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Cited by 39Schizophrenia research and treatmentCounseling, Therapy, and Family DynamicsPsychotherapy Techniques and Applications

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Personalizing interventions using real-world interactions: Improving symptoms and social functioning in schizophrenia with tailored metacognitive therapy.

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Minor, Kyle S., Marggraf, Matthew P., Davis, Beshaun J., Mickens, Jessica L., Abel, Danielle B., Robbins, Megan L., Buck, Kelly D., Wiehe, Sarah E., Lysaker, Paul H.·2022·Journal of Consulting and Clinical Psychology
DOI 10.1037/ccp0000672PMC PMC8857308
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Abstract

OBJECTIVE: When clients' lives are not reflected in therapy, they struggle to apply the skills learned in treatment to everyday situations. In this pilot study, we determined if using clients' real-world interactions in therapy could effectively target metacognitive capacity-yielding improved symptoms and social functioning-by tailoring treatment to focus on issues faced by clients in daily life. METHOD: Using a randomized controlled trial design, schizophrenia subjects with metacognitive deficits completed 24 sessions of: (a) Standard Metacognitive Reflection and Insight Therapy (MERIT); or (b) Tailored MERIT. Real-world interactions were captured via the Electronically Activated Recorder (EAR), a smartphone application that passively records audio in daily life. All subjects wore the EAR; however, real-world interactions were only used to personalize sessions in Tailored MERIT. RESULTS: Feasibility and acceptability were shown; those in Tailored MERIT wore the EAR 84% of their waking hours and reported minimal burden. When compared to Standard MERIT, Tailored MERIT participants showed large pre-post reductions in negative metacognitive beliefs and disorganized symptoms. Small, but nonsignificant, improvements in social functioning were also observed. CONCLUSIONS: Compared to an evidence-based benchmark, we observed that real-world interactions can be used to tailor metacognitive therapy and improve outcomes in schizophrenia. Tailored MERIT has the potential to impact practice by personalizing treatment to account for individual variations in environment and lifestyle-aligning with the Precision Medicine Initiative-in a way that is not possible with current therapy. This is particularly salient in schizophrenia, where limited insight and cognitive deficits often make subjective reporting unreliable. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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  • Metacognitive interventions improved social functioning in schizophrenia in one study, but not in another.

    “This study found statistically significant improvements in social functioning, social activity levels and social interactions and reduced auditory hallucinations and delusions in psychosis compared to TAU (Han and Lee 2022).”

    From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Minor et al. 2022

    The Results (Preliminary Effectiveness; page unavailable) report no significant difference in overall social functioning between Tailored MERIT and Standard MERIT, supporting the claim that one study did not find a significant improvement. This paper does not establish the claimed improvement in the other study, and its comparison was with Standard MERIT, not treatment as usual. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The lack of immersive realism may explain why the second metacognitive intervention did not improve social functioning.

    “possibly due to the lack of immersive realism (Minor et al. 2022).”

    From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Minor et al. 2022

    The Introduction says that relying on retrospective reports rather than accurate, real-world interactions may limit MERIT’s effectiveness. But the paper does not identify a lack of immersive realism as the reason social functioning failed to improve significantly; the Discussion instead suggests that the 24-week intervention may have been too short. The Results report small gains, but no significant overall social-functioning difference between tailored and standard MERIT. (LLM, conf=0.80)

    Experimental — accuracy not yet measured

  • The second metacognitive study did not find significant improvements in social functioning.

    “However, this study did not find statistically significant improvements in social functioning, possibly due to the lack of immersive realism (Minor et al. 2022).”

    From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Minor et al. 2022

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Research works printed but not linked: 49

  1. Abel DB, & Minor KS (2021). Social functioning in schizophrenia: Comparing laboratory-based assessment and real-world measures. Journal of Psychiatric Research, 138, 500– 506. 33971484 PMC8192459
  2. Abel DB, Salyers MP, Wu W, Monette MA, & Minor KS (in press). Quality versus quantity: Determining real-world social functioning in schizophrenia. Accepted at Psychiatry Research in April, 2021. PMC8206017 33979764
  3. Ashley EA (2015). The precision medicine initiative: A new national effort. JAMA, 313, 2119– 2120. 25928209
  4. Bargenquast R, & Schweitzer RD (2014). Enhancing sense of recovery and self-reflectivity in people with schizophrenia: A pilot study of Metacognitive Narrative Psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice, 87, 338– 356. 24375887
  5. Beck EM, Cavelti M, Kvrgic S, Kleim B, & Vauth R (2011). Are we addressing the ‘right stuff’ to enhance adherence in schizophrenia? Understanding the role of insight and attitudes towards medication. Schizophrenia Research, 132, 42– 49. 21820875
  6. Bell MD, Lysaker PH, Goulet JB, Milstein RM, & Lindenmayer JP (1994). Five component model of schizophrenia: Assessing the factorial invariance of the PANSS. Psychiatry Research, 52, 295– 303. 7991723
  7. Bell M, Milstein R, Beam-Goulet J, Lysaker P, & Cicchetti D (1992). The Positive and Negative Syndrome Scale and the Brief Psychiatric Rating Scale: Reliability, comparability, and predictive validity. Journal of Nervous and Mental Diseases, 180, 723– 728. 1431824
  8. Bellack AS, Green MF, Cook JA, Fenton W, Harvey PD, Heaton RK, Laughren T, Leon AC, Mayo DJ, Patrick DL, Patterson TL, Rose A, Stover E, & Wykes T (2007). Assessment of community functioning in people with schizophrenia and other severe mental illnesses: A white paper based on an NIMH-sponsored workshop. Schizophrenia Bulletin, 33, 805– 822. 16931542 PMC2526156
  9. Ben-Zeev D, Wang R, Abdullah S, Brian R, Scherer EA, Mistler LA, Hauser M, Kane JM, Choudhury T, & Campbell A (2016). Mobile behavioral sensing for outpatients and inpatients with schizophrenia. Psychiatric Services, 67, 558– 561. 26695497 PMC4918904
  10. Bowie CR, & Harvey PD (2008). Communication abnormalities predict functional outcomes in chronic schizophrenia: differential associations with social and adaptive functions. Schizophrenia Research, 103, 240– 247. 18571378 PMC4104169
  11. Bright M, Parker S, French P, Fowler D, Gumley A, Morrison AP, Birchwood M, Jones PB, Stewart SLK, & Wells A (2018). Metacognitive beliefs as psychological predictors of social functioning: An investigation in young people at risk of psychosis. Psychaitry Research, 262, 520– 526. PMC5884305 28942953
  12. Buck KD, & George SE (2016). Metacognitive Reflective and Insight Therapy for a person who gained maximal levels of metacognitive capacity and was able to terminate therapy. Journal of Contemporary Psychotherapy, 46, 187– 195.
  13. Cohen J (1992). A power primer. Psychological Bulletin, 112, 155– 159. 19565683
  14. De Jong S, van Donkersgoed RJM, Timmerman ME, Aan Het Rot M, Wunderink L, Arends J, van der Gaag M, Aleman A, Lysaker PH, & Pijnenborg GHM (2019). Metacognitive reflection and insight therapy (MERIT) for patients with schizophrenia. Psychological Medicine, 49, 303– 313. 29692285
  15. Dimaggio G, & Lysaker PH (2015). Metacognition and mentalizing in the psychotherapy of patients with psychosis and personality disorders. Journal of Clinical Psychology, 71, 117– 124. 25557317
  16. Dubey H, Mehl MR, & Mankodiya K (2016). BigEAR: Inferring the ambient and emotional correlates from smartphone-based acoustic big data. 2016 IEEE First International Conference on Connected Health: Applications, Systems and Engineering Technologies (CHASE). Washington, DC, USA.
  17. Fulford D, Mote J, Gonzalez R, Abplanalp S, Zhang Y, Luckenbaugh J, Onnela J, Busso C, & Gard DE (2020). Smartphone sensing of social interactions in people with and without schizophrenia. Journal of Psychiatric Research, 137, 613– 620. 33190842 PMC8084875
  18. Green MF, Llerena K, & Kern RS (2015). The “right stuff” revisited: What have we learned about the determinants of daily functioning in schizophrenia? Schizophrenia Bulletin, 41, 781– 785. 25750248 PMC4466185
  19. Gupta N, Mattoo SK, Basu D, Lobana A (2000). Psychometric properties of quality of life (QLS) scale: a brief report. Indian Journal of Psychiatry, 42, 415– 420. 21407980 PMC2962744
  20. Harvey CA, Jeffreys SE, McNaught AS, Blizard RA, & King MB (2007). The camden schizophrenia surveys III: Five-year outcome of a sample of individuals from a prevalence survey and the importance of social relationships. International Journal of Social Psychiatry, 53, 340– 356. 17703650
  21. Heinrichs DW, Hanlon TE, & Carpenter WT (1984). The Quality of Life Scale: An instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin, 10, 388– 398. 6474101
  22. James AV, Hasson-Ohayon I, Vohs J, Minor KS, Leonhardt BL, Buck KD, George S, & Lysaker PH (2016). Metacognition moderates the relationship between dysfunctional self-appraisal and social functioning in prolonged schizophrenia independent of psychopathology. Comprehensive Psychiatry, 69, 62– 70. 27423346
  23. Kaplan DM, Rentscher KE, Lim M, Reyes R, Keating D, Romero J, Shah A, Smith AD, York KA, Milek A, Tackman AM, & Mehl MR (2020). Best practices for Electronically Activated Recorder (EAR) research: A practical guide to coding and processing EAR data. Behavior Research Methods, 52, 1538– 1551. 31898289
  24. Kay SR, Fiszbein A, & Opler LA (1987). The positive and negative syndrome scale for schizophrenia. Schizophrenia Bulletin, 13, 261– 276. 3616518
  25. Kwapil TR, Brown LH, Silvia PJ, Myin-Germeys I, & Barrantes-Vidal N (2012). The expression of positive and negative schizotypy in daily life: An experience sampling study. Psychological Medicine, 42, 2555– 2566. 22716971 PMC12815227
  26. Lysaker PH, & Dimaggio G (2014). Metacognitive capacities for reflection in schizophrenia: Implications for developing treatments. Schizophrenia Bulletin, 40, 487– 491. 24636965 PMC3984530
  27. Lysaker PH, Gagen EC, Klion R, Zalzala AB, Vohs J, Faith LA, Leonhardt BL, Hamm JA, & Hasson-Ohayon I (2020). Metacognitve Reflection and Insight Therapy: A recovery oriented treatment approach for psychosis. Psychology Research and Behavior Management, 13, 331– 341. 32308511 PMC7135118
  28. Lysaker PH, Gumley A, Luedtke B, Buck KD, Ringer JM, Olesek K, Kukla M, Leonhardt BL, Popolo R, & Dimaggio G (2013). Social cognition and metacognition in schizophrenia: Evidence of their independence and linkage with outcomes. Acta Psychiatrica Scandinavica, 127, 239– 247. 22967227
  29. Lysaker PH, & Klion RE (2017). Recovery, Meaning-making, and Severe Mental Illness: A Comprehensive Guide to Metacognitive Reflection and Insight Therapy. Routledge, New York, New York.
  30. Lysaker PH, Minor KS, Lysaker JT, Hasson-Ohayon I, Bonfils K, Hochheiser J, & Vohs J (2020). Metacognitive function and fragmentation in schizophrenia: Relationship to cognition, self-experience and developing frameworks. Schizophrenia Research: Cognition, 19. PMC6889776 31828019
  31. Lyu J, & Zhang J (2014). Characteristics of schizophrenia suicides compared with suicides by other diagnosed psychiatric disorders and those without a psychiatric disorder. Schizophrenia Research, 155, 59– 65. 24657011 PMC4003875
  32. Manson JH, & Robbins ML (2017). New evaluation of the electronically activated recorder (EAR): Obtrusiveness, compliance, and participant self-selection effects. Frontiers in Psychology. PMC5408068 28503162
  33. Mehl MR, Vazire S, Ramirez-Esparza N, Slatcher RB, & Pennebaker JW (2007). Are women really more talkative than men? Science, 317, 82. 17615349
  34. Mehl MR, & Robbins ML (2012). Naturalistic observation sampling: The Electronically Activated Recorder (EAR). In Mehl MR & Conner TS (Eds.), Handbook of Research Methods for Studying Daily Life (pp. 176– 192). New York, NY: Guilford Press.
  35. Mehl MR, Robbins ML, & Deters FG (2012). Naturalistic observation of health-relevant social processes: The electronically activated recorder methodology in psychosomatics. Psychosomatic Medicine, 74, 410– 417. 22582338 PMC3351696
  36. Mehl MR (2017). The Electronically Activated Recorder (EAR): A method for the naturalistic observation of daily social behavior. Current Directions in Psychological Science, 26, 184– 190. 28529411 PMC5434514
  37. Mehl MR, Pennebaker JW, Crow DM, Dabbs J, & Price JH (2001). The electronically activated recorder (EAR): A device for sampling naturalistic daily activities and conversations. Behavior Research Methods, Instruments, & Computers, 33, 517– 523. 11816455
  38. Minor KS, Davis BJ, Marggraf MP, Luther L, & Robbins ML (2018). Words matter: Implementing the electronically activated recorder in schizotypy. Personality Disorders: Theory, Research, and Treatment, 9, 133– 143. 29215902
  39. Minor KS, Hardin KL, Beaudette DM, Waters LC, White AL, Gonzenbach V, & Robbins ML (2020). Social functioning in schizotypy: How affect influences social behavior in daily life. Journal of Clinical Psychology, 76, 2212– 2221. 32613629 PMC7879378
  40. Minor KS, & Lysaker PH (2014). Necessary but not sufficient: Links between neurocognition, social cognition, and metacognition in schizophrenia are moderated by disorganized symptoms. Schizophrenia Research, 159, 198– 204. 25192756
  41. Minor KS, Marggraf MP, Davis BJ, Luther L, Vohs JL, Buck KD, & Lysaker PH (2015). Conceptual disorganization weakens links in cognitive pathways: Disentangling neurocognition, social cognition, and metacognition in schizophrenia. Schizophrenia Research, 169, 153– 158. 26441007
  42. Minor KS, Marggraf MP, Davis BJ, Mehdiyoun N, & Breier A (2016). Affective systems induce formal thought disorder in early-stage psychosis. Journal of Abnormal Psychology, 125, 537– 543. 26999283
  43. Minor KS, Willits JA, Marggraf MP, Jones MN, & Lysaker PH (2018). Measuring disorganized speech in schizophrenia: Automated analysis explains variance in cognitive deficits beyond clinician-rated scales. Psychological Medicine, 49, 440– 448. 29692287
  44. Robbins ML, Focella ES, Kasle S, Lopez AM, Weihs KL, & Mehl MR (2011). Naturalistically observed swearing, emotional support and depressive symptoms in women coping with illness. Health Psychology, 30, 789– 792. 21574707 PMC3193870
  45. Robbins ML, Karan A, Lopez AM, & Weihs KL (2018). Naturalistically observing noncancer conversations among couples coping with breast cancer. Psycho-Oncology, 27, 2206– 2213. 29904980
  46. Robbins ML, López AM, Weihs KL, & Mehl MR (2014). Cancer conversations in context: Naturalistic observation of couples coping with breast cancer. Journal of Family Psychology, 28, 380– 390. 24730380 PMC4041838
  47. Robbins ML, Wright RC, María López A, & Weihs K (2019). Interpersonal positive reframing in the daily lives of couples coping with breast cancer. Journal of Psychosocial Oncology. PMC6476696 30741121
  48. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, & Dunbar GC (1998). The Mini-international neuropsychiatric interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22– 33. 9881538
  49. van Donkersgoed RJM, de Jong S, & Pijnenborg GHM (2016). Metacognitive Reflection and Insight Therapy (MERIT) with a patient with persistent negative symptoms. Journal of Contemporary Psychotherapy, 46, 245– 253. 27795575 PMC5061837

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Metadata

Authors
Minor, K. S., Marggraf, M. P., Davis, B. J., Mickens, J. L., Abel, D. B., Robbins, M. L., Buck, K. D., Wiehe, S. E., & Lysaker, P. H.
Corresponding author
Minor, Kyle S.
ORCID
Venue
Journal of Consulting and Clinical Psychology
Publisher
American Psychological Association (APA)
Published
2022-01
Volume
90
Issue
1
Pages
18-28
ISSN
  • 0022-006X (ISSN-L)
  • 1939-2117
DOI
10.1037/ccp0000672
PMC
PMC8857308
OpenAlex
W3195827382
Cited by
39
References
0
Citations by year
2026: 4 · 2025: 9 · 2024: 8 · 2023: 10 · 2022: 8
FWCI
4.66
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
Funders
  • National Institutes of Health (KL2TR001106; UL1TR001108)
  • American Psychological Foundation
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
schizophrenia, metacognitive therapy, personalized treatment, real-world interaction, Electronically Activated Recorder, metacognitive beliefs, negative symptoms, disorganized symptoms, social functioning, precision medicine, treatment acceptability
MeSH terms
Metacognition, Social Interaction, Humans, Pilot Projects, Schizophrenia, Social Adjustment

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