Metacognitive Interpersonal Therapy for Treating Persecutory Delusions in Schizophrenia

MIT aims at progressively fostering metacognition until patients are able to understand what kind of interpersonal events or ideas about self and interpersonal interactions trigger their persecutory delusions and to question the delusional meaning they attribute to events.

A persecutory delusion (PD) is a person’s false belief that others are focusing their attention on him or her with malevolent intentions, which often results in intense anxiety and significant disruption of daily life. PDs are common in schizophrenia, and many patients with schizophrenia do not respond well to current pharmacological treatments. Therefore, effective psychological treatments are needed. The most well-known intervention for PDs continues to be cognitive-behavioral therapy. It aims to reduce patients’ stigma and then help them to question the delusional meaning they attribute to events. The authors hypothesized that it is possible to reinforce the clinical approach to PDs on the basis of two important considerations: delusions have a meaning that is connected to a fundamental experiencing of the self as being ontologically vulnerable, and PDs seem to be correlated to dysfunctions in metacognition, a spectrum of mental activities involving thinking about one’s own and others’ mental states. The authors describe the treatment with metacognitive interpersonal therapy of a young man with paranoid schizophrenia and pervasive PD. The four main stages described are: regulating the therapeutic relationship to avoid potential rupture; reducing the emotional suffering caused by the PD and teaching the patient behavioral strategies for coping with this suffering, promoting the patient’s ability to reflect on his own mind and thereby to develop a more sophisticated metacognitive mastery of the PD, and promoting a more nuanced understanding of the other’s mind.