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Peer-reviewedCC BYFrontiers in psychology

Baseline cognitive insight moderates the efficacy of metacognitive training for psychosis: an individual participant data analysis.

  • Adrien Goncalves1,2
  • Susana Ochoa3,4,5
  • Steffen Moritz6
  • Łukasz Gawęda7
  • Vanessa Acuña8
  • Caroline König9
  • Maria Lamarca3,4,5,10
  • Fabrice Berna1,11,12
12 affiliations
  1. 1INSERM, UMR_S 1329: Strasbourg Translational Neuroscience & Psychiatry, Strasbourg, France.
  2. 2École doctorale des sciences de la vie et de la santé: ED 414, Université de Strasbourg, Strasbourg, France.
  3. 3Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
  4. 4Grup MERITT, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
  5. 5Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
  6. 6Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
  7. 7Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland.
  8. 8Departamento de Psiquiatría, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile.
  9. 9Soft Computing Research Group at Intelligent Data Science and Artificial Intelligence Research Center, Universitat Politècnica de Catalunya, Barcelona, Spain.
  10. 10Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain.
  11. 11Faculté de Médecine, Université de Strasbourg, Strasbourg, France.
  12. 12Hôpitaux universitaires de Strasbourg, Strasbourg, France.
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Abstract

Background

Metacognitive Training (MCT) for psychosis is designed to target metacognitive processes, yet evidence for its effects on cognitive insight remains inconclusive, owing primarily to the limited methodological quality of available trials. A potential explanation lies in baseline heterogeneity, with a substantial proportion of participants presenting high baseline cognitive insight, thereby limiting observable change.Methods

This study used harmonized individual participant data from the PERMEPSY database, including 614 participants with schizophrenia spectrum disorders from 13 international studies. Cognitive insight was assessed using the Beck Cognitive Insight Scale (BCIS), including Self-Reflectiveness (SR), Self-Certainty (SC), and a composite index (CI). Baseline moderation effects were examined using ANCOVA models with a continuous Group × Baseline interaction term, complemented by stratified ANOVAs to visualize the interaction pattern and estimate within-stratum effect sizes.Results

ANCOVA models revealed significant Group × Baseline interactions across all BCIS dimensions, indicating that baseline cognitive insight moderated treatment response. Stratified ANOVAs yielded convergent results for SR and SC. Effect sizes followed a consistent gradient, with larger improvements observed among participants with lower baseline insight. Notably, 26.5% of participants already scored in the high-insight category at baseline, suggesting that ceiling effects may have partially obscured treatment effects at the group level in previous trials.Conclusion

MCT appears to improve cognitive insight, particularly among participants with greater baseline impairment. These findings suggest that baseline heterogeneity is a key determinant of MCT efficacy and may account for previously inconsistent results.

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Cite

BibTeXRIS
BibTeX
@article{goncalves2026baseline,
  title = {{Baseline cognitive insight moderates the efficacy of metacognitive training for psychosis: an individual participant data analysis.}},
  author = {Adrien Goncalves and Susana Ochoa and Steffen Moritz and Łukasz Gawęda and Vanessa Acuña and Caroline König and Maria Lamarca and Fabrice Berna},
  journal = {Frontiers in psychology},
  year = {2026},
  month = oct,
  doi = {10.3389/fpsyg.2026.1934181},
  url = {https://europepmc.org/article/MED/43011308},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Baseline cognitive insight moderates the efficacy of metacognitive training for psychosis: an individual participant data analysis.
AU  - Adrien Goncalves
AU  - Susana Ochoa
AU  - Steffen Moritz
AU  - Łukasz Gawęda
AU  - Vanessa Acuña
AU  - Caroline König
AU  - Maria Lamarca
AU  - Fabrice Berna
PY  - 2026
DA  - 2026/10/27
JO  - Frontiers in psychology
DO  - 10.3389/fpsyg.2026.1934181
UR  - https://europepmc.org/article/MED/43011308
AB  - Background  Metacognitive Training (MCT) for psychosis is designed to target metacognitive processes, yet evidence for its effects on cognitive insight remains inconclusive, owing primarily to the limited methodological quality of available trials. A potential explanation lies in baseline heterogeneity, with a substantial proportion of participants presenting high baseline cognitive insight, thereby limiting observable change.Methods  This study used harmonized individual participant data from the PERMEPSY database, including 614 participants with schizophrenia spectrum disorders from 13 international studies. Cognitive insight was assessed using the Beck Cognitive Insight Scale (BCIS), including Self-Reflectiveness (SR), Self-Certainty (SC), and a composite index (CI). Baseline moderation effects were examined using ANCOVA models with a continuous Group × Baseline interaction term, complemented by stratified ANOVAs to visualize the interaction pattern and estimate within-stratum effect sizes.Results  ANCOVA models revealed significant Group × Baseline interactions across all BCIS dimensions, indicating that baseline cognitive insight moderated treatment response. Stratified ANOVAs yielded convergent results for SR and SC. Effect sizes followed a consistent gradient, with larger improvements observed among participants with lower baseline insight. Notably, 26.5% of participants already scored in the high-insight category at baseline, suggesting that ceiling effects may have partially obscured treatment effects at the group level in previous trials.Conclusion  MCT appears to improve cognitive insight, particularly among participants with greater baseline impairment. These findings suggest that baseline heterogeneity is a key determinant of MCT efficacy and may account for previously inconsistent results.
SN  - 1664-1078
ER  -