A manual-based individual therapy to improve metacognition in schizophrenia: protocol of a multi-center RCT

Abstract

BackgroundMetacognitive dysfunction has been widely recognized as a feature of schizophrenia. As it is linked with deficits in several aspects of daily life functioning, improvement of metacognition may lead to improvement in functioning. Individual psychotherapy might be a useful form of treatment to improve metacognition in patients with schizophrenia; multiple case reports and a pilot study show promising results. The present study aims to measure the effectiveness of an individual, manual-based therapy (Metacognitive Reflection and Insight Therapy, MERIT) in improving metacognition in patients with schizophrenia. We also want to examine if improvement in metacognitive abilities is correlated with improvements in aspects of daily life functioning namely social functioning, experience of symptoms, quality of life, depression, work readiness, insight and experience of stigma.Methods/DesignMERIT is currently evaluated in a multicenter randomized controlled trial. Thirteen therapists in six mental health institutions in the Netherlands participate in this study. Patients are randomly assigned to either MERIT or the control condition: treatment as usual (TAU).DiscussionIf proven effective, MERIT can be a useful addition to the care for schizophrenia patients. The design brings along some methodological difficulties, these issues are addressed in the discussion of this paper.Trial registrationCurrent Controlled Trials: ISRCTN16659871.

Affective empathy in schizophrenia: a meta-analysis

“…Additionally, existing therapies could be investigated as to their impact on empathy. For example, Metacognitive Reflection and Insight Therapy (Van Donkersgoed et al, 2014) aims to help people with schizophrenia form complex and integrated ideas of others, which may in and of itself foster empathic skills.…”

“…Additional literature further indicates impairments in self-reported cognitive empathy (e.g., see Corbera et al, 2013;Fischer-Shofty et al, 2013;Michaels et al, 2014;Shamay-Tsoory et al, 2007;Singh et al, 2015;Sparks et al, 2010). Some interventions have been designed to foster cognitive empathy in people diagnosed with schizophrenia, such as Metacognitive Reflection and Insight Therapy (Lysaker et al, 2007;Lysaker et al, 2010;Van Donkersgoed et al, 2014) and training to enhance understanding of thoughts, behavioral motivations and emotions in video tasks that are often used to assess aspects of cognitive empathy (Kayser et al, 2006).…”

Metacognition in Relation to Cognitive and Social Functioning in Schizophrenia

“…Participants were recruited from the Metacognitive Reflection and Insight Therapy (MERIT) study, a randomized controlled trial in which a new metacognitive therapy for patients with schizophrenia is being compared to regular treatment (Van Donkersgoed et al, 2014). The MERIT study has been approved by the medical ethical board of the University Medical Center Groningen.…”

Language and hope in schizophrenia-spectrum disorders

“…Our findings also indicate it may be important not to take use of hope words at face value, as they were not associated with self-reported hope in our sample. Further, interventions targeted to increase agency and a sense of self (such as Metacognitive Reflection and Insight Therapy; Van Donkersgoed et al, 2014) may also positively impact hope. Future research should aim to replicate our findings in larger samples.…”