Metacognitive training

Domain II · Behavioural & cognitive · Steffen Moritz, Todd Woodward · Hamburg

What it is

MCT is a structured, manualised, mostly group-based cognitive programme for people with psychosis, especially delusions. It does not target the content of delusions head-on. Instead it trains awareness of the thinking styles (cognitive biases) thought to build and maintain delusions: single-cause…

Format

• It is a modular programme, not a phased therapy. Group MCT has no clinical phases or progression criteria. It is a rolling cycle of self-contained modules. MCT+ has an ordered sequence of units.
• Group MCT (core cycle)

Who practises it, and how they are trained or regulated

• Leaders can be psychiatrists, psychologists or psychiatric nurses following the manual. A therapist experienced in running groups with people with psychosis can lead without formal psychotherapy certification. The developers offer optional certified e-learning (e-MCT, about 10 hours, ending in an exam).
• Version followed: group Metacognitive Training for psychosis (MCT; Moritz & Woodward, University Medical Center Hamburg-Eppendorf), current English module set labelled 7.3 with parallel Cycles A and B: 8 core modules plus 2 add-on modules (self-esteem, stigma); and the individualised MCT+ in its 11-unit form as described in the MCT+ multicentre RCT protocol. The full manual (Moritz et al., 2016, VanHam) is not drawn…

Evidence status, as the guide reports it

• MCT is a structured, manualised, mostly group-based cognitive programme for people with psychosis, especially delusions. It does not target the content of delusions head-on. Instead it trains awareness of the thinking styles (cognitive biases) thought to build and maintain delusions: single-cause…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Low completion. See section 5.
• Paranoid concerns about phones or apps. Make the app optional.
• Suicidality. Assess risk using your service's standard procedure.
• Overconfident single choices. Ask "what would make you less sure?"
• Distress from past discrimination. Validate it before moving to coping.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.