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 delusional ideas), negative symptoms (difficulties in emotional expression) and disorganization in language and behavior interfere very unfavorably with the patient’s daily functioning in the personal, family, professional or social sphere.
In this article we will see what one of the tools consists of to improve the quality of the relationship between people with schizophrenia and their social environment. This is the MOSST program: Training in Social Skills Oriented to Metacognition
Current psychological interventions in schizophrenia
The psychological interventions that have traditionally demonstrated greater effectiveness have been aimed at promoting social skills and enhancing a behavioral repertoire that allows the person to develop a competent role both in the personal sphere and in the community context. Thus, multi-component cognitive-behavioral interventions that include elements such as learning coping strategies and problem solving behavioral tests, modeling, training in self-control and self-instructions, learning of cognitive strategies and family psychoeducational interventions have proven their superiority in effectiveness in multiple investigations compared to other types of interventions where the components are worked on separately.
However, although Social Skills Training (EHS) is considered an essential part of the intervention in schizophrenia and is highly recommended in very diverse clinical contexts, according to Almerie (2015), it seems that the difficulty in applying the strategies worked on during the session in the patient’s real context, the so-called generalization capacity, compromises the effectiveness rates of this type of treatment.
On the other hand, authors such as Barbato (2015) have shown that a fundamental deficient element refers to the metacognitive difficulties that schizophrenic people present that is, the ability to reflect and analyze one’s own thoughts, feelings, one’s own and others’ attitudinal and behavioral intentions, and the representation that these patients make of their daily reality.
What skills are worked on?
Currently The main treatments in schizophrenia either derive from behavior modification techniques with the aim of improving the person’s psychosocial functioning and reducing positive symptoms or, in a more innovative way, they focus on working on social cognition skills to achieve greater understanding and more competence in their interpersonal functioning and in understanding the mental and emotional states involved in this type of interactions.
According to the theoretical proposal of Lysaker et al. (2005) there are four basic processes of metacognition:
Focusing on promoting 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 in getting patients to identify incorrect or biased reasoning repertoires, Ottavi et al. (2014) have developed the MOSST program (Training in Social Skills Oriented to Metacognition).
MOSST Program Components
This novel and promising initiative presents many elements in common with the main EHS described above, although it attempts to give greater emphasis to 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 modeling and role-playing techniques
Regarding its particularities, first of all, the application of the program is carried out in a hierarchical manner, in such a way that the simplest skills are initially addressed (for example, recognizing one’s own thoughts – Self-reflexivity) and, subsequently, progress is made towards the training of more complex abilities related to the Domain component.
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 are active agents participating, expressing self-disclosures and positively validating attendees. All this favors the establishment of a positive bond between members of the patient group and therapists or metacognitive facilitators (FM), who guide them in the sessions.
On a practical level, this program is designed for outpatients who present a stable symptomatological profile without neurological diagnosis or mental retardation Groups are made up of 5-10 people and 90-minute sessions take place weekly. In each of them a different skill is worked on. Below are those that make up the program:
The sessions are divided into two different parts. Firstly, 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 role-play is carried out by the participants, after preparing the specific skill to be practiced, and ends with a debate evaluating the metacognitive states experienced or observed by the group members during the session. representation.
Otavii et al. (2014) have found promising results after applying the MOSST in small groups both in patients with chronic schizophrenia and in subjects with incipient psychotic episodes
Subsequently, once the adaptation of the program to Spanish was completed, Inchausti and his team of collaborators (2017) have corroborated what Ottavi obtained, achieving a high level of acceptance by patients and a high rate in terms of therapeutic efficacy. 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 has been found by the researchers mentioned to date.
