Metacognitive Training for the Acute Psychiatric Setting (MCT-Acute)
MCT-Acute was developed by our group under the leadership of Rabea Fischer and Jakob Scheunemann as an adaptation of the Metacognitive Training for people with psychosis as well as one module from the Metacognitive Training for depression. As with conventional MCT for psychosis, the thematic focus is on cognitive distortions associated with psychotic experiences. Due to the comorbidity with affective disorders common in this setting, depressive thought distortions are also addressed to a greater extent
The link for downloading the program can be found at the end of this page.
In MCT-Acute, topics relevant to as many acute care patients as possible are conveyed, as this setting is known to consist of a diverse patient population (i.e. especially people with psychoses (schizophrenia, bipolar disorder), but also people with depression, borderline personality disorders, and addiction disorders). As it is intended to be a component of treatment in an acute care setting, it is conveyed as a low-threshold group intervention. It consists of 7 modules, which are significantly reduced in scope and complexity compared to the other MCTs. The modules are subdivided into clearly defined segments, allowing the trainer to design the session flexibly (for example, shortening the session if the concentration of the participants visibly drops). Text elements are written using the simplest language possible. Pictures were largely omitted, since this can be very distracting, especially for patients with loose associations. Similarly, slides and sections that could potentially trigger agitation or disturbances among patients were removed. In particular, the terms "schizophrenia" and "psychosis" are now only used sporadically, since their use can create resistance in many patients. The delusion-neutral content offers a new opportunity to discuss relevant yet non-distressing topics. Furthermore, the training also offers the opportunity for patients to share their experiences with others.
Instructions for Implementation
If possible, trainers should be familiar with the regular MCT for people with psychosis and its manual.
Due to the high symptomatic burden on patients in acute psychiatric settings and the frequent occurrence of social interaction problems (including social anxiety and paranoia), it is advised to form smaller groups (3-6 people) than is usually the case with MCT (up to 12 people). The MCT-Acute is designed to last between 30 and a maximum of 45 minutes with facilitation by two trainers*. As in other MCT versions, PowerPoint or PDF slides, a projector, and a laptop can be used to present the material. It has proven to be a good idea for participants to sit in a semicircle with the trainer in the middle.
Introductions: At the beginning of each session, a small introduction round can be made so that all participants have a chance to speak. This can reduce inhibitions about participating in the group.
Group rules: Discussing the group rules at the beginning of the session has proven to be effective in limiting disruptive patients or those who repeatedly interrupt others. This way, rules can be pointed out in a friendly manner, especially the rule of letting others finish speaking, without expecting the rules to be followed consistently.
Coming and going: Some patients do not have the ability to sit in the group for long. In general, we recommend the basic stance: The patients are in the group voluntarily. If a patient wants to leave, we leave it up to him/her to leave the room as quietly as possible. No patient is required defend him/herself in the group, as this can lead to conflicts or unnecessary shame. The reasons for leaving can be inquired about afterwards. It is also reasonable to offer the patient the option to return to the group.
Safety and Feasibility of the Intervention
MCT-Acute is currently being evaluated in an initial feasibility study. The full study protocol can be viewed here.
Download the Training Program
The current version of MCT-Acute (in German and English) can be downloaded free of charge here. If you use MCT-Acute, we would be pleased to receive feedback directed to Rabea Fischer (email@example.com).