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Efficacy of metacognitive training to reduce delusions: a randomized clinical trial

English title Efficacy of metacognitive training to reduce delusions: a randomized clinical trial
Applicant Favrod Jérôme
Number 129784
Funding scheme DORE project funding
Research institution Institut & Haute Ecole de la Santé La Source HES-SO
Institution of higher education University of Applied Sciences and Arts Western Switzerland - HES-SO
Main discipline Health
Start/End 01.06.2010 - 31.05.2012
Approved amount 148'480.00
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Keywords (6)

delusion; insight; cognitive and behavioural therapy; metacognitive training; psychotic disorder; psychotic symptoms

Lay Summary (English)

Lead
Lay summary
Lead: Persistent psychotic symptoms remain a major obstacle to recovery in people suffering from schizophrenia. Delusional activity is associated with work disability, repeated hospitalisations and lower quality of life. Metacognitive training is a new intervention which aims at reducing delusions.

Summary:Despite recent advances in pharmacological and psychosocial treatments of schizophrenia, slightly over half of modern-day patients with schizophrenia are vulnerable to frequent or persistent delusional activity after the acute phase even when treatment compliance is not an issue. Adjunctive cognitive behavioural therapy of psychotic symptoms can produce robust but moderate supplementary improvements which give room for progress. During the past decade basic sciences have put in evidence several cognitive biases associated with delusion. People with delusion are not aware of these cognitive errors. Metacognitive training aims at helping patient to become aware of the cognitive mechanisms leading to false beliefs. Participants who will give their informed consent to participate at the study will be randomized to receive either eight one-hour metacognitive training in weekly group session in addition to usual treatment or usual treatment alone. Participant will be assessed at baseline, at the end of the intervention and at six month follow-up.

Specific Aims: As main outcome, the study will compare the impact of the addition of metacognitive training on severity of delusions to usual treatment alone. The impact of the training on insight, hallucinations, use of services and functional consequences of psychosis will be also assessed as secondary outcomes.

Expected value of the study: This study expects to improve the psychosocial treatment of persistent psychotic symptoms in patients suffering from schizophrenia. This outlook is based on the results of our pilot study which indicated excellent acceptation of the training by participants, reduction in the severity of delusions and improvement of insight and depression. In addition, metacognitive training popularizes the acquired knowledge from basic research on cognitive biases into terms that are understandable. Finally, metacognitive training is a free, open access program, translated in various languages, available on: www.uke.de/mkt. If its efficacy is demonstrated, it can be easily implemented in routine clinical practice.

Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Project partner

Publications

Publication
Effets de l’entraînement métacognitif sur la conscience des idées délirantes
Favrod J. Brana A. Nguyen A. Nicolier A. Perret M. Rexhaj S. (2015), Effets de l’entraînement métacognitif sur la conscience des idées délirantes, in Journal de Thérapie Comportementale et Cognitive, 25(3), 117-124.
Metacognitive training for schizophrenia : a multicentric randomized controlled trial
Briki M Monnin JHaffen E Sechter D Favrod J Netillard C Cheraitia E Marin K & al. (2014), Metacognitive training for schizophrenia : a multicentric randomized controlled trial, in Schizophrenia Research, 157, 99-106.
Safety-seeking behaviours and verbal auditory hallucinations in schizophrenia
Chaix J Ma E Nguyen A Ortiz Collado MA Rexhaj S & Favrod J. (2014), Safety-seeking behaviours and verbal auditory hallucinations in schizophrenia, in Psychiatry research, 220(1-2), 158-162.
Sustained antipsychotic effect of metacognitive training in psychosis: a randomized-controlled study
Favrod J Rexhaj S Bardy S Ferrari P Hayoz C Moritz S Conus P & Bonsack C. (2014), Sustained antipsychotic effect of metacognitive training in psychosis: a randomized-controlled study, in European Psychiatry, 29:(5), 275-281.
Effet antipsychotique supplémentaire et soutenu de l’entraînement métacognitif: une étude randomisée contrôlée
Favrod J (2013), Effet antipsychotique supplémentaire et soutenu de l’entraînement métacognitif: une étude randomisée contrôlée, in European Pschiatry, 28(2), 95 -96.
Hallucinations auditives et recherche de sécurité
Chaix J. Ma E. Nguyen A. Ortiz Collado M.A. Rexhaj S. & Favrod J (2013), Hallucinations auditives et recherche de sécurité, in Santé mentale, (179), 40-43.
Entraînement des Habiletés Métacognitives pour les patients avec une schizophrénie (EMC)
Moritz Steffen, Woodward Todd, Le groupe métacognition, Favrod Jérôme (2012), Entraînement des Habiletés Métacognitives pour les patients avec une schizophrénie (EMC).
Entraînement métacognitif et schizophrénie
Favrod Jérôme, Rexhaj Shyhrete, Bardy Sabrina, Gremaud Katya, Brana Armando, Hayoz Claude, Moritz Steffen (2012), Entraînement métacognitif et schizophrénie, Elsevier Masson, Issy-les-Moulineaux, 161-168.
French version validation of the psychotic symptom rating scales (PSYRATS) for outpatients with persistent psychotic symptoms.
Favrod Jérôme, Rexhaj Shyhrete, Ferrari Pascale, Bardy Sabrina, Hayoz Claude, Morandi Stéphane, Bonsack Charles, Giuliani Fabienne (2012), French version validation of the psychotic symptom rating scales (PSYRATS) for outpatients with persistent psychotic symptoms., in BMC psychiatry, 12(1), 161-161.
Se rétablir de la schizophrénie
Favrod Jerome, Maire Agnès (2012), Se rétablir de la schizophrénie.

Collaboration

Group / person Country
Types of collaboration
Département de psychologie de l’Université de Fribourg Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Father Muller College of Nursing Mangalore India (Asia)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Universitätsklinikum Hamburg-Eppendorf Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Clinical Psychiatry Department, Dijon University Hospital, 21000 Dijon, France France (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
4ème colloque de l’AFRC - Métacognition et Schizophrénie Talk given at a conference Entraînement métacognitif 21.09.2012 Bordeaux, France Favrod Jérôme;
First European Congress of Social Psychiatry Talk given at a conference Efficacité de l’entraînement métacognitif pour réduire les idées délirantes: un essai clinique 05.07.2012 Geneva, Switzerland Favrod Jérôme;
Translational Research : Nurses making the difference Talk given at a conference Efficacy of Metacognitive Training to Reduce Delusions: A Randomized Clinical Trial 02.11.2011 Mangalore, India Favrod Jérôme;
3ème colloque de l'Association Francophone de Remédiation Cognitive - Remédiation cognitive et réinsertion professionnelle des perssonnes souffrant de schizophrénie Talk given at a conference Entraînement métacognitif et symptômes psychotiques. Remédiation cognitive et réinsertion professionnelle des personnes souffrant de schizophrénie 30.09.2011 Lausanne, Switzerland Favrod Jérôme;
JOURNEES REGIONALES DE THERAPIE COMPORTEMENTALE ET COGNITIVE Talk given at a conference Entraînement métacognitif 20.05.2011 Bordeaux, France Favrod Jérôme;


Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
Pratique infirmière en santé mentale : où en sommes nous? 30.11.2011 Vision conférence Montréal, Paris, Lausanne, Switzerland Favrod Jérôme;


Communication with the public

Communication Title Media Place Year
Media relations: print media, online media CQFD de jeudi 04.09.2014 RTS Western Switzerland 2014
Talks/events/exhibitions Se rétablir de la schizophrénie Western Switzerland 2014
Talks/events/exhibitions Les psychoses et leurs conséquences International 2010

Abstract

Background:Despite recent advances in the pharmacological treatment of schizophrenia, this illness remains a serious lifelong mental illness for which current treatments may only be partially effective. Many patients experience residual symptoms even when treatment compliance is not an issue. Residual psychotic symptoms remain a major obstacle to recovery and represent a major challenge for social and health-care professionals. Cognitive behavioural therapy of psychotic symptoms is a promising approach for adjunctive treatment of positive symptoms in patients with schizophrenia. However, if effect sizes of this approach are robust, they still are moderate and there is place for improvement. Our experience with new approaches such as metacognitive training (MCT) shows additional improvement of symptoms but these approaches need to be tested in a randomized clinical trial. Working Hypotheses:We hypothesize that eight one-hour sessions of MCT will have more impact on psychotic symptoms than standard care. Specific Aims:In this study we will compare the impact of MCT on severity of delusion to the impact of treatment as usual. We will also compare both groups on insight, hallucinations, use of services and functional consequences of delusions. Methods:We will use a randomized controlled trial comparing MCT with treatment as usual in patients with schizophrenia. At baseline, demographic and clinical data will be gathered. Intervention will then be proposed for 2 months. Outcome will be assessed at post-test and at 6 months after the end of the intervention regarding: psychotic symptoms, insight, medication, service use and functional consequences of psychotic symptoms.Expected Value of the Proposed Project:This study should allow improving treatment of psychotic symptoms in patients suffering from schizophrenia.
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