Metacognitive Training and Therapy: An Individualized and Group Intervention for Psychosis.

Metacognitive training (MCT) is a novel group-based treatment program for schizophrenia and psychosis, and this has recently been expanded into an individualized treatment application labeled metacognitive therapy (MCT+). MCT+is a hybrid of group MCT and cognitive behavioral therapy for psychosis (CBTp). In either version, the primary aim of MCT is to raise awareness in people with psychosis of the nature of the unhealthy thinking and reasoning patterns that underlie delusions by providing experiences of these thinking patterns, either in a group or individual setting. MCT unpacks the elements of biased thinking and reasoning styles that underlie delusions ('cognitive biases') and introduces them experientially (in a wide range of situations) by walking participants through visual displays inspired by research into the cognitive underpinnings of delusions in schizophrenia. Breaking down the thinking that underlies delusions in this fashion helps participants compartmentalize and recognize the different thought patterns contributing to delusions. MCT and MCT+are both currently available in multiple languages and can be downloaded at no cost online via http://www.uke.de/mct. This chapter will provide an overview for the MCT program, examine the evidence for the cognitive biases underlying each of its modules, and summarize a number of preliminary randomized controlled trials that suggest the efficacy of MCT in treating the symptoms of psychosis. We conclude that MCT is a potentially valuable tool for clinical care teams interested in novel, evidence-based nonpharmacologic interventions.