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Effects of a Korean version of the metacognitive training program for outpatients with schizophrenia on theory of mind, positive symptoms, and interpersonal relationships

Published online by Cambridge University Press:  18 October 2019

Sungwon Park ,
Hye Kyung Lee  and
Hyunlye Kim
Sungwon Park
Affiliation:
Faculty of Department of Nursing, College of Life Science and Nano Technology, Hannam University, Daejeon, South Korea
Hye Kyung Lee
Affiliation:
Faculty of Department of Social Welfare, College of Rehabilitation & Welfare & Education, Konyang University, Nonsan, South Korea
Hyunlye Kim*
Affiliation:
Faculty of Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea
*
*Corresponding author. Email: hlkim5207@chosun.ac.kr
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Abstract

Background:

Since the significance of metacognition as the theoretical basis of a psychological intervention for schizophrenia first emerged, there have been ongoing attempts to restore or strengthen patients’ metacognitive abilities.

Aim:

A Korean version of the metacognitive training (MCT) program was developed, and its effects on theory of mind, positive and negative symptoms, and interpersonal relationships were examined in stable outpatients with schizophrenia.

Method:

A pre-test–post-test design with a control group was used. The participants were 59 outpatients (30 in experimental group, 29 in control group) registered at five mental health facilities in a city in South Korea. The developed MCT program was applied for a total of 18 sessions, 60 min per session, over a period of 14 weeks. The hinting task, false belief task, Scale for the Assessment of Positive and Negative Symptoms, and Relationship Change Scale were used to verify the effects of this program. Data were analysed by the chi-square test, t-test, and Mann–Whitney U-test using the SPSS/PASW 18.0 statistics program.

Results:

The general characteristics, intelligence, and outcome variables of the two groups were homogeneous. After the intervention, the experimental group showed significant improvements in theory of mind, positive and negative symptoms and interpersonal relationships compared with the control group.

Conclusion:

These results suggest that the MCT program can be a complementary psychotherapy that contributes to symptom relief and interpersonal functioning in patients with schizophrenia, and is effective in the Korean culture, beyond the Western context.

Keywords

interpersonal relationsmetacognitionpositive symptomsschizophreniatheory of mind
Type
Empirically Grounded Clinical Interventions
Information
Behavioural and Cognitive Psychotherapy , Volume 48 , Issue 1 , January 2020 , pp. 14 - 24
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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References

Abdel-Hamid, M., Lehmkämper, C., Sonntag, C., Juckel, G., Daum, I., & Brüne, M. (2009). Theory of mind in schizophrenia: the role of clinical symptomatology and neurocognition in understanding other people’s thoughts and intentions. Psychiatry Research, 165, 19–26. https://doi.org/10.1016/j.psychres.2007.10.021CrossRefGoogle ScholarPubMed
Aghotor, J., Pfueller, U., Moritz, S., Weisbrod, M., & Roesch-Ely, D. (2010). Metacognitive training for patients with schizophrenia (MCT): feasibility and preliminary evidence for its efficacy. Journal of Behavior Therapy and Experimental Psychiatry, 41, 207–211. https://doi.org/10.1016/j.jbtep.2010.01.004CrossRefGoogle ScholarPubMed
Andreasen, N. C. (1984a). Scale for the Assessment of Negative Symptoms (SANS). Iowa City: University of Iowa.Google Scholar
Andreasen, N. C. (1984b). Scale for the Assessment of Positive Symptoms (SAPS). Iowa City: University of Iowa.Google Scholar
Bora, E., Yucel, M., & Pantelis, C. (2009). Theory of mind impairment in schizophrenia: meta-analysis. Schizophrenia Research, 109, 1–9. https://doi.org/10.1016/j.schres.2008.12.020CrossRefGoogle ScholarPubMed
Buck, K. D., & Lysaker, P. H. (2009). Addressing metacognitive capacity in the psychotherapy for schizophrenia: a case study. Clinical Case Studies, 8, 463–472. https://doi.org/10.1177/1534650109352005CrossRefGoogle Scholar
Brüne, M. (2005). ‘Theory of mind’ in schizophrenia: a review of the literature. Schizophrenia Bulletin, 31, 21–42. https://doi.org/10.1093/schbul/sbi002CrossRefGoogle Scholar
Brüne, M., Dimaggio, G., & Lysaker, P. H. (2011). Metacognition and social functioning in schizophrenia: evidence, mechanisms of influence and treatment implications. Current Psychiatry Reviews, 7, 239–247. https://doi.org/10.2174/157340011797183210CrossRefGoogle Scholar
Bulzacka, E., Meyers, J. E., Boyer, L., Le Gloahec, T., Fond, G., Szöke, A. et al. (2016). WAIS-IV seven-subtest short form: validity and clinical use in schizophrenia. Archives of Clinical Neuropsychology, 31, 915–925. https://doi.org/10.1093/arclin/acw063Google Scholar
Chun, S. K. (1995). A study on the effectiveness of social skills training program for rehabilitation of the schizophrenic patients. Dissertation, The Soongsil University, Seoul.Google Scholar
Corcoran, R., Mercer, G., & Frith, C. D. (1995). Schizophrenia, symptomatology and social inference: investigating ‘theory of mind’ in people with schizophrenia. Schizophrenia Research, 17, 5–13. https://doi.org/10.1016/0920-9964(95)00024-GCrossRefGoogle ScholarPubMed
Couture, S. M., Granholm, E. L., & Fish, S. C. (2011). A path model investigation of neurocognition, theory of mind, social competence, negative symptoms and real-world functioning in schizophrenia. Schizophrenia Research, 125, 152–160. https://doi.org/10.1016/j.schres.2010.09.020CrossRefGoogle Scholar
Eichner, C., & Berna, F. (2016). Acceptance and efficacy of metacognitive training (MCT) on positive symptoms and delusions in patients with schizophrenia: a meta-analysis taking into account important moderators. Schizophrenia Bulletin, 42, 952–962. https://doi.org/10.1093/schbul/sbv225CrossRefGoogle ScholarPubMed
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191.CrossRefGoogle ScholarPubMed
Favrod, J., Rexhaj, S., Bardy, S., Ferrari, P., Hayoz, C., Moritz, S. et al. (2014). Sustained antipsychotic effect of metacognitive training in psychosis: a randomized-controlled study. European Psychiatry, 29, 275–281. https://doi.org/10.1016/j.eurpsy.2013.08.003CrossRefGoogle ScholarPubMed
Frith, C. D., & Corcoran, R. (1996). Exploring ‘theory of mind’ in people with schizophrenia. Psychological Medicine, 26, 521–530. https://doi.org/10.1017/S0033291700035601CrossRefGoogle ScholarPubMed
Hamm, J. A., Renard, S. B., Fogley, R. L., Leonhardt, B. L., Dimaggio, G., Buck, K. D. et al. (2012). Metacognition and social cognition in schizophrenia: stability and relationship to concurrent and prospective symptom assessments. Journal of Clinical Psychology, 68, 1303–1312.CrossRefGoogle ScholarPubMed
Kim, K. E., Kim, K. H., & Oh, S. W. (2005). The validity of Korean-Wechsler Intelligence Scale short-form: Ward 7-subtest short form. Korean Journal of Clinical Psychology, 24, 379–396.Google Scholar
Koren, D., Seidman, L. J., Goldsmith, M., & Harvey, P. D. (2006). Real-world cognitive-and metacognitive-dysfunction in schizophrenia: a new approach for measuring (and remediating) more ‘right stuff’. Schizophrenia Bulletin, 32, 310–326. https://doi.org/10.1093/schbul/sbj035CrossRefGoogle Scholar
Liu, Y. C., Tang, C. C., Hung, T. T., Tsai, P. C., & Lin, M. F. (2018). The efficacy of metacognitive training for delusions in patients with schizophrenia: a meta‐analysis of randomized controlled trials informs evidence‐based practice. Worldviews on Evidence‐Based Nursing, 15, 130–139. https://doi.org/10.1111/wvn.12282CrossRefGoogle ScholarPubMed
Lysaker, P. H., Buck, K. D., Carcione, A., Procacci, M., Salvatore, G., Nicolò, G., & Dimaggio, G. (2011). Addressing metacognitive capacity for self reflection in the psychotherapy for schizophrenia: a conceptual model of the key tasks and processes. Psychology and Psychotherapy: Theory, Research and Practice, 84, 58–69. https://doi.org/10.1348/147608310X520436Google ScholarPubMed
Lysaker, P. H., Dimaggio, G., Carcione, A., Procacci, M., Buck, K. D., Davis, L. W., & Nicolò, G. (2010). Metacognition and schizophrenia: the capacity for self-reflectivity as a predictor for prospective assessments of work performance over six months. Schizophrenia Research, 122, 124–130. https://doi.org/10.1016/j.schres.2009.04.024CrossRefGoogle ScholarPubMed
Lysaker, P. H., Gagen, E., Moritz, S., & Schweitzer, R. D. (2018a). Metacognitive approaches to the treatment of psychosis: a comparison of four approaches. Psychology Research Behavior Management, 11, 341–351. https://doi.org/10.2147/PRBM.S146446CrossRefGoogle ScholarPubMed
Lysaker, P. H., Hamm, J. A., Hasson-Ohayon, I., Pattison, M. L., & Leonhardt, B. L. (2018b). Promoting recovery from severe mental illness: implications from research on metacognition and metacognitive reflection and insight therapy. World Journal of Psychiatry, 8, 1–11. https://doi.org/10.5498/wjp.v8.i1.1CrossRefGoogle ScholarPubMed
Lysaker, P. H., Vohs, J. L., Ballard, R., Fogley, R., Salvatore, G., Popolo, R., & Dimaggio, G. (2013). Metacognition, self-reflection and recovery in schizophrenia. Future Neurology, 8, 103–115. https://doi.org/10.2217/fnl.12.78CrossRefGoogle Scholar
McGurk, S. R., Twamley, E. W., Sitzer, D. I., McHugo, G. J., & Mueser, K. T. (2007). A meta-analysis of cognitive remediation in schizophrenia. American Journal of Psychiatry, 164, 1791–1802. https://doi.org/10.1176/appi.ajp.2007.07060906CrossRefGoogle Scholar
Moon, S. M., & Lee, H. D. (1980). A study on the effect of human relations training of university students. Journal of Gyeongsang National University, 19, 195–204.Google Scholar
Moritz, S., Andreou, C., Schneider, B. C., Wittekind, C. E., Menon, M., Balzan, R. P. et al. (2014). Sowing the seeds of doubt: a narrative review on metacognitive training in schizophrenia. Clinical Psychology Review, 34, 358–366. http://dx.doi.org/10.1016/j.cpr.2014.04.004CrossRefGoogle Scholar
Moritz, S., Kerstan, A., Veckenstedt, R., Randjbar, S., Vitzthum, F., Schmidt, C. et al. (2011). Further evidence for the efficacy of a metacognitive group training in schizophrenia. Behaviour Research and Therapy, 49, 151–157. https://doi.org/10.1016/j.brat.2010.11.010CrossRefGoogle Scholar
Moritz, S., & Lysaker, P. H. (2018). Metacognition – what did James H. Flavell really say and the implications for the conceptualization and design of metacognitive interventions. Schizophrenia Research, 201, 20–26. https://doi.org/10.1016/j.schres.2018.06.001CrossRefGoogle Scholar
Moritz, S., & Woodward, T. S. (2007). Metacognitive training for schizophrenia patients (MCT): a pilot study on feasibility, treatment adherence, and subjective efficacy. German Journal of Psychiatry, 10, 69–78.Google Scholar
Moritz, S., Vitzthum, F., Randjbar, S., Veckenstedt, R., & Woodward, T. S. (2010). Detecting and defusing cognitive traps: metacognitive intervention in schizophrenia. Current Opinion in Psychiatry, 23, 561–569. https://doi.org/10.1097/YCO.0b013e32833d16a8CrossRefGoogle Scholar
Rocha, N. B., & Queirós, C. (2013). Metacognitive and social cognition training (MSCT) in schizophrenia: a preliminary efficacy study. Schizophrenia Research, 150, 64–68. https://doi.org/10.1016/j.schres.2013.07.057CrossRefGoogle ScholarPubMed
Savla, G. N., Vella, L., Armstrong, C. C., Penn, D. L., & Twamley, E. W. (2013). Deficits in domains of social cognition in schizophrenia: a meta-analysis of the empirical evidence. Schizophrenia Bulletin, 39, 979–992. https://doi.org/10.1093/schbul/sbs080CrossRefGoogle ScholarPubMed
Sarin, F., & Wallin, L. (2014). Cognitive model and cognitive behavior therapy for schizophrenia: an overview. Nordic Journal of Psychiatry, 68, 145–153. https://doi.org/10.3109/08039488.2013.789074CrossRefGoogle ScholarPubMed
Schlein, A., & Guerney, B. G. (1971). Relationship Enhancement. San Francisco, CA, USA: Josey-Bass.Google Scholar
Sprong, M., Schothorst, P., Vos, E., Hox, J., & Van Engeland, H. (2007). Theory of mind in schizophrenia: meta-analysis. British Journal of Psychiatry, 191, 5–13. https://doi.org/10.1192/bjp.bp.107.035899CrossRefGoogle ScholarPubMed
Vitzthum, F. B., Veckenstedt, R., & Moritz, S. (2014). Individualized metacognitive therapy program for patients with psychosis (MCT+): introduction of a novel approach for psychotic symptoms. Behavioural and Cognitive Psychotherapy, 42, 105–110. https://doi.org/10.1017/S1352465813000246CrossRefGoogle ScholarPubMed
Ward, L. C. (1990). Prediction of verbal, performance, and full scale IQs from seven subtests of the WAIS-R. Journal of Clinical Psychology, 46, 436–440.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
Wells, A. (2011). Metacognitive therapy. In Herbert, J. D. and Forman, E. M. (eds), Acceptance and Mindfulness in Cognitive Behavior Therapy: Understanding and Applying the New Therapies. New Jersey, USA: John Wiley & Sons. https://doi.org/10.1002/9781118001851.ch4Google Scholar
Wykes, T., Huddy, V., Cellard, C., McGurk, S. R., & Czobor, P. (2011). A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. American Journal of Psychiatry, 168, 472–485. https://doi.org/10.1176/appi.ajp.2010.10060855CrossRefGoogle ScholarPubMed
Yi, J. S., Ahn, Y. M., Shin, H. K., An, S. K., Joo, Y. H., Kim, S. H. et al. (2001). Reliability and validity of the Korean version of the Positive and Negative Symptoms Scale. Journal of Korean Neuropsychiatric Association, 40, 1090–1105.Google Scholar
Yum, T. H., Park, Y. S., Oh, K. J., Kim, J. K., & Lee, Y. H. (1992). K-WAIS (Korean Wechsler Adult Intelligence Scale) Manual. Seoul: Korea Guidance.Google Scholar
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