Metacognitive and cognitive-behavioral interventions for psychosis: new developments.
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This review describes four cognitive approaches for the treatment of schizophrenia: cognitive-behavioral therapy for psychosis (CBTp), metacognitive therapy, metacognitive training, and metacognitive reflection insight therapy (MERIT). A central reference point of our review is a seminal paper by James Flavell, who introduced the term metacognition ("cognition about cognition"). In a way, every psychotherapeutic approach adopts a metacognitive perspective when therapists reflect with clients about their thoughts. Yet, the four approaches map onto different components of metacognition. CBTp conveys some "metacognitive knowledge" (eg, thoughts are not facts) but is mainly concerned with individual beliefs. Metacognitive therapy focuses on unhelpful metacognitive beliefs about thinking styles (eg, thought suppression). Metacognitive training brings distorted cognitive biases to the awareness of patients; a central goal is the reduction of overconfidence. MERIT focuses on larger senses of identity and highlights metacognitive knowledge about oneself and other persons. For CBTp and metacognitive training, meta-analytic evidence supports their efficacy; single studies speak for the effectiveness of MERIT and metacognitive therapy. .
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Deficits in metacognitive knowledge and awareness are believed to lead to cognitive distortions, dysfunctional beliefs and expectancies, and a lack of cognitive insight into cognitive biases.
“Deficits in metacognitive knowledge and awareness moreover are believed to lead to cognitive distortions (e.g., jumping to conclusions, attributional biases, theory of mind deficits) (60), dysfunctional beliefs and expectancies (associated with a low self-esteem and negative symptoms) (10, 95) and a lack of cognitive insight into those cognitive biases (96).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [60]
The citation is attached to the cognitive-distortions clause, not the later claims about dysfunctional beliefs or cognitive insight. In “Metacognitive training for psychosis” (page unavailable), the review identifies jumping to conclusions, theory of mind and attributional style as relevant biases and says patients’ awareness of these biases is often poor. It does not say that deficits in metacognitive knowledge and awareness lead to those distortions. (LLM, conf=0.82)
Experimental — accuracy not yet measuredCompared to Metacognitive Therapy by Wells and Matthews, MCT focuses not only on general thinking mechanisms from a metacognitive perspective but also on specific thoughts from a cognitive one by directly addressing thought contents.
“Compared to Metacognitive Therapy by Wells and Matthews, MCT not only focuses on general thinking mechanisms from a metacognitive perspective, but also on specific thoughts from a cognitive one by directly addressing thought contents (60).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [60]
The “Metacognitive training for psychosis” section says MCT raises awareness of cognitive biases and that its recent depression and self-esteem modules have a CBTp signature. But it also says MCT’s authors dispute the general characterization that the intervention deals with the content of negative thoughts. The claim overgeneralizes that content-focused aspect to MCT as a whole. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe concept of MCT by Moritz and Woodward was originally inspired by research on cognitive biases in psychosis and aims to convey metacognitive knowledge and raise metacognitive awareness for dysfunctional thought patterns.
“The concept of MCT by Moritz and Woodward was originally inspired by research on cognitive biases in psychosis (65) and aims to convey metacognitive knowledge and raise metacognitive awareness for dysfunctional thought patterns (60, 122).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [60]
MCT was originally developed for psychosis but has been adapted for treating other disorders such as depression and personality disorders and can be applied transdiagnostically.
“Although MCT was originally developed for psychosis, it has been adapted for use in treating other disorders such as depression and personality disorders and can be applied in a transdiagnostic manner (60).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [60]
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- Authors
- Moritz, S., Klein, J. P., Lysaker, P. H., & Mehl, S.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- University of Lübeck (DE)
- Richard L. Roudebush VA Medical Center (US)
- Philipps University of Marburg (DE)
- Corresponding author
- Moritz, Steffen
- Venue
- Dialogues in Clinical Neuroscience
- Publisher
- Informa UK Limited
- Published
- 2019-09-30
- Volume
- 21
- Issue
- 3
- Pages
- 309-317
- ISSN
- 1294-8322 (ISSN-L)
- 1958-5969
- PMC
- PMC6829173
- OpenAlex
- W2990591564
- Cited by
- 101
- References
- 55
- Citations by year
- 2026: 15 · 2025: 14 · 2024: 19 · 2023: 16 · 2022: 24 · 2021: 7 · 2020: 5 · 2018: 1
- FWCI
- 1.52
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Dialogues in Clinical Neuroscience (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- IUScholarWorks (Indiana University) (submittedVersion, cc-by)
- Funders
- Bundesministerium für Gesundheit
- Servier
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- psychosis, schizophrenia, cognitive behavioural therapy for psychosis, metacognitive therapy, metacognitive training, metacognition, metacognitive beliefs, thought suppression, cognitive biases, overconfidence, identity, psychotherapy efficacy
- MeSH terms
- Metacognition, Humans, Psychotic Disorders, Cognitive Behavioral Therapy
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