The MOSST program: a new treatment for schizophrenia

One of the central problems that schizophrenic people present is related to severe difficulties in the area of ​​interpersonal and social interaction. Positive symptoms (hallucinations or delusions), negative symptoms (difficulties in affective expression) and disorganization in language and behavior interfere very unfavorably in the daily performance in the personal, family, professional or social sphere of the patient.

In this article we will see what one of the tools to improve the quality of the relationship between people with schizophrenia and their social environment consists of. This is the MOSST program: Training in Social Skills Oriented to Metacognition.

• Related article: "What is schizophrenia? symptoms and treatments"

Current psychological interventions in schizophrenia

Psychological interventions that have traditionally shown greater efficacy have focused on promoting social skills and promote a behavioral repertoire that allows the person to develop a competent role both personally and in the context community. Thus, multi-component cognitive-behavioral interventions that include elements such as

learning coping strategies and problem solving, conduct trials, modeling, training in self-control and self-instructions, learning cognitive strategies and family psychoeducational interventions have proven its superiority in efficacy in multiple investigations compared to other types of interventions where the components are worked on by separate.

However, despite the fact that Social Skills Training (EHS) is considered an essential part of intervention in schizophrenia and is highly recommended in many different clinical contexts, according to Almerie (2015), it seems that the difficulty in applying the strategies worked during the session in the real context of the patient, the so-called generalization capacity, compromises the efficacy indices of this type of treatments.

On the other hand, authors such as Barbato (2015) have shown that a fundamental element in deficit refers to the metacognitive difficulties presented by schizophrenic people, that is, the ability to reflect and analyze one's own thoughts, feelings, intentions attitudes and behavior of their own and others and the representation that these patients make of their reality daily.

• You may be interested in: "Cognitive Behavioral Therapy: what is it and what principles is it based on?"

What skills are worked on?

Currently the main treatments in schizophrenia are well derived from behavior modification techniques in order to improve the psychosocial functioning of the person and reduce positive symptoms or, in a more innovative way, they focus on working on cognition skills to achieve a greater understanding and more competence in their interpersonal functioning and in the understanding of the mental and emotional states involved in this type of interactions.

According to the theoretical proposal of Lysaker et al. (2005) four are the basic processes of metacognition:

• self-reflexivity: thinking about one's own mental states.
• Differentiation: thinking about other people's mental states.
• Decentering: understanding that there are other perspectives in the interpretation of reality apart from one's own.
• Domain: integrate subjective information in a broader and more adaptive way.

Focusing on the promotion of the indicated skills and continuing with the proposals of Lysaker (2011), who worked on the application of a type of psychotherapy based on optimizing the power of self-reflection, or Moritz and Woodward (2007), who focused their interventions on getting patients to identify incorrect reasoning repertoires or biased, Ottavi et al. (2014) have developed the MOSST program (Training in Social Skills Oriented to Metacognition).

Components of the MOSST program

This new and promising initiative has many elements in common with the main EHS described above, although it tries to give greater Emphasis on the power of generalization of the contents worked on in therapy, to promote the understanding and expression of metacognitive phenomena, in addition to giving more weight to the use of the modeling and role-playing technique.

Application conditions

Regarding its particularities, first of all, the application of the program is carried out in a hierarchical way, in such a way that the simplest skills are initially addressed. (for example, recognizing one's own thoughts - Self-reflexivity) and, later, progress is made towards the training of more complex capacities related to the component of Domain.

On the other hand, the physical space where the sessions take place must be free of interruptions or interfering sounds. The environment must be relaxed and playful, although safe for patients, therefore, therapists they are active agents participating, expressing self-disclosures and positively validating others. assistants. All this favors the establishment of a positive bond between patient group members and therapists, or metacognitive facilitators (FM), who guide them in the sessions.

On a practical level, this program is intended for outpatients presenting with a stable symptom profile without a neurological diagnosis or mental retardation. The groups are made up of 5-10 people and the 90-minute sessions take place weekly. Each of them works on a different skill. The following are those that make up the program:

• greet others
• listen to others.
• Ask for information.
• Start and end conversations.
• hold conversations.
• Receive and give praise.
• Make and reject requests.
• Compromise and negotiate.
• suggest activities.
• Make constructive criticism.
• Respond to negative reviews.
• Apologize.
• Express unpleasant feelings
• Express positive feelings.

The sessions are divided into two different parts. In the first place, a self-reflection practice is carried out, remembering a specific situation and answering some questions to enhance its metacognitive evocation in patients. Subsequently the same process is carried out on a live role play and about listening to a narrative, both issued by the therapists.

In the second block of the session, a second staging is carried out by the participants, after preparing the specific skill to practice, and it ends with a discussion of the metacognitive states experienced or observed by the members of the group during the representation.

By way of conclusion: the effectiveness of MOSST

Otavii et al. (2014) have found some promising results after the application of the MOSST in small groups. both in patients with chronic schizophrenia and in subjects with early psychotic episodes.

Subsequently, once the adaptation of the program into Spanish was completed, Inchausti and his team of collaborators (2017) have corroborated that obtained by Ottavi, achieving a high level of acceptance by patients and a high rate in terms of efficacy therapy. This is transmitted in an increase in the performance of interpersonal activities, an improvement in social relationships and a decrease in disruptive or aggressive behaviors.

Despite all of the above, due to the novelty of the proposal, Inchausti indicates the need to carry out more studies that rigorously validate what was found by the researchers mentioned to date. date.

Bibliographic references:

• Ottavi, P., D'Alia, D., Lysaker, P., Kent, J., Popolo, R., Salvatore, G. & Damaggio, G. (2014a). Metacognition-oriented social skills training for individuals with long term schizophrenia: methodology and clinical illustration. Clinical Psychology and Psychotherapy, 21 (5), 465-473. doi: 10.1002/cpp. 1850.
• Inchausti, F., Garcia-Poveda, N. V., Prado-Abril, J., Ortuño-Sierra, J., Gainza-Tejedor, I. (2017). Metacognition-Oriented Social Skills Training (MOSST): Theoretical framework, work methodology and treatment description for patients with schizophrenia. Papers of the Psychologist 2017, vol. 38(3), p. 2014-212.