The MOSST program: a new treatment for schizophrenia.

A new perspective of psychological intervention with positive results in psychotic patients.

One of the main problems presented by schizophrenic people is related with severe difficulties in the area of interpersonal and social interaction.. Positive symptomatology (hallucinations or delusional ideas), negative symptomatology (difficulties in affective expression) and disorganization in language and behavior interfere very unfavorably in the daily performance in the personal, family, professional or social environment 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: Metacognition-Oriented Social Skills Training..

Current Psychological Interventions in Schizophrenia

The psychological interventions that have traditionally demonstrated greater efficacy 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, which include elements such as learning of coping and problem-solving strategies, behavioral rehearsals, modeling, modeling, role-playsThe effectiveness of multi-component cognitive-behavioral interventions, which include elements such as learning coping and problem-solving strategies, behavioral rehearsal, modeling, self-control training and self-instructions, learning cognitive strategies and family psychoeducational interventions, has been proven to be superior to other types of interventions where the components are worked on separately.

However, despite the fact that Social Skills Training (SST) is considered an essential part of schizophrenia intervention and is highly recommended in many different clinical contexts, as stated by Almerie (2015), it seems that the difficulty in applying the strategies worked on during the session in the real context of the patient, 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 element of deficit refers to the difficulties at the metacognitive level presented by schizophrenic personsi.e. the ability to reflect and analyze one's own thoughts, feelings, attitudinal and behavioral intentions and the representation that these patients make of their daily reality.

What competencies are worked on?

At present, the main treatments in schizophrenia the main treatments in schizophrenia either derive from behavior modification techniques with the aim of improving the psychosocial functioning of the person and reducing positive symptoms or, more recently, they focus on working on social cognition skills to achieve greater understanding and more competence in 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:

• Self-reflexivitySelf-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.
• Mastery: integrating 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 or biased reasoning repertoires, Ottavi et al. (2014) have developed the MOSST program (Metacognition-Oriented Social Skills Training).

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 to the generalization power of the contents worked on in therapy, to foster understanding and the expression of metacognitive phenomena, in addition to giving more weight to the use of modeling and role-playing techniques..

Application conditions

Regarding its particularities, first of all, the application of the program is done in a hierarchical way, so that the simplest skills are initially addressed (e.g. recognizing one's own thoughts - Self-reflexivity) and, subsequently, progress is made towards the training of more complex skills related to the Mastery component.

On the other hand, the physical space where the sessions take place must be free of interruptions or interfering sounds. The atmosphere should be relaxed and playful but safe for the patients, so therapists are active agents participating, expressing self-revelations and positively validating the assistants. All this favors the establishment of a positive between the members of the group of patients and the therapists, or metacognitive facilitators.The program is designed as a practical program, and is designed to be used as a tool for the development of a positive bond between the patient group members and the therapists, or metacognitive facilitators (FM), who guide them in the sessions.

On a practical level, this program is designed for outpatients with a stable symptomatological profile without a stable symptomatological profile without a neurological or mental retardation diagnosis.. The groups are made up of 5-10 people and the 90-minute sessions take place weekly. In each one of them a different skill is worked on. The following are the skills that make up the program:

• Greeting others.
• Listening to others..
• Asking for information.
• Initiating and ending conversations.
• Maintaining conversations..
• Receiving and giving compliments.
• Make and reject requests.
• Compromise and negotiate.
• Suggest activities.
• Make constructive criticisms.
• Responding to negative criticism.
• Apologizing.
• Expressing unpleasant feelings
• Expressing positive feelings.

The sessions are divided into two distinct parts. Firstly, a self-reflection practice is carried out, recalling a specific situation and answering some questions to enhance its metacognitive evocation in the patients. Subsequently the same process is carried out on a live role-play and on the hearing of a narration and on the hearing of a narration, both of them broadcast by the therapists.

In the second block of the session, a second staging is carried out by the participants, after preparation of the specific skill to be practiced, and ends with a discussion to evaluate the metacognitive states experienced or observed by the members of the group during the performance.

By way of conclusion: the effectiveness of MOSST

Otavii et al. (2014) have found promising results following the application of 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 Ottavi's findings, achieving a high level of acceptance by patients and a high rate in terms of therapeutic efficacy. This results in an increase in interpersonal activities, improved social relationships and a decrease in disruptive or aggressive behaviors. a decrease in disruptive or aggressive behavior..

In spite of all the above, due to the novelty of the proposal, Inchausti indicates the need for more studies to rigorously validate what has been found by the researchers mentioned to date.

Bibliographical 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., García-Poveda, N. V., Prado-Abril, J., Ortuño-Sierra, J., Gainza-Tejedor, I. (2017). Metacognition-oriented social skills training (MOSST): theoretical framework, working methodology, and treatment description for patients with schizophrenia. Psychologist's Papers 2017, vol. 38(3), pp. 2014-212.