Gender Differences in Response to Metacognitive Training in People With First-Episode Psychosis

Introduction: The study aimed to assess gender differences in the efficacy of metacognitive training (MCT) in people with first-episode psychosis in terms of symptoms and cognitive insight as a primary outcome and other metacognitive and social cognition measures as a secondary outcome. Method: A multicenter, controlled, randomized clinical trial was performed including 122 patients with first-episode psychosis. A total of 8 weekly group sessions of MCT or a psychoeducational intervention were performed. Patients were assessed at baseline. posttreatment, and follow-up. Symptoms were assessed with the Positive and Negative Syndrome Scale and cognitive insight with the Beck Cognitive Insight Scale. A battery of questionnaires on metacognition and social cognition variables was included to assess secondary outcomes. A regression model for repeated measures was performed by gender. Results: Women of the MCT group improved more in general symptoms (p = .046). self-certainty (p = .010), and a composite index of the cognitive insight (p = .031). Moreover, women in the MCT group showed a reduction in personalizing bias (p = .021) and irrational beliefs related to dependence (p = .024), while men in the MCI group showed an improvement in intolerance to frustration (p = .017). In the Jumping to Conclusions task, men in the MCI group improved in the affective task (p = .021) while no differences were found in women. Conclusions: Our results suggest that MCT is more effective in reducing symptoms and improving cognitive insight for women than men. Moreover, different irrational beliefs and cognitive biases were reduced differently considering gender. MCT could be a gender-sensitive intervention.