Heterogeneity in Response to MCT and Psychoeducation: A Feasibility Study Using Latent Class Mixed Models in First-Episode Psychosis

Abstract

Metacognitive training (MCT) is an effective treatment for psychosis. Longitudinal trajectories of treatment response are unknown but could point to strategies to maximize treatment efficacy during the first episodes. This work aims to explore the possible benefit of using latent class mixed models (LCMMs) to understand how treatment response differs between metacognitive training and psychoeducation. We conducted LCMMs in 28 patients that received MCT and 34 patients that received psychoeducation. We found that MCT is effective in improving cognitive insight in all patients but that these effects wane at follow-up. In contrast, psychoeducation does not improve cognitive insight, and may increase self-certainty in a group of patients. These results suggest that LCMMs are valuable tools that can aid in treatment prescription and in predicting response to specific treatments.

Keywords: first-episode psychosis; latent class mixed models; metacognition; metacognitive training; psychoeducation; social cognition.

Figure 1

Trajectories of self-reflectivity in the MCT group. The red trajectory depicts the “High SR” trajectory (n = 20). The second trajectory (in blue), refers to “Improving SR” (n = 8).

Figure 2

Trajectories of self-certainty in the MCT group: “Initial Decline” (in red, n = 22) and “Responsive SC” (in blue, n = 6).

Figure 3

Trajectories of self-reflectivity in the psychoeducation group. The red line refers to the “Low-SR” trajectory (n = 18). The second trajectory (in blue), refers to the “Worsening-SR” (n = 16) trajectory.

Figure 4

Trajectories of self-certainty in the psychoeducation group. In red is depicted the “Low and Stable SC” (n = 23) trajectory. The second trajectory, in blue, refers to the “Worsening SC” (n = 11) trajectory.