Metacognitive training for schizophrenia suffers (and everybody else)

July 2, 2011 10:33 PM

Metacognitive training is a useful complementary treatment approach to schizophrenia. MCT aims at sharpening the awareness of patients for a variety of cognitive biases (e.g. jumping to conclusions, attributional biases, over-confidence in errors), which are implicated in the formation and maintenance of schizophrenia positive symptoms (especially delusions), and to ultimately replace these biases with functional cognitive strategies. Researchers at the Universitätsklinikum Hamburg-Eppendorf have developed an MCT program, comprised of eight modules targeting common cognitive errors and problem solving biases in schizophrenia.

There is a presentation overview here (PDF). The course is intended to be presented by an expert, and access to the course manual requires click-through registration from the main page.

[After reading this program, I am of the opinion that it is an excellent rationality training aid, that is generally applicable to everyone, whether or not a schizophrenia sufferer.]

Thanks to jeffburdges for the initial signposting.

posted by aeschenkarnos (16 comments total)

For one remembers now what one saw or otherwise experienced formerly; the moment of the original experience and the moment of the memory of it are never identical.

-Aristotle, On Memory and Reminiscence.
posted by clavdivs at 11:37 PM on July 2, 2011 [4 favorites]

This sounds like it would have to be pretty intensive therapy, to work.

I don't see how just learning about "cognitive distortions" would have helped the people I've known who had schizophrenic episodes (eg: a friend who stopped eating, and stopped sleeping, but who was feeling BETTER THAN EVER, walking around town trying to avoid streetlights, because they all had cameras installed by the Coca Cola corporation and the KKK), unless they were stabilized first somehow.
posted by thelonius at 12:59 AM on July 3, 2011

perhaps that's what they mean by "complementary treatment approach"
posted by thelonius at 1:05 AM on July 3, 2011 [2 favorites]

Yes, definitely. Insight would be a prerequisite. The sufferer would have to be aware of their condition, and have a desire to mitigate it. It's teaching new habits of thinking, and as such it requires the active intention and capacity of the student to take those new habits up.
posted by aeschenkarnos at 1:57 AM on July 3, 2011

A relative of mine has suffered schizophrenia for the last four decades. A couple of years ago, he went with a couple of family members to see a friend. When they rang at the friend's door, nobody answered, so they were about to leave again when my relative said:
"Wait, I hear voices!...(smile) no, not those voices." His friend was indeed home.

So, yes, schizophrenia patients can be quite aware of their condition, and even take it with a peculiarly wry humour. I guess that such metacognitive training can indeed be helpful for coping with it.
posted by Skeptic at 1:59 AM on July 3, 2011 [8 favorites]

I've had someone describe the gnome under her bed, and the conversation she was having with it, and say that she was enjoying the conversation too much to stop even though she knew it wasn't real. I've had friend describe the experience of having an epiphany where he realized that a mutual friend was literally a damsel in distress that he had to defend from real dragons and demons. He was able to talk about the influence this realization still had, while also acknowledging that it was a delusion.

It doesn't seem like this therapy could have helped with the subjective part of the experience (the feeling that a gnome was there, the overwhelming epiphany that there were dragons to be fought). But I can see how a set of tools could help them refine that idea or sense they already had of when they were coherent and when they were delusional. And I can imagine how they could be helpful for figuring out how to act when they had those feelings so that they were at the very least not hurting anyone (including of course themselves).
posted by idiopath at 2:54 AM on July 3, 2011 [2 favorites]

There are several people I'd like to sign up for this, and not all of them are schizophrenic. Heck, maybe everyone needs this training.
posted by Soliloquy at 5:56 AM on July 3, 2011

I sincerely wonder what would happen if everyone were to go through some variety of MCT as an adolescent. Would this backfire? Would people protest?
posted by Sticherbeast at 6:33 AM on July 3, 2011

So... mindfulness as a treatment for schizophrenia?
posted by Mooski at 6:38 AM on July 3, 2011 [1 favorite]

I'm glad we all agree this could be generally useful.
posted by dragonsi55 at 6:39 AM on July 3, 2011 [1 favorite]

I sincerely wonder what would happen if everyone were to go through some variety of MCT as an adolescent. Would this backfire? Would people protest?

We had a semester-long critical thinking class in middle school. This could easily be part of a syllabus like that.
posted by condour75 at 7:04 AM on July 3, 2011

There are several people I'd like to sign up for this, and not all of them are schizophrenic. Heck, maybe everyone needs this training.

I sincerely wonder what would happen if everyone were to go through some variety of MCT as an adolescent.

That would be Cognitive Behavioral Therapy (CBT). It was created by Aaron Beck, who popularized it with this excellent book.

Previously on Metafilter.

I wouldn't be at all surprised if this grew out of CBT.

It might work on Republicans, but side effects would include head explosions, uncontrollable weeping and weeks-long meth-fueled gay sex binges.
posted by PlusDistance at 7:19 AM on July 3, 2011 [5 favorites]

This sounds like it would be really useful for people who have a more delusional-based psychosis, and not just those with schizophrenia. I've met patients who sometimes get kind of an episodic paranoia with things like bipolar disorder, where everything is peachy until something triggers them to start making unwarranted connections between things. All of the sudden there's a conspiracy, which builds into a full-scale systematic delusion that's pretty much impossible to shake, and off we go to hospital for a week or two. Nipping it in the bud by being more mindful could definitely be helpful.
posted by greatgefilte at 7:33 AM on July 3, 2011

I've had someone describe the gnome under her bed, and the conversation she was having with it, and say that she was enjoying the conversation too much to stop even though she knew it wasn't real.

Yeah, I've definitely wondered how many delusions grow out of simply imagining something better than the real world, so much better that they don't want to let the delusion go. As aeschenkarnos says, for any of this to work, they would need to not only be aware, which I think many of them are, but also have a desire to mitigate it, which is not a small requirement.

The easiest way, it seems to me, to mitigate the delusions of someone who just doesn't want to let them go is to improve their reality. In the case of your friend, for instance, it's likely all she needed was not therapy or treatment so much as just someone wonderful to talk to; someone she could have a better conversation with than the one she was having with the gnome. It seems almost cruel, in a case like that, to take someone's delusions away from them and leave them nothing but the unpleasant reality they had rejected. (Of course that's also a situation where she wasn't really harming anyone.)

Which is not to say I don't think this whole course of treatment wouldn't do a world of good for basically everyone. (Which is maybe a sad comment in and of itself.)
posted by mstokes650 at 10:29 AM on July 3, 2011

[you know where metatalk is, please don't jump in with your favorite HURF DURF CONGITIVE BIAS stuff just to take cheap shots at people whose thinking you don't like. Thank you. ]
posted by jessamyn at 10:34 AM on July 3, 2011 [1 favorite]

For those interested in applying CBT to their own, relatively non-schizophrenic lives and relationships, let me recommend Feeling Good and Feeling Good Together by David Burns.

All of Burns stuff is a result of the application of wll-researched CBT variables to everyday existence. Frankly, almost everyone can profit by a read through of Burns' books (there are others). The latter book is exceptional in its insights, and means to application. Highly recommended.

As for metacognitive approaches as a supplementary to those cursed with the oft-times devastating disease of schizophrenia: anything that helps is a blessing!
posted by Vibrissae at 4:52 PM on July 3, 2011 [2 favorites]