A Study on the Effectiveness of Metacognitive Training in Treating Negative Symptoms of Different Subtypes of Schizophrenia

Lijuan Shen,1,* Jing Yan,2,* Weixia Xiao,3 Lixin Sun,3 Mingjun Du,3 Yiqun He3 1Department of Clinical Psychology, the Second Affiliated Hospital of Xinxiang Medical University (Henan Mental Hospital), Xinxiang Key Laboratory of Diagnosis and Treatment Technology of Psychosomatic Diseases, Xinxiang, Henan, People’s Republic of China; 2Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, People’s Republic of China; 3The Second Affiliated Hospital of Xinxiang Medical University (Henan Mental Hospital), Xinxiang, Henan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lijuan Shen, Department of Clinical Psychology, the Second Affiliated Hospital of Xinxiang Medical University (Henan Mental Hospital), Xinxiang Key Laboratory of Diagnosis and Treatment Technology of Psychosomatic Diseases, Xinxiang, Henan, 453002, People’s Republic of China, Email [email protected] Jing Yan, Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, People’s Republic of China, Email [email protected]: This study aims to investigate the efficacy of metacognitive training (MCT) as an adjunctive treatment strategy for schizophrenia, particularly its impact on negative symptoms and potential mechanisms.Patients and Methods: This study included a total of 73 inpatients with schizophrenia. 36 patients were in the MCT group and 37 patients were in the control group. Both groups of patients were receiving a single second-generation antipsychotic drug treatment. The MCT group underwent a 4-week MCT program consisting of 8 modules, while the control group received non-cognitive psychological support for the same duration and frequency. The Positive and Negative Syndrome Scale (PANSS) five-factor model and negative symptom two-factor model were used to assess psychiatric symptoms, and the Snyder’s Self-Monitoring Scale (SSMS) and the Personal and Social Performance Scale (PSP) were used as functional evaluation indicators.Results: After treatment, compared to the control group, the MCT group had significantly lower scores in the PANSS total score (p< 0.001), negative factor (p=0.002), and hostility factor (p=0.046). Further, the PSP score (p< 0.001) and SSMS score (p=0.042) were significantly improved. In the two-factor analysis of negative symptoms, the MCT group showed significant improvements in both diminished expression (DE) symptoms (p< 0.001) and social amotivation (SA) symptoms (p=0.010) after treatment. Multivariate linear regression analysis revealed that changes in the reduction rates of P2 (Conceptual disorganization), N7 (stereotyped thinking), and SA scores had a significant impact on the reduction in DE scores; changes in the reduction rates of P6 (Suspiciousness/persecution) and DE scores had a significant impact on the reduction rate of SA scores (p< 0.05).Conclusion: MCT can improve the clinical symptoms and functions of patients with schizophrenia, especially in the DE factor characterized by conceptual disorganization and stereotyped thinking, and the SA factor prominent in suspiciousness/persecution symptom. This provides insights for the precise treatment of negative symptoms.Keywords: metacognitive training, schizophrenia, negative symptoms, diminished expression, social amotivation