Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study.

BACKGROUND: Theory-driven interventions targeting specific factors that contribute to delusions are receiving increased interest. The present study aimed to assess the efficacy of individualized metacognitive therapy (MCT+), a short manualized intervention that addresses delusion-associated cognitive biases. METHODS: 92 patients with current or past delusions were randomized to receive 12 twice-weekly sessions of either MCT+ or a control intervention within a randomized controlled rater-blind design. Psychopathology and cognitive biases were assessed at baseline, 6 weeks and 6 months. ANCOVAs adjusted for baseline scores were used to assess differences between groups regarding outcome variables. Both per-protocol and intention-to-treat analyses were conducted. RESULTS: At 6 weeks, there was a significant difference in favor of MCT+ regarding decrease in delusion severity and improvement of self-reflectiveness (medium effect size), and a trend-wise difference regarding probability thresholds to decision. These effects increased, when only patients attending a minimum of 4 therapy sessions were considered. Control group patients subsequently showed further improvement while patients in the MCT+ group remained stable, such that there were no differences between groups at the 6-month follow-up. LIMITATIONS: Lower attendance rates in the control group possibly leading to unequal therapeutic effort; lower baseline delusion severity in the MCT+ group. CONCLUSIONS: The result pattern suggests that MCT+ led to earlier improvement in delusions and cognitive biases compared to the control intervention. The absence of a long-term effect might reflect floor effects in the MCT+ group, but may also indicate the need for further measures to promote sustainability of MCT+ effects.

Emotion recognition in depression: An investigation of performance and response confidence in adult female patients with depression.

Abnormalities in emotion recognition are frequently reported in depression. However, emotion recognition is not compromised in some studies, and confidence judgments, which are essential for social interaction, have not been considered to date. Due to the high prevalence rate of depression in women, and sex differences in emotion recognition, the aim of the present study was to investigate emotion recognition and confidence judgments in women with depression. A sample of female patients with depressive disorders (n=45) was compared with female healthy controls (n=30) in their ability to correctly identify facial emotion expressions along with confidence judgments. Groups performed similarly on emotional face recognition and showed no difference regarding confidence ratings. A negative correlation between self-assessed depression and response confidence was found. While some limitations of the study must be taken in consideration (e.g., small number of items per emotion category, low severity of depression), abnormalities in emotion recognition do not seem to be a major feature of depression. As self-assessed depression is accompanied by low response confidence for emotional faces, it is crucial to further examine the role of confidence judgments in emotion recognition, as underconfidence may foster interpersonal insecurity in depression.

Sensory properties of obsessive thoughts in OCD and the relationship to psychopathology.

For decades hallucinations and perception-laden thoughts were considered specific indicators of schizophrenia. This assumption has been revised over the years. Novel studies indicate that a subgroup of patients with obsessive-compulsive disorder (OCD), borderline disorder or depression display hallucinations and "loud"/perceptual thoughts. The present study examined the frequency of sensory-laden obsessive thoughts and their relationship with the severity of obsessive-compulsive, paranoid and depressive symptoms in a sample of 137 OCD patients who were recruited via the Internet. Participants were asked to fill out the Sensory Properties of Obsessions Questionnaire (SPOQ), the Obsessive-Compulsive Inventory-Revised (OCI-R), the Paranoia Checklist and the Patient Health Questionnaire (PHQ9). In line with a prior study, a total of 72% displayed perceptual intrusions (i.e. vivid obsessions). Correlations emerged between perceptual thoughts and obsessive-compulsive, paranoid and depressive symptoms. Results further strengthen the assumption of a continuum ranging from "silent" thoughts to vivid intrusions and hallucinations.