The influence of adjunctive treatment and metacognitive deficits in schizophrenia on the experience of work

Abstract

Enhancing work function is now widely considered a core element of comprehensive schizophrenia treatment. While research efforts have illuminated factors that influence how well patients perform at work, less is known about the factors influencing the subjective experience of work. It is not known how, and to what extent, symptoms, cognitive deficits or metacognitive capacities impact job satisfaction and whether treatment can have an effect on job satisfaction. To explore this issue, data from a trial in which participants in a six-month vocational program were assigned to either a standard support group or a cognitive behavioral group therapy, and asked to fill in weekly self-reports of job satisfaction was analyzed. Work satisfaction and the consistency of these ratings were compared between the two groups and the moderating influence of metacognitive capacity was analyzed. A significant interaction effect revealed that higher metacognitive capacity predicted higher average job satisfaction only in the CBT group. Additionally, higher metacognitive capacity led to a more varied appraisal of work satisfaction only in the support group.

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

“…Concerning behavior and functioning, metacognition, as assessed with the MAS-A, has also been found, concurrently and prospectively to predict work functioning (Lysaker et al, 2010), physical activity (Snethen et al, 2014), response to rehabilitation work experience (de Jong et al, 2014) and social behavior (Lysaker et al, 2011c) independent of general levels of psychopathology or neuropsychological functioning. Cross-sectional research across diverse international settings using the MAS-A has also found that lower levels of metacognitive capacity were associated with more severe levels of negative symptoms (Lysaker et al, 2005a; Lysaker et al, 2018b; MacBeth et al, 2016; Nicolo et al, 2012; Popolo et al, 2017; Trauelsen et al, 2016; Vohs et al, 2014; WeiMing et al, 2015).…”

Impact of insight and metacognition on vocational rehabilitation of individuals with severe mental illness: A systematic review.

“…Among the four studies using specific validated tools to assess metacognition, three studies used the Metacognition Assessment Scale–Abbreviated (MAS-A) (de Jong et al, 2014; Luedtke et al, 2012; Lysaker et al, 2010). MAS-A scores did not predict job satisfaction in the whole sample, the prediction was statistically significant only in a subgroup who benefited from a Cognitive Behavioral Therapy (de Jong et al, 2014).…”

“…Among the four studies using specific validated tools to assess metacognition, three studies used the Metacognition Assessment Scale–Abbreviated (MAS-A) (de Jong et al, 2014; Luedtke et al, 2012; Lysaker et al, 2010). MAS-A scores did not predict job satisfaction in the whole sample, the prediction was statistically significant only in a subgroup who benefited from a Cognitive Behavioral Therapy (de Jong et al, 2014). Patients with high self-reflectivity according to the MAS-A had higher mean WBI work quality scores than patients with low self-reflectivity (Luedtke et al, 2012) and patients with both low and medium self-reflectivity (Lysaker et al, 2010).…”

Metacognition in schizophrenia: A practical overview of psychometric metacognition assessment tools for researchers and clinicians

“…Numerous studies showed that pronounced worsening in metacognition skills predicted more severe negative symptoms from 6 to 36 months after basal evaluation ( 37 – 40 ). Functional metacognition abilities, instead, predict better work functioning ( 41 ), increased physical activity ( 42 ), higher response to rehabilitation work experience ( 43 ) and more adaptive social behavior ( 44 ) regardless of general psychopathology or neuropsychological functioning, thus becoming a potential target for specific psychotherapies such as “ cognitive behavioral therapy for psychosis ” (CBT-P) ( 45 ), “ Metacognitive Therapy ” ( 46 ), “ Metacognitive Training ” ( 47 ), “ Metacognitive Reflection Insight Therapy ” (MERIT) ( 48 ) and “ Metacognitive Interpersonal Therapy for Psychosis ” (MIT-P) ( 49 ). Though sharing the term metacognitive, these treatments differ for epistemological basis, structure, format, hypothesized mechanisms of action and results ( 50 ).…”