Disturbances in dialogue and metacognition: A renewed way to understand and respond to alterations in self-experience in psychosis

Lysaker, Paul H.; Lysaker, John T.

doi:10.1177/0959354320973752

Cited by 15 publications

(12 citation statements)

References 67 publications

(72 reference statements)

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“…With the deficits in self-reflectivity and decentration found in psychosis, persons would be unlikely to have a working sense of themselves as having multiple facets which may be contradictory and change over time. Without this quality of partiality, the cohesion of a larger sense of self would be threatened by inconsistencies and dissolve [ 137 , 138 ]. This could result in a sense of self in which different aspects of the self are experienced as active but unrelated to one another, where no aspect of the self is distinguished from another, and hence all are experienced as absent.…”

Section: The Unique Experimental Theoretical and Clinical Implications Of Metacognitive Research In Psychosismentioning

confidence: 99%

Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

et al. 2021

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Research using the integrated model of metacognition has suggested that the construct of metacognition could quantify the spectrum of activities that, if impaired, might cause many of the subjective disturbances found in psychosis. Research on social cognition and mentalizing in psychosis, however, has also pointed to underlying deficits in how persons make sense of their experience of themselves and others. To explore the question of whether metacognitive research in psychosis offers unique insight in the midst of these other two emerging fields, we have offered a review of the constructs and research from each field. Following that summary, we discuss ways in which research on metacognition may be distinguished from research on social cognition and mentalizing in three broad categories: (1) experimental procedures, (2) theoretical advances, and (3) clinical applications or indicated interventions. In terms of its research methods, we will describe how metacognition makes a unique contribution to understanding disturbances in how persons make sense of and interpret their own experiences within the flow of life. We will next discuss how metacognitive research in psychosis uniquely describes an architecture which when compromised – as often occurs in psychosis – results in the loss of persons’ sense of purpose, possibilities, place in the world and cohesiveness of self. Turning to clinical issues, we explore how metacognitive research offers an operational model of the architecture which if repaired or restored should promote the recovery of a coherent sense of self and others in psychosis. Finally, we discuss the concrete implications of this for recovery-oriented treatment for psychosis as well as the need for further research on the commonalities of these approaches.

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Section: The Unique Experimental Theoretical and Clinical Implications Of Metacognitive Research In Psychosismentioning

confidence: 99%

Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

et al. 2021

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“…Across psychological disciplines, the concept of metacognition has been used to refer to persons' awareness of their thoughts and feelings and how they adjust their thoughts and actions as a result (Flavell, 1979 ; Semerari et al, 2003 ; Moritz and Lysaker, 2018 ). In research on disturbances in subjectivity in psychosis, metacognition has been used to operationalize the processes that enable a reflexive awareness of oneself and others (Lysaker and Lysaker, 2020 ; Lysaker et al, 2020b ). Specifically, this work has used an integrative model of metacognition that considers metacognition as the spectrum of activities that allow persons to become aware of specific cognitive, emotional and bodily experiences and to integrate these into a broader and evolving sense of their and others' unique identities and places in the world (Lysaker and Hasson-Ohayon, 2021 ).…”

Section: Metacognition and Disturbances In Social Functioningmentioning

confidence: 99%

“…Key for the study of social function in psychosis are at least two features of this model. The first is that metacognition is always an intersubjective activity (Hasson-Ohayon et al, 2020 ), such that any sense formed about oneself or others is always done so with an actual or potential partner who can share that sense (Lysaker and Lysaker, 2020 ). Second, in this model sense of self and sense of others, while naturally related, can be measured separately.…”

Section: Metacognition and Disturbances In Social Functioningmentioning

confidence: 99%

“…One avenue of research that has sought to transcend these limitations and offer a potentially more nuanced understanding of the phenomena which shape social dysfunction in psychosis has focused on the relationship of the metacognitive deficits with interpersonal function (Lysaker et al, 2020b ). In this work, metacognition refers to the processes that enable persons to notice and make sense of their own and other's embodied, cognitive and emotional states, both within the moment and over the course of a life (Lysaker and Lysaker, 2020 ). In contrast to social cognition, metacognition is concerned with the degree to which information is integrated, rather than the accuracy or speed with which a particular conclusion is reached (Lysaker and Hasson-Ohayon, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

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Social Dysfunction in Psychosis Is More Than a Matter of Misperception: Advances From the Study of Metacognition

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Many with psychosis experience substantial difficulties forming and maintaining social bonds leading to persistent social alienation and a lack of a sense of membership in a larger community. While it is clear that social impairments in psychosis cannot be fully explained by symptoms or other traditional features of psychosis, the antecedents of disturbances in social function remain poorly understood. One recent model has proposed that deficits in social cognition may be a root cause of social dysfunction. In this model social relationships become untenable among persons diagnosed with psychosis when deficits in social cognition result in inaccurate ideas of what others feel, think or desire. While there is evidence to support the influence of social cognition upon social function, there are substantial limitations to this point of view. Many with psychosis have social impairments but not significant deficits in social cognition. First person and clinical accounts of the phenomenology of psychosis also do not suggest that persons with psychosis commonly experience making mistakes when trying to understand others. They report instead that intersubjectivity, or the formation of an intimate shared understanding of thoughts and emotions with others, has become extraordinarily difficult. In this paper we explore how research in metacognition in psychosis can transcend these limitations and address some of the ways in which intersubjectivity and more broadly social function is compromised in psychosis. Specifically, research will be reviewed on the relationship between social cognitive abilities and social function in psychosis, including measurement strategies and limits to its explanatory power, in particular with regard to challenges to intersubjectivity. Next, we present research on the integrated model of metacognition in psychosis and its relation to social function. We then discuss how this model might go beyond social cognitive models of social dysfunction in psychosis by describing how compromises in intersubjectivity occur as metacognitive deficits leave persons without an integrated sense of others' purposes, relative positions in the world, possibilities and personal complexities. We suggest that while social cognitive deficits may leave persons with inaccurate ideas about others, metacognitive deficits leave persons ill equipped to make broader sense of the situations in which people interact and this is what leaves them without a holistic sense of the other and what makes it difficult to know others, share experiences, and sustain relationships. The potential of developing clinical interventions focused on metacognition for promoting social recovery will finally be explored.

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“…Persons know themselves only as they experience themselves experiencing the world. It has been suggested that these kinds of subjective alterations may be more effectively understood if one considers how they lead to a loss of a sense of purpose, meaning and possibility in life, and returning to the issue of intersubjectivity, how they also lead to a loss of one's sense of place and position relative to others and one's community (Lysaker & Lysaker, 2020; Lysaker et al, 2020).…”

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confidence: 99%

Emerging psychotherapeutic approaches to addressing self‐experience in schizophrenia spectrum disorders

2021

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Growing awareness that many who are diagnosed with schizophrenia recover has spurred the development of new psychosocial approaches to treatment. These new approaches include forms of individual and group psychotherapy whose focus extends beyond reducing symptoms and improving skills to subjective outcomes related to sense of self. This paper introduces an issue of In Session which presents six case reports which illustrating these approaches in differing international contexts. First, we explore the larger issues of subjective outcomes from schizophrenia. We then discuss each of the papers separately along with implications of these papers as a group for how treatment might promote the recapturing of a sense of self or place in the world.

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Disturbances in dialogue and metacognition: A renewed way to understand and respond to alterations in self-experience in psychosis

Cited by 15 publications

References 67 publications

Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

Social Dysfunction in Psychosis Is More Than a Matter of Misperception: Advances From the Study of Metacognition

Emerging psychotherapeutic approaches to addressing self‐experience in schizophrenia spectrum disorders

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