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Metacognitive approaches to the treatment of psychosis: a comparison of four approaches

Authors Lysaker PH, Gagen E, Moritz S, Schweitzer RD

Received 12 April 2018

Accepted for publication 28 May 2018

Published 5 September 2018 Volume 2018:11 Pages 341—351

DOI https://doi.org/10.2147/PRBM.S146446

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Igor Elman


Paul H Lysaker,1,2 Emily Gagen,3 Steffen Moritz,4 Robert D Schweitzer5

1Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA; 2Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA; 3Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 4Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 5School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia

Abstract: In light of increasing interest in metacognition and its role in recovery from psychosis, a range of new treatments focused on addressing metacognitive deficits have emerged. These include Metacognitive Therapy, Metacognitive Training, metacognitive insight and reflection therapy, and metacognitive interpersonal therapy for psychosis. While each of these treatments uses the term metacognitive, each differs in terms of their epistemological underpinnings, their structure, format, presumed mechanisms of action, and primary outcomes. To clarify how these treatments converge and diverge, we first offer a brief history of metacognition as well as its potential role in an individual’s response to and recovery from complicated mental health conditions including psychosis. We then review the background, practices, and supporting evidence for each treatment. Finally, we will offer a framework for thinking about how each of these approaches may ultimately complement rather than contradict one another and highlight areas for development. We suggest first that each is concerned with something beyond what people with psychosis think about themselves and their lives. Each of these four approaches is interested in how patients with severe mental illness think about themselves. Each looks at immediate reactions and ideas that frame the meaning of thoughts. Second, each of these approaches is more concerned with why people make dysfunctional decisions and take maladaptive actions rather than what comprised those decisions and actions. Third, despite their differences, each of these treatments is true to the larger construct of metacognition and is focused on person’s relationships to their mental experiences, promoting various forms of self-understanding which allow for better self-management. Each can be distinguished from other cognitive and skills-based approaches to the treatment of psychosis in their emphasis on sense-making rather than learning a new specific thing to say, think, or do in a given situation.

Keywords: schizophrenia, psychosis, metacognition, rehabilitation, psychotherapy, recovery

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