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Meta-Analysis
. 2020 Oct;50(14):2289-2301.
doi: 10.1017/S0033291720003384. Epub 2020 Oct 14.

Can metacognitive interventions improve insight in schizophrenia spectrum disorders? A systematic review and meta-analysis

Javier-David Lopez-Morinigo  1   2 , Olesya Ajnakina  3   4 , Adela Sánchez-Escribano Martínez  2 , Paula-Jhoana Escobedo-Aedo  2 , Verónica González Ruiz-Ruano  1   2 , Sergio Sánchez-Alonso  2 , Laura Mata-Iturralde  2 , Laura Muñoz-Lorenzo  2 , Susana Ochoa  5   6 , Enrique Baca-García  1   2   7 , Anthony S David  8
Affiliations
Meta-Analysis

Can metacognitive interventions improve insight in schizophrenia spectrum disorders? A systematic review and meta-analysis

Javier-David Lopez-Morinigo et al. Psychol Med. 2020 Oct.

Abstract

Background: Patients with schizophrenia spectrum disorders (SSD) tend to lack insight, which is linked to poor outcomes. The effect size of previous treatments on insight changes in SSD has been small. Metacognitive interventions may improve insight in SSD, although this remains unproved.

Methods: We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effects of metacognitive interventions designed for SSD, namely Metacognitive Training (MCT) and Metacognitive Reflection and Insight Therapy (MERIT), on changes in cognitive and clinical insight at post-treatment and at follow-up.

Results: Twelve RCTs, including 10 MCT RCTs (n = 717 participants) and two MERIT trials (n = 90), were selected, totalling N = 807 participants. Regarding cognitive insight six RCTs (n = 443) highlighted a medium effect of MCT on self-reflectiveness at post-treatment, d = 0.46, p < 0.01, and at follow-up, d = 0.30, p < 0.01. There was a small effect of MCT on self-certainty at post-treatment, d = -0.23, p = 0.03, but not at follow-up. MCT was superior to controls on an overall Composite Index of cognitive insight at post-treatment, d = 1.11, p < 0.01, and at follow-up, d = 0.86, p = 0.03, although we found evidence of heterogeneity. Of five MCT trials on clinical insight (n = 244 participants), which could not be meta-analysed, four of them favoured MCT compared v. control. The two MERIT trials reported conflicting results.

Conclusions: Metacognitive interventions, particularly Metacognitive Training, appear to improve insight in patients with SSD, especially cognitive insight shortly after treatment. Further long-term RCTs are needed to establish whether these metacognitive interventions-related insight changes are sustained over a longer time period and result in better outcomes.

Keywords: Insight; metacognitive interventions; outcomes; schizophrenia spectrum disorders.

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Figures

Fig. 1.
Fig. 1.
Flow chart of the studies selection process.
Fig. 2.
Fig. 2.
Meta-analysis of the effects of Metacognitive Training on cognitive insight - BCIS-Self-Reflectiveness -: at baseline, at post-treatment and at a follow-up.
Fig. 3.
Fig. 3.
Meta-analysis of the effects of Metacognitive Training on cognitive insight - BCIS-Self-Certainty -: at baseline, at post-treatment and at follow-up.
Fig. 4.
Fig. 4.
Meta-analysis of the effects of Metacognitive Training on cognitive insight - BCISComposite Index -: at baseline, at post-treatment and at follow-up.
See this image and copyright information in PMC

References

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