Meaning, integration, and the self in serious mental illness: Implications of research in metacognition for psychiatric rehabilitation.

Abstract

Objective: It has been established that recovery is a common outcome for adults diagnosed with serious mental illness which involves objective and subjective phenomenon. While considerable work has examined objective aspects of recovery, it remains difficult to know how to quantify the processes which support more subjective aspects of recovery related to sense of self. This article explores the potential of recent research on metacognition to offer new avenues to measure the processes which make a sense of self available within the flow of life. Method: Emerging definitions of metacognition using an integrative model of metacognition are reviewed. Research is presented suggesting adults diagnosed with serious mental illness are often confronted by metacognitive deficits which interfere with their ability to make sense of their psychiatric challenges and effectively direct their own recovery. Findings: Metacognitive capacity may be a quantifiable phenomenon which contributes to certain aspects of recovery related to meaning making, agency and self-direction. Conclusions and Implications for Practice: Promoting metacognitive capacity may be a previously unrecognized active element of existing rehabilitative interventions.

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

“…Applied to psychosis, deficits in metacognition have been suggested to result in a sense of oneself and others as relatively more fragmented, resulting in the subjective sense of diminished self-experience reported in qualitative research [ 6 ]. In a manner consistent with the initial formulations of Bleuler [ 25 ] and Jung [ 26 ], decrements in metacognition have been suggested to explain how persons diagnosed with those conditions experience fragmentation of thoughts, affect and will, withdraw from social interaction, and understand themselves and the world in ways that are often inaccessible to others [ 7 ].…”

“…This has fueled research on the processes that might undermine or enhance self-experience [ 5 ]. For example, interest has grown in describing and measuring aspects related to self-experience, which if compromised, may contribute to the loss of agency and self-coherence, and if recaptured, may enable recovery from psychosis [ 6 ].…”

“…This research relies on an integrative model which understands metacognition as a spectrum of activities that includes awareness of specific discrete experiences as well as an understanding of how those specific experiences are connected in one’s broader life experience. This awareness is thought to enable a sense of self and others that impacts momentary experience [ 6 ]. This integrated model of metacognition has suggested that reduction in the capacity for metacognitive activity could derail a person’s ability to effectively make sense of and manage the challenges related to psychosis [ 8 ].…”

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

“…In an effort to clarify how alterations in sense of self could occur and then be resolved in psychosis, one research paradigm began to use the construct of metacognition to specify processes that enable senses of self to be available for reflection (P. H. Lysaker, Kukla, et al, 2020;P. H. Lysaker, Minor, et al, 2020).…”

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

“…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).…”