Promoting recovery from severe mental illness: implications from research on metacognition and metacognitive reflection and insight therapy.
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Research indicates that individuals with schizophrenia recover. Recovery, however means different things to different individuals and regardless of what kind of experiences define recovery, the individual diagnosed with the serious mental illness must feel ownership of their recovery. This raises the issue of how mental health services should systematically promote recovery. This paper explores the practical implications for research on metacognition in schizophrenia for this issue. First, we present the integrated model of metacognition, which defines metacognition as the spectrum of activities which allow individual to have available to themselves an integrated sense of self and others as they appraise and respond to the unique challenges they face. Second, we present research suggesting that many with schizophrenia experience deficits in metacognition and that those deficits compromise individuals' abilities to manage their lives and mental health challenges. Third, we discuss a form of psychotherapy inspired by this research, Metacognitive Reflection and Insight Therapy which assists individuals to recapture the ability to form integrated ideas about themselves and others and so direct their own recovery. The need for recovery oriented interventions to focus on process and on patient's purposes, assess metacognition and consider the intersubjective contexts in which this occurres is discussed.
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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 [138]
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Holm, T., Thomsen, D. K., & Bliksted, V. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.08.116 · Cited by 20 · see citing works
Adherence, insight and disability in paranoid schizophrenia
García‐Cabeza, I., Díaz‐Caneja, C. M., Bruna, M. M. O., & Portugal, E. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.09.021 · Cited by 21 · see citing works
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
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-citationBeainy, C., Haddad, C., Fekih‐Romdhane, F., Hallit, S. R., & Haddad, G. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04711-1 · Cited by 18 · 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
Does childhood trauma predict poorer metacognitive abilities in people with first-episode psychosis?
Trauelsen, A. M., Gumley, A. I., Jansen, J. E., Pedersen, M. B., Nielsen, H. L., Haahr, U., & Simonsen, E. H. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.01.018 · Cited by 19 · see citing works
Martin, S. S., Del-Monte, J., & Graziani, P. (2019) · Heliyon · doi:10.1016/j.heliyon.2019.e02564 · Cited by 17 · see citing works
Verdoux, H., Quiles, C., Bon, L., Chéreau-Boudet, I., Dubreucq, J., Fiegi, L., Guillard-Bouhet, N., Massoubre, C., Plasse, J., & Franck, N. (2020) · Psychological Medicine · doi:10.1017/s0033291720001403 · Cited by 16 · see citing works
Persons with first episode psychosis have distinct profiles of social cognition and metacognition
Ferrer-Quintero, M., Fernández, D., López‐Carrilero, R., Birulés, I., Barajas, A., Lorente-Rovira, E., Díaz-Cutraro, L., Verdaguer-Rodríguez, M., García‐Mieres, H., Sevilla‐Llewellyn‐Jones, J., et al. (2021) · Schizophrenia · doi:10.1038/s41537-021-00187-8 · Cited by 14 · see citing works
García‐Mieres, H., Villaplana, A., López‐Carrilero, R., Grasa, E., Barajas, A., Pousa, E., Feixas, G., & Ochoa, S. (2019) · Schizophrenia Bulletin · doi:10.1093/schbul/sbz082 · Cited by 14 · see citing works
Synnes, O., Romm, K. L., & Bondevik, H. (2021) · Medicine Health Care and Philosophy · doi:10.1007/s11019-020-09998-5 · Cited by 14 · see citing works
Gamieldien, F., Galvaan, R., MYERS, B. J., & Sorsdahl, K. R. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-032912 · Cited by 14 · see citing works
A Disorder by Any Other Name: Metacognition, Schizophrenia, and Diagnostic Practice
Lysaker, P. H., Zalzala, A. B., Ladegaard, N., Buck, B., Leonhardt, B. L., & Hamm, J. A. (2018) · Journal of Humanistic Psychology · doi:10.1177/0022167818787881 · Cited by 13 · see citing works
Gagen, E. C., Zalzala, A. B., Hochheiser, J., Martin, A. M. S., & Lysaker, P. H. (2019) · Journal of Experimental Psychopathology · doi:10.1177/2043808719830821 · Cited by 13 · see citing works
Creative writing as a means to recover from early psychosis– Experiences from a group intervention
Romm, K. L., Synnes, O., & Bondevik, H. (2022) · Arts & Health · doi:10.1080/17533015.2022.2130379 · Cited by 12 · see citing works
The Recovery Model and Psychosis
Leonhardt, B. L., Hamm, J. A., & Lysaker, P. H. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815012-2.00005-5 · Cited by 11 · see citing works
Neurocognitive and Metacognitive Profiles of Intact Social Cognition in Prolonged Schizophrenia
James, A. V., Johannesen, J., & Lysaker, P. H. (2018) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000900 · Cited by 11 · see citing works
Wiesepape, C. N., Smith, E. A., Hillis, J. D., Soza, S. E. Q., Morris, M., James, A. V., & Stokes, A. B. (2024) · Behavioral Sciences · doi:10.3390/bs14040336 · Cited by 11 · see citing works
Lysaker, P. H., Buck, K. D., Pattison, M. L., Beasley, R. E., Hillis, J. D., & Hamm, J. A. (2019) · The American Journal of Psychoanalysis · doi:10.1057/s11231-019-09198-y · Cited by 9 · see citing works
Verdoux, H., Quiles, C., Cervello, S., Dubreucq, J., Bon, L., Massoubre, C., Pommier, R., Legros-Lafarge, E., Jaafari, N., Guillard-Bouhet, N., et al. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.112543 · 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
Musket, C. W., Bullock, J. S., Fiszdon, J. M., Stacy, M. A., Martino, S., James, A. V., Lysaker, P. H., & Martin, A. M. S. (2024) · Behavioral Sciences · doi:10.3390/bs14070520 · Cited by 8 · see citing works
Rakitzi, S., Georgila, P., & Becker-Woitag, A. P. (2020) · European Psychologist · doi:10.1027/1016-9040/a000400 · Cited by 8 · see citing works
Fekih‐Romdhane, F., Azzi, V., Obeïd, S., Gerges, S., Dine, A. S. E., Malaeb, D. N., Soufia, M., & Hallit, S. R. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05308-4 · Cited by 10 · see citing works
Psychotherapy on an Acute Psychiatric Ward: Preliminary Findings From a Controlled Study
Cohen‐Chazani, Y., Igra, L., Hamm, J. A., Leonhardt, B. L., Klion, R. E., Cheli, S., & Hasson‐Ohayon, I. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.3002 · Cited by 7 · see citing works
Lee, S. W., Kim, Y. J., Kim, Y. J., Jin, B., Chang, Y., & Lee, S. J. (2024) · Brain Imaging and Behavior · doi:10.1007/s11682-023-00845-8 · Cited by 7 · see citing works
Emerging Psychotherapies for Psychosis
Knauss, D. P. C., Ridenour, J. M., & Hamm, J. A. (2018) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000329 · Cited by 7 · see citing works
Park, S., Lee, H., & Kim, H. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465819000560 · Cited by 7 · 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
Henningsson, S., Brestisson, J. T., Bjørkedal, S. T. B., Bundesen, B., Nielsen, K. S., Ebersbach, B. K., Hjorthøj, C. R., & Eplov, L. F. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06254-5 · Cited by 6 · see citing works
Schweitzer, R., Sonnenburg, C., & Komandur, P. (2022) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-022-09563-6 · Cited by 6 · see citing works
Why using “consciousness” in psychotherapy? Insight, metacognition and self-consciousness
Martin, S. S. (2023) · New Ideas in Psychology · doi:10.1016/j.newideapsych.2023.101015 · Cited by 8 · see citing works
Evolution of social networks in early psychosis
Massé, M., Paquin, K., Lysaker, P. H., & Lecomte, T. (2020) · Psychosis · doi:10.1080/17522439.2020.1736611 · Cited by 6 · see citing works
Triola, M., Cobo, J., González-Rodríguez, A., Nieto, L., Ochoa, S., Usall, J., García-Ribera, C., Baños, I., González, B., Solanilla, A., et al. (2024) · Psychopathology · doi:10.1159/000536360 · Cited by 5 · see citing works
Relationship Between Insight, Adherence and Disability in the Diagnose of Paranoid Schizophrenia
Cabeza, I. G. (2018) · JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY · doi:10.29245/2578-2959/2018/6.1172 · Cited by 5 · see citing works
Turner, P. R. (2023) · Journal of Social Work Practice · doi:10.1080/02650533.2023.2284358 · Cited by 5 · 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
Metacognition and mentalising as core mechanisms of psychotherapy
Inchausti, F., MacBeth, A. M., & Dimaggio, G. (2026) · The British Journal of Psychiatry · doi:10.1192/bjp.2026.10536 · Cited by 4 · see citing works
Yılmazer, E., Hamamcı, Z., & Türk, F. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1411733 · Cited by 4 · see citing works
Introspective accuracy for substance use across a year of treatment for first episode psychosis
Mervis, J., Fischer, J., Cooper, S. E., Deckert, A. C., Lysaker, P. H., MacDonald, A. W., & Meyer-Kalos, P. (2021) · Schizophrenia Research Cognition · doi:10.1016/j.scog.2021.100200 · Cited by 4 · see citing works
Khazaie, H., Khazaie, A., Yasamy, M. T., Zakiei, A., & Komasi, S. (2025) · Current Psychology · doi:10.1007/s12144-025-07759-2 · Cited by 3 · see citing works
Patterns and correlates of insight among patients with schizophrenia in China:A network perspective
Wang, F., Yang, Y., Tan, W., Lin, H.-C., Yang, C.-J., Lin, Y.-Q., Jia, F., Wang, S.-B., & Hou, C. (2023) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2023.103735 · Cited by 3 · see citing works
Gussmann, E., Lucae, S., Falkai, P., Padberg, F., Egli, S., & Kopf-Beck, J. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1160075 · Cited by 2 · see citing works
“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).”
BackgroundRakitzi, S. (2023) · Springer eBooks · doi:10.1007/978-3-031-27837-2_2 · Cited by 2 · see citing works
The double-strand bond between metacognition and schizophrenia: actual impact and future directions
Martiadis, V., Raffone, F., Pessina, E., & Scognamiglio, P. (2023) · Mental Wellness · doi:10.4081/mw.2023.6 · Cited by 2 · see citing works
Clesse, C., Salime, S., Dumand, I., Concetta-Ciciarelli, S. B., Lavenir, S., Kacemi, K., Heckel-Chalet, P., Sissung, F., Poinsignon, A., Simón, A., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.540680 · Cited by 2 · see citing works
Turner, P. R., & Saeteurn, E. R. (2022) · Schizophrenia Bulletin Open · doi:10.1093/schizbullopen/sgac052 · Cited by 2 · see citing works
Gussmann, E., Lindner, C., Lucae, S., Falkai, P., Padberg, F., Egli, S., & Kopf‐Beck, J. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-023-01690-y · Cited by 2 · see citing works
Schizotypal Disorder: Phenomenological Perspectives on Diagnosis, Psychopathology, and Psychotherapy
Škodlar, B., & Henriksen, M. G. (2023) · Springer eBooks · doi:10.1007/978-3-031-41788-7_5 · Cited by 1 · see citing works
Mervis, J., Kuhney, F. S., Russell, M. T., Kinney, K. S., Olino, T. M., Mittal, V. A., Schiffman, J. E., & Ellman, L. M. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.02.004 · Cited by 1 · see citing works
Webb, E. L., Ireland, J. L., & Lewis, M. D. (2025) · Issues in Mental Health Nursing · doi:10.1080/01612840.2025.2473375 · Cited by 1 · see citing works
Cognitive Impairment in Schizophrenia: Definition, Classification, and Course
Penadés, R., Mezquida, G., Forte, M. F., & Ayesa, R. (2025) · Comprehensive approach to psychiatry · doi:10.1007/978-3-032-06209-3_8 · Cited by 1 · see citing works
Psychedelic-assisted therapy, metacognition, and the problem of integration: a tri-phasic approach
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Accessing the mind: relating metacognition to attention, memory, and cognitive function
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Role and limits of socio-normative influences in delusions of control
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Epilogue: Madness Revisited—A 360-Degree Perspective
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Beyond treatment: making social inclusion central to mental health recovery
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Religious Psychopathology: Overview of Clinical, Cultural, and Neurobiological Perspectives
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Orlov, N. D., Sarzyńska, I., Góral-Półrola, J., Leśnicka, P., Bartkowska, O., Stańczyk, S., Siwiec, E., Ziółkowski, A., & Kopańska, M. (2026) · Brain Sciences · doi:10.3390/brainsci16090956
- Authors
- Lysaker, P. H., Hamm, J. A., Hasson-Ohayon, I., Pattison, M. L., & Leonhardt, B. L.
- Affiliations
- Richard L. Roudebush VA Medical Center (US)
- Eskenazi Health (US)
- University of Indianapolis (US)
- Indiana University Indianapolis (US)
- Venue
- World Journal of Psychiatry
- Publisher
- Baishideng Publishing Group Inc.
- Published
- 2018-03-22
- Volume
- 8
- Issue
- 1
- Pages
- 1-11
- ISSN
- 2220-3206 (ISSN-L)
- PMC
- PMC5862649
- OpenAlex
- W2794407239
- Cited by
- 102
- References
- 76
- Citations by year
- 2026: 12 · 2025: 9 · 2024: 9 · 2023: 14 · 2022: 3 · 2021: 6 · 2020: 11 · 2019: 21 · 2018: 17
- FWCI
- 2.12
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc
- Locations
- World Journal of Psychiatry (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- schizophrenia, metacognition, Metacognitive Reflection and Insight Therapy, metacognitive deficits, recovery-oriented interventions, self-awareness, intersubjectivity
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