Addressing Metacognitive Capacity in the Psychotherapy for Schizophrenia: A Case Study

Abstract

Deficits in metacognition, that is, in the ability to think about one's own thinking and the thinking of others, have been identified as a significant barrier to recovery from schizophrenia. While this has raised the possibility that individual psychotherapy might be focused to help persons with schizophrenia improve their capacity for metacognition, little has been written about what that might entail. To explore this issue, a case study is presented in which ongoing assessments of metacognition were used to guide the selection of interventions. Interventions were chosen in particular to match the client's capacity for metacognition at that time and were conceptualized as offering maximal opportunities for the practice and development of metacognitive capacity. Improvements in function and the development of the ability to perform increasingly complex acts of metacognition are reported over the course of approximately 1.5 years of therapy and implications for research and theory are discussed.

An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments

“…Consistent with work on the role of metacognition in general reflectivity and insight, there has also been increasing interest in metacognitive-oriented psychotherapies to promote insight [123][124][125][126][127][128][129]. Although there are similarities with REFLEX in that many of the same issues are addressed, metacognitive-oriented therapies more directly target metacognitive deficits.…”

Metacognitive Reflective and Insight Therapy for a Person Who Gained Maximal Levels of Metacognitive Capacity and Was Able to Terminate Therapy

“…Van Donkersgoed et al 2014). To date, evidence supporting this approach includes case studies (Buck and Lysaker 2009;Lysaker et al 2007;Salvatore et al 2012;Hillis et al 2015) and two small open trials (Bargenquast and Schweitzer 2014;De Jong et al submitted).…”

Addressing metacognitive capacity for self reflection in the psychotherapy for schizophrenia: A conceptual model of the key tasks and processes

“…Regarding the potential of psychotherapy to address metacognitive deficits, a broad literature has suggested that psychotherapy can promote metacognitive capacity (sometimes referred to as mentalizing) in persons with personality disorders, depression, and anxiety (Bateman & Fonagy, 2001; Dimaggio et al , 2007; Karlsson & Kermott, 2006). With regard to schizophrenia, case studies have provided some evidence that metacognitive capacity may be addressed in individual psychotherapy and that changes in metacognition may lead to improvements in function (Buck & Lysaker, 2009; Lysaker, Buck, & Ringer, 2007; Lysaker, Davis, et al , 2005; Salvatore et al , 2009). Others (Silverstein, 2007), spurred on by reports of the limitations of symptom‐focused cognitive therapies to address more subjective elements of recovery (Wykes, Steel, Everitt, & Tarrier, 2008), have reported successfully delivered cognitive behavioural treatments focusing on the development of sense of self.…”