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Bartsch DR, Cooke-O'Connor L, Connerty TJ, van Roekel H, Cammell P. Acceptability and feasibility of a short-term group therapy for people with borderline personality disorder symptoms. Australas Psychiatry 2024:10398562241246485. [PMID: 38621694 DOI: 10.1177/10398562241246485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVE This study evaluated the acceptance, feasibility and safety of a short-term group program for adults (18 years and older) and youth (16 to 18 years) with borderline personality disorder (BPD) symptoms. Termed Road Maps, the content and development were informed by common treatment factors identified from evidence-based therapies for BPD. METHOD Two-hundred and eight people consented to participate in the research trial and completed baseline measures. Intervention participants rated the acceptability and subjective experience of the group. Attrition rates informed feasibility, and serious adverse events were tracked to identify potential harms. RESULTS Participant post-group ratings of the group's acceptability and subjective experience were above average across both adult and youth populations. Attrition rate after commencement of group was 38% for adults and 27% among youth. The incidence rate of emergency department presentations was reduced by 41% in the 6 months post-group, relative to 6 months pre-group. CONCLUSIONS The current study provides preliminary support for the acceptability and feasibility of a short-term group therapy program for people with a diagnosis of BPD. Road Maps may be a useful intermediate intervention in a broader model of stepped care. Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au/ACTRN12622000849796.aspx, (ACTRN12622000849796).
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Affiliation(s)
- Dianna R Bartsch
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, SA, Australia; and School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Laura Cooke-O'Connor
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, SA, USA
| | - Tracy J Connerty
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, SA, USA
| | - Helen van Roekel
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, SA, USA
| | - Paul Cammell
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, SA, USA
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Martin S. Why using “consciousness” in psychotherapy? Insight, metacognition and self-consciousness. New Ideas in Psychology 2023. [DOI: 10.1016/j.newideapsych.2023.101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Jörg C, Clemm von Hohenberg C, Schmahl C. [Evidence-based inpatient psychotherapy in borderline personality disorder]. Nervenarzt 2023; 94:206-212. [PMID: 36735037 DOI: 10.1007/s00115-023-01438-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD) is frequent (prevalence in Germany between 0.7% and 4.5%) [11] and is associated with a high level of psychological stress and frequent emergency inpatient admissions. The provision of disorder-specific outpatient psychotherapy is still insufficient also in Germany. OBJECTIVE This article provides an overview of the available data on the effectiveness of inpatient psychotherapy for BPD. MATERIAL AND METHODS A qualitative review on the effectiveness and therapy outcome predictors was conducted based on a literature search in PubMed. RESULTS Overall, very few randomized controlled trials are available; in contrast uncontrolled studies are predominant. Most evidence is available for dialectical behavior therapy (DBT) but other approaches, including psychodynamic procedures, have also been studied. DISCUSSION The currently available data suggest an efficacy of inpatient psychotherapy for BPD; however, randomized trials with larger samples and sufficient representation including male patients are largely lacking. There is also no substantial direct evidence for the superiority of inpatient compared to outpatient psychotherapy.
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Affiliation(s)
- Christian Jörg
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Christian Clemm von Hohenberg
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Christian Schmahl
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland.
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Fischer R, Scheunemann J, Bohlender A, Duletzki P, Nagel M, Moritz S. 'You are trying to teach us to think more slowly!': Adapting Metacognitive Training for the acute care setting-A case report. Clin Psychol Psychother 2022; 29:1877-1885. [PMID: 35586971 DOI: 10.1002/cpp.2755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/11/2022]
Abstract
Psychological group interventions for the acute inpatient care setting are scarce. Whereas Metacognitive Training for patients with Psychosis (MCT) provides a widely accessible, easy-to-implement intervention for patients with mild to moderate symptoms, it is less adequate for the acute care setting with respect to length and density of information. We present the adaptation process and the resulting adaptation of MCT, MCT-Acute, for the acute inpatient care setting. We report the case of a first patient, NK, who participated in MCT-Acute during her mandated stay on the locked acute ward due to an exacerbation of schizophrenia. NK participated in MCT-Acute 12 times, evaluated the training overall as positive and reported that she used exercises she had learned during training to improve her mood. She also described changing her behaviour in everyday life to think more slowly and make less hasty decisions, which is a central topic discussed in MCT and MCT-Acute. Conducting an adapted version of MCT in the acute care setting is feasible, and the present case report suggests that MCT-Acute may be a useful complement to a multidisciplinary treatment plan to stabilize patients with severe mental illness in acute inpatient care.
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Affiliation(s)
- Rabea Fischer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, Asklepios Clinic North-Wandsbek, Hamburg, Germany
| | - Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alison Bohlender
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patric Duletzki
- Department of Psychiatry and Psychotherapy, Asklepios Clinic North-Wandsbek, Hamburg, Germany
| | - Matthias Nagel
- Department of Psychiatry and Psychotherapy, Asklepios Clinic North-Wandsbek, Hamburg, Germany.,Clinic for Psychiatry and Psychotherapy, University Clinic Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Wasmuth S, Mokol E, Szymaszek K, Gaerke KJ, Manspeaker T, Lysaker P. Intersections of occupational participation and borderline personality disorder: A grounded theory approach. Cogent Psychology 2020. [DOI: 10.1080/23311908.2020.1803580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Sally Wasmuth
- Department of Occupational Therapy, School of Health & Human Sciences, Indiana University, Purdue University (IUPUI), Indianapolis, IN, USA
| | - Emily Mokol
- School of Occupational Therapy, College of Health Sciences, University of Indianapolis, Indianapolis, IN, USA
| | | | | | | | - Paul Lysaker
- Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychiatry, School of Medicine, Indiana University, Indianapolis, IN, USA
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Miegel F, Demiralay C, Moritz S, Wirtz J, Hottenrott B, Jelinek L. Metacognitive Training for Obsessive-Compulsive Disorder: a study protocol for a randomized controlled trial. BMC Psychiatry 2020; 20:350. [PMID: 32631261 PMCID: PMC7336399 DOI: 10.1186/s12888-020-02648-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/04/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A high number of patients with obsessive-compulsive disorder (OCD) do not receive cognitive-behavioral therapy with exposure and response prevention, which is the most effective treatment for OCD. Therefore, Metacognitive Training for OCD (MCT-OCD) was developed, which is a structured group therapy aiming at the modification of dysfunctional (meta-)cognitive biases, beliefs and coping styles. It can be administered by less trained personnel, thus may reach a higher number of patients. An uncontrolled pilot study (MCT-OCD pilot version) provided first evidence that the training is highly accepted by patients; OC symptoms decreased with a high effect size (η2partial = 0.50). The aim of the present study is to address the shortcomings of the pilot study (e.g., no control group) and to assess the efficacy of the revised version of the MCT-OCD in the framework of a randomized controlled trial. METHODS Eighty patients with OCD will be recruited. After a blinded assessment at baseline (-t1), patients will be randomly assigned either to the intervention group (MCT-OCD; n = 40) or to a care as usual control group (n = 40). The MCT-OCD aims to enhance patients' metacognitive competence in eight modules by addressing dysfunctional (meta-)cognitive biases and beliefs associated with OCD (e.g., intolerance of uncertainty). After 8 weeks, patients will be invited to a post assessment (t1), and then they will receive a follow-up online questionnaire 3 months following t1 (t2). The primary outcome is the Y-BOCS total score, and the secondary outcomes include the HDRS, OCI-R, OBQ-44, MCQ-30, WHOQOL-BREF, BDI-II, and subjective appraisal ratings of the MCT-OCD. We expect that OC symptoms will decrease more in the intervention group compared with the care as usual control group from -t1 to t1 and that treatment gains will be maintained until t2. DISCUSSION The planned study is the first to investigate the MCT-OCD, a promising new treatment, in a randomized controlled trial. The MCT-OCD may help to overcome existing treatment barriers for patients with OCD. TRIAL REGISTRATION German Registry for Clinical Studies ( DRKS00013539 ), 22.02.2018.
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Affiliation(s)
- Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Janina Wirtz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Birgit Hottenrott
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Storebø OJ, Stoffers-Winterling JM, Völlm BA, Kongerslev MT, Mattivi JT, Jørgensen MS, Faltinsen E, Todorovac A, Sales CP, Callesen HE, Lieb K, Simonsen E. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 2020; 5:CD012955. [PMID: 32368793 PMCID: PMC7199382 DOI: 10.1002/14651858.cd012955.pub2] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Over the decades, a variety of psychological interventions for borderline personality disorder (BPD) have been developed. This review updates and replaces an earlier review (Stoffers-Winterling 2012). OBJECTIVES To assess the beneficial and harmful effects of psychological therapies for people with BPD. SEARCH METHODS In March 2019, we searched CENTRAL, MEDLINE, Embase, 14 other databases and four trials registers. We contacted researchers working in the field to ask for additional data from published and unpublished trials, and handsearched relevant journals. We did not restrict the search by year of publication, language or type of publication. SELECTION CRITERIA Randomised controlled trials comparing different psychotherapeutic interventions with treatment-as-usual (TAU; which included various kinds of psychotherapy), waiting list, no treatment or active treatments in samples of all ages, in any setting, with a formal diagnosis of BPD. The primary outcomes were BPD symptom severity, self-harm, suicide-related outcomes, and psychosocial functioning. There were 11 secondary outcomes, including individual BPD symptoms, as well as attrition and adverse effects. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, extracted data, assessed risk of bias using Cochrane's 'Risk of bias' tool and assessed the certainty of the evidence using the GRADE approach. We performed data analysis using Review Manager 5 and quantified the statistical reliability of the data using Trial Sequential Analysis. MAIN RESULTS We included 75 randomised controlled trials (4507 participants), predominantly involving females with mean ages ranging from 14.8 to 45.7 years. More than 16 different kinds of psychotherapy were included, mostly dialectical behaviour therapy (DBT) and mentalisation-based treatment (MBT). The comparator interventions included treatment-as-usual (TAU), waiting list, and other active treatments. Treatment duration ranged from one to 36 months. Psychotherapy versus TAU Psychotherapy reduced BPD symptom severity, compared to TAU; standardised mean difference (SMD) -0.52, 95% confidence interval (CI) -0.70 to -0.33; 22 trials, 1244 participants; moderate-quality evidence. This corresponds to a mean difference (MD) of -3.6 (95% CI -4.4 to -2.08) on the Zanarini Rating Scale for BPD (range 0 to 36), a clinically relevant reduction in BPD symptom severity (minimal clinical relevant difference (MIREDIF) on this scale is -3.0 points). Psychotherapy may be more effective at reducing self-harm compared to TAU (SMD -0.32, 95% CI -0.49 to -0.14; 13 trials, 616 participants; low-quality evidence), corresponding to a MD of -0.82 (95% CI -1.25 to 0.35) on the Deliberate Self-Harm Inventory Scale (range 0 to 34). The MIREDIF of -1.25 points was not reached. Suicide-related outcomes improved compared to TAU (SMD -0.34, 95% CI -0.57 to -0.11; 13 trials, 666 participants; low-quality evidence), corresponding to a MD of -0.11 (95% CI -0.19 to -0.034) on the Suicidal Attempt Self Injury Interview. The MIREDIF of -0.17 points was not reached. Compared to TAU, psychotherapy may result in an improvement in psychosocial functioning (SMD -0.45, 95% CI -0.68 to -0.22; 22 trials, 1314 participants; low-quality evidence), corresponding to a MD of -2.8 (95% CI -4.25 to -1.38), on the Global Assessment of Functioning Scale (range 0 to 100). The MIREDIF of -4.0 points was not reached. Our additional Trial Sequential Analysis on all primary outcomes reaching significance found that the required information size was reached in all cases. A subgroup analysis comparing the different types of psychotherapy compared to TAU showed no clear evidence of a difference for BPD severity and psychosocial functioning. Psychotherapy may reduce depressive symptoms compared to TAU but the evidence is very uncertain (SMD -0.39, 95% CI -0.61 to -0.17; 22 trials, 1568 participants; very low-quality evidence), corresponding to a MD of -2.45 points on the Hamilton Depression Scale (range 0 to 50). The MIREDIF of -3.0 points was not reached. BPD-specific psychotherapy did not reduce attrition compared with TAU. Adverse effects were unclear due to too few data. Psychotherapy versus waiting list or no treatment Greater improvements in BPD symptom severity (SMD -0.49, 95% CI -0.93 to -0.05; 3 trials, 161 participants), psychosocial functioning (SMD -0.56, 95% CI -1.01 to -0.11; 5 trials, 219 participants), and depression (SMD -1.28, 95% CI -2.21 to -0.34, 6 trials, 239 participants) were observed in participants receiving psychotherapy versus waiting list or no treatment (all low-quality evidence). No evidence of a difference was found for self-harm and suicide-related outcomes. Individual treatment approaches DBT and MBT have the highest numbers of primary trials, with DBT as subject of one-third of all included trials, followed by MBT with seven RCTs. Compared to TAU, DBT was more effective at reducing BPD severity (SMD -0.60, 95% CI -1.05 to -0.14; 3 trials, 149 participants), self-harm (SMD -0.28, 95% CI -0.48 to -0.07; 7 trials, 376 participants) and improving psychosocial functioning (SMD -0.36, 95% CI -0.69 to -0.03; 6 trials, 225 participants). MBT appears to be more effective than TAU at reducing self-harm (RR 0.62, 95% CI 0.49 to 0.80; 3 trials, 252 participants), suicidality (RR 0.10, 95% CI 0.04, 0.30, 3 trials, 218 participants) and depression (SMD -0.58, 95% CI -1.22 to 0.05, 4 trials, 333 participants). All findings are based on low-quality evidence. For secondary outcomes see review text. AUTHORS' CONCLUSIONS Our assessments showed beneficial effects on all primary outcomes in favour of BPD-tailored psychotherapy compared with TAU. However, only the outcome of BPD severity reached the MIREDIF-defined cut-off for a clinically meaningful improvement. Subgroup analyses found no evidence of a difference in effect estimates between the different types of therapies (compared to TAU) . The pooled analysis of psychotherapy versus waiting list or no treatment found significant improvement on BPD severity, psychosocial functioning and depression at end of treatment, but these findings were based on low-quality evidence, and the true magnitude of these effects is uncertain. No clear evidence of difference was found for self-harm and suicide-related outcomes. However, compared to TAU, we observed effects in favour of DBT for BPD severity, self-harm and psychosocial functioning and, for MBT, on self-harm and suicidality at end of treatment, but these were all based on low-quality evidence. Therefore, we are unsure whether these effects would alter with the addition of more data.
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Affiliation(s)
- Ole Jakob Storebø
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | | | - Birgit A Völlm
- Department of Forensic Psychiatry, Center for Neurology, University Rostock, Rostock, Germany
| | - Mickey T Kongerslev
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Jessica T Mattivi
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Mie S Jørgensen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | - Erlend Faltinsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | - Adnan Todorovac
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | - Christian P Sales
- Duncan MacMillan House, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- Institute of Mental Health, Department of Psychiatry & Applied Psychology, Nottingham, UK
| | | | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
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Miegel F, Cludius B, Hottenrott B, Demiralay C, Sure A, Jelinek L. Session-specific effects of the Metacognitive Training for Obsessive-Compulsive Disorder (MCT-OCD). Psychother Res 2019; 30:474-486. [PMID: 31072282 DOI: 10.1080/10503307.2019.1613582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective: Most studies focus on overall treatment effects by assessing symptom severity before and after treatment, but few investigate session-specific effects of an intervention. The aim of the present study was to elucidate session-specific effects of a group therapy for obsessive-compulsive disorder (OCD) that targets cognitive biases known as the Metacognitive Training for OCD (MCT-OCD).Method: In an uncontrolled pilot trial, 44 inpatients with OCD participated in the MCT-OCD once a week over four weeks. Before and after each session, patients answered questionnaires on thought monitoring, control of thoughts, obsessions, compulsions, and mood.Results: Primary analyses using linear mixed-effect models showed that the module on control of thoughts (within-session effect) significantly reduced patients' control of thoughts. Exploratory analyses displayed an improvement in thought monitoring, control of thoughts, obsessions, and compulsions over the treatment period. Control of thoughts decreaed after the module on biased attention/biased cognitive networks and compulsions reduced one week after the module on overestimation of threat/responsibility (between-session effect). More compulsions were reported one week after the module on thought-action fusion/control of thoughts.Conclusions: Certain MCT-OCD modules seemed to improve specific cognitive biases that might in turn act as mechanisms of change. The results are being used to revise the MCT-OCD.
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Affiliation(s)
- Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Cludius
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Hottenrott
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Sure
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Philipp R, Kriston L, Lanio J, Kühne F, Härter M, Moritz S, Meister R. Effectiveness of metacognitive interventions for mental disorders in adults-A systematic review and meta-analysis (METACOG). Clin Psychol Psychother 2018; 26:227-240. [PMID: 30456821 DOI: 10.1002/cpp.2345] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 01/08/2023]
Abstract
We evaluated the effectiveness and acceptability of metacognitive interventions for mental disorders. We searched electronic databases and included randomized and nonrandomized controlled trials comparing metacognitive interventions with other treatments in adults with mental disorders. Primary effectiveness and acceptability outcomes were symptom severity and dropout, respectively. We performed random-effects meta-analyses. We identified Metacognitive Training (MCTrain), Metacognitive Therapy (MCTherap), and Metacognition Reflection and Insight Therapy (MERIT). We included 49 trials with 2,609 patients. In patients with schizophrenia, MCTrain was more effective than a psychological treatment (cognitive remediation, SMD = -0.39). It bordered significance when compared with standard or other psychological treatments. In a post hoc analysis, across all studies, the pooled effect was significant (SMD = -0.31). MCTrain was more effective than standard treatment in patients with obsessive-compulsive disorder (SMD = -0.40). MCTherap was more effective than a waitlist in patients with depression (SMD = -2.80), posttraumatic stress disorder (SMD = -2.36), and psychological treatments (cognitive-behavioural) in patients with anxiety (SMD = -0.46). In patients with depression, MCTherap was not superior to psychological treatment (cognitive-behavioural). For MERIT, the database was too small to allow solid conclusions. Acceptability of metacognitive interventions among patients was high on average. Methodological quality was mostly unclear or moderate. Metacognitive interventions are likely to be effective in alleviating symptom severity in mental disorders. Although their add-on value against existing psychological interventions awaits to be established, potential advantages are their low threshold and economy.
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Affiliation(s)
- Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Lanio
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Kühne
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ramona Meister
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Moritz S, Lysaker PH. Metacognition - What did James H. Flavell really say and the implications for the conceptualization and design of metacognitive interventions. Schizophr Res 2018; 201:20-26. [PMID: 29903626 DOI: 10.1016/j.schres.2018.06.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/01/2018] [Accepted: 06/03/2018] [Indexed: 01/17/2023]
Abstract
In the last two decades years, several interventions have been designed for people with major psychological disorders that all have "metacognitive" in their name: Metacognitive Therapy (MCT), Metacognitive Training (e.g., for people with psychosis) and Metacognitive Reflection and Insight Therapy (MERIT). Two of these interventions are primarily targeted at patients with schizophrenia. Prompted by a recent discussion about what constitutes "true" metacognitive treatment, we will first explore the original concept of metacognition as defined by James H. Flavell. Then, we will describe each approach in detail before highlighting how each intervention picks up on slightly different aspects of Flavell's original metacognitive construct. We will also discuss inherent problems with the label "metacognition."
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Paul H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN, USA; Indiana University School of Medicine, IN, USA
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Gordon-King K, Schweitzer RD, Dimaggio G. Metacognitive Interpersonal Therapy for Personality Disorders Featuring Emotional Inhibition: A Multiple Baseline Case Series. J Nerv Ment Dis 2018; 206:263-9. [PMID: 29377848 DOI: 10.1097/NMD.0000000000000789] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Metacognitive interpersonal therapy (MIT) is an integrative psychotherapeutic approach targeting personality disorders (PDs) featuring inhibition and avoidance. The current case series reports the outcome of a time-limited, 12-month MIT intervention for people with PDs featuring emotional inhibition. Seven participants were diagnosed with a PD on the basis of a structured clinical interview. The study followed a multiple baseline design, with baseline measures taken for 3 weeks before intervention. Participants underwent 12 months of weekly MIT sessions, with outcome measures taken every 3 months. Outcome variables were diagnostic recovery, symptom severity, and alexithymia. All participants improved over the course of the 12-month intervention across most measures. For six of the participants, the intervention was a likely driver of change. The current study contributes to a growing evidence base regarding the effectiveness of MIT for the treatment of PDs.
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Harned MS, Wilks CR, Schmidt SC, Coyle TN. Improving functional outcomes in women with borderline personality disorder and PTSD by changing PTSD severity and post-traumatic cognitions. Behav Res Ther 2018; 103:53-61. [PMID: 29448136 PMCID: PMC5837954 DOI: 10.1016/j.brat.2018.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 01/27/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
Although functional impairment typically improves during evidence-based psychotherapies (EBPs) for borderline personality disorder (BPD), functional levels often remain suboptimal after treatment. The present pilot study evaluated whether and how integrating PTSD treatment into an EBP for BPD would improve functional outcomes. Participants were 26 women with BPD, PTSD, and recent suicidal and/or self-injurious behavior who were randomized to receive one year of Dialectical Behavior Therapy (DBT) or DBT with the DBT Prolonged Exposure (DBT PE) protocol for PTSD. Five domains of functioning were assessed at 4-month intervals during treatment and at 3-months post-treatment. DBT + DBT PE was superior to DBT in improving global social adjustment, health-related quality of life, and achieving good global functioning, but not interpersonal problems or quality of life. Results of time-lagged mixed effects models indicated that, across both treatments, reductions in PTSD severity significantly predicted subsequent improvement in global social adjustment, global functioning, and health-related quality of life, whereas reductions in post-traumatic cognitions significantly predicted later improvement in all functional outcomes except global social adjustment. These findings provide preliminary evidence supporting the role of change in PTSD severity and trauma-related cognitions as active mechanisms in improving functional outcomes among individuals with BPD and PTSD.
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Schilling L, Moritz S, Kriston L, Krieger M, Nagel M. Efficacy of metacognitive training for patients with borderline personality disorder: Preliminary results. Psychiatry Res 2018; 262:459-464. [PMID: 28927866 DOI: 10.1016/j.psychres.2017.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/31/2017] [Accepted: 09/10/2017] [Indexed: 11/25/2022]
Abstract
'Metacognitive training for borderline personality disorder' (B-MCT) represents a complementary group intervention. It aims at raising awareness for cognitive biases that may play an important role in the development and maintenance of borderline symptomatology. For the present study, we evaluated the effectiveness of this new approach against a control condition. Seventy-four inpatients with borderline personality disorder (BPD) were randomly assigned to metacognitive training for BPD or progressive muscle relaxation training as an add-on intervention to treatment as usual. Severity of symptomatology was assessed at baseline, four weeks after beginning and six months after completion of the intervention. The per-protocol and intention-to-treat analyses revealed that patients in the metacognitive training group showed significantly greater reductions on the primary outcome (Borderline Symptom List-23) after six months. Progressive muscle relaxation was superior in alleviating depressive symptoms (secondary outcome: Beck Depression Inventory) at the long-term follow-up. Findings provide preliminary evidence that metacognitive training for BPD yields surplus effects to standard treatment.
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Affiliation(s)
- Lisa Schilling
- Department of Psychiatry and Psychotherapy, Asklepios Clinic Nord, Horner Landstraße 302-304, 22111 Hamburg, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Maria Krieger
- Department of Psychiatry and Psychotherapy, Asklepios Clinic Nord, Horner Landstraße 302-304, 22111 Hamburg, Germany; Refugio Stuttgart e.V., Weißenburgstraße 15, 70180 Stuttgart, Germany
| | - Matthias Nagel
- Department of Psychiatry and Psychotherapy, Asklepios Clinic Nord, Horner Landstraße 302-304, 22111 Hamburg, Germany; Department of Psychiatry and Psychotherapy, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
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Jelinek L, Zielke L, Hottenrott B, Miegel F, Cludius B, Sure A, Demiralay C. Patients’ Perspectives on Treatment with Metacognitive Training for OCD. Zeitschrift für Neuropsychologie 2018. [DOI: 10.1024/1016-264x/a000211] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract. There is much room for improvement in the treatment of obsessive-compulsive disorder (OCD). The current study introduces a newly developed version of Metacognitive Training for OCD (MCT-OCD), inspired by the self-help intervention myMCT as well as by MCT group programs for other disorders. The current study examines the acceptability of the training. Forty-four patients with OCD received four sessions of MCT-OCD in addition to inpatient treatment. At post assessment, patients provided a subjective appraisal of the training. Analyses revealed high acceptability and added value of the MCT-OCD. The current, preliminary version of the MCT-OCD is promising in terms of patient acceptance. Results will be used to improve current shortcomings of the training and to develop a more comprehensive MCT-OCD.
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Affiliation(s)
- Lena Jelinek
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
- joint first authors
| | - Lotta Zielke
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
- joint first authors
| | - Birgit Hottenrott
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
| | - Franziska Miegel
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
| | - Barbara Cludius
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
| | - Anna Sure
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
| | - Cüneyt Demiralay
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
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Moritz S, Menon M, Andersen D, Woodward TS, Gallinat J. Moderators of Symptomatic Outcome in Metacognitive Training for Psychosis (MCT). Who Benefits and Who Does Not? Cogn Ther Res 2018; 42:80-91. [DOI: 10.1007/s10608-017-9868-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kühne F, Meister R, Jansen A, Härter M, Moritz S, Kriston L. Effectiveness of metacognitive interventions for mental disorders in adults: a systematic review protocol (METACOG). BMJ Open 2017; 7:e015428. [PMID: 28645966 PMCID: PMC5734416 DOI: 10.1136/bmjopen-2016-015428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/03/2017] [Accepted: 04/21/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Whereas the efficacy of cognitive-behavioural therapy has been demonstrated for a variety of mental disorders, there is still need for improvement, especially regarding less prevalent or more severe disorders. Recently, metacognitive interventions have been developed and are now available for a variety of diagnoses. Still, a systematic review investigating the effectiveness of different metacognitive interventions for various mental disorders is missing. METHODS AND ANALYSIS Randomised controlled trials (RCTs), cross-over and cluster RCTs and non-randomised controlled trials on metacognitive interventions (ie, metacognitive therapy, metacognitive training, others) in adults with any mental disorder will be included. As comparators, another psychological or pharmacological treatment, a combined psychological and pharmacological treatment, treatment as usual or no active treatment are eligible. Outcomes refer to efficacy and acceptability of metacognitive interventions. ETHICS AND DISSEMINATION In light of the popularity of metacognitive interventions, the systematic review will provide researchers, clinicians and patients with substantial information on the intervention's effectiveness across different mental disorders. Results will be published in peer-reviewed journals and disseminated through a patient workshop.
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Affiliation(s)
- Franziska Kühne
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychology, University of Postdam, Potsdam, Germany
| | - Ramona Meister
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessa Jansen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- The Federal Chamber of Psychotherapists in Germany (BPTK), Berlin, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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