a personalized cognitive strategy.
Authors: Marina Verdaguer-Rodríguez, Josep Oriol Comas, Raquel López-Carrilero, Luciana Díaz-Cutraro, Victoria Espinosa, Isabel Ruiz-Delgado, María Luisa Barrigón, Eva Grasa, Esther Pousa, Fermín González-Higueras, Jordi Cid, Esther Lorente-Rovira, Ana Barajas, Spanish Metacognition Study Group, A. Acevedo, A. Alonso-Solís, J. Anglès, L. Ansó, M. A. Argany, A. Aznar, M. L. Barrigón, M. Beltrán, I. Birulés, J. L. Bogas, N. Camprubí, M. Carbonero, E. Carrasco, R. Casañas, J. Cid, E. Conesa, I. Corripio, P. Cortes, A. de Apraiz, M. Delgado, L. Domínguez, M. J. Escartí, A. Escudero, I. Esteban Pinos, C. Franco, C. García, R. Gonzalez-Casares, F. González-Higueras, M. A. L. González-Montoro, E. González, E. Grasa-Bello, A. Guasp, M. E. Huerta-Ramos, P. Huertas, A. Jiménez-Díaz, L. L. Lalucat, B. Llacer, R. López-Carrilero, A. López-Frutos, E. Lorente, A. Luengo, N. Mantecón, L. Mas-Expósito, M. Montes, S. Moritz, E. Murgui, M. Nuñez, E. Palomer, T. Peláez, K. Planell, C. Planellas, P. Pleguezuelo-Garrote, E. Pousa, M. Renovell, N. Rodríguez, R. Rubio, I. Ruiz-Delgado, M. San Emeterio, E. Sánchez, S. Sánchez-Alonso, J. Sanjuán, B. Sans, H. Sió, M. Teixidó, P. Torres, M. Vidiella, M. A. Vila, R. Vila-Badia, F. Villegas, Susana Ochoa
Institutions: Universitat Autònoma de Barcelona, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Andalusian Health Service, Universidad Complutense de Madrid, Hospital General Universitario Gregorio Marañón, Institut de Recerca Sant Pau, Hospital de Sant Pau, Complejo Hospitalario de Jaén, Institut d'Assistència Sanitària, Hospital Clínico Universitario de Valencia, Generalitat de Catalunya
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,990
OpenAlex ID: W7128387448