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Detecting and defusing cognitive traps: metacognitive intervention in schizophrenia

Moritz, Steffena; Vitzthum, Francescaa; Randjbar, Saraha; Veckenstedt, Rutha; Woodward, Todd Sb,c

doi: 10.1097/YCO.0b013e32833d16a8
Clinical therapeutics: Edited by Dieter Naber and Harold Pincus

Purpose of review Until recently, psychological therapy for schizophrenia was considered harmful or inefficient by many clinicians. The reservation against psychotherapy is partly rooted in the assumption that delusions in particular and schizophrenia in general are not amenable to psychological understanding and represent ‘utter madness’. However, meta-analyses suggest that cognitive intervention is effective in ameliorating schizophrenia symptoms. In addition, evidence has accumulated that cognitive biases, such as jumping to conclusions, are involved in the pathogenesis of schizophrenia positive symptoms, particularly delusions. A recently developed group program, called metacognitive training (MCT), is presented targeting these biases. MCT is a hybrid of psychoeducation, cognitive remediation and cognitive–behavioural therapy.

Recent findings This review introduces new evidence on cognitive biases involved in the pathogenesis of schizophrenia and demonstrates how the MCT raises the patients' (metacognitive) awareness to detect and defuse such ‘cognitive traps’. At the end, a new individualized variant entitled MCT+ is presented targeting individual delusional ideas. Finally, empirical results are summarized that speak in favour of the feasibility and efficacy of MCT.

Summary Recent studies assert marked cognitive biases in schizophrenia. MCT has evolved as a feasible and effective complement of standard psychiatric treatment.

aDepartment of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

bDepartment of Psychiatry, University of British Columbia, Canada

cBC Mental Health and Addictions Research Institute, Vancouver, British Columbia, Canada

Correspondence to Steffen Moritz, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany Tel: +49 40 7410 56565; fax: +49 40 7410 57566; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.