Adapted Metacognitive Interpersonal Therapy for Improving Adherence to Intersubjective Contexts in a Person With Schizophrenia

Abstract

Deficits in the ability to make sense of mental states both of oneself and others, which we term metacognition, is a key difficulty in persons with schizophrenia and psychotherapy needs to address this deficit in order to be effective. We describe here the steps in the treatment of a young woman meeting the criteria for paranoid schizophrenia. Treatment was aimed at helping her to progressively improve her ability to comprehend mental states in order to reduce the intensity of her delusional beliefs and social withdrawal. She was treated with an adapted version of Metacognitive Interpersonal Therapy, the aims of which were to (a) encourage the reconstruction of autobiographical episodes in order to place symptoms in the context of life episodes; (b) stimulate an understanding of the link between problematic feelings and onset of symptoms; (c) build up psychological links between feelings, inability to understand others' intentions and delusional reasoning; and (d) prevent social withdrawal. Implications for considering poor metacognition a key target of psychotherapy of schizophrenia are discussed.

Vulnerable Self, Poor Understanding of Others' Minds, Threat Anticipation and Cognitive Biases as Triggers for Delusional Experience in Schizophrenia: A Theoretical Model

“…The TAM offers a multifactorial perspective that is consistent with factor analytic studies of patients' experiences (Garety, Everitt, & Hemsley, ; Kendler, Glazer, & Morgenstern, ) and predictors of treatment response (Trower, Birchwood, Meaden, et al, ). Moreover, the TAM introduces an intriguing link between anxiety as an intrapersonal phenomenon and the interpersonal instinct of humans to make sense of intrinsically ambiguous communicative acts (Salvatore, Procacci, Popolo et al, ; Salvatore, Dimaggio, & Lysaker, ; Salvatore, Dimaggio, Popolo, & Lysaker, ).…”

Enhancing sense of recovery and self‐reflectivity in people with schizophrenia: A pilot study of Metacognitive Narrative Psychotherapy

“…Case‐study evidence has demonstrated that the approach yields positive effects on metacognitive capacity, narrative structure and content, quality of life, symptom severity, and insight in the treatment of people with schizophrenia (Buck & Lysaker, ; Lysaker et al ., ; Lysaker, Davis, et al ., ; Lysaker & Hermans, ; Salvatore et al ., , ). Metacognitive Narrative Psychotherapy is also the only intervention to date, with the exception of a case study of mentalization‐based therapy (Brent, ), that has been designed specifically to target metacognitive deficits in people with schizophrenia.…”

Addressing metacognitive capacity for self reflection in the psychotherapy for schizophrenia: A conceptual model of the key tasks and processes

“…Regarding the potential of psychotherapy to address metacognitive deficits, a broad literature has suggested that psychotherapy can promote metacognitive capacity (sometimes referred to as mentalizing) in persons with personality disorders, depression, and anxiety (Bateman & Fonagy, 2001; Dimaggio et al , 2007; Karlsson & Kermott, 2006). With regard to schizophrenia, case studies have provided some evidence that metacognitive capacity may be addressed in individual psychotherapy and that changes in metacognition may lead to improvements in function (Buck & Lysaker, 2009; Lysaker, Buck, & Ringer, 2007; Lysaker, Davis, et al , 2005; Salvatore et al , 2009). Others (Silverstein, 2007), spurred on by reports of the limitations of symptom‐focused cognitive therapies to address more subjective elements of recovery (Wykes, Steel, Everitt, & Tarrier, 2008), have reported successfully delivered cognitive behavioural treatments focusing on the development of sense of self.…”