Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

Abstract

Synthetic metacognition is defined by integrative and contextualizing processes of discrete reflexive moments. These processes are supposed to be needed to meet intrapsychic as well as interpersonal challenges and to meaningfully include psychotic experience in a personal life narrative. A substantial body of evidence has linked this phenomenon to psychosocial functioning and treatment options were developed. The concept of synthetic metacognition, measured with the Metacognition Assessment Scale-Abbreviated (MAS-A), rises hope to bridge gaps between therapeutic orientations and shares valuable parallels to modern psychodynamic constructs, especially the 'levels of structural integration' of the Operationalized Psychodynamic Diagnosis (OPD-2). As theoretical distinctions remain, aim of this study was to compare the predictive value of both constructs with regard to psychosocial functioning of patients with non-affective psychoses, measured with the International Classification of Functioning, Disability and Health (MINI-ICF-APP). It was further explored if levels of structural integration (OPD-LSIA) would mediate the impact of metacognition (MAS-A) on function (MINI-ICF-APP). Expert ratings of synthetic metacognition (MAS-A), the OPD-2 'levels of structural integration' axis (OPD-LSIA), psychosocial functioning (MINI-ICF-APP) and assessments of general cognition and symptoms were applied to 100 individuals with non-affective psychoses. Whereas both, MAS-A and OPD-LSIA, significantly predicted MINI-ICF-APP beyond cognition and symptoms, OPD-LSIA explained a higher share of variance and mediated the impact of MAS-A on MINI-ICF-APP. Levels of structural integration, including the quality of internalized object representations and unconscious interpersonal schemas, might therefore be considered as valuable predictors of social functioning and as one therapeutic focus in patients with non-affective psychoses. Structural integration might go beyond and form the base of a person's actual reflexive and metacognitive capabilities. Psychotherapeutic procedures

Structural impairment and conflict load as vulnerability factors for burnout – A cross-sectional study from the German working population

“…Thus, people with structural impairments may have greater difficulties in regulating themselves and their relationships to others in stressful situations, which makes them more prone to burnout. These results are in line with previous studies that found positive correlations between structural impairment and various mental problems in general (Mestel et al, 2004;Benecke et al, 2009Benecke et al, , 2018Ehrenthal et al, 2012;Obbarius et al, 2019;Baie et al, 2020;Bröcker et al, 2020) and burnout in particular (Bugaj et al, 2016). A concept that is close to structural impairment is emotional intelligence (Jauk and Ehrenthal, 2020).…”

“…This, in turn, can lead to a reduced ability to regulate internal and external states of tension, which makes it difficult to cope with developmental tasks and stressful situations later in life (OPD Task Force, 2011;Bugaj et al, 2016). In general, previous research found that people with structural impairments are prone to various mental illnesses (Grande et al, 1998;Mestel et al, 2004;Benecke et al, 2009Benecke et al, , 2018Ehrenthal et al, 2012;Obbarius et al, 2019;Baie et al, 2020;Bröcker et al, 2020). Furthermore, it has been shown that structural impairment is higher in patients with a personality disorder than in patients without a personality disorder (Benecke et al, 2009;Ehrenthal et al, 2012).…”

Mentalization-based treatment for psychotic disorder: a rater-blinded, multi-center, randomized controlled trial

“…Next to mentalizing impairments (see Fett, Viechtbauer, Penn, van Os, & Krabbendam, 2011 for an overview), impaired metacognition, a construct largely overlapping with mentalization, has also been identified as a major contributor to social dysfunction (e.g. see Arnon-Ribenfeld, Hasson-Ohayon, Lavidor, Atzil-Slonim, & Lysaker, 2017 for an overview; Gagen, Zalzala, Hochheiser, Martin, & Lysaker, 2019 ; Bröcker et al, 2020 ), particularly deficits in specific sub-components of meta-cognition such as empathic perspective taking and self-reflectivity (see Brüne, Dimaggio, and Lysaker, 2011 for a review).…”

Spiritual understandings of psychosis: the perspectives of spiritual care staff

“…Making sense of FEP was shown to be important both prior to seeking help from a service and afterwards, and work is needed to understand how it can be best addressed within services. With psychotherapeutic interventions for voice-hearing, it may be beneficial to include interventions such as meta-cognition , narrative insight, and rapport-building, as research has demonstrated improved outcomes (Bröcker et al, 2020;Eichner & Berna, 2016;Lopez-Morinigo et al, 2020;Moritz et al, 2019;Rosenbaum et al, 2012).…”