Sex differences in neurocognitive response to metacognitive training in first-episode psychosis: Implications for personalized interventions

PURPOSE: Neurocognitive impairments are a core feature of psychosis and impact long-term outcomes. While sex differences in neurocognition have been observed in first-episode psychosis (FEP), findings remain mixed, and little is known about differential responses to metacognitive interventions. This...

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Bibliographic Details
Authors: Verdaguer-Rodríguez, M., Comas, J.O., López-Carrilero, R., Díaz-Cutraro, L., Espinosa, V., Ruiz-Delgado, I., Barrigón, M.L., Grasa, E., Pousa, E., González-Higueras, F., Cid, J., Lorente-Rovira, E., Barajas, A., Ochoa, S.
Format: article
Status:Published version
Publication Date:2026
Country:España
Institution:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repository:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p21181
Online Access:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21181
https://www.scopus.com/inward/record.uri?eid=2-s2.0-105029604904&doi=10.1007%2fs00737-025-01637-3&partnerID=40&md5=984fce862e4024585bd2449cd932f7d0
Access Level:Open access
Keyword:Cognition
Intersectionality
Gender
Psychological Interventions
Psychosis
Adolescent
Adult
Cognitive Behavioral Therapy
Female
Humans
Male
Metacognition
Neuropsychological Tests
Psychotic Disorders
Sex Factors
Treatment Outcome
Young Adult
adolescent
adult
cognition
cognitive behavioral therapy
controlled study
female
human
male
metacognition
neuropsychological assessment
physiology
procedures
psychology
psychosis
randomized controlled trial
sex factor
therapy
treatment outcome
young adult
Description
Summary:PURPOSE: Neurocognitive impairments are a core feature of psychosis and impact long-term outcomes. While sex differences in neurocognition have been observed in first-episode psychosis (FEP), findings remain mixed, and little is known about differential responses to metacognitive interventions. This study examined sex differences in the effectiveness of Metacognitive Training (MCT) on neurocognitive outcomes in FEP. METHODS: A total of 122 individuals with FEP were randomized to receive either MCT or psychoeducational intervention. Neurocognitive performance was assessed at baseline and at 6-month follow-up using a comprehensive battery (CPT-II, TMT, WCST, Stroop test, TAVEC, WAIS-III Digit Span). General Linear Models tested the effects of intervention, sex, and their interaction, both unadjusted and adjusted for covariates. RESULTS: MCT led to greater improvements than psychoeducation in immediate recall, processing speed, cognitive flexibility, inhibitory control, and attention. Improvements in immediate recall and Stroop Interference remained significant after adjustment, with Stroop performance also influenced by diagnosis. Across groups, men performed better in verbal memory, while women showed increased serial clustering in short-term recall, an effect that remained significant after adjustment. Notably, a group-by-sex interaction indicated that women receiving MCT experienced greater gains in short-term recall after controlling for covariates. CONCLUSIONS: MCT enhances specific neurocognitive functions in FEP and shows promising effects for women in verbal memory processes. These findings underscore the importance of incorporating sex and diagnostic factors when tailoring early interventions for psychosis and highlight the potential of MCT as a personalized cognitive strategy. © 2026. The Author(s).

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