Skip to main navigation menu Skip to main content Skip to site footer
Quaderni di Psicoterapia Cognitiva - Open Access

Social withdrawal and personality pathology

No. 48 (2021)

Addressing negative symptoms in schizophrenia through Metacognitive Reflection and Insight Therapy: An illustrated Case Study

DOI
https://doi.org/10.3280/qpc48-2021oa12139
Submitted
luglio 1, 2021
Published
2021-07-19

Abstract

The resistance of negative symptoms to pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence.
Accordingly, recent research has suggested that deficits in metacognition, or the ability to form integrated ideas about oneself, others and the world, are involved in the development and maintenance of negative symptoms. One implication of this work is that treatments which address metacognition may effectively lead to reduction in negative symptoms. This paper explores the application of one such treatment, designed to address deficits in metacognition, Metacognitive Reflection and Insight Therapy (MERIT), to addressing persistent negative symptoms. First the basic principles of MERIT are presented and then its potential to address negative symptoms is illustrated by a comprehensive case report.

References

  1. Austin S.F., Lysaker P.H., Jansen J.E., Trauelsen A.M., Pedersen M.B., Simonsen E., Nielsen H.-G.L., Pedersen M.B., Haahr U.H., Simonsen E. (2019). Metacognitive capacity and negative symptoms in first episode psychosis: Evidence of a prospective relationship over a 3-year follow-up. Journal of Experimental Psychopathology, 10: 1-11. DOI: 10.1177/2043808718821572.
  2. Brady Jr. R.O., Gonsalvez I., Lee I., Öngür D., Seidman L.J., Schmahmann J.D., Eack S.M., Keshavan M.S., Pascual-Leone A., Halko M.A. (2019). Cerebellarprefrontal network connectivity and negative symptoms in schizophrenia. The American Journal of Psychiatry, 176(7): 512-520. DOI: 10.1176/appi.ajp.2018.18040429.
  3. Buck K.D., Roe D., Yanos P., Buck B., Fogley R.L., Grant M., Lubin F., Lysaker P.H. (2012). Challenges to assisting with the recovery of personal identity and wellness for persons with serious mental illness: Considerations for mental health professionals. Psychosis: Psychological Social and Integrative Approaches, 5: 127-133. DOI: 10.1080/17522439.2012.699544.
  4. Cicero D.C., Martin E.A., Becker T.M., Kerns J.G. (2016). Decreased self-concept clarity in people with schizophrenia. The Journal of Nervous and Mental Disease, 204(2): 142-147. DOI: 10.1097/NMD.0000000000000442.
  5. Dimaggio G., Montano A., Popolo R., Salvatore G. (2015). Metacognition interpersonal therapy for personality disorders. London: Routledge.
  6. Faith L.A., Lecomte T., Corbiere M., Francoeur A., Hach Labelle C., Lysaker P.H. (2020). Metacognition is uniquely related to concurrent and prospective assessments of negative symptoms independent of verbal memory in serious mental illness. Journal of Nervous and Mental Disease, 208(11): 837-842. DOI: 10.1097/NMD.0000000000001219.
  7. Flavel J.H. (1979) Metacognition and cognitive monitoring: A new area of cognitive-developmental inquiry. American Psychologist, 34: 906-11. DOI: 10.1037/0003-066X.34.10.906.
  8. Fusar-Poli P., Papanastasiou E., Stahl D., Rocchetti M., Carpenter W., Shergill S., McGuire P. (2014) Treatments of negative symptoms in schizophrenia: Metaanalysis of 168 randomized placebo-controlled trials. Schizophrenia Bulletin, 41(4): 892-899. DOI: 10.1093/schbul/sbz071.
  9. Galderisi S., Mucci A., Buchanan R.W., Arango C. (2018). Negative symptoms of schizophrenia: New developments and unanswered research questions. The Lancet Psychiatry, 5: 664-677. DOI: 10.1016/S2215-0366(18)30050-6.
  10. García-Cabeza I., Díaz-Caneja C.M., Ovejero M., de Portugal E. (2018). Adherence, insight and disability in paranoid schizophrenia. Psychiatry Research, 270: 274-280. DOI: 10.1016/j.psychres.2018.09.021Get.
  11. García-Mieres H., Villaplana A., López-Carrilero R., Grasa E., Barajas A., Pousa E., Feixas G., Ochoa S. (2020). The role of personal identity on positive and negative symptoms in psychosis: A study using the repertory grid technique. Schizophrenia Bulletin, 46(3): 572-580. DOI: 10.1093/schbul/sbz082.
  12. Gruber O., Santuccione Chadha A., Aach H. (2014) Magnetic resonance imaging in studying schizophrenia, negative symptoms, and the glutamate system. Frontiers in Psychiatry, 5: 32. DOI: 10.3389/fpsyt.2014.00032.
  13. Hamm J.A., Leonhardt B.L. (2016). The Role of interpersonal connection, personal narrative, and metacognition in integrative psychotherapy for schizophrenia: A case report. Journal of Clinical Psychology, 72(2): 132-141. DOI: 10.1002/jclp.22247.
  14. Hamm J.A., Renard S.B., Fogley R.L., Leonhardt B.L., Dimaggio G., Buck K.D., Lysaker P.H. (2012). Metacognition and social cognition in schizophrenia: Stability and relationship to concurrent and prospective symptom assessments. Journal of Clinical Psychology, 68(12): 1303-1312. DOI: 10.1002/jclp.21906.
  15. Hasson-Ohayon I., Goldzweig G., Lavi-Rotenberg A., Luther L., Lysaker P.H. (2018). The centrality of cognitive symptoms and metacognition within the interacting network of symptoms, neurocognition, social cognition and metacognition in schizophrenia. Schizophrenia Research, 202: 260-266. DOI: 10.1016/j.schres.2018.07.007.
  16. Hasson-Ohayon I., Gumley A., McLeod H., Lysaker P.H. (2020). Metacognition and intersubjectivity: Reconsidering their relationship following advances from the study of persons with psychosis . Frontiers, 11: 567. DOI: 10.3389/fpsyg.2020.00567.
  17. Hesse K., Kriston L., Wittorf A., Herrlich J., Wölwer W., Klingberg S. (2015). Longitudinal relations between symptoms, neurocognition, and self-concept in schizophrenia. Frontiers in Psychology, 6: 917. DOI: 10.3389/fpsyg.2015.00917.
  18. Inchausti F., García-Poveda N.V., Ballesteros-Prados A., Ortuño-Sierra J., Sánchez-Reales S., Prado-Abril J., Aldaz-Armendáriz J.A., Mole J., Dimaggio G., Ottavi P., Fonseca-Pedrero E. (2018). The effects of metacognition-oriented social skills training on psychosocial outcome in schizophrenia-spectrum disorders: A randomized controlled trial. Schizophrenia Bulletin, 44(6): 1235-1244. DOI: 10.1093/schbul/sbx168.
  19. Kaiser S., Lyne J., Agartz I., Clarke M., Morch-Johnson L., Faerden A. (2017). Individual negative symptoms and domains – Relevance for assessment, pathomechanisms, and treatment. Schizophrenia Research, 186: 39-45. DOI: 10.1016/j.schres.2016.07.013.
  20. Leonhardt B.L., Benson K., George S., Buck K.D., Shaieb R., Vohs J.L. (2016). Targeting insight in first episode psychosis: A case study of metacognitive reflection insight therapy (MERIT). Journal of Contemporary Psychotherapy, 46(4): 207-216. DOI: 10.1007/s10879-016-9332-9.
  21. Leonhardt B.L., Hamm J.A., Belanger E.A., Lysaker P.H. (2015). Childhood sexualabuse moderates the relationship of self reflectivity with increased emotional distress in schizophrenia. Psychosis: Psychological, Social, and Integrative Approaches, 7(3): 195-205. DOI: 10.1080/17522439.2014.968858.
  22. Lysaker P.H., Buck K.D., Ringer J.M. (2007). The recovery of metacognitive capacity in schizophrenia across 32 months of individual psychotherapy: A case study. Psychotherapy Research, 17(6): 713-720. DOI: 10.1080/10503300701255932.
  23. Lysaker P.H., Carcione A., Dimaggio G., Johannesen J.K., Nicolo G., Procacci M., Semerari A. (2005). Metacognition amidst narratives of self and illness in schizophrenia: Associations with neurocognition, symptoms, insight and quality of life. Acta Psychiatrica Scandinavica, 112: 64-71. DOI: 10.1111/j.1600-0447.2005.00514.x.
  24. Lysaker P.H., Chernov N., Moiseeva T., Sozinova M., Dmitryeva N., Alyoshin V., Faith L.A., Karpenko O., Kostyuk G. (2020). Contrasting metacognitive profiles and their association with negative symptoms in groups with schizophrenia, early psychosis and depression in a Russian sample. Psychiatry Research, 291. DOI: 10.1016/j.psychres.2020.113177.
  25. Lysaker P.H., Dimaggio G. (2014). Metacognitive capacities for reflection in schizophrenia: Implications for developing treatments. Schizophrenia Bulletin, 40(3): 487-491. DOI: 10.1093/schbul/sbu038.
  26. Lysaker P.H., Gagen E.C., Klion R., Zalzala A.B., Vohs J., Faith L.A., Leonhardt B.L., Hamm J.A., Hasson-Ohayon I. (2020). Metacognitive Reflection and Insight Therapy: A recovery-oriented treatment approach for psychosis. Psychology Research and Behavior Management, 13: 331-341. DOI: 10.2147/PRBM.S198628.
  27. Lysaker P.H., Klion R. (2017) Recovery, Meaning-making, and Severe Mental Illness: A Comprehensive Guide to Metacognitive Reflection and Insight Therapy. London: Routledge.
  28. Lysaker P.H., Kukla M., Dubreucq J., Gumley A., Mcleod H., Vohs J.L., Buck K.D., Minor K.S., Luther L., Leonhardt B.L., Belanger E.A., Popolo R., Dimaggio G. (2015). Metacognitive deficits predict future levels of negative symptoms in schizophrenia controlling for neurocognition, affect recognition, and selfexpectation of goal attainment. Schizophrenia Research, 168: 267-272. DOI: 10.1016/j.schres.2015.06.015.
  29. Lysaker P.H., Kukla M., Leonhardt B.L., Hamm J.A., Schnackenberg Martin A., Zalzala A.B., Gagen E.C., Hasson-Ohayon I. (2020). Meaning, integration, and the self in serious mental illness: Implications of research in metacognition for psychiatric rehabilitation. Journal of Psychiatric Rehabilitation, 43(4): 275-283. DOI: 10.1037/prj0000436.
  30. Lysaker P.H., Lysaker J.T. (2020). Disturbances in dialogue and metacognition: A renewed way to understand and respond to alterations in self-experience in psychosis. Theory and Psychology. DOI: 10.1177/0959354320973752.
  31. Lysaker P.H., Minor K.S., Lysaker J.T., Hasson-Ohayon I., Bonfils K., Hochheiser J., Vohs J.L. (2020). Metacognitive function and fragmentation in schizophrenia: Relationship to cognition, self-experience and developing treatments. Schizophrenia Research: Cognition, 19: 1-9. DOI: 10.1016/j.scog.2019.100142.
  32. Moritz S., Andreou C., Schneider B.C., Wittekind C.E., Menon M., Balzan R.P., Woodward T.S. (2014). Sowing the seeds of doubt: A narrative review on metacognitive training in schizophrenia. Clinical Psychology Review, 34(4): 358-366. DOI: 10.1016/j.cpr.2014.04.004.
  33. Moritz S., Lysaker P.H. (2018) Metacognition – what did James H. Flavell really say and the implications for the conceptualization and design of metacognitive interventions in schizophrenia. Schizophrenia Research, 201: 20-26. DOI: 10.1016/j.schres.2018.06.001.
  34. Marder S.R., Galderisi S. (2017). The current conceptualization of negative symptoms in schizophrenia. World Psychiatry, 16(1): 14-24. DOI: 10.1002/wps.20385.
  35. McLeod H.J., Gumley A.I., Macbeth A., Schwannauer M., Lysaker P.H. (2014). Metacognitive functioning predicts positive and negative symptoms over 12 months in first episode psychosis. Journal of Psychiatric Research, 54: 109-115. DOI: 10.1016/j.jpsychires.2014.03.018.
  36. Rector N.A., Beck A.T., Stolar N. (2005). The negative symptoms of schizophrenia: A cognitive perspective. The Canadian Journal of Psychiatry, 50(5): 247-257. DOI: 10.1177/070674370505000503.
  37. Sarkar S., Hillner K., Velligan D.I. (2015). Conceptualization and treatment of negative symptoms in schizophrenia. World Journal of Psychiatry, 5(4): 352-361. DOI: 10.5498/wjp.v5.i4.352.
  38. Savill M., Banks C., Khanom H., Priebe S. (2015). Do negative symptoms of schizophrenia change over time? A meta-analysis of longitudinal data. Psychological Medicine, 45: 1613-1627. DOI: 10.1017/S0033291714002712.
  39. Strassnig M.T., Raykov T., O’Gorman C., Bowie C.R., Sabbag S., Durand D., Patterson T.L., Pinkham A., Penn D.L., Harvey P.D. (2015). Determinants of different aspects of everyday outcome in schizophrenia: The roles of negative symptoms, cognition, and functional capacity. Schizophrenia Research, 165(1): 76-82. DOI: 10.1016/j.schres.2015.03.033.
  40. Sumiyoshi C., Sumiyoshi T., Nohara S., Yamashita I., Matsui M., Kurachi M., Niwa S. (2005). Disorganization of semantic memory underlies alogia in schizophrenia: An analysis of verbal fluency performance in Japanese subjects. Schizophrenia Research, 74: 91-100. DOI: 10.1016/j.schres.2004.05.011.
  41. Trauelsen A.M., Gumley A., Jansen J.E., Pedersen M.B., Nielsen H.G., Trier C.H., Haahr U.H., Simonsen E. (2016). Metacognition in first-episode psychosis and its association with positive and negative symptom profiles. Psychiatry Research, 238: 14-23. DOI: 10.1016/j.psychres.2016.02.003.
  42. van Donkersgoed R.J.M., de Jong S., Pijnenborg G.H.M. (2016). Metacognitive reflection and insight therapy (MERIT) with a patient with persistent negative symptoms. Journal of Contemporary Psychotherapy, 46: 245-253. DOI: 10.1007/s10879-016-9333-8.

Metrics

Metrics Loading ...