Jaargang 30 (2010)
Nummer: 4
Artikel: 263


Recente onderzoeksbevindingen tonen aan dat een aantal denk- en redeneerprocessen een belangrijke rol speelt bij het ontstaan en voortduren van wanen bij schizofreniepatiënten. In een poging om deze bevindingen om te zetten in een voor de praktijk relevante klinische interventie is de zogenaamde metacognitieve training (MCT) ontwikkeld. We onderzochten of MCT cognitieve tendensen en wanen kan verminderen. Het effect van acht sessies groepsgewijze MCT werd geëvalueerd in een ongecontroleerde studie met 29 klinisch paranoïde patiënten.

Paranoïde gedachten en wanen verminderden. De onderdelen ‘overhaast concluderen’ en ‘cognitieve flexibiliteit’ verbeterden en bij ‘sociale cognitie’ (inlevingsvermogen) werd een tendens tot verbetering gesignaleerd als resultaat van voorlichting en doelgericht oefenen. Op ‘zelfwaardering’ en ‘geheugencorruptie’ had de training geen effect. We concluderen dat MCT mogelijkheden kan bieden bij de psychologische behandeling van wanen. Een gecontroleerde studie is gestart om de effecten van de MCT op cognitieve tendensen en psychopathologie verder te onderzoeken.


Cognitive biases are associated to the formation and maintenance of delusions. We tried to demonstrate that metacognitive training can make patients aware of these biases and correct them. The effects of eight sessions of metacognitive training have been evaluated in an uncontrolled study with 29 clinically paranoid schizophrenia patients.

Paranoid thoughts and delusions diminished. Data gathering and cognitive flexibility improved and theory of mind showed a tendency to improve as a result of targeted training. Depression, self-esteem and knowledge corruption were unaffected in this study. We concluded that metacognitive training is a promising intervention in the psychological treatment of delusions.


Aghotor, J., Pfueller, U., Moritz, S., Weisbrod, M., & Roesch-Ely, D. (2010). Metacognitive training for patients with schizophrenia (MCT): Feasibility and preliminary evidence for its efficacy. Journal of Behavior Therapy and Experimental Psychiatry, 41, 207-211.

Agid, O., Kapur, S., Arenovich, T., & Zipursky, R.B. (2003). Delayed-Onset Hypothesis of Antipsychotic Action. A Hypothesis Tested and Rejected. Archives General Psychiatry, 60, 1228-1235.

Beck, A.T., Baruch, E., Balter, J.M., Steer, R.A., & Warman, D.M. (2004). A new instrument for measuring insight: the Beck Cognitive Insight Scale. Schizophrenia Research, 68), 319-329.

Beck, A.T., Steer, R.A., & Brown, G.K. (1996). BDI-II Manual. The Psychological Corporation. San Antonio (Texas): Harcourt Brace & Company.

Bentall, R.P. (1994). Cognitive biases and abnormal beliefs: Towards a model of persecutory delusions. In: A.S. David (Ed.), The neuropsychology of schizophrenia (pp. 337-360). Hove, UK: Lawrence Erlbaum Associates.

Bora, E., Yucel, M., & Pantelis, C. (2009). Theory of mind impairment in schizophrenia: Meta-Analysis. Schizophrenia Research, 109, 1-9.

Brüne, M. (2005). ‘Theory of mind’ in schizophrenia: a review of the literature. Schizophrenia Bulletin, 31, 21-42.

Combs, D.R., Penn, D.L., Chadwick, P., Trower, P., Michael, C.O., & Basso, M.R.( 2007). Subtypes of paranoia in a nonclinical sample. Cognitive Neuropsychiatry, 12(6), 537-553.

Corcoran, R., Mercer, G., & Frith, F.D. (1995). Schizophrenia, symptomatology and social inference: Investigating ‘theory of mind’ in people with schizophrenia. Schizophrenia Research, 17(1), 5-13.

Danion, J.M., Cuervo, C., Piolino, P., Huron, C., Riutort, M., Peretti, C.S., et al. (2005). Conscious recollection in autobiographical memory: an investigation in schizophrenia. Consciousness and Cognition, 14, 535-547.

Does, A.J.W. van der (2002). BDI-II-NL; Handleiding Beck Depression Inventory-II, Ned. vertaling en bewerking. Lisse: Swets Test Publisher.

Freeman, D. (2007). Suspicious minds: the psychology of persecutory delusions. Clinical Psychology Review, 27, 425-457.

Freeman, D., Pugh, K., & Garety, P. (2008). Jumping to conclusions and paranoid ideation in the general population. Schizophrenia Research, 102, 254-260.

Fugelsang, J.A., Stein, C.B., Green, A.E., & Dunbar, K.N. (2004). Theory and data interactions of the scientific mind: evidence from the molecular and the cognitive laboratory. Canadian Journal of Experimental Psychology, 58, 86-95.

Green, C.E.L., Freeman, D., Kuipers, E., Bebbington, P., Fowler, D., Dunn, G., & Garety, P.A. (2008). Measuring ideas of persecution and social reference: the Green et al. Paranoid Thought Scales (GPTS). Psychological Medicine, 38, 101-111.

Haddock, G., McCarron, J., Tarrier, N., & Faragher, E.B. (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychological Medicine, 29, 879-889.

Huq, S.F., Garety, P.A., & Hemsley, D.R. (1988). Probabilistic judgements in deluded and non-deluded subjects. Quarterly Journal of Experimental Psychology, 40(4), 801-812

Janssen, I., Versmissen, D., Campo, J.A., Myin-Germeys, I., Os, J. van, & Krabbendam, L. (2006). Attribution style and psychosis: evidence for an externalizing bias in patients but not in individuals at high risk. Psychological Medicine, 36, 771-778.

Kerr, N., Dunbar, R.I., & Bentall, R.P. (2003). Theory of mind deficits in bipolar affective disorder. Journal of Affective Disorders, 73, 253-259.

Kinderman, P. & Bentall, R.P. (1997). Causal attributions in paranoia and depression: internal, personal, and situational attributions for negative events. Journal of Abnormal Psychology, 106, 341-345.

Krstev, H., Jackson, H., & Maude, D. (1999). An investigation of attributional style in first-episode psychosis. British Journal of Clinical Psychology, 38, 181-194.

Lecomte, T., Corbière, M., & Laisné, F. (2004). Investigating self-esteem in individuals with schizophrenia: relevance of the Self-Esteem Rating Scale-Short Form Psychiatric research, 143(1), 99-108.

Lincoln, T.M., Lullmann, E., & Rief, W. (2007). Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophrenia Bulletin, 33, 1324-1342.

Moritz, S. & Woodward, T.S. (2005). Jumping to conclusions in delusional and non-delusional schizophrenic patients. British Journal of Clinical Psychology 44, 193-207.

Moritz, S. & Woodward, T.S. (2006a). A generalized bias against disconfirmatory evidence in schizophrenia. Psychiatric Research, 142, 157-165.

Moritz, S. & Woodward, T.S. (2006b) The Contribution of Metamemory Deficits to Schizophrenia. Journal of Abnormal Psychology, 15(1), 15-25.

Moritz, S. & Woodward, T.S. (2007a). Metacognitive training in schizophrenia: from basic research to knowledge translation and intervention. Current Opinions in Psychiatry, 20, 619-625.

Moritz, S. & Woodward, T.S. (2007b). Metacognitive training for schizophrenia patients (MCT): A pilot study on feasibility, treatment adherence, and subjective efficacy. German Journal of Psychiatry, 10, 69-78.

Moritz, S., Woodward, T.S., Burlon, M., Braus, D.F., & Andresen, B. (2007). Attributional style in schizophrenia: Evidence for a decreased sense of self-causation in currently paranoid patients. Cognitive Therapy and Research, 31, 371-383.

Moritz, S., Woodward, T.S., & Rodriguez-Raecke, R. (2006). Patients with schizophrenia do not produce more false memories than controls but are more confident in them. Psychological Medicine, 36, 659-667.

Phillips, M.L., & David, A.S. (1995). Facial processing in schizophrenia and delusional misidentification: cognitive neuropsychiatric approaches. Schizophrenia Research, 17, 109-114.

Premack, D.G. & Woodruff, G. (1978). Does the chimpanzee have a theory of mind? Behavioral and Brain Sciences, 1, 515-526.

Ross, K., Freeman, D., Dunn, G., & Garety, P. (in press). A randomized experimental investigation of reasoning training for people with delusions. Schizophrenia Bulletin (advance access juni 11, 2009).

Uekermann, J., Channon, S., Lehmkamper, C., Abdel-Hamid, M., Vollmoeller, W., & Daum, I. (2008). Executive function, mentalizing and humor in major depression. Journal of the International Neuropsychological Society, 14, 55-62.

Dael, F. van, Versmissen, D., Janssen, I., Myin-Germeys, I., Os, J. van, & Krabbendam, L. (2006). Data gathering: biased in psychosis? Schizophrenia Bulletin, 32, 341-351.

White, L.O. & Mansell, W. (2009). Failing to ponder? Delusion-prone individuals rush to conclusions. Clinical Psychology and Psychotherapy, 16(2), 111-124.

Woodward, T.S., Buchy, L., Moritz, S., & Liotti, M. (2007). A bias against disconfirmatory evidence is associated with delusion proneness in a nonclinical sample. Schizophrenia Bulletin, 33, 1023-1028.

Woodward, T.S., Moritz, S., Cuttler, C., & Whitman, J.C. (2006). The contribution of a cognitive bias against disconfirmatory evidence (BADE) to delusions in schizophrenia. Journal of Clinical and Experimental Neuropsychology, 28, 605-617.

Woodward, T.S., Moritz, S., Menon, M., & Klinge, R. (2008). Belief inflexibility in schizophrenia. Cognitive Neuropsychiatry, 13, 267-277.