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METACOGNITIVE TRAINING IN SCHIZOPHRENIA PATIENTS (MCT)
S2
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
describes metacognitive training, a computer assisted bias modification approach designed to assist individuals with schizophrenia in coming to more accurate conclusions based upon data presented to them, decreasing distortions in their perceptions and minimizing the tendency to jump to unfounded conclusions. Christos Pantelis describes the imaging data on cognitive remediation techniques and will examine whether these techniques are associated with changes in brain function. Finally, Michael Green discusses the importance of social cognition for daily functioning, and then describes a social cognition training intervention that is designed to help patients with deficits in this area to more accurately and effectively perceive, interpret and respond to social situations.
NEUROIMAGING AND COGNITIVE REHABILITATION; A HYPOTHESIS BASED ON THE EVIDENCE FOR PROGRESSIVE BRAIN CHANGES IN SCHIZOPHRENIA Christos Pantelis The University of Melbourne, Neuropsychiatry Centre, Melbourne, Australia While it is suggested that cognitive deficits are stable throughout all stages of the schizophrenia, the evidence for progressive brain changes identified with neuroimaging would suggest that function might also be affected. If there is evidence of cognitive change with illness progression, this could influence the approach taken to managing these deficits. To date few studies have examined neuroimaging changes associated with cognitive rehabilitation strategies. These studies provide some evidence for positive effects on brain structure and function (e.g. [1–3]. However, studies have not compared strategies to remediate these deficits versus cognitive adaptation approaches. I will present findings regarding progressive brain structural changes in the early course of the illness involving medial temporal and frontal regions, and relate these findings to results from the Melbourne long-term follow-up studies demonstrating progressive deterioration in relevant neurocognitive domains (associative memory and set-shifting ability), while other domains such as spatial working memory are stable across illness stages [4]. These findings are best understood when placed in the context of brain maturational trajectories for these abilities and may be differentially amenable to alternate intervention strategies [4,5]. I will suggest that: (i) cognitive remediation approaches should target those abilities that have matured, are relatively unimpaired at psychosis onset, but which show later deterioration; (ii) cognitive adaptation (i.e. an approach that compensates for the deficits through environmental manipulation) [6] would be more appropriate for those abilities that have never fully matured and are impaired at all illness stages. It is hypothesized that the former would have beneficial effects in minimizing or ameliorating progressive brain changes in schizophrenia. References: [1] Wykes T, Brammer M, Mellers J, Bray P, Reeder C, Williams C, Corner J (2002). Effects on the brain of a psychological treatment: cognitive remediation therapy: functional magnetic resonance imaging in schizophrenia. The British Journal of Psychiatry, 181, 144-152. [2] Eack SM, Hogarty GE, Cho RY, Prasad KM, Greenwald DP, Hogarty SS, Keshavan MS (2010). Neuroprotective effects of cognitive enhancement therapy against gray matter loss in early schizophrenia: results from a 2-year randomized controlled trial. Archives of General Psychiatry, 67(7), 674-682. [3] Bor J, Brunelin J, d’Amato T, Costes N, Suaud-Chagny MF, Saoud M, Poulet E (2011). How can cognitive remediation therapy modulate brain activations in schizophrenia? An fMRI study. Psychiatry Research, 192(3), 160-166. [4] Pantelis C, Wood SJ, Proffitt TM, Testa R, Mahony K, Brewer WJ, Buchanan JA, Velakoulis D, McGorry PD (2009). Attentional set-shifting ability in first-episode and established schizophrenia: Relationship to working memory. Schizophrenia Research, 112(1-3), 104-113. [5] Pantelis C, Yucel M, Bora E, Fornito A, Testa R, Brewer WJ, Velakoulis D, Wood SJ (2009). Neurobiological Markers of Illness Onset in Psychosis and Schizophrenia: The Search for a Moving Target. Neuropsychology Reviews, 19, 385-398. [6] Velligan DI, Draper M, Stutes D, Maples N, Mintz J, Tai S, Turkington, D (2009). Multimodal cognitive therapy: combining treatments that bypass cognitive deficits and deal with reasoning and appraisal biases. Schizophrenia Bulletin, 35(5), 884893.
METACOGNITIVE TRAINING IN SCHIZOPHRENIA PATIENTS (MCT) Steffen Moritz, Ruth Veckenstedt, Francesca Bohn, Todd Woodward University Medical Centre Hamburg-Eppendorf, Clinic for Psychiatry and Psychotherapy Antipsychotic medication represents the treatment of choice for schizophrenia. Still, a subgroup of patients is only partially, or even non-responsive, and rates of noncompliance are high for various reasons (e.g., side-effects, lack of illness insight). Hence, clinicians are intensively looking for complementary therapeutic options. Cognitive research has elucidated a number of cognitive biases (i.e., deviations in the processing and appraisal of information rather than dysfunctions per se) in schizophrenia that seem to play a crucial role in the formation and maintenance of the disorder: jumping to conclusions, attributional biases, a bias against disconfirmatory evidence, overconfidence in errors, and social cognitive abnormalities. The talk will introduce metacognitive training for schizophrenia patients (MCT). MCT is a group intervention that seeks to sharpen the awareness of schizophrenia patients on these biases. The training is available in 25 languages, and can be downloaded at no cost (www.uke.de/mkt). In addition, the talk will briefly present a new treatment program called MCT+, which is a hybrid of MCT and individualized cognitive-behavioral therapy. Results assert that MCT and MCT+ are feasible interventions. Evidence from randomized controlled trials tentatively suggests that metacognitive intervention leads to accelerated symptom improvement, and alleviates some cognitive biases (particularly jumping to conclusions) in patients relative to (active) control interventions.
COGNITIVE BEHAVIOR THERAPY FOR POSITIVE AND NEGATIVE SYMPTOMS Douglas Turkington The Institute of Neuroscience, Newcastle This presentation will summarise the current state of CBT research in relation to schizophrenia. It will comment on randomised controlled trials of efficacy and pragmatic outcomes within effectiveness trials. It will explore the issue of trauma in relation to vulnerability and maintenance of symptoms. Advances in CBT techniques for schizophrenia including the use of metacognitive and compassion based strategies will be outlined. The use of imaging to elucidate a putative biological method of action will be summarised in relation to hallucinations and delusions. The relative role of CBT in relation to other psychosocial interventions will be explored including the interface with cognitive remediation, cognitive adaptation training, social skills training, psychoeducation and family therapy. The possible use of CBT for patients with schizophrenia who refuse all antipsychotic medication is discussed. Finally future directions for research will be summarised.
SOCIAL COGNITION SCHIZOPHRENIA: RATIONALE AND STRATEGIES FOR TRAINING INTERVENTION Michael Green, William Horan UCLA and VA, Greater Los Angeles, California, USA Social cognition is a rapidly emerging area of research in schizophrenia. This presentation will cover: 1) how social cognition is defined and measured in schizophrenia research; 2) its importance for community outcome; and 3) the development of training interventions for social cognition. Social cognition can be reliably measured in schizophrenia and it can be divided into subcomponents, including emotion processing, social perception, theory of mind (i.e. mentalizing), and attributional bias. Social cognition can be divided into lower-level processes (e.g., perception of emotional cues) and higher-level processes (e.g., making good inferences about what other people are thinking or feeling). Recently more attention has focused on integrative areas, such as empathy, that include both high-level and lowlevel components. Across studies, measures of social cognition (particularly emotion perception and social perception) show consistent relationships to daily functioning, and these associations tend to be larger than those between non-social neurocognition and community functioning. Also, social cognition consistently acts as a mediator between neurocognition and
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
describes metacognitive training, a computer assisted bias modification approach designed to assist individuals with schizophrenia in coming to more accurate conclusions based upon data presented to them, decreasing distortions in their perceptions and minimizing the tendency to jump to unfounded conclusions. Christos Pantelis describes the imaging data on cognitive remediation techniques and will examine whether these techniques are associated with changes in brain function. Finally, Michael Green discusses the importance of social cognition for daily functioning, and then describes a social cognition training intervention that is designed to help patients with deficits in this area to more accurately and effectively perceive, interpret and respond to social situations.
NEUROIMAGING AND COGNITIVE REHABILITATION; A HYPOTHESIS BASED ON THE EVIDENCE FOR PROGRESSIVE BRAIN CHANGES IN SCHIZOPHRENIA Christos Pantelis The University of Melbourne, Neuropsychiatry Centre, Melbourne, Australia While it is suggested that cognitive deficits are stable throughout all stages of the schizophrenia, the evidence for progressive brain changes identified with neuroimaging would suggest that function might also be affected. If there is evidence of cognitive change with illness progression, this could influence the approach taken to managing these deficits. To date few studies have examined neuroimaging changes associated with cognitive rehabilitation strategies. These studies provide some evidence for positive effects on brain structure and function (e.g. [1–3]. However, studies have not compared strategies to remediate these deficits versus cognitive adaptation approaches. I will present findings regarding progressive brain structural changes in the early course of the illness involving medial temporal and frontal regions, and relate these findings to results from the Melbourne long-term follow-up studies demonstrating progressive deterioration in relevant neurocognitive domains (associative memory and set-shifting ability), while other domains such as spatial working memory are stable across illness stages [4]. These findings are best understood when placed in the context of brain maturational trajectories for these abilities and may be differentially amenable to alternate intervention strategies [4,5]. I will suggest that: (i) cognitive remediation approaches should target those abilities that have matured, are relatively unimpaired at psychosis onset, but which show later deterioration; (ii) cognitive adaptation (i.e. an approach that compensates for the deficits through environmental manipulation) [6] would be more appropriate for those abilities that have never fully matured and are impaired at all illness stages. It is hypothesized that the former would have beneficial effects in minimizing or ameliorating progressive brain changes in schizophrenia. References: [1] Wykes T, Brammer M, Mellers J, Bray P, Reeder C, Williams C, Corner J (2002). Effects on the brain of a psychological treatment: cognitive remediation therapy: functional magnetic resonance imaging in schizophrenia. The British Journal of Psychiatry, 181, 144-152. [2] Eack SM, Hogarty GE, Cho RY, Prasad KM, Greenwald DP, Hogarty SS, Keshavan MS (2010). Neuroprotective effects of cognitive enhancement therapy against gray matter loss in early schizophrenia: results from a 2-year randomized controlled trial. Archives of General Psychiatry, 67(7), 674-682. [3] Bor J, Brunelin J, d’Amato T, Costes N, Suaud-Chagny MF, Saoud M, Poulet E (2011). How can cognitive remediation therapy modulate brain activations in schizophrenia? An fMRI study. Psychiatry Research, 192(3), 160-166. [4] Pantelis C, Wood SJ, Proffitt TM, Testa R, Mahony K, Brewer WJ, Buchanan JA, Velakoulis D, McGorry PD (2009). Attentional set-shifting ability in first-episode and established schizophrenia: Relationship to working memory. Schizophrenia Research, 112(1-3), 104-113. [5] Pantelis C, Yucel M, Bora E, Fornito A, Testa R, Brewer WJ, Velakoulis D, Wood SJ (2009). Neurobiological Markers of Illness Onset in Psychosis and Schizophrenia: The Search for a Moving Target. Neuropsychology Reviews, 19, 385-398. [6] Velligan DI, Draper M, Stutes D, Maples N, Mintz J, Tai S, Turkington, D (2009). Multimodal cognitive therapy: combining treatments that bypass cognitive deficits and deal with reasoning and appraisal biases. Schizophrenia Bulletin, 35(5), 884893.
METACOGNITIVE TRAINING IN SCHIZOPHRENIA PATIENTS (MCT) Steffen Moritz, Ruth Veckenstedt, Francesca Bohn, Todd Woodward University Medical Centre Hamburg-Eppendorf, Clinic for Psychiatry and Psychotherapy Antipsychotic medication represents the treatment of choice for schizophrenia. Still, a subgroup of patients is only partially, or even non-responsive, and rates of noncompliance are high for various reasons (e.g., side-effects, lack of illness insight). Hence, clinicians are intensively looking for complementary therapeutic options. Cognitive research has elucidated a number of cognitive biases (i.e., deviations in the processing and appraisal of information rather than dysfunctions per se) in schizophrenia that seem to play a crucial role in the formation and maintenance of the disorder: jumping to conclusions, attributional biases, a bias against disconfirmatory evidence, overconfidence in errors, and social cognitive abnormalities. The talk will introduce metacognitive training for schizophrenia patients (MCT). MCT is a group intervention that seeks to sharpen the awareness of schizophrenia patients on these biases. The training is available in 25 languages, and can be downloaded at no cost (www.uke.de/mkt). In addition, the talk will briefly present a new treatment program called MCT+, which is a hybrid of MCT and individualized cognitive-behavioral therapy. Results assert that MCT and MCT+ are feasible interventions. Evidence from randomized controlled trials tentatively suggests that metacognitive intervention leads to accelerated symptom improvement, and alleviates some cognitive biases (particularly jumping to conclusions) in patients relative to (active) control interventions.
COGNITIVE BEHAVIOR THERAPY FOR POSITIVE AND NEGATIVE SYMPTOMS Douglas Turkington The Institute of Neuroscience, Newcastle This presentation will summarise the current state of CBT research in relation to schizophrenia. It will comment on randomised controlled trials of efficacy and pragmatic outcomes within effectiveness trials. It will explore the issue of trauma in relation to vulnerability and maintenance of symptoms. Advances in CBT techniques for schizophrenia including the use of metacognitive and compassion based strategies will be outlined. The use of imaging to elucidate a putative biological method of action will be summarised in relation to hallucinations and delusions. The relative role of CBT in relation to other psychosocial interventions will be explored including the interface with cognitive remediation, cognitive adaptation training, social skills training, psychoeducation and family therapy. The possible use of CBT for patients with schizophrenia who refuse all antipsychotic medication is discussed. Finally future directions for research will be summarised.
SOCIAL COGNITION SCHIZOPHRENIA: RATIONALE AND STRATEGIES FOR TRAINING INTERVENTION Michael Green, William Horan UCLA and VA, Greater Los Angeles, California, USA Social cognition is a rapidly emerging area of research in schizophrenia. This presentation will cover: 1) how social cognition is defined and measured in schizophrenia research; 2) its importance for community outcome; and 3) the development of training interventions for social cognition. Social cognition can be reliably measured in schizophrenia and it can be divided into subcomponents, including emotion processing, social perception, theory of mind (i.e. mentalizing), and attributional bias. Social cognition can be divided into lower-level processes (e.g., perception of emotional cues) and higher-level processes (e.g., making good inferences about what other people are thinking or feeling). Recently more attention has focused on integrative areas, such as empathy, that include both high-level and lowlevel components. Across studies, measures of social cognition (particularly emotion perception and social perception) show consistent relationships to daily functioning, and these associations tend to be larger than those between non-social neurocognition and community functioning. Also, social cognition consistently acts as a mediator between neurocognition and