What Is Metacognitive Training?
Metacognitive training (MCT) is an intervention generally framed to modify metacognitive beliefs in people. Here and now, it is inclined to treat the symptoms of schizophrenia (periods of psychosis) and psychosis. Stephen Moritz and Todd Woodward developed this training. Metacognitive training is based on the theories of cognitive behavioral therapy (a psychosocial approach for mental disorders to reduce depression, anxiety, and cognitive thoughts). And this intervention chiefly focuses on and withdraws the cognitive biases, which could be the first positive sign of psychosis.
What Are Psychosis and Its Cognitive Bias?
Psychosis is a mental health disorder in which a person gets detached from reality. Psychosis may occur underlying psychotic illness like schizophrenia, drug abuse, or any medication.
Common symptoms of psychosis,
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Delusion-false belief.
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Impairment in talking and learning.
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Disturbed thoughts.
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Hyperactivity.
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Aggression.
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Nervousness.
Cognitive thoughts or delusion is the prevalent stuff in psychosis that makes one disconnect from reality. Cognitive bias is the systematic thought process in which an individual forms a subject reality with their perception. This might result in impairment and distorted behavior. Here, the brain simplifies the information on their input, personalized experiences, and preferences. An example of cognitive thoughts is ‘jumping to conclusions.
What Is ‘Jumping to Conclusion’?
It is a psychological term known for communication obstacles in which one decides or presumes the situation without knowing the facts, thus resulting in an unwarranted conclusion. In simple words, we do not see things clearly and make our own undesirable decisions. An example of the ‘jumping to conclusion’ phrase is, If one is not talking to a person passing by, then the person ends up thinking that he/she is angry. But the actual reason is not based on that fact or conclusion.
What Is the Aim of Metacognitive Training?
Metacognition is ‘thinking about thinking. Metacognitive training aims at identifying one's insights or perceptions and recovering them. Also, aims to give awareness about cognitive thoughts and bias. Over time of metacognitive training, the positive symptoms of psychosis are diminished, particularly paranoid ideas. It also aims to dwindle one’s confidence in false belief in reality and also show possible effects on "jumping to conclusions."
What Are the Types of Metacognitive Training?
The training is available in two forms,
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Group format metacognitive training (MCT).
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Individualized metacognitive training (MCT+).
Both individualized and group training target positive symptoms, cognitive thoughts, and jumping to conclusions. However, Individualized metacognitive training would be even more effective as it cares about individualized topics.
How Does Metacognitive Intervention Work?
The metacognitive intervention comprises eight MCT modules(training units) and four additional modules. They present these modules in a joyful way to patients experiencing psychosis or schizophrenia. So that the patients watch over the sessions and observe in a group or person, then they ask them to reflect on their thoughts and prompt them, which leads to distorted behavior. And they are also informed to implement those training in their day-to-day life. End of the day, assignments will be given to each patient. One group cycle represents eight modules within four weeks, and another cycle would be optional based on the patient's cooperation.
Steps in the Training:
Every module begins with psychoeducational elements with examples and exercises. All domains are explained one at a time. And also, the drawback of being cognition is illustrated. The next step is defining the pathological extremes of each bias. Then, they are taught how to overcome the exaggeration of thinking bias in life with case examples of psychotic patients. The group metacognitive training is allowed to share their own delusion experiences.
Eight modules of MCT,
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Attributional distortions or monocausal (single-handed) attributions.
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Jumping to conclusion bias.
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Bias against conformational evidence.
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Shortfalls in the theory of mind.
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Overconfidence in memory errors.
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Shortfalls in the theory of mind.
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Jumping to conclusion bias.
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Depressive cognition.
While the additional modules are for,
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Stigma.
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Low self-esteem.
Correction of these problematic or impractical thinking styles would eventually reduce the symptoms.
Is Metacognitive Training Effective?
After fulfilling diagnostic criteria and baseline assessments, patients were categorized for pharmacological therapies and psychotherapy. They are examined with Psychotic Symptoms Rating Scales (PSYRATS) and are then treated accordingly. The results are evident that metacognitive training has surplus effects on psychosis even with the patients showing partial response to antipsychotic drugs. An older analysis of metacognitive training with patients showed less effect. At the same time, the new meta-analysis proved enough efficacious findings on the improvement of symptoms and delusions. Royal Australian and New Zealand College of Psychiatrists and the German Association for Psychiatry, Psychosomatics, and Psychotherapy suggested metacognitive training as evidence-based training for psychosis and psycho-related disorders.
Metacognitive Training for Other Disorders;
Metacognitive training has been practiced in other psycho-related disorders since its founding. Those disorders include depression, bipolar disorders, schizophrenia, obsessive-compulsive disorder (OCD), and borderline personality disorder.
How does Cognitive Behavioral Therapy (CBT) Differ From Metacognitive Training(MCT)?
Cognitive behavioral therapy is a psychosocial intervention to treat mental health disorders that primarily aids in depression and anxiety disorders. Like metacognition training, this relieves cognizant thinking bias and their associated distorted behaviors. Both therapies are goal-directed, brief, well-oriented, and structured, but CBC focuses only on cognition, and MCT focuses on the meta-level of cognition (cognition over cognition).
Conclusion
Although persistent positive symptoms and cognition bias are the major challenge of psychiatric care, the training demotes the symptoms and induces a bias-free person. However, further studies are going on to elucidate the mechanism and efficiency of metacognitive training.
