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Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis

Authors Lysaker PH, Gagen E, Klion R, Zalzala A, Vohs J, Faith LA, Leonhardt B, Hamm J, Hasson-Ohayon I

Received 25 November 2019

Accepted for publication 15 February 2020

Published 2 April 2020 Volume 2020:13 Pages 331—341


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Igor Elman

Paul H Lysaker,1,2 Emily Gagen,3 Reid Klion,4 Aieyat Zalzala,5 Jenifer Vohs,2 Laura A Faith,1,6 Bethany Leonhardt,2,7 Jay Hamm,7 Ilanit Hasson-Ohayon8

1Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; 2Indiana University School of Medicine, Indianapolis, IN, USA; 3Providence VA Medical Center Department of Psychology, Providence, RI, USA; 4MERIT Institute, Boulder, CO, USA; 5Institute of Living, Hartford, CT, USA; 6University of Missouri - Kansas City, KS, USA; 7Eskenazi Health- Midtown Community Mental Health, Indianapolis, IN, USA; 8Bar Ilan University, Ramat-Gan, Israel

Correspondence: Paul H Lysaker
Richard L. Roudebush VA Medical Center, Department of Psychiatry 116A, 1481 West 10th Street, Indianapolis, IN IN 46202, USA
Email [email protected]

Abstract: 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.

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

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