A 26-year-old white male had been battling schizophrenia for years. Diagnosed at age 20, he had been in and out of the hospital due to hallucinations, paranoia, interpersonal conflicts and medication noncompliance. Despite these setbacks, he had managed to finish high school and some college and worked for a period of time. However, worsening symptoms began to impede his ability to live in the community and hospitalizations were becoming more and more frequent.
Finally, he entered a residential treatment facility where metacognitive training (MCT) was employed. MCT (known as “thinking about one’s thinking”) combines cognitive behavioral therapy, cognitive remediation and psychoeducation. In other words, patients are taught how to recognize their feelings and translate them to specific coping behaviors. In this case, coping behaviors included deep breathing for two minutes, T’ai Chi for five minutes and headphones for 10 minutes.
The study’s residential setting was ideal because the patient could first be medically stabilized, then begin intensive MCT training. As episodes occurred, coping behaviors could be instituted and reinforced. “As needed” medications were available when he felt he needed them during the transitional process. After eight weeks, he requested less as-needed medications and reported less anxiety.
The patient did well, according to staff and was discharged after 10 weeks, with three weeks of outpatient therapy remaining. After one year, this patient demonstrated continued cognitive function improvement, increased physical exercise and improved sleep.
This study, published in 2015 in Perspectives in Psychiatric Care, was conducted by Kathryn Puskar, Dr.P.H., of the University of Pittsburgh School of Nursing and her colleagues. The authors highlight the importance of MCT, exercise and sleep to promote healthy adaptation of the nervous system’s structure, connection and functions, also known as neuroplasticity. This study demonstrated that using MCT can enhance neuroplasticity and mental health practitioners are in a position to facilitate the process. The authors call for more research to identify further strategies to improve patient function and outcomes.
Schizophrenia and metacognitive therapy
Schizophrenia is a chronic, severe, disabling brain disorder characterized by negative or positive symptoms. Positive symptoms include delusions, hallucinations and paranoia. Negative symptoms include depressed mood, minimal verbal conversation and inability to plan or carry out activities. Symptoms begin in boys between ages 12 and 25. Exacerbations and remissions are common.
Treatment is geared toward symptom management and prevention of acute episodes. Historically, schizophrenic patients were treated mainly with psychiatric medication. The advent of cognitive-behavioral therapy has shown promise and led to further advances through psychological approaches, such as MCT.
MCT helps make patients aware of their thought biases and provides corrective experiences in an engaging and supportive fashion. Research evidence exists supporting MCT in conjunction with medication regimens for the feasible and effective treatment of schizophrenia.
Many patients with schizophrenia also suffer from substance abuse. Treatment centers that address both conditions are recommended for these patients. Detoxification, medication stabilization, MCT and other treatment modalities can best be achieved in residential programs that offer dual diagnosis care. These programs strive to promote healthy neuroplasticity so that patients move toward happier, more productive lives.
Specialty care can help
Some symptoms of schizophrenia in boys can be mistaken for troubles at school or teenage depression. Parental instincts can usually determine whether or not a significant problem exists, but the parents likely need to consult with a professional to determine the extent of illness and direction to take.
Severe behavior problems or repeated hospitalizations can interfere with educational goals and disrupt the entire family’s lives. Specialty care in the form of a boarding school provide medication stabilization, treatment, behavioral therapy and management of other issues without the need to drop out of school.