Paul H Lysaker1, Giancarlo Dimaggio2, Jay A Hamm3, Bethany L Leonhardt4, Jesse Hochheiser5, John T Lysaker6. 1. Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, Indiana, USA, plysaker@iupui.edu. 2. Center for Metacognitive Interpersonal Therapy, Rome, Italy. 3. Department of Psychiatry, Midtown Mental Health Center, Purdue University, Indianapolis, Indiana, USA. 4. Department of Psychiatry, Midtown Mental Health Center, Indiana University School of Medicine, Indianapolis, Indiana, USA. 5. Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA. 6. Department of Philosophy, Emory University, Atlanta, Georgia, USA.
Abstract
BACKGROUND/AIMS: Disturbances in first person experience is a broadly noted feature of schizophrenia, which cannot be reduced to the expression of psychopathology. Yet, though categorically linked with profound suffering, these disturbances are often ignored by most contemporary treatment models. METHODS: In this paper, we present a model, which suggests that deficits in metacognition and their later resolution parsimoniously explain the development of self-disturbance and clarify how persons can later recover. We define "metacognition" as processes integral to the availability of a sense of self and others within the flow of life and report research suggesting its contribution to schizophrenia and link to self-disturbance. RESULTS: We describe a newly emerging integrative form of psychotherapy, Metacognitive Reflection and Insight Therapy (MERIT), designed to target metacognition and enhance the recovery of healthy self-experience. We describe eight measurable core elements that allow MERIT to be operationalized and discuss about how to address disturbances in self-experience. CONCLUSIONS: We detail research that provides evidence of the feasibility, acceptability, and effectiveness of MERIT across a broad range of patients, including those who might not otherwise be offered psychotherapy. MERIT represents one form of psychotherapy that may address self-disorders among adults with schizophrenia.
BACKGROUND/AIMS: Disturbances in first person experience is a broadly noted feature of schizophrenia, which cannot be reduced to the expression of psychopathology. Yet, though categorically linked with profound suffering, these disturbances are often ignored by most contemporary treatment models. METHODS: In this paper, we present a model, which suggests that deficits in metacognition and their later resolution parsimoniously explain the development of self-disturbance and clarify how persons can later recover. We define "metacognition" as processes integral to the availability of a sense of self and others within the flow of life and report research suggesting its contribution to schizophrenia and link to self-disturbance. RESULTS: We describe a newly emerging integrative form of psychotherapy, Metacognitive Reflection and Insight Therapy (MERIT), designed to target metacognition and enhance the recovery of healthy self-experience. We describe eight measurable core elements that allow MERIT to be operationalized and discuss about how to address disturbances in self-experience. CONCLUSIONS: We detail research that provides evidence of the feasibility, acceptability, and effectiveness of MERIT across a broad range of patients, including those who might not otherwise be offered psychotherapy. MERIT represents one form of psychotherapy that may address self-disorders among adults with schizophrenia.