No abstract

Results suggest that certain forms of metacognition mediate the influence of neurocognition upon function in schizophrenia.

Individual psychotherapy can be modified and utilized to assist persons with schizophrenia to move towards recovery by assisting them to develop the capacity for self-reflectivity. This may lead to clients having a fuller experience of themselves as a being in the world with a richer and more coherent personal narrative.

Metacognition reflects a spectrum of activities that includes discrete acts in which persons form ideas about specific thoughts and feelings, and synthetic acts in which persons integrate discrete thoughts and feelings into complex representations of themselves and others. This article reviews literature suggesting that persons with schizophrenia and related psychosis experience deficits across the spectrum of metacognitive activities and that these deficits play a key role in dysfunction, often mediating and moderating the impact of symptoms and social adversity on daily life. Treatment approaches including metacognitive training and adaptations of psychotherapy are still in their infancy. Future work is needed to study the etiology of deficits in discrete and synthetic metacognition, as well as their overlap with related constructs such as mentalization and social cognition.

Poor insight or unawareness of illness has been commonly observed in schizophrenia and has been long recognized as a potent barrier to treatment adherence and a risk factor for a range of poorer outcomes. Paradoxically, the achievement of insight often poses a different set of problems including depression and low self-esteem. One barrier to the treatment of poor insight has been a lack of understanding of the phenomenon, which causes poor insight to develop and persist over time. Without knowing what promotes poor insight, treatment to date has had little to offer beyond the supportive provision of information. To explore these issues, this article reviews emerging literature on the correlates of poor insight in schizophrenia, and newly developing ways of conceptualizing insight. It then details a number of innovative integrative group and individual treatment approaches in the early stages of development, which take into account some of the potential causal forces behind poor insight, including deficits in neurocognition, social cognition, metacognition and heightened self-stigma. A plan for further research is presented to develop a model of the factors whose interaction influences insight, and to refine and test integrative treatments.