Metacognition – What did James H. Flavell really say and the implications for the conceptualization and design of metacognitive interventions.
Abstract
In the last two decades years, several interventions have been designed for people with major psychological disorders that all have "metacognitive" in their name: Metacognitive Therapy (MCT), Metacognitive Training (e.g., for people with psychosis) and Metacognitive Reflection and Insight Therapy (MERIT). Two of these interventions are primarily targeted at patients with schizophrenia. Prompted by a recent discussion about what constitutes "true" metacognitive treatment, we will first explore the original concept of metacognition as defined by James H. Flavell. Then, we will describe each approach in detail before highlighting how each intervention picks up on slightly different aspects of Flavell's original metacognitive construct. We will also discuss inherent problems with the label "metacognition."
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Existing treatments only cover certain aspects of the larger construct of metacognition, and authors call for intervention development that incorporates all four metacognitive domains into hybrid approaches.
“However, authors criticize that existing treatments only cover certain aspects of the larger construct of metacognition (see Supplementary Table 3) (93) and call for intervention development that incorporate all four metacognitive domains into hybrid approaches (104).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [93]
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Lysaker, P. H., Dimaggio, G., Hamm, J. A., Leonhardt, B. L., Hochheiser, J., & Lysaker, J. T. (2018) · Psychopathology · doi:10.1159/000495297 · Cited by 23 · see citing works
Schizophrenia, recovery and the self: An introduction to the special issue on metacognition
Lysaker, P. H., Keane, J. E., Culleton, S. P., & Lundin, N. B. (2019) · Schizophrenia Research Cognition · doi:10.1016/j.scog.2019.100167 · Cited by 21 · see citing works
Exploring the effects of cognitive remediation on metacognition in people with schizophrenia
Cella, M., Edwards, C., Swan, S., Elliot, K., Reeder, C., & Wykes, T. (2019) · Journal of Experimental Psychopathology · doi:10.1177/2043808719826846 · Cited by 19 · see citing works
Lysaker, P. H., Владимирович, Ч. Н., Moiseeva, T., Sozinova, M. V., Dmitryeva, N., Alyoshin, V., Faith, L. A., Karpenko, O., & Kostyuk, G. P. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113177 · Cited by 21 · see citing works
Gehlenborg, J., Bücker, L., Berthold, M., Miegel, F. S., & Moritz, S. (2020) · Journal of Gambling Studies · doi:10.1007/s10899-020-09975-w · Cited by 21 · see citing works
Narrative identity, metacognition, and well-being in patients with schizophrenia or HIV
Holm, T., Thomsen, D. K., Huling, K. S., Fischer, M. W., & Lysaker, P. H. (2020) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0000000000001238 · Cited by 19 · see citing works
Self-citationSession-specific effects of the Metacognitive Training for Obsessive-Compulsive Disorder (MCT-OCD)
Miegel, F., Cludius, B., Hottenrott, B., Demiralay, C., Sure, A., & Jelinek, L. (2020) · Psychotherapy Research · doi:10.1080/10503307.2019.1613582 · Cited by 19 · see citing works
Vita, A., Barlati, S., Cavallaro, R., Mucci, A., Riva, M. A., Rocca, P., Rossi, A., & Galderisi, S. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1451832 · Cited by 24 · see citing works
Miegel, F., Demiralay, C., Moritz, S., Wirtz, J., Hottenrott, B., & Jelinek, L. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02648-3 · Cited by 18 · see citing works
“specific versions have been intended as hybrids, to amalgamate a CBT and Metacognitive Training approach” ([15], p.”
BackgroundInfluentialClinical insight, cognitive insight and metacognition in psychosis: Evidence of mediation
Lysaker, P. H., Владимирович, Ч. Н., Moiseeva, T., Sozinova, M. V., Dmitryeva, N., Alyoshin, V., Luther, L., Karpenko, O., & Kostyuk, G. P. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.05.030 · Cited by 17 · see citing works
Lysaker, P. H., Владимирович, Ч. Н., Moiseeva, T., Sozinova, M. V., Dmitryeva, N., Makarova, A., Kukla, M., Myers, E. J., Karpenko, O., & Kostyuk, G. P. (2023) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001612 · Cited by 18 · see citing works
Lysaker, P. H., & Lysaker, J. T. (2020) · Theory & Psychology · doi:10.1177/0959354320973752 · Cited by 17 · see citing works
Wiesepape, C. N., Smith, E. A., Muth, A. J., & Faith, L. A. (2025) · Behavioral Sciences · doi:10.3390/bs15020150 · Cited by 24 · see citing works
Meta-analysis of the relationship between metacognition and disorganized symptoms in psychosis
Myers, E. J., Abel, D. B., Mickens, J. L., Russell, M. T., Rand, K. L., Salyers, M. P., Lysaker, P. H., & Minor, K. S. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2023.12.009 · Cited by 17 · see citing works
Faith, L. A., Lecomte, T., Corbière, M., Francoeur, A., Hache‐Labelle, C., & Lysaker, P. H. (2020) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001219 · Cited by 16 · see citing works
The Metacognitive Training for obsessive-compulsive disorder: A pilot study
Miegel, F., Demiralay, C., Sure, A., Moritz, S., Hottenrott, B., Cludius, B., & Jelinek, L. (2022) · Current Psychology · doi:10.1007/s12144-020-01158-5 · Cited by 15 · see citing works
Self-citationDalkner, N., Moore, R. C., Depp, C. A., Ackerman, R. A., Pinkham, A. E., & Harvey, P. D. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2022.12.034 · Cited by 15 · see citing works
Moritz, S., & Lysaker, P. H. (2018) · Schizophrenia Bulletin · doi:10.1093/schbul/sby151 · Cited by 15 · see citing works
Kajka, N., & Kulik, A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18030878 · Cited by 15 · see citing works
Two decades of metacognitive training for psychosis: successes, setbacks, and innovations
Moritz, S., Balzan, R. P., Menon, M., Rojahn, K. M., Schlechte, M., Veckenstedt, R., Schöttle, D., & Meinhart, A. (2025) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2025.2483204 · Cited by 12 · see citing works
Utilizing MERIT to promote recovery in schizotypal personality disorder: An illustrative case study
Dmitryeva, N., Владимирович, Ч. Н., Kostyuk, G. P., & Lysaker, P. H. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23239 · Cited by 14 · see citing works
Schneider, B. C., Veckenstedt, R., Karamatskos, E., Ahlf-Schumacher, J., Gehlenborg, J., Schultz, J., Moritz, S., & Jelinek, L. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.10.118 · Cited by 14 · see citing works
Cohen‐Chazani, Y., Lysaker, P. H., Roe, D., & Hasson‐Ohayon, I. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23209 · Cited by 13 · see citing works
Lysaker, P. H., Hasson‐Ohayon, I., Wiesepape, C. N., Huling, K. S., Musselman, A., & Lysaker, J. T. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.723952 · Cited by 13 · see citing works
Roux, P., Faivre, N., Urbach, M., Aouizerate, B., Brunel, L., Capdevielle, D., Chéreau, I., Dubertret, C., Dubreucq, J., Fond, G. B., et al. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2022.12.037 · Cited by 12 · see citing works
Is too much insight bad for you?
López-Moríñigo, J.-D., & David, A. S. (2024) · The British Journal of Psychiatry · doi:10.1192/bjp.2024.173 · Cited by 12 · see citing works
Metacognition, Adaptation, and Mental Health
Martin, A. M. S., & Lysaker, P. H. (2021) · Biological Psychiatry · doi:10.1016/j.biopsych.2021.09.028 · Cited by 12 · see citing works
Zhao, L., Wang, S. Y., & Su, Y.-S. (2024) · Education and Information Technologies · doi:10.1007/s10639-023-12439-4 · Cited by 14 · see citing works
Metacognitive monitoring in schizotypy: Systematic literature review and new empirical data
Lehmann, M., & Ettinger, U. (2023) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2023.101891 · Cited by 13 · see citing works
Bonfils, K. A., Haas, G. L., & Salyers, M. P. (2019) · Schizophrenia Research Cognition · doi:10.1016/j.scog.2019.100139 · Cited by 12 · see citing works
de Jong, S., Hasson‐Ohayon, I., van Donkersgoed, R. J. M., Timmerman, M. E., van der Gaag, M., Aleman, A., Pijnenborg, G. H. M., & Lysaker, P. H. (2019) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2388 · Cited by 10 · see citing works
Moderators of cognitive insight outcome in metacognitive training for first-episode psychosis
González‐Blanch, C., Birulés, I., Pousa, E., Barrigón, M. L., López‐Carrilero, R., Lorente-Rovira, E., Ayesa‐Arriola, R., Setién‐Suero, E., Barajas, A., Grasa, E., et al. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.06.040 · Cited by 11 · see citing works
Wiesepape, C. N., Lysaker, J. T., Soza, S. E. Q., & Lysaker, P. H. (2023) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2023.2216384 · Cited by 10 · see citing works
Group‐based meta‐emotion and emotion responses to intergroup threat
Pauketat, J. V. T., Mackie, D. M., & Tausch, N. (2019) · British Journal of Social Psychology · doi:10.1111/bjso.12364 · Cited by 11 · see citing works
Metacognitive sensitivity and symptoms of mental disorder: A systematic review and meta-analysis
Hohendorf, M., & Bauer, M. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.991339 · Cited by 9 · see citing works
Horváth, D., Kovács-Tóth, B., Oláh, B., & Fekete, Z. (2024) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2024.152489 · Cited by 9 · see citing works
Bröcker, A., Bayer, S., Stuke, F., Just, S. A., Bertram, G., Funcke, J., Grimm, I., Lempa, G., von Haebler, D., & Montag, C. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.00269 · Cited by 9 · see citing works
Littrell, S., Fugelsang, J. A., & Risko, E. F. (2024) · Personality and Individual Differences · doi:10.1016/j.paid.2024.112570 · Cited by 8 · see citing works
Espinosa, V., Bagaeva, A., López‐Carrilero, R., Barajas, A., Barrigón, M. L., Birulés, I., Capell, E. F., Díaz-Cutraro, L., González‐Higueras, F., Grasa, E., et al. (2024) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01813-z · Cited by 8 · see citing works
Metacognitive training modified for negative symptoms: A feasibility study
Swanson, L., Schwannauer, M., Bird, T., Eliasson, E. T., Millar, A., Moritz, S., & GRIFFITHS, H. M. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2692 · Cited by 8 · see citing works
Dubreucq, J., Martin, A., Gabayet, F., Plasse, J., Wiesepape, C. N., Quilès, C., Verdoux, H., Nicolas Franck, B., & Lysaker, P. H. (2022) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001530 · Cited by 9 · see citing works
Metacognitive Therapy in Patients with ObsessiveCompulsive Disorder: A review
Atmaca, M. (2022) · ALPHA PSYCHIATRY · doi:10.5152/alphapsychiatry.2022.22840 · Cited by 9 · see citing works
Lysaker, P. H., Владимирович, Ч. Н., Moiseeva, T., Sozinova, M. V., Dmitryeva, N., Alyoshin, V., Kukla, M., Wiesepape, C. N., Karpenko, O., & Kostyuk, G. P. (2020) · Journal of Clinical Psychology · doi:10.1002/jclp.23076 · Cited by 8 · see citing works
Seow, T. X. F., Jelinek, L., Moritz, S., & Hauser, T. U. (2025) · Nature Reviews Psychology · doi:10.1038/s44159-025-00503-4 · Cited by 10 · see citing works
Park, S., Lee, H., & Kim, H. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465819000560 · Cited by 7 · see citing works
Understanding experiential awareness in humanistic‐phenomenological counseling
Wilkinson, B. D. (2022) · The Journal of Humanistic Counseling · doi:10.1002/johc.12196 · Cited by 7 · see citing works
CONSTRUÇÃO DE DEFINIÇÕES OPERACIONAIS EM METACOGNIÇÃO
Peixoto, M. A. P., Brandão, M. A. G., & Tavares, B. F. (2021) · Psicologia Escolar e Educacional · doi:10.1590/2175-35392021224728 · Cited by 7 · see citing works
Fischer, R., Scheunemann, J., Bohlender, A., Duletzki, P., Nagel, M., & Moritz, S. (2022) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2755 · Cited by 6 · see citing works
Nikzad, A. H., Lysaker, P. H., Minor, K. S., Leonhardt, B. L., Liberman, M., Vohs, J. L., Wiesepape, C. N., & Tang, S. X. (2024) · Early Intervention in Psychiatry · doi:10.1111/eip.13628 · Cited by 6 · see citing works
Guo, Y., & Ye, Q. (2026) · Humanities and Social Sciences Communications · doi:10.1057/s41599-026-06621-5 · Cited by 6 · see citing works
Eficacia del entrenamiento metacognitivo en una muestra chilena de personas con esquizofrenia
Vanessa Acuña, P., Otto, A., Álvaro Cavieres, F., & Villalobos, H. (2021) · Revista Colombiana de Psiquiatría · doi:10.1016/j.rcp.2020.12.006 · Cited by 6 · see citing works
Metacognition in Language Teaching and Research: A Conversation With Professor Lawrence Jun Zhang
Xu, Z. (2023) · RELC Journal · doi:10.1177/00336882231157497 · Cited by 6 · see citing works
Cheli, S., Cavalletti, V., & Hopwood, C. J. (2023) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001726 · Cited by 6 · see citing works
Pedone, R., & Semerari, A. (2023) · PubMed Central · doi:10.36131/cnfioritieditore20230606 · Cited by 5 · see citing works
Faith, L. A., Lecomte, T., Corbière, M., & Lysaker, P. H. (2022) · Journal of Mental Health · doi:10.1080/09638237.2022.2091758 · Cited by 6 · see citing works
Nagendra, A., Mueser, K. T., & Cather, C. (2022) · Springer eBooks · doi:10.1007/978-3-031-10239-4_23 · Cited by 6 · see citing works
Promoting insight into delusions: Issues and challenges in therapy
Kumar, D. (2020) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2019.1711420 · Cited by 6 · see citing works
Newman‐Taylor, K., Richardson, T. H., Lees, R., Petrilli, K., Bolderston, H., Hindocha, C., Freeman, T. P., & Bloomfield, M. (2021) · Psychosis · doi:10.1080/17522439.2020.1853203 · Cited by 5 · see citing works
Efficacy and Feasibility of the CO-OP Approach in Parkinson's Disease: RCT Study Protocol
Davies, S. J., Gullo, H., & Doig, E. (2023) · Canadian Journal of Occupational Therapy · doi:10.1177/00084174231156287 · Cited by 5 · see citing works
Metacognitive Beliefs and Metacognitive Capacity
Ayala, A., Mickens, J. L., Myers, E. J., Abel, D. B., Hegwood, C. M., Davis, B. J., Lysaker, P. H., & Minor, K. S. (2023) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001636 · Cited by 6 · see citing works
McGuire, N., Gumley, A. I., Hasson‐Ohayon, I., Allan, S., Aunjitsakul, W., Aydın, O., Bo, S., Bonfils, K. A., Bröcker, A., de Jong, S., et al. (2023) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12505 · Cited by 5 · see citing works
Pena-Garijo, J., & Monfort-Escrig, C. (2020) · Revista de la Asociación Española de Neuropsiquiatría · doi:10.4321/s0211-57352020000100007 · Cited by 5 · see citing works
Phulpin, H., Gozé, T., Faure, K., & Lysaker, P. H. (2021) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001420 · Cited by 5 · see citing works
Sekmek, Ö. S. Ö., Kamış, G. Z., Şenol, B., Erol, Ö. Ö., Ugurlu, M. M., & Göka, E. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06686-7 · Cited by 4 · see citing works
Wiesepape, C. N., Leonhardt, B. L., Hamm, J. A., & Faith, L. A. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1746025 · Cited by 6 · see citing works
The Assessment of Metacognition in Psychosis: Systematic Review and Future Lines of Research
Díaz-Cutraro, L., Verdaguer-Rodríguez, M., Ferrer-Quintero, M., Montserrat, R., Moritz, S., Lysaker, P. H., Dimaggio, G., Palma‐Sevillano, C., Lamarca, M., Espinosa, V., et al. (2026) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70223 · Cited by 4 · see citing works
Metacognitive Training to Improve Insight and Work Outcome in Schizophrenia
Zalzala, A. B., Fiszdon, J. M., Moritz, S., Wardwell, P., Petrik, T., Mathews, L. L., Shagan, D. S., Bracken, D., Bell, M. D., Pearlson, G. D., et al. (2022) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001512 · Cited by 4 · see citing works
Cain, L., Strodl, E. S., & Howard, G. (2024) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-023-09605-7 · Cited by 4 · see citing works
- Authors
- Moritz, S., & Lysaker, P. H.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- Richard L. Roudebush VA Medical Center (US)
- Corresponding author
- Moritz, Steffen
- Venue
- Schizophrenia Research
- Publisher
- Elsevier BV
- Published
- 2018-11
- Volume
- 201
- Pages
- 20-26
- ISSN
- 0920-9964 (ISSN-L)
- OpenAlex
- W2808041219
- Cited by
- 187
- References
- 85
- Citations by year
- 2026: 24 · 2025: 15 · 2024: 19 · 2023: 24 · 2022: 23 · 2021: 27 · 2020: 24 · 2019: 20 · 2018: 10
- FWCI
- 3.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Schizophrenia Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
- Keywords
- metacognition
- MeSH terms
- Metacognition, Humans, Terminology as Topic, Psychological Theory, Schizophrenia, Cognitive Behavioral Therapy
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