Metacognition, or “thinking about thinking1” is a key aspect of psychotic experiences and recovery in Psychosis-Spectrum Disorders2 (PSD). Metacognition is associated with symptom severity3, cognition4 and mood5; and can predict outcomes (including wellbeing and functioning6–8, and mediate the relationship between neurocognitive deficits and functional outcomes9). Cognitive models suggest metacognition is required to understand psychotic symptoms10.
Metacognitive therapy for PSD encourages metacognitive reflection about, and re-appraisal of, psychotic symptoms11. Improvements in metacognition translate to better engagement of patients in their personal recovery plan12. Current metacognitive therapies are lengthy, require specialised training, and are costly to implement. Metacognitive training, however, aims to be a brief intervention that can be implemented online. In healthy adults, online training resulted in improved metacognitive accuracy13. In PSD, RCTs demonstrate that in-person cognitive training and metacognitive therapy have a positive impact on cognition and functioning in PSD14,15, however no online metacognitive training is currently available for clinical groups. A pilot feasibility study of online metacognitive training is in development.
The benefits of online interventions is that individuals with PSD can complete training at a time and in a place to suit them, when engagement and attendance at in-person therapy varies according to a number of inter-personal factors16. Use of adaptive digital strategies such as SMS-reminders can improve clinical engagement in PSD17. However, some people with PSD experience internet- and technology-related delusions of suspicion (ITDS), which was highlighted as a barrier to clinical engagement via telehealth systems during the Coronavirus pandemic18. An under-researched area outside of computerised learning systems19, ITDS will become more significant as automated technologies increasingly mediate many aspects of daily life.
This project will build on preliminary work with local patient and public involvement (PPI) partners (Southern Health NHS Trust and Metacognition in Psychosis Panel [MIPP]) to understand engagement, trust and acceptability of digital systems in PSD. This knowledge will support the development of online metacognitive training for PSD.
This proposal has two key aims:
- To determine how ITDS impact engagement with digital systems in PSD;
- To develop a working group with individuals who have lived experience of PSD. This working group will later co-develop a user-friendly, fit-for-purpose version of an online metacognitive training module.
A UKRI (ESRC or MRC) or NIHR Research for Patient Benefit bid on metacognitive training in PSD will be co-developed with the lived experience working group. This bid will draw on the findings of this stimulus fund scoping research, and test efficacy of the system in terms of engagement and symptom change in PSD, also involving individuals with lived experiences of PSD to explore areas for further development.
To achieve these aims, the proposed 6-month study will consist of three stages:
- Review literature related to psychosis, delusions, and clinical engagement associated with internet- and technology-related services.
- PPImeetings with the MIPP to discuss personal perspectives and experiences related to internet- and technology-related services and delusions. The MIPP consists of 10 individuals from Hampshire who have lived experience of PSD, as well as their carers. These discussions will a) explore how individuals with PSD might respond to online training in the context of suspicious or paranoid delusions, and how we can develop digital systems to be more acceptable to individuals experiencing delusions and b) co-develop research approaches and questions to investigate in more detail how ITDS may impact engagement with and trust in online cognitive training specifically.
- Wider mixed-methods research investigating ITDS in PSD. Recruitment will utilise online and offline methods to ensure participants who are suspicious of internet- and technology-related services can still take part. To ensure data is collected within the tight timeline, recruitment of people with PSD will involve the CiMH mental health screener tool on Prolific20, where 63 individuals can be contacted and surveyed. Participants will also be recruited offline using word of mouth and poster adverts in local mental health centres (no power calculation will be utilised, as recruitment is based on ability to recruit participants quickly). Final questions and data collection methods for stage 3 will be decided with the MIPP panel in Stage 2.
Dissemination: Findings from the review and study will be written up for relevant publications.
We will co-produce lay resources with the MIPP, to share with local organisations; Southern Health NHSFT and Solent Mind.
- Short video (School of Psychology’s YouTube Channel)
- Brochure (digital and hard-copy)
- CiMH blog
- The Psychologist
Resources will summarise the project, and make recommendations for researchers and clinicians relating to considering ITDS when working with people with PSD.