Article of the month – May: Efficacy of metacognitive training on delusional conviction and preoccupation in recent-onset psychosis

The study was led by Dr Esther Lorente-Rovira and involved researchers from several Spanish clinical and academic institutions, including Dr Ana Barajas, Associate Professor at the Department of Clinical and Health Psychology, Faculty of Psychology, Universitat Autònoma de Barcelona. The article was published in Clinical Psychology & Psychotherapy in 2026 and forms part of a multicenter randomized controlled trial on metacognitive training for psychosis, led by principal investigator Dr Susana Ochoa, from Parc Sanitari Sant Joan de Déu.

Metacognitive training is a psychological intervention derived from cognitive behavioral therapy that targets cognitive biases involved in the formation and maintenance of delusions, such as jumping to conclusions, belief inflexibility and overconfidence in errors. The intervention also addresses emotional processes such as depression and self-esteem, which may play an important role in psychotic symptoms.

The trial included 122 patients with a recent diagnosis of a schizophrenia spectrum disorder, who were randomly assigned to either an eight-session metacognitive training program or an eight-session psychoeducational intervention. Participants were assessed at baseline, after treatment and six months after the intervention using a battery of psychometric instruments that evaluated delusional and depressive symptoms and self-esteem, among other variables.

The results showed that, compared with the psychoeducational group, participants who received metacognitive training improved at follow-up in several dimensions of delusions: the intensity and duration of preoccupation with delusions, as well as delusional conviction. These findings are particularly relevant because reducing delusional conviction is one of the central aims of metacognitive training, whose core mechanism is described as “sowing the seed of doubt”.

The study found no significant differences between the two interventions in self-esteem or depressive symptoms. However, both groups showed improvements in self-esteem six months after the intervention, suggesting that both metacognitive training and psychoeducation may contribute to emotional recovery through different mechanisms. No specific improvement in depressive symptoms was observed in either group.

Overall, these findings support the usefulness of metacognitive training as a therapeutic option for people with recent-onset psychosis, particularly for reducing the conviction and preoccupation associated with delusions. The research team also highlights the need for future studies with longer follow-up periods and interventions that address self-esteem, self-stigma and depressive symptoms more directly.