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Cited by 70Schizophrenia research and treatmentMental Health and PsychiatryPsychotherapy Techniques and Applications

Metacognitive approaches to the treatment of psychosis: a comparison of four approaches.

Open access
Lysaker, Paul H, Gagen, Emily, Moritz, Steffen, Schweitzer, Robert·2018·Psychology Research and Behavior Management
DOI 10.2147/prbm.s146446PMC PMC6130286
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Abstract

In light of increasing interest in metacognition and its role in recovery from psychosis, a range of new treatments focused on addressing metacognitive deficits have emerged. These include Metacognitive Therapy, Metacognitive Training, metacognitive insight and reflection therapy, and metacognitive interpersonal therapy for psychosis. While each of these treatments uses the term metacognitive, each differs in terms of their epistemological underpinnings, their structure, format, presumed mechanisms of action, and primary outcomes. To clarify how these treatments converge and diverge, we first offer a brief history of metacognition as well as its potential role in an individual's response to and recovery from complicated mental health conditions including psychosis. We then review the background, practices, and supporting evidence for each treatment. Finally, we will offer a framework for thinking about how each of these approaches may ultimately complement rather than contradict one another and highlight areas for development. We suggest first that each is concerned with something beyond what people with psychosis think about themselves and their lives. Each of these four approaches is interested in how patients with severe mental illness think about themselves. Each looks at immediate reactions and ideas that frame the meaning of thoughts. Second, each of these approaches is more concerned with why people make dysfunctional decisions and take maladaptive actions rather than what comprised those decisions and actions. Third, despite their differences, each of these treatments is true to the larger construct of metacognition and is focused on person's relationships to their mental experiences, promoting various forms of self-understanding which allow for better self-management. Each can be distinguished from other cognitive and skills-based approaches to the treatment of psychosis in their emphasis on sense-making rather than learning a new specific thing to say, think, or do in a given situation.

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  • There is convincing evidence for the contribution of metacognitive deficits to both severe psychotic symptoms and subsequent crisis development.

    “In summary, there is convincing evidence for the contribution of metacognitive deficits to both severe psychotic symptoms and subsequent crisis development (104).”

    From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [104]

    The Introduction (page unavailable) says metacognitive deficits could potentially worsen the development and course of symptoms, supporting a possible contribution to psychotic symptoms. But the paper does not establish that contribution as convincing evidence concerning severe symptoms, and the searched passages do not address subsequent crisis development. The Metacognitive Therapy section (page unavailable) also cautions that some reported links with psychosis are weak or heterogeneous. (LLM, conf=0.86)

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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 [104]

    The citation to this paper is attached to the call for future hybrid approaches. The Discussion (page unavailable) says that models should incorporate what each of the four treatment approaches contributes and that hybrid approaches are worth exploring. It does not specifically call for incorporating all four metacognitive domains; the cited paper discusses four approaches, not four domains, in this recommendation. (LLM, conf=0.86)

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  • The concept of metacognition is believed to serve as a valid candidate for filling the gap between simplistic biological treatment models and psychosocial ones.

    “The concept of metacognition thereby is believed to serve as a valid candidate for filling the gap between simplistic biological treatment models and psychosocial ones (104).”

    From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [104]

  • The intervention's overarching emphasis on transdiagnostic metacognitive change mechanisms (cognitive insight and cognitive defusion) fits in a new generation of treatments promoting recovery from serious mental illnesses including psychosis.

    “Our intervention’s overarching emphasis on transdiagnostic metacognitive change mechanisms (cognitive insight and cognitive defusion) furthermore fits in a new generation of treatments promoting recovery from serious mental illnesses including psychosis (104, 138).”

    From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [104]

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Research works printed but not linked: 1

  1. [20]Wells A Emotional Disorders and Metacognition: Innovative Cognitive Therapy New York, NY John Wiley and Sons 2000

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Authors
Lysaker, P. H., Gagen, E., Moritz, S., & Schweitzer, R.
Affiliations
  • Richard L. Roudebush VA Medical Center (US)
  • University of North Carolina at Chapel Hill (US)
  • University Medical Center Hamburg-Eppendorf (DE)
  • Queensland University of Technology (AU)
Corresponding author
Lysaker, Paul H
ORCID
Venue
Psychology Research and Behavior Management
Publisher
Informa UK Limited
Published
2018-09
Volume
Volume 11
Pages
341-351
ISSN
1179-1578 (ISSN-L)
DOI
10.2147/prbm.s146446
PMC
PMC6130286
OpenAlex
W2890483061
Cited by
70
References
93
Citations by year
2026: 10 · 2025: 8 · 2024: 5 · 2023: 16 · 2022: 6 · 2021: 7 · 2020: 10 · 2019: 8
FWCI
0.95
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychology Research and Behavior Management (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • QUT ePrints (Queensland University of Technology) (submittedVersion, cc-by-nc)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
  • IUScholarWorks (Indiana University) (submittedVersion, cc-by-nc-nd)
  • PMC
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
metacognition, psychosis, metacognitive therapy, metacognitive training, treatment comparison, self-understanding, sensemaking, self-management, recovery from psychosis, severe mental illness

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