Development of the trainer skill evaluation scale for metacognitive training.

Aim: The purpose of this study is manifold: to develop a trainer skill rating scale for metacognitive training (MCT), to determine the difficulty level of the behavioral checklist, and to examine the reliability and validity of the MCT Trainer Skills Rating Scale. Method: In Study 1, an MCT trainer skill behavior checklist was developed with expert staff members, and a questionnaire was administered to MCT trainers. Item categorization was identical to that used in previous studies. In Study 2, a video was used to conduct the survey. All subjects were given a 1-hour training session, instructed on evaluating the MCT Trainer Skills Rating Scale, and asked to rate their trainer skills on a mock video designed for beginners and a mock video designed for advanced trainers. Result: In Study 1, responses from 49 respondents were obtained. The survey results showed that 72 items were classified similarly to previous studies. In Study 2, two pairs were randomly selected, and weighted kappa coefficients were calculated for the sub-items of the MCT Trainer Skills Rating Scale. High agreement was obtained with K = 0.71 and K = 0.73, indicating high reliability. Conclusion: High reliability was obtained for all eight items of the MCT Trainer Skills Rating Scale created in this study. In addition, the video evaluation scores for the advanced trainer were significantly higher than those for the beginner trainer, suggesting that discriminant validity was confirmed among the criterion-related validity. These results confirm that the scale has both high reliability and validity.

[Cognitive behavioral therapy for psychosis (CBTp): the concept and current practice].

Cognitive behavioral therapy (CBT) is now being used to treat schizophrenia. Such therapy is referred to as CBT for psychosis (CBTp). Some techniques employed in CBT for mood and anxiety disorders are also useful in the treatment of schizophrenia. Therapists also need to be attentive regarding the establishment of a rapport and relationship with patients, and they should be aware of the characteristic cognitive biases associated with schizophrenia. The guidelines for CBTp proposed by some research and clinical groups include: (1) collaborative empiricism, (2) improvement of flexibility in cognition and behavior, as well as enhancement of coping strategies, (3) extensive evaluation and case formulation, (4) normalization of information deficit, and (5) prevention of relapse. Several clinical studies in European and North American countries have provided strong evidence for the effectiveness of CBTp. However, some questions remain unanswered. In Japan, in line with the national psychiatric service system, CBTp is expected to be developed further and practiced to improve the QOL of individuals with schizophrenia.

Reliability and validity of the Nepean Beliefs Scale for delusions and overvalued ideas in chronic schizophrenia: analysis of a preliminary pilot study.

Introduction: The Nepean Beliefs Scale by Brakoulias et al. is an interview-based multidimensional instrument that measures pathological beliefs in various psychiatric disorders. This study examined the reliability and validity of Nepean Beliefs Scale (NBS) for delusions and overvalued ideas in patients with chronic-phase schizophrenia. Methods: Multiple raters at two healthcare settings examined the beliefs of 28 individuals with schizophrenia using the NBS. Concurrently, PANSS, PDI-21, BCIS, PHQ-9 and GAD-7 were administered. Results: The NBS had high reliability and correlation with relevant scales. Discussion: The NBS was found to have sufficient reliability and validity for assessing the pathological beliefs of patients with chronic schizophrenia. Although NBS is an easy-to-instruct instrument, it should be noted that appropriate explanations and examples should be added to instructions to obtain reliable responses from patients with chronic schizophrenia.

Clinical effectiveness of metacognitive training as a transdiagnostic program in routine clinical settings: A prospective, multicenter, single-group study.

AIM: To evaluate the clinical effectiveness of metacognitive training (MCT) as a transdiagnostic program, on a diverse population with mental disorders in routine Japanese day-care settings. METHODS: This study employed a prospective, multicenter, single-group pre-post design. Participants diagnosed with various mental disorders received 10 MCT group sessions. We set transdiagnostic outcomes to assess quality of life, global functioning, cognitive insight, and depressive symptoms. At the end of the MCT, we also evaluated participants' satisfaction with treatment. Assessments were conducted at baseline (Pre), Week 5 (Mid), Week 10 (Post), and Week 14 (follow-up: FU). RESULTS: Thirty-four participants enrolled in the study and received MCT (schizophrenia = 22, non-schizophrenia = 12). Intent-to-treat analyses revealed significant improvements in quality of life/global functioning during the intervention period, and further improvements were observed during the follow-up (all p < .05). The Pre-FU treatment effect sizes for quality of life and global functioning were small (Hedge's g = 0.44 and 0.47, respectively). Significant improvements were also found in depressive symptoms during both the intervention and follow-up periods (all p < .05), but not in cognitive insight. Overall, participants were highly satisfied with the MCT content and format. Scores on almost all outcomes (except for depression) at each assessment point were not significantly different between the schizophrenic and non-schizophrenic sub-groups. CONCLUSIONS: Despite several limitations, mainly due to small sample size and having no control conditions, our results suggest that MCT for a diverse population with mental disorders is a potentially effective approach in improving quality of life/global functioning and other clinical outcomes in routine day-care settings.

The efficacy of extended metacognitive training for psychosis: A randomized controlled trial.

This study investigated the efficacy of 10-module metacognitive training (MCT) among Japanese patients with schizophrenia by conducting a multicenter randomized controlled trial to test the influence of the most recent and extended version of MCT on positive symptoms. A six-center, randomized, assessor-blind, controlled trial between "treatment as usual" (TAU) and TAU + MCT was conducted. Fifty inpatients and outpatients with schizophrenia, schizotypal, and delusional disorders (ICD 10) were enrolled, then randomly assigned to TAU (n = 26) or TAU + MCT (n = 24). Assessments were made at baseline, after six weeks, immediately posttreatment, and 1-month post-treatment. The primary outcome was positive symptom score, as measured by the Positive and Negative Syndrome Scale (PANSS). General assessment of functioning (GAF) and measures of cognitive biases were secondary outcomes. Completion at post-treatment (10 weeks later) and 1-month follow-up was high-TAU + MCT, n = 22 (91.67%) and TAU, n = 23 (88.46%). The severity of PANSS positive symptoms declined significantly in the TAU + MCT treatment group compared with the TAU group. GAF also showed significantly greater improvement in the TAU + MCT group compared with the TAU group. There was also a trend for greater efficacy of MCT on cognitive biases. In conclusion, this study provides support for the efficacy of 10 module MCT concerning positive symptomatology (especially, delusion) and general functioning.