Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study

Theory-driven interventions targeting specific factors that contribute to delusions are receiving increased interest. The present study aimed to assess the efficacy of individualized metacognitive therapy (MCT+), a short manualized intervention that addresses delusion-associated cognitive biases.; 92 patients with current or past delusions were randomized to receive 12 twice-weekly sessions of either MCT+ or a control intervention within a randomized controlled rater-blind design. Psychopathology and cognitive biases were assessed at baseline, 6 weeks and 6 months. ANCOVAs adjusted for baseline scores were used to assess differences between groups regarding outcome variables. Both per-protocol and intention-to-treat analyses were conducted.; At 6 weeks, there was a significant difference in favor of MCT+ regarding decrease in delusion severity and improvement of self-reflectiveness (medium effect size), and a trend-wise difference regarding probability thresholds to decision. These effects increased, when only patients attending a minimum of 4 therapy sessions were considered. Control group patients subsequently showed further improvement while patients in the MCT+ group remained stable, such that there were no differences between groups at the 6-month follow-up.; Lower attendance rates in the control group possibly leading to unequal therapeutic effort; lower baseline delusion severity in the MCT+ group.; The result pattern suggests that MCT+ led to earlier improvement in delusions and cognitive biases compared to the control intervention. The absence of a long-term effect might reflect floor effects in the MCT+ group, but may also indicate the need for further measures to promote sustainability of MCT+ effects

Efficacy of approach bias modification as an add-on to smoking cessation treatment: study protocol for a randomized-controlled double-blind trial

Background Although effective treatments for smoking cessation are available, long-term abstinence is the exception rather than the norm. Accordingly, there is a need for novel interventions that potentially improve clinical outcome. Although implicit information processing biases, for example approach biases for smoking-related stimuli, are ascribed a dominant role in the maintenance of tobacco dependence, these biases are hardly targeted in current treatment. Past research has shown that so-called Approach Bias Modification (AppBM) trainings, aiming to modify this bias, lead to improved long-term abstinence in abstinent alcoholic inpatients when delivered as an add-on to treatment-as-usual. Findings on the efficacy of AppBM in smoking have been inconsistent. The present large-scale clinical trial pursues two goals. First, it aims to investigate the efficacy of AppBM as an add-on to treatment-as-usual in a representative sample of adult smokers. Second, possible mechanisms of change are investigated. Methods The study is a randomized-controlled, double-blind, parallel-group superiority trial. We aim at a final sample of at least 336 adult smokers. Participants are allocated with a 1:1:1 allocation ratio to one of the following conditions: (1) treatment-as-usual + AppBM, (2) treatment-as-usual + Sham, (3) treatment-as-usual only. During the add-on training, participants are presented smoking-related and positive pictures and are instructed to respond by either pushing or pulling a joystick, depending on the tilt of the pictures (5 ○ to the left/right). During AppBM, all smoking-related pictures are tilted in the direction that is associated with pushing, thereby aiming to train an avoidance bias for smoking. All positive pictures are tilted in the direction associated with pulling. During Sham, the contingency is 50/50. Participants are assessed before and after the intervention and at a 6-month follow-up. The primary outcome is prolonged abstinence, and secondary outcomes include smoking-related variables and psychological distress. Additionally, the motivational significance of smoking-related stimuli (i.e., approach bias, valence) is assessed with different experimental tasks (Approach-Avoidance Task; Single Target Implicit Association Test) and psychophysiological measures. Discussion This is the first large-scale clinical trial investigating the efficacy of AppBM as an add-on in smokers including a TAU only condition. Additionally, it is the first study to systematically investigate potential mechanisms mediating the effects of treatment on clinical outcome

Sowing the seeds of doubt: a narrative review on metacognitive training in schizophrenia

AbstractThe present article provides a narrative review of empirical studies on metacognitive training in psychosis (MCT). MCT represents an amalgam of cognitive-behavioral therapy (CBT), cognitive remediation (CRT) and psychoeducation. The intervention is available in either a group (MCT) or an individualized (MCT+) format. By sowing the seeds of doubt in a playful and entertaining fashion, the program targets positive symptoms, particularly delusions. It aims to raise patients’ awareness for common cognitive traps or biases (e.g., jumping to conclusions, overconfidence in errors, bias against disconfirmatory evidence) that are implicated in the formation and maintenance of psychosis. The majority of studies confirm that MCT meets its core aim, the reduction of delusions. Problems (e.g., potential allegiance effects) and knowledge gaps (i.e., outcome predictors) are highlighted. The preliminary data suggest that the individual MCT format is especially effective in addressing symptoms, cognitive biases and insight. We conclude that MCT appears to be a worthwhile complement to pharmacotherapy

Comparing PTSD symptom networks in type I vs. type II trauma survivors

Background: Network analysis has gained increasing attention as a new framework to study complex associations between symptoms of post-traumatic stress disorder (PTSD). A number of studies have been published to investigate symptom networks on different sets of symptoms in different populations, and the findings have been inconsistent. Objective: We aimed to extend previous research by testing whether differences in PTSD symptom networks can be found in survivors of type I (single event; sudden and unexpected, high levels of acute threat) vs. type II (repeated and/or protracted; anticipated) trauma (with regard to their index trauma). Method: Participants were trauma-exposed individuals with elevated levels of PTSD symptomatology, most of whom (94%) were undergoing assessment in preparation for PTSD treatment in several treatment centres in Germany and Switzerland (n = 286 with type I and n = 187 with type II trauma). We estimated Bayesian Gaussian graphical models for each trauma group and explored group differences in the symptom network. Results: First, for both trauma types, our analyses identified the edges that were repeatedly reported in previous network studies. Second, there was decisive evidence that the two networks were generated from different multivariate normal distributions, i.e. the networks differed on a global level. Third, explorative edge-wise comparisons showed moderate or strong evidence for specific 12 edges. Edges which emerged as especially important in distinguishing the networks were between intrusions and flashbacks, highlighting the stronger positive association in the group of type II trauma survivors compared to type I survivors. Flashbacks showed a similar pattern of results in the associations with detachment and sleep problems (type II > type I). Conclusion: Our findings suggest that trauma type contributes to the heterogeneity in the symptom network. Future research on PTSD symptom networks should include this variable in the analyses to reduce heterogeneity

Comparing PTSD symptom networks in type I vs. type II trauma survivors

Background: Network analysis has gained increasing attention as a new framework to study complex associations between symptoms of post-traumatic stress disorder (PTSD). A number of studies have been published to investigate symptom networks on different sets of symptoms in different populations, and the findings have been inconsistent. Objective: We aimed to extend previous research by testing whether differences in PTSD symptom networks can be found in survivors of type I (single event; sudden and unexpected, high levels of acute threat) vs. type II (repeated and/or protracted; anticipated) trauma (with regard to their index trauma). Method: Participants were trauma-exposed individuals with elevated levels of PTSD symptomatology, most of whom (94%) were undergoing assessment in preparation for PTSD treatment in several treatment centres in Germany and Switzerland (n = 286 with type I and n = 187 with type II trauma). We estimated Bayesian Gaussian graphical models for each trauma group and explored group differences in the symptom network. Results: First, for both trauma types, our analyses identified the edges that were repeatedly reported in previous network studies. Second, there was decisive evidence that the two networks were generated from different multivariate normal distributions, i.e. the networks differed on a global level. Third, explorative edge-wise comparisons showed moderate or strong evidence for specific 12 edges. Edges which emerged as especially important in distinguishing the networks were between intrusions and flashbacks, highlighting the stronger positive association in the group of type II trauma survivors compared to type I survivors. Flashbacks showed a similar pattern of results in the associations with detachment and sleep problems (type II > type I). Conclusion: Our findings suggest that trauma type contributes to the heterogeneity in the symptom network. Future research on PTSD symptom networks should include this variable in the analyses to reduce heterogeneity

Imagery Rescripting Helps Victims Cope With Experienced Injustice

In clinical psychology, imagery rescripting (ImRs) is a promising intervention to target negative emotional memories after victimization experiences. The present research tested the effects of ImRs in “minor” cases of experienced injustice. After imagining being the victim of an injustice, participants (N = 272) were randomly assigned to one of four conditions in a univariate design (treatment: active ImRs, passive ImRs; control: pleasant imagery, imagery rehearsal). Dependent variables were positive and negative affect; mediator variables were justice-related satisfaction and empowerment. Both justice-related satisfaction and empowerment increased positive and decreased negative affect, but empowerment was higher in the active than in the passive ImRs condition (while justice-related satisfaction was increased by both ImRs conditions). These results suggest that ImRs can be beneficial even in minor victimization experiences and that these beneficial effects are mediated by both empowerment and justice-related satisfaction

Metacognitive deficits are associated with lower sensitivity to preference reversals in nicotine dependence

Deficits in impulse control belong to the core profile of nicotine dependence. Smokers might thus benefit from voluntarily self-restricting their access to the immediate temptation of nicotine products (precommitment) in order to avoid impulse control failures. However, little is known about how smokers’ willingness to engage in voluntary self-restrictions is determined by metacognitive insight into their general preferences for immediate over delayed rewards. Here, with a series of monetary intertemporal choice tasks, we provide empirical evidence for reduced metacognitive accuracy in smokers relative to non-smokers and show that smokers overestimate the subjective value of delayed rewards relative to their revealed preferences. In line with the metacognitive deficits, smokers were also less sensitive to the risk of preference reversals when deciding whether or not to restrict their access to short-term financial rewards. Taken together, the current findings suggest that deficits not only in impulse control but also in metacognition may hamper smokers’ resistance to immediate rewards and capacity to pursue long-term goals

The influence of outcome expectancy on interpretation bias training in social anxiety: an experimental pilot study

Abstract Background Cognitive bias modification for interpretation (CBM-I) trainings have shown positive effects on interpretation bias in both active interpretation bias training conditions and structurally similar control conditions. Outcome expectations have been suggested to contribute to these placebo effects. The goal of this pilot experimental study was to test the feasibility of positive expectancy induction, to gain preliminary insight into whether this has implications for the efficacy of CBM-I training, and to assess the feasibility of recruitment and the overall study design. Methods Socially anxious individuals aged 18 years and older received a single session (approx. 45 min) of either CBM-I or placebo training preceded by either a positive expectancy induction or no expectancy induction. We first tested whether the expectancy induction had modified participants’ expectations of training. We then explored the effects of CBM-I training and expectancy induction on interpretation bias. Finally, we assessed the feasibility of recruitment and further study procedures. Results Due to pandemic-related difficulties, fewer participants were recruited than initially planned. Thirty-four (22 females and 12 males) participants were randomly assigned to one of four conditions (interpretation bias training + high expectancy = 10, interpretation bias training + no expectancy = 8, placebo training + high expectancy = 11, placebo training + no expectancy = 5). Participants in the positive expectancy condition had more positive expectations of the training (CBM-I or placebo) than participants in the no expectancy condition. We were unable to conduct the planned 2 × 2 × 2 analysis of interpretation bias due to the small sample size. When looking at these groups individually, we found that participants in the active training condition and participants in the high expectancy condition showed increases in positive interpretation bias and decreases in negative interpretation bias from pre- to post-training, while participants in the placebo and no expectancy conditions showed no change. Conclusions These findings suggest that the expectancy manipulation utilized in this study may be adopted by future studies which investigate outcome expectations as an unspecific mechanism of CBM-I. Preliminary analyses suggest that participants’ expectations are likely to play a role in the effect of CBM-I training, although these effects require replication in a larger sample. Several observations about the study feasibility were made which could inform future trials. Trial registration Retrospectively registered on the August 23, 2022, through the German Clinical Trials Register ( DRKS00029768 )

Do it yourself? Self-help and online therapy for people with obsessive-compulsive disorder

In spite of advances in the understanding and treatment of obsessive-compulsive disorder (OCD), for most patients some symptoms persist even after therapeutic intervention. Another large subgroup does not seek treatment at all, particularly due to shame or fear of stigma. The treatment gap in OCD is large and self-help is increasingly seen as a low-threshold form of intervention for individuals with minor symptoms or who are currently treatment-reluctant. Our review summarizes the expanding but still small literature on self-help and Internet interventions for OCD and provides advice on how to conduct (Internet) studies on self-help. Strategies to deal with methodological problems that notoriously plague Internet research are discussed. Despite methodological limitations inherent in most studies considered for the current review, as well as the unreplicated nature of some of the more recent findings, self-help tools hold some promise. In particular, self-help interventions that are rooted in evidence-based concepts may be helpful as an add-on to standard interventions and as (initial) therapeutic strategies for those who are presently reluctant to participate in face-to-face treatment. The current review identifies self-help, which is based on evidence-based concepts, as a promising clinical tool for the treatment of OCD. The current literature suggests that self-help can be a facilitator and aid to standard face-to-face interventions, rather than a rival

Harnessing the Web: Internet and Self-Help Therapy for People with Obsessive–Compulsive Disorder and Posttraumatic Stress Disorder

Notwithstanding advances in the treatment of anxiety disorders, many patients show incomplete symptom remission following even state-of-the-art (psycho)therapy. Moreover, many people suffering from anxiety do not seek treatment at all. Self-help is increasingly regarded as a low-threshold approach to fill the apparent treatment gap. Our review summarizes the expanding but still small literature on self-help and Internet interventions for obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) suggesting that self-help rooted in evidence-based concepts is a promising clinical tool that may aid and facilitate face-to-face treatment