Psychosis is characterized by distorted perceptions of reality, often involving persecutory delusions. Research links these symptoms to cognitive biases like "jumping to conclusions." Despite mixed reviews of Cognitive Behavioral Therapy (CBTp) for psychosis, a study will explore metacognitive training (MCT) delivered online. This training will be tested over 10 weeks with participants from a psychosis service in Kent, assessing its effect through interviews and questionnaires before and after the program, focusing on symptom improvement and cognitive changes.
Psychosis is described as disruptions to a person's beliefs and view of the world that make it challenging for them to establish what is a reality. Some people with psychosis experience persecutory delusions, which is a distressing belief that harm will happen to them by others. Research indicated that certain errors in thinking (called cognitive biases, e.g.: jumping to conclusions) have been linked to psychotic symptoms in at high risk from psychosis. Studies reveal that certain errors in thinking may be causal factors for the development and maintenance of delusions. National Institute of Health and Care Excellence recommends psychological interventions such as Cognitive Behavioural Therapy for a Psychosis (CBTp), but the efficacy of CBTp has been questioned, and small uptake by clients has also been discovered. This research is based on the metacognitive training delivered in groups, which is a psycho-educational programme targeting these thinking errors in psychosis. Research indicates that this training can be delivered online in a group to participants with psychosis, hence it offered a promising treatment approach in times of pandemic. The participants will be recruited from an Early Intervention in Psychosis service in Kent and will take part in a ten week MCT or Treatment as Usual (TAU). The MCT will consist of spending 90 minutes a week in a small online group setting working through a series of workshops. Participants will also be asked to complete homework each week and they will be supported with this. Interviews and questionnaires regarding symptoms and thinking errors will be used before and immediately after the intervention. The participants who attended the group and improved in their symptoms and thinking errors will be invited to an interview asking them what worked for them and how they found the group.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
72
The MCT will consist of spending 90 minutes a week in a small online group setting working through a series of workshops. Participants will also be asked to complete homework each week and they will be supported with this. Interviews and questionnaires regarding symptoms and thinking errors will be used before and immediately after the intervention. The participants who attended the group and improved in their symptoms and thinking errors will be invited to an interview asking them what worked for them and how they found the group.
Kent and Medway NHS and Social Care Partnership Trust
Maidstone, Kent, United Kingdom
RECRUITINGThe Psychotic Symptom Rating Scales (PSYRATS) created by Haddock et al. (1999)
This scale to measures delusional beliefs and auditory hallucinations. The scale has demonstrated excellent inter-rater, test-retest reliability (Haddock et al 1999). Furthermore, its validity has been established through research on individuals experiencing a first episode of psychosis (Drake et al., 2007).
Time frame: 1 week pre intervention and 1 week post-intervention
The Cognitive Biases Questionnaire for Psychosis (CBQp), developed by Peters et al. (2014)
It evaluates specific cognitive biases such as catastrophizing, dichotomous thinking, emotional reasoning, and jumping to conclusions by using thirty vignettes that depict everyday life scenarios. Participants are asked to rate the scenarios based on four response options. Peters et al. (2014) have determined that this questionnaire has good reliability and concurrent validity.
Time frame: 1 week pre-intervention and 1 week post-intervention
The Positive and Negative Syndrome Scale (PANSS)
This is demonstrated in various studies such as Moritz et al. (2011), Favrod et al. (2014), Moritz et al. (2013), and Briki et al. (2014). The PANSS is a 30-item interview assessment tool designed to evaluate the intensity of psychotic symptoms and has demonstrated high interrater reliability (Kay et al., 1987).
Time frame: 1 week pre-intervention and 1 week post-intervention
The Revised Green et al. Paranoid Thoughts Scale - 18 items (R-GPTS; Freeman et al., 2019)
It is an outcome measure that is used to assess the presence and severity of paranoid thoughts. It consists of 18 items and was revised by Freeman et al. in 2019. The R-GPTS is used to assess the severity of paranoid thoughts in individuals with a range of mental health conditions such as paranoia and schizophrenia. The results of the studies conducted by Freeman et al. (2019) provide evidence for the validity and reliability of the R-GPTS as a measure of paranoid thoughts. These findings suggest that the R-GPTS can be used with confidence in clinical and research settings to accurately assess the presence and severity of paranoid thoughts.
Time frame: 1 week pre-intervention and 1 week post-intervention
The Fast and Slow Thinking Questionnaire (FAST, Hardy et al., 2020)
It is a measure of reasoning biases in individuals with paranoid thoughts. The study by Hardy et al. (2020) showed that the FAST has good internal consistency and test-retest reliability. The FAST scores were significantly associated with other measures of paranoid thoughts and were able to differentiate between individuals with high and low levels of paranoia, demonstrating its concurrent and discriminant validity. These findings suggest that the FAST is a reliable and valid tool for assessing reasoning biases in individuals with paranoia.
Time frame: 1 week pre-intervention and 1 week post-intervention
Delusional conviction will be self-rated weekly post each MCT Module using a visual scale (adapted from Freeman et al.'s RCT, 2021)
Scale will ask respondents to state how strongly they believe their persecutory belief, ranging from 0 (no conviction in belief) to 100 conviction (total conviction in belief). Level of happiness will be self-rated weekly after each MCT Module using a visual scale that will ask respondents how happy they feel, ranging from 0 (not at all) to 100 (very much).
Time frame: 1 week pre-intervention, weekly questionnaires over 10 weeks after each intervention, and 1 week post-intervention
The Clinical Outcomes in Routine Evaluation (CORE-OM 34; Evans et al., 2002)
It is a widely used measure of distress in the psychology department\'s Early Intervention for Psychosis Service, where the researcher will conduct the study. The highest possible score on the questionnaire is 136, which indicates extreme levels of distress. It has been established as a valid measure with robust outcomes (Evans et al., 2002).
Time frame: 1 week pre-intervention and 1 week post-intervention
The CHOICE short form measure (Greenwood et al., 2010)
It evaluates psychological recovery and has demonstrated strong psychometric properties. It is also regularly utilized in the local Trust and service. This questionnaire assesses changes within CBTp and may also be useful in measuring outcomes of MCT.
Time frame: 1 week pre-intervention and 1 week post-intervention
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