Front Psychol. 2015 Jul 09;6:967. doi: 10.3389/fpsyg.2015.00967. eCollection 2015.

Metacognitive therapy (MCT+) in patients with psychosis not receiving antipsychotic medication: A case study.

Frontiers in psychology

Ryan P Balzan, Cherrie Galletly

PMID: 26217283 PMCID: PMC4496559 DOI: 10.3389/fpsyg.2015.00967

Abstract

BACKGROUND: Psychotherapies for psychosis typically aim to develop an awareness of the implausible content of a delusion or target the underlying cognitive biases (i.e., problematic thinking styles, such as hasty decisions and illusory control) that foster and maintain delusional beliefs. A recently designed individual-based treatment entitled metacognitive therapy (MCT+) combines these two approaches. Emerging evidence suggests individualized MCT+, when used concurrently with antipsychotic medication, may be an effective psychological treatment for reducing delusional symptoms. However, it remains to be tested whether MCT+ can be effective in patients with active delusions who are not currently receiving psychotropic drugs.

METHOD: We present two cases (one patient with schizophrenia and the other with delusional disorder) experiencing active delusions who underwent 4-weeks of intensive MCT+, without concurrent antipsychotic medication (minimum 6-months unmedicated). Baseline and 6-week follow-up data are presented on a variety of measures assessing delusion symptom severity (i.e., PANSS, PSYRATS, SAPS), clinical insight, and cognitive bias propensity.

RESULTS: After 4-weeks of MCT+, both patients showed substantial reduction in delusional symptoms, reported improved clinical insight, and were less prone to making illusory correlations.

CONCLUSIONS: The presented case studies provide preliminary evidence for the feasibility of MCT+ in treating patients not taking, or resistant to, antipsychotic medication.

Keywords: CBT; cognitive bias; delusions; psychotherapy; schizophrenia

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• Case Reports