Clinical Trial Details
— Status: Not yet recruiting
Administrative data
NCT number |
NCT06005766 |
Other study ID # |
VVSJYUMCT01 |
Secondary ID |
|
Status |
Not yet recruiting |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
September 2023 |
Est. completion date |
December 2026 |
Study information
Verified date |
August 2023 |
Source |
University of Jyvaskyla |
Contact |
Leo Kuutti, MA |
Phone |
029 524 3058 |
Email |
leo.kuutti[@]vvs.fi |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Deficiencies in social cognition are part of the core symptomatology of psychotic disorders.
And deficiencies in social cognition, the closely related concept of metacognition, and, for
example, paranoid attitudes are all associated with violence. The link between social
cognition and violence is also observed through rehabilitation, as both group-based Social
Cognition Interaction Training (SCIT) and group-based Metacognitive Skills Training (MCT)
have reduced violent behavior in patients with psychotic disorders. Thus, a better knowledge
of social cognition and its rehabilitation in psychotic disorders can help to reduce risky
behavior and to rehabilitate the significant social difficulties often found in psychotic
disorders. This research study aims to examine factors underlying the efficacy of group-based
MCT.
The goal of the metacognitive skills training group developed by Moritz and partners is to
strengthen the social and metacognitive skills of the patients participating in the group.
The group consists of 10 sessions during which exercises and discussion are emphasized. The
themes of the group sessions are, for example, jumping to conclusions -bias, empathy, and
memory. Detailed information is available from the MCT website
(https://clinical-neuropsychology.de/metacognitive_training-psychosis/). Overall there is
meta-analysis-level evidence for the moderate effectiveness of MCT on positive symptoms of
psychotic illnesses, such as delusions. Prior studies have argued that the unique factor
underpinning MCT's efficacy is its impact on various cognitive biases, and that participating
in the group especially reduces patients' tendency to jump to conclusions, which is a
cognitive style associated with delusions and deficits in social perception and reasoning. As
delusionality is related to the risk of violence, these results form a logical link between
jumping to conclusions, delusionality, and violence.
But the results regarding the effectiveness of MCT are still somewhat conflicting, and
studies seem to be of varying quality. Additional longitudinal research and research related
to the jumping to conclusion bias are also needed. The hypothesis regarding this study is
that the MCT group reduces patients' tendency to jump to conclusions. These reductions are
presumed to be associated in one-year follow-up with fewer mood symptoms, delusions,
paranoia, and more psychological flexibility.
Description:
Based on their multi-professional treatment plan in the Vanha Vaasa hospital, participation
in the MCT group intervention is offered to patients who could benefit from it. The
intervention under investigation is part of the standard care of the hospital. Participation
does not prevent participation in other forms of rehabilitation, and patients can participate
in the group even if they don't participate in the study. Being part of the control group
does not prevent participation in the intervention group, but being part of the control group
might delay participation. When these are in conflict, treatment takes precedence over
research.
Data is collected until the sample size is satisfactory (at least 20 to 25 patients).
Patients in the MCT condition are compared to patients (n=30) and controls (n=30) measured
with a psychological test battery not completing the group. The test battery is the same for
all the groups. It consists of valid tasks measuring neurocognition, social cognition, and
psychiatric symptoms and a task for measuring the tendency to jump to conclusions. Patients
in the group condition are tested before the group and nine months after the group has
concluded. For both control groups testing interval is one year.
The comparison between the groups (intervention group, patient controls, and non-patient
controls) is done by comparing the rate of change in the tendency to jump to conclusions.
This comparison is done with regression analysis. If minor differences and equal variances
are assumed (delta of slope 0.1), the power of the comparison is around 0.57. If larger
differences are assumed (delta of slope 0.5), the power of the comparison approaches 1. In a
previous study, a medium-sized comparative difference between patients in MCT condition and
patients in cognitive remediation condition was found.
To avoid problems with multiple testing, the differences in magnitudes of mood symptoms,
delusions, paranoia, and psychological flexibility after the delay are assessed with MANOVA.
In a recent meta-analysis, the observed effect of MCT on delusions was high medium (g=0.69).
The observed effect on negative symptoms was small but significant (g=0.23). Consequently,
the expected power of the MANOVA ranges from 0.48 to 0.99. Direct comparisons are made with
discriminant analysis with identical power estimates. Univariate ANOVAs can also be used, but
with much worse power estimates, when controlling for multiple testing.