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Schizophrenia is characterized by positive symptoms such as delusions and hallucinations, which significantly impact daily functioning. While antipsychotics are the primary treatment, many patients exhibit resistance or intolerance. Metacognitive Training (MCT) has shown promise in addressing cognitive biases related to positive symptoms, offering potential benefits as an adjunct to pharmacological treatment. Additionally, cognitive biases are prevalent in other psychiatric disorders, such as bipolar disorder and major depression, and are closely related to the onset and persistence of emotional symptoms. Preliminary studies have supported the effectiveness of MCT in reducing depressive symptoms and related biases. However, its effects in Taiwan remain unexplored. Therefore, this study aims to examine the effectiveness of the Traditional Chinese version of MCT for individuals with schizophrenia in Taiwan.
This study adopts a one-group pretest-posttest design, recruiting 26 participants to undergo an 8-session MCT group intervention over four weeks. Assessments include the Chinese versions of the Psychotic Symptom Rating Scales (C-PSYRATS), the Traditional Chinese version of the PROMIS Depression and Anxiety Short Forms (4a v1.0), the Modified Davos Assessment of Cognitive Biases Scale (MCL-DACOBS), the Self-reported Graphic Personal and Social Performance Scale (SRG-PSP), Self-Reported Activities of Daily Living Scale, third version (sf-ADLS), and Neuro-QoL Item Bank v2.0 - Cognitive Function- Short Form. Participant satisfaction is also collected. Statistical analyses will utilize non-parametric Wilcoxon Signed-Rank Test and Cohen's d for effect size calculations.
Despite limitations such as a single-group design and recruitment from one hospital, this study is the first to examine MCT's applicability in Taiwanese clinical settings. Expected outcomes include improvements in positive symptoms, depressive and anxiety symptoms, cognitive biases, cognitive functioning, daily living skills, and social functioning. Future research should validate these findings through randomized controlled trials across multiple sites.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Metacognitive Training Group | Experimental | Participants in this arm will receive group-based Metacognitive Training (MCT), the Traditional Chinese version adapted for the Taiwanese population. The intervention consists of 8 sessions delivered twice weekly over 4 weeks. Each session focuses on cognitive biases commonly associated with psychotic and affective disorders, including jumping to conclusions, attribution biases, and social cognitive deficits, etc. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Metacognitive Training (MCT), Traditional Chinese version | Behavioral | The intervention is a culturally adapted version of Metacognitive Training (MCT) for psychiatric populations in Taiwan. The program consists of 8 group sessions over 4 weeks. Each session includes psychoeducation, cognitive exercises, and group discussion to help participants recognize and reduce cognitive biases. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in PROMIS Depression 4a T-score | PROMIS Depression 4a v1.0 (Traditional Chinese version) is a 4-item patient-reported outcome scale. Items are rated 1-5 and converted into T-scores; higher T-scores indicate greater depression severity. | Baseline and Week 5 (within 1 week after completing the final MCT session) |
| Change in C-PSYRATS Total Score | The Chinese version of the Psychotic Symptom Rating Scales (C-PSYRATS) includes 17 items measuring severity of delusions and auditory hallucinations. Each item is rated 0-4, with higher scores indicating more severe symptoms. | Baseline and Week 5 (within 1 week after completing the final MCT session) |
| Change in PROMIS Anxiety 4a T-score | PROMIS Anxiety 4a v1.0 (Traditional Chinese version) is a 4-item patient-reported scale. Items are rated 1-5 and converted into T-scores; higher T-scores reflect higher anxiety severity. | Baseline and Week 5 (within 1 week after completing the final MCT session) |
| Change in MCL-DACOBS Total Score | The Modified Chinese version of the Davos Assessment of Cognitive Biases Scale (MCL-DACOBS) includes 42 items across cognitive biases, limitations, and avoidance. Each item is rated on a 7-point scale; higher scores indicate greater cognitive distortions. | Baseline and Week 5 (within 1 week after completing the final MCT session) |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Neuro-QoL Cognitive Function Short Form Score | The Neuro-QoL Cognitive Function Short Form (Traditional Chinese version) contains 8 self-report items. Each is rated on a 1-5 scale, with higher scores indicating better perceived cognitive function. | Baseline and Week 5 (within 1 week after completing the final MCT session) |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| National Taiwan University Hospital, Department of Psychiatry, General Psychiatry Day Hospital | Taipei | Taiwan Province | 100 | Taiwan |
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| Change in SRG-PSP Total Score |
The Self-Reported Graphic version of the Personal and Social Performance Scale (SRG-PSP) assesses role performance, interpersonal relationships, self-care, and disruptive behaviors. Each domain is rated 1-3; higher scores in most domains reflect better function. |
| Baseline and Week 5 (within 1 week after completing the final MCT session) |
| Change in sf-ADLS Total Score | The Self-Reported Activities of Daily Living Scale, 3rd edition (sf-ADLS), includes 14 items rated 1-3. Higher total scores indicate greater independence in daily life. | Baseline and Week 5 (within 1 week after completing the final MCT session) |
| Participant Satisfaction with Metacognitive Training (MCT) Program | A 4-item self-reported questionnaire developed by the investigator to assess participants' satisfaction with the MCT program. Each item is rated on a 4-point scale: 1 = Very Dissatisfied, 2 = Dissatisfied, 3 = Satisfied, 4 = Very Satisfied. The questionnaire evaluates perceived helpfulness, understanding, utility, and overall satisfaction. Higher scores indicate greater satisfaction. | Week 5 (within 1 week after completing the final MCT session) |
| ID | Term |
|---|---|
| D012559 | Schizophrenia |
| D003865 | Depressive Disorder, Major |
| D001714 | Bipolar Disorder |
| ID | Term |
|---|---|
| D019967 | Schizophrenia Spectrum and Other Psychotic Disorders |
| D001523 | Mental Disorders |
| D003866 | Depressive Disorder |
| D019964 | Mood Disorders |
| D000068105 | Bipolar and Related Disorders |
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