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Randomized Controlled Trial
. 2022 Jan;90(1):18-28.
doi: 10.1037/ccp0000672. Epub 2021 Aug 19.

Personalizing interventions using real-world interactions: Improving symptoms and social functioning in schizophrenia with tailored metacognitive therapy

Kyle S Minor  1 , Matthew P Marggraf  1 , Beshaun J Davis  1 , Jessica L Mickens  1 , Danielle B Abel  1 , Megan L Robbins  1 , Kelly D Buck  2 , Sarah E Wiehe  3 , Paul H Lysaker  2
Affiliations
Randomized Controlled Trial

Personalizing interventions using real-world interactions: Improving symptoms and social functioning in schizophrenia with tailored metacognitive therapy

Kyle S Minor et al. J Consult Clin Psychol. 2022 Jan.

Abstract

Objective: When clients' lives are not reflected in therapy, they struggle to apply the skills learned in treatment to everyday situations. In this pilot study, we determined if using clients' real-world interactions in therapy could effectively target metacognitive capacity-yielding improved symptoms and social functioning-by tailoring treatment to focus on issues faced by clients in daily life.

Method: Using a randomized controlled trial design, schizophrenia subjects with metacognitive deficits completed 24 sessions of: (a) Standard Metacognitive Reflection and Insight Therapy (MERIT); or (b) Tailored MERIT. Real-world interactions were captured via the Electronically Activated Recorder (EAR), a smartphone application that passively records audio in daily life. All subjects wore the EAR; however, real-world interactions were only used to personalize sessions in Tailored MERIT.

Results: Feasibility and acceptability were shown; those in Tailored MERIT wore the EAR 84% of their waking hours and reported minimal burden. When compared to Standard MERIT, Tailored MERIT participants showed large pre-post reductions in negative metacognitive beliefs and disorganized symptoms. Small, but nonsignificant, improvements in social functioning were also observed.

Conclusions: Compared to an evidence-based benchmark, we observed that real-world interactions can be used to tailor metacognitive therapy and improve outcomes in schizophrenia. Tailored MERIT has the potential to impact practice by personalizing treatment to account for individual variations in environment and lifestyle-aligning with the Precision Medicine Initiative-in a way that is not possible with current therapy. This is particularly salient in schizophrenia, where limited insight and cognitive deficits often make subjective reporting unreliable. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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Conflict of interest statement

The authors have no conflicts of interest to report. Outcome data from this clinical trial has not been previously published (see Appendix 1). ClinicalTrials.gov Identifier: NCT04665401

Figures

Figure 1.
Figure 1.
Consort Flow Diagram for Study
Figure 2.
Figure 2.
Illustration of how the Electronically Activated Recorder (EAR) is implemented across conditions.
See this image and copyright information in PMC

References

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