Embracing Psychosis: A Cognitive Insight Intervention Improves Personal Narratives and Meaning-Making in Patients With Schizophrenia

Abstract

Schizophrenia is a complex psychiatric disorder with unknown and presumably heterogeneous etiology. While the disorder can have various outcomes, research is predominantly "deficit-oriented" emphasizing the hardship that the disorder inflicts on sufferers as well as their families and society. Beyond symptom reduction, imparting patients with hope and meaning in life is increasingly considered an important treatment target, which may raise self-esteem, and reduce self-stigma and suicidal ideation. The present study compared a psychotherapeutic treatment aimed at improving cognitive insight, individualized metacognitive intervention (MCT+), with an active control in order to elucidate if personal meaning-making and hope can be improved in patients with psychosis across time. A total of 92 patients were randomized to either individualized metacognitive therapy (MCT+) or CogPack (neuropsychological training) and followed up for up to 6 months. The "Subjective Sense in Psychosis Questionnaire" (SUSE) was administered which covers different salutogenetic vs pathogenetic views of the disorder, valence of symptom experiences and the consequences of psychosis. Patients in the MCT+ group showed a significant positive shift in attitudes towards the consequences of their illness over time relative to patients in the active control condition. There was some evidence that MCT+ also enhanced meaning-making. The perceived negative consequences of psychosis were highly correlated with depression and low self-esteem, as well as suicidality. The study shows that a cognitive insight training can improve meaning-making in patients and help them come to terms with their diagnosis.

Metacognitive Training Modulates Default-Mode Network Homogeneity During 8-Week Olanzapine Treatment in Patients With Schizophrenia

“…Furthermore, memory delusion distress and social quality of life were improved by MCT in patients with schizophrenia, suggesting that MCT had beneficial effects on symptomatic parameters and several cognitive functions (51). They also showed that patients with schizophrenia who received MCT exhibited a significant positive change in attitude toward their illness compared with the active control condition and enhanced meaning-making in patients (52). A systematic review showed that MCT was effective in reducing cognitive biases and delusions and improving insights and several aspects of neurocognitive functions in schizophrenia (9).…”

Metacognitive Abilities within Personal Narratives of Inpatients with Schizophrenia: Associations with Clinical Insight and Drug Compliance

“…Poor insight in schizophrenia is prevalent across cultures and phases of illness (Lysaker et al 2018). A previous study reported that up to 80% of all psychotic patients do not take their medication as prescribed mainly because of poor insight, which consequently affecting their awareness about their own needs (Garcíaet al 2016).…”

“…The integrated model of insight in schizophrenia has suggested that poor insight may result from multiple factors which compromise persons' abilities to integrate streams of information into a personal awareness of psychiatric challenges, and make adaptive responses (Lysaker et al 2018). This model hypothesized that the origins of poor insight in schizophrenia may result, in part, from deficits in metacognitive capacity, or difficulties forming a complex and integrated understanding of both one's own thinking as well as the thinking of others regardless of clinical profile .…”

“…Metacognitive deficits might block the ability to perceive and trust the view of others that treatment is needed (Lysaker et al 2018). These deficits might further limit persons' abilities to know how their own mental states have changed or are changing and to judge the impact of those changes on others (Pinho et al2017).…”

“…Moreover, they might lead to a lack of complex ideas about painful and confusing events. When these deficits are combined, it likely leads to a fragmented view of a life including experiences of mental illness (Lysaker et al 2018).…”