yes, therapy helps!
The MOSST program: a new treatment for schizophrenia

The MOSST program: a new treatment for schizophrenia

June 14, 2024

One of the problematic centers presented by schizophrenic persons 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 of the patient.

In this article we will see what is one of the tools 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 towards Metacognition .


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

Current psychological interventions in schizophrenia

Psychological interventions that have traditionally shown greater efficacy have been aimed at fostering social skills and promoting a behavioral repertoire that allows the person to develop a competent role both in the personal 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-instruction, learning cognitive strategies and family psychoeducational interventions have proved 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 to apply the strategies worked during the session in the real context of the patient, the so-called capacity for generalization, compromises the effectiveness indexes of this type of treatment.

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


  • Perhaps you are interested: "Behavioral Cognitive Therapy: what is it and on what principles is it based?"

What competences are worked?

Nowadays the main treatments in schizophrenia are well derived from behavior modification techniques in order to improve the psychosocial functioning of the person and decrease positive symptoms or, in a more novel way, focus on working social cognition skills to achieve greater understanding and more competence in interpersonal functioning and 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 : think about one's mental states.
  • Differentiation: thinking about the mental states of others.
  • Decentralization: understand that there are other perspectives in the interpretation of reality apart from one's own.
  • Domain: integrate subjective information more broadly and adaptively.

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), which focused their interventions in getting patients to identify incorrect or skewed repertoires of reasoning, Ottavi et al. (2014) have developed the MOSST program (Training in Social Skills oriented to Metacognition).

Components of the MOSST program

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

Conditions of application

Regarding its particularities, first of all, the application of the program is carried out in a hierarchical manner, so that the simplest skills are initially addressed (for example, recognizing one's thoughts - Self-reflexivity) and, subsequently, progressing towards the training of more complex capabilities 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 should be relaxed and playful but safe for patients, therefore, the therapists are active agents participating, expressing self-revelations and positively validating the attendees. All this favors the establishment of a positive link between the members of the patient group and the therapists , or metacognitive facilitators (FM), who guide them in the sessions.

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

  • Greet others
  • Listen to others .
  • Ask for information.
  • Start and end conversations.
  • Keep conversations .
  • Receive and give praise.
  • Make and reject requests.
  • Commit 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 practice of self-reflection is performed remembering some concrete situation and answering some questions to enhance their metacognitive evocation in patients. Later the same process is performed on a live role representation and about the hearing of a narration, both issued 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 of the evaluation 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 promising results after the application of 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 the results obtained by Ottavi, achieving a high level of acceptance by patients and a high rate of therapeutic efficacy. This is transmitted in an increase in the performance of interpersonal activities, an improvement in social relations and a decrease in disruptive or aggressive behavior .

Despite all 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.

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., García-Poveda, N.V., Prado-Abril, J., Ortuño-Sierra, J., Gainza-Tejedor, I. (2017). Training in social skills oriented to metacognition (MOSST): Theoretical framework, work methodology and description of treatment for patients with schizophrenia. Papers of the Psychologist 2017, vol. 38 (3), pp. 2014-212.

Schizophrenia Symptoms : What Is Schizophrenia? (June 2024).


Similar Articles