A Disorder by Any Other Name: Metacognition, Schizophrenia, and Diagnostic Practice

Lysaker, Paul H.; Zalzala, Aieyat B.; Ladegaard, Nicolai; Buck, Benjamin; Leonhardt, Bethany L.; Hamm, Jay A.

doi:10.1177/0022167818787881

Cited by 11 publications

(11 citation statements)

References 75 publications

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“…2,9 Recovery can include experiences that are difficult to quantify or observe by others, because as fundamentally subjective matters they can only be known by the recovering person. [10][11][12] This growing work on recovery has pointed to the need to revisit the purposes and mechanisms of mental health treatment. If deeply subjective change is at issue, then teaching skills and reducing symptoms may not go far enough in promoting recovery.…”

Section: Introductionmentioning

confidence: 99%

<p>Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis</p>

Lysaker¹,

Gagen²,

Klion

et al. 2020

PRBM

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Recent research has suggested that recovery from psychosis is a complex process that involves recapturing a coherent sense of self and personal agency. This poses important challenges to existing treatment models. While current evidence-based practices are designed to ameliorate symptoms and skill deficits, they are less able to address issues of subjectivity and self-experience. In this paper, we present Metacognitive Insight and Reflection Therapy (MERIT), a treatment approach that is explicitly concerned with self-experience in psychosis. This approach uses the term metacognition to describe those cognitive processes that underpin self-experience and posits that addressing metacognitive deficits will aid persons diagnosed with psychosis in making sense of the challenges they face and deciding how to effectively manage them. This review will first explore the conceptualization of psychosis as the interruption of a life and how persons experience themselves, and then discuss in more depth the construct of metacognition. We will next examine the background, practices and evidence supporting MERIT. This will be followed by a discussion of how MERIT overlaps with other emerging treatments as well as how it differs. MERIT's capacity to engage patients who reject the idea that they have mental illness as well as cope with entrenched illness identities is highlighted. Finally, limitations and directions for future research are discussed.

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Section: Introductionmentioning

confidence: 99%

<p>Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis</p>

Lysaker¹,

Gagen²,

Klion

et al. 2020

PRBM

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“…To date, the majority of work using this method has had the aim of understanding co-occurring alterations in self-experience and the associated interpersonal challenges to relate to others in schizophrenia (Lysaker et al, 2019). In this work, conjoint disturbances in the ability to form a sense of how others perceive or value experience and an inability to see relationships of fragments of experience with one another, are thought to result in the loss of capacity for the experience of interiority, historicity, agency, and intimacy.…”

Section: Introductionmentioning

confidence: 99%

Metacognition and Intersubjectivity: Reconsidering Their Relationship Following Advances From the Study of Persons With Psychosis

et al. 2020

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As research on metacognition has progressed a significant array of definitions, methodologies and therapeutic applications have emerged. Some of this work has primarily framed metacognition as an activity carried out by one person in order to know, monitor, and adjust their beliefs, memories, and behaviors. Accordingly, problems with metacognition have often been characterized as issues related to cognition. This, however, risks neglecting how metacognition is also a fundamentally intersubjective act, one in which human beings know and reflect upon themselves and others primarily with and through connections with other people. In this paper, we review research on metacognition in schizophrenia using the integrative model of metacognition and a research paradigm in which metacognition is assessed within personal narratives. Stimulated by this work, we discuss how disturbances in intersubjective experience and metacognitive capacity mutually influence one another, with disruptions in metacognition perhaps more deeply understood as disruptions in relatedness with others. We then discuss how metacognition and intersubjectivity each affect mental health. We finally focus on the implications of this for treatments that target metacognition as well as future directions for research.

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“…Piecing together these early definitions and later psychological research on health and interpersonal wellness, an integrated model of metacognition has been proposed in which metacognition is a spectrum of activities that mutually influence one another. These activities range from the awareness and reflection about specific singular immediate experiences to a larger more complex multifaceted sense of self and others (Lysaker, Zalzala, et al, 2018). In this sense, metacognition includes both noticing an isolated thought or bodily sensation (e.g., "I feel sad" or "I don't trust a particular person"), as well as a larger sense of oneself (e.g., "I am having a hard time in my life now because of the death of a loved one").…”

Section: The Concept Of Metacognitionmentioning

confidence: 99%

“…In contrast, MERIT may stretch the work of humanistic and psychodynamic therapists as it requires that the approach to the issues of meaning and experience be sensitive and titrated to patients' metacognitive capacities (Lysaker, Zalzala, et al, 2018). MERIT requires a step beyond these treatments as usually practiced, in that it conceptualizes metacognitive deficits as limiting the degree of complexity with which a person can find meaning.…”

Section: Overlap and Divergence With Humanistic And Dynamic Treatmentsmentioning

confidence: 99%

“…Beyond controlled trials, case studies conducted under routine clinical conditions have also reported that a broad range of patients with very different clinical presentations, as well as profiles of strengths and needs, including heightened levels of negative symptoms, comorbid substance misuse, cognitive disorganization, depression, and lack of insight can benefit from MERIT (Arnon-Ribenfeld, Bloom, et al, 2017;de Jong, van Donkersgoed, Aleman, et al, 2016;Dubreucq, Delorme, & Roure, 2016;Hamm & Firmin, 2016;Hasson-Ohayon, Kravetz, & Lysaker, 2017;James, Leonhardt, & Buck, in press;Leonhardt et al, 2016;Leonhardt, Ratliff, & Buck, 2018;. In contrast to other more supportive therapy experiences, patients who received MERIT, whether via routine care (Lysaker, Kukla, et al, 2015) or within a clinical trial (de Jong et al, 2017), reported the development of a sense of personal agency, connections with one's own unique history, and a greater capacity to tolerate and manage painful affects and emotion.…”

Section: Evidence Supporting Meritmentioning

confidence: 99%

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Metacognition and recovery in schizophrenia: From research to the development of metacognitive reflection and insight therapy

Lysaker

Kukla

Vohs

et al. 2019

Journal of Experimental Psychopathology

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Metacognition refers to a spectrum of activities which spans from noticing discrete experiences to synthesizing them into a larger sense of the self and others. Evidence suggesting that deficits in metacognition are broadly present in schizophrenia and represent a potent barrier to recovery from schizophrenia has led to increasing interest in the development of metacognitively oriented treatments. In this article, we will describe the development of one such treatment, metacognitive reflection and insight therapy (MERIT), an integrative form of psychotherapy defined by eight core elements. We will first discuss the concept of metacognition as a means to operationalize the processes which enable persons to have a sense of themselves and others available for reflection and that can then serve as the basis for effective and agentic responses to psychosocial challenges. We will then discuss methods for assessing metacognition, the development of MERIT as a treatment that targets metacognition, and how MERIT compares with other treatments. Next, we will discuss empirical support for MERIT's role in recovery including its potential to assist persons to develop their own personally meaningful sense of their challenges and then decide how to effectively respond to those challenges and manage their own recovery.

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A Disorder by Any Other Name: Metacognition, Schizophrenia, and Diagnostic Practice

Cited by 11 publications

References 75 publications

<p>Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis</p>

<p>Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis</p>

Metacognition and Intersubjectivity: Reconsidering Their Relationship Following Advances From the Study of Persons With Psychosis

Metacognition and recovery in schizophrenia: From research to the development of metacognitive reflection and insight therapy

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