Background: Metacognitive training (MCT) is a novel group psychotherapy method for schizophrenia, but there is, as yet, no conclusive evidence of its efficacy.
Aims: Conduct a meta-analysis to assess the effectiveness of MCT in schizophrenia.
Methods: Electronic and hand searches were conducted to identify randomized controlled trials about the effects of MCT in schizophrenia that met pre-defined inclusion criteria. The Cochrane Risk of Bias tool was employed to assess of risk of biases, and Cochrane Review Manager version 5.3 and R version 3.1.1 were used to conduct the data synthesis.
Results: Ten trials from 54 unduplicated reports were included in the review, but differences in the methods of assessing outcomes limited the number of studies that could be included in the meta-analysis. Pooling four studies that assessed the positive symptom subscale of the Positive and Negative Syndrome Scale (PANSS) at the end of the trial identified a small but statistically significant greater reduction in the MCT group than in the control group. But pooling four studies that assessed the delusion subscale of the Psychotic Symptom Rating Scales (PSYRATS) at the end of the trial found no significant difference between the groups. Results from the qualitative assessment of the other results that could not be pooled across studies were mixed, some showed a trend in favor of MCT but many found no difference between the groups.
Conclusions: The limited number of RCT trials, the variability of the method and time of the outcome evaluation, and methodological problems in the trials make it impossible to come to a conclusion about the effectiveness of MCT for schizophrenia. More randomized trials that use standardized outcome measures, that use intention-to-treat (ITT) analyses, and that follow-up participants at regular intervals after the intervention are needed to determine whether or not MCT should become a recommended adjunctive treatment for schizophrenia.
背景: 元认知训练（metacognitive training, MCT）是一组全新的针对精神分裂症的心理治疗方法，但是到目前为止还没有确凿的证据证实其疗效。.
目的: 采用meta 分析评估MCT 治疗精神分裂症的有效性。.
方法: 使用电子检索和手工检索的方法筛查文献，从而识别出有关MCT 治疗精神分裂症疗效的随机对照试验（randomized controlled trials, RCT），这些RCT 都满足预先规定的纳入标准。本研究采用Cochrane 风险评估偏倚工具评估各种偏倚的风险性，并使用Cochrane Review Manager 5.3 版和R 3.1.1 版进行数据合成。.
结果: 54 项不重复报告中的10 项试验被纳入，但评估结果方法上的差异限制了可能被纳入meta 分析的研究数量。综合分析了四项在试验结束时使用阳性和阴性症状量表（Positive and Negative Syndrome Scale,PANSS）的研究，发现MCT组比对照组有一个较小的降低，但具有统计学意义。但综合四项在试验结束时使用精神病症状评定量表（Psychotic Symptom Rating Scales, PSYRATS）的错觉分量表的研究，发现两组间无显著差异。将那些无法汇集的各研究的其它结果进行定性的综合分析，显示出一些有利于MCT 的趋势，但多数发现两组之间是没有差异的。.
结论: 纳入的RCT 试验数量有限、各试验结果评价的方法和时间的多样性、以及方法学上的问题使我们无法得出一个关于使用MCT 治疗精神分裂症的有效性的结论。我们需要更多的使用标准化的结果评估方法、使用意向性治疗（intention-to-treat ITT）分析、以及在干预后对参与者进行有规律的定期随访的随机试验，从而确定MCT 是否应该成为一个值得推荐的精神分裂症辅助治疗。.
中文全文: 本文全文中文版从2015年08月06日起在http://dx.doi.org/10.11919/j.issn.1002-0829.215065可供免费阅览下载.
Keywords: meta-analysis; metacognitive training; randomized controlled trials; schizophrenia.