Metacognitive Reflection and Insight Therapy (MERIT) for Persons With a Schizophrenia Spectrum Disorder and Interpersonal Trauma

Hillis, Jaclyn D.; Bidlack, Nathan; Macobin, Brian

doi:10.1176/appi.psychotherapy.20180031

Cited by 19 publications

(15 citation statements)

References 27 publications

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“…Potential candidates for this type of intervention include metacognitive training (Moritz et al, 2014), which promotes reflection upon reasoning processes within the flow of life, and metacognitive reflection and insight therapy (Lysaker & Klion, 2017), which assists persons in forming and using more complex understandings of themselves and others. These findings, coupled with an analysis of a broad group of case reports (Hamm & Lysaker, 2018; Hillis, Bidlack, & Macobin, 2018; James, Leonhardt, & Buck, 2018; Leonhardt, Ratliff, & Vohs, 2018), suggest that it may be useful to include treatments such as these in larger batteries which flexibly respond to the recovery needs of patients.…”

Section: Discussionmentioning

confidence: 99%

Metacognitive deficits and social functioning in schizophrenia across symptom profiles: A latent class analysis

Gagen

Zalzala

Hochheiser

et al. 2019

Journal of Experimental Psychopathology

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Functional deficits are a hallmark of schizophrenia spectrum disorders, but much debate still exists over why and how they originate. One model suggests that disturbances in social functioning are a result of metacognitive deficits or a failure to integrate information to form more complex ideas of themselves and others. It is unclear if this social dysfunction is present across different symptom presentations. We examined the relationship of metacognition, symptoms, and social functioning among a sample of adults with schizophrenia spectrum disorders (N ¼ 334). A latent class analysis produced a four-class model. Groups were classified as follows: diffuse symptoms/moderately impaired social functioning (Class 1), positive and hostility symptoms/mildly impaired social functioning (Class 2), minimal symptoms/good social functioning (Class 3), and negative and cognitive symptoms/severely impaired social functioning (Class 4). Class 3 demonstrated better overall metacognitive capacity than both Classes 1 and 4 but did not differ significantly from Class 2. Classes 2 and 3 both demonstrated better interpersonal functioning than Classes 1 and 4. Together, these findings provide support for models of poor functioning that stem from fragmentation of an individual's experience, leading to diminished abilities to form meaningful connections with others. Additional interpretations, limitations, and research implications are discussed.

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Section: Discussionmentioning

confidence: 99%

Metacognitive deficits and social functioning in schizophrenia across symptom profiles: A latent class analysis

Gagen

Zalzala

Hochheiser

et al. 2019

Journal of Experimental Psychopathology

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“…It is also unclear to what extent this treatment can be applied to other patient groups. Case reports have suggested MERIT may be useful for adults with Borderline Personality Disorder (Buck et al, 2018; Vohs and Leonhardt, 2016), as well as with considerable histories of trauma (Hillis et al, 2018), though it remains unclear what types of modifications are needed for these and other groups. MERIT also proposes its actions occur through eight different processes, but it remains an empirical question whether the presence of all or only specific elements is sufficient for change.…”

Section: Summary and Future Directionsmentioning

confidence: 99%

Metacognitive function and fragmentation in schizophrenia: Relationship to cognition, self-experience and developing treatments

Lysaker

Minor

Lysaker

et al. 2020

Schizophrenia Research: Cognition

106

137

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Bleuler suggested that fragmentation of thought, emotion and volition were the unifying feature of the disorders he termed schizophrenia. In this paper we review research seeking to measure some of the aspects of fragmentation related to the experience of the self and others described by Bleuler. We focus on work which uses the concept of metacognition to characterize and quantify alterations or decrements in the processes by which fragments or pieces of information are integrated into a coherent sense of self and others. We describe the rationale and support for one method for quantifying metacognition and its potential to study the fragmentation of a person's sense of themselves, others and the relative place of themselves and others in the larger human community. We summarize research using that method which suggests that deficits in metacognition commonly occur in schizophrenia and are related to basic neurobiological indices of brain functioning. We also present findings indicating that the capacity for metacognition in schizophrenia is positively related to a broad range of aspects of psychological and social functioning when measured concurrently and prospectively. Finally, we discuss the evolution and study of one therapy that targets metacognitive capacity, Metacognitive Reflection and Insight Therapy (MERIT) and its potential to treat fragmentation and promote recovery.

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“…A final source of evidence for MERIT comes from published case studies. [55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70] While susceptible to selection and confirmation bias, case studies present important idiographic and clinical information about unique and subjective experiences which can potentially complement other evidence and be synthesized into a larger understanding of this treatment approach. Table 1 presents 15 MERIT case studies (describing 16 individuals in total) which provide rich descriptions of patients' problems, goals, and treatment outcomes, as well as changes in metacognition as measured by the MAS-A.…”

Section: Case Studiesmentioning

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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Metacognitive Reflection and Insight Therapy (MERIT) for Persons With a Schizophrenia Spectrum Disorder and Interpersonal Trauma

Cited by 19 publications

References 27 publications

Metacognitive deficits and social functioning in schizophrenia across symptom profiles: A latent class analysis

Metacognitive deficits and social functioning in schizophrenia across symptom profiles: A latent class analysis

Metacognitive function and fragmentation in schizophrenia: Relationship to cognition, self-experience and developing treatments

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

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