Efficacy of individualised metacognitive therapy (MCT+) for delusions in psychosis

INTERVENTION: Metacognitive therapy (MCT+) is a novel psychotherapeutic approach that builds on the concepts and goals of cognitive‐behavioural therapy for psychosis. MCT+ targets the cognitive biases (i.e. distortions in the collection and processing of information) thought to underlie the formation and maintenance of delusional beliefs, and aims to bring to the attention of patients the cognitive dysfunctions that may be causing or maintaining their delusional symptoms (i.e. ‘metacognitive’ implies ‘thinking about one’s thinking’). One of the three fundamental components of the programme is knowledge translation. The second component is a demonstration of the negative consequences of these cognitive biases via exercises that target each bias individually. Finally, patients are offered alternative thinking strategies, which may help them to arrive at more appropriate inferences and thereby avoid the ‘cognitive traps’ that otherwise lead to delusional beliefs. It consists of 8 modules covering (i) six cognitive biases common in psychosis (jumping‐to‐conclusions, attribution bias, belief inflexibility, theory of mind deficits, false memories, depressive thinking styles), (ii) an introductory and relapse prevention module. It is individually administered (face‐to‐face) by a psychologist (eligible or working towards eligibility for clinical endorsement) across 4 x 2 hour sessions, once/week for 4 weeks (plus 3 assessment sessions at baseline, 6‐week follow‐up, 6‐month follow‐up) at Lyell McEwin, Flinders and Noarlunga Hospitals. Attendance to the four individual therapy sessions will be recorded for each participant. CONDITION: delusions schizophrenia spectrum disorders PRIMARY OUTCOME: Delusional severity as assessed by mean Positive and Negative Syndrome Scale (PANSS) P1 item (Delusions). Delusional severity as assessed by mean Psychotic Symptom Rating Scales (PSYRATS) delusion subscale total score. SECONDARY OUTCOME: Brief Assessment of Cognition in Schizophrenia (BACS) will be used to assess various cognitive domains (e.g., working memory, verbal learning, reasoning and problem‐solving, processing speed). Clinical insight will be assessed with the Schedule for Assessment of Insight ; Cognitive insight will be assessed with the Beck Cognitive Insight Scale (i.e., measures of self‐certainty and self‐reflectiveness) INCLUSION CRITERIA: a) Must have a DSM‐5 diagnosis of a schizophrenia spectrum disorder (this will be confirmed by the ‘Psychotic Disorder’ subscale of the Mini‐International Neuropsychiatric Interview or M.I.N.I). b) Must hold mild to moderate delusional beliefs as a minimum; this will be confirmed by a baseline ‘Delusions’ subscale score >3 of the Positive and Negative Syndrome Scale (PANSS). c) Must be able to speak, read and understand English and have the ability to respond to questions and follow instructions.