Two decades of metacognitive training for psychosis: successes, setbacks, and innovations

Introduction: Schizophrenia is among the most debilitating mental health conditions. While antipsychotic medication represents the primary pillar of treatment, guidelines now also recommend psychotherapy. Metacognitive Training (MCT) has emerged over the past 20 years as a novel approach that addresses the cognitive biases involved in the pathogenesis of schizophrenia. MCT seeks to enhance patients’ awareness of their cognitive distortions and reduce overconfidence. MCT is available in individual and group formats. Areas covered: This review provides a comprehensive overview of MCT, detailing its theoretical foundations, development, and implementation. The authors present meta-analyses demonstrating its efficacy in improving positive symptoms as well as negative symptoms and self-esteem. Lastly, the review covers the integration of the COGITO app to support MCT. For our narrative review we searched data bases including PubMed, Web of Science, EMBASE, PsycINFO, and MEDLINE. Expert opinion: MCT represents a significant advance in the treatment of schizophrenia, offering a flexible, low-threshold intervention that can be easily implemented in various clinical settings. The training’s focus on metacognitive processes provides patients with tools to understand and manage their symptoms. Future research should seek to develop shortened as well as more personalized versions and investigate the long-term sustainability of the effects.