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Leonhardt BL, Visco AC, Hamm JA, Vohs JL. A Recovery-Oriented Approach: Application of Metacognitive Reflection and Insight Therapy (MERIT) for Youth with Clinical High Risk (CHR) for Psychosis. Behav Sci (Basel) 2024; 14:325. [PMID: 38667121 PMCID: PMC11047690 DOI: 10.3390/bs14040325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/29/2024] Open
Abstract
Clinical High Risk for psychosis (CHR) refers to a phase of heightened risk for developing overt psychosis. CHR often emerges during adolescence or early adulthood. CHR has been identified as a group to target for intervention, with the hope that early intervention can both stave off prolonged suffering and intervene before mental health challenges become part of an individual's identity. However, there are few treatment modalities that can address some of the specific needs of CHR. Metacognitive Reflection and Insight Therapy (MERIT) is an integrative psychotherapy that can be applied to the CHR population. MERIT offers unique advantages to working with the CHR population as it aims to improve self-direction and recovery through stimulation of metacognitive capacity, a phenomenon that has been associated with recovery. This paper explores unique aspects of the CHR population and how MERIT can address barriers to recovery for individuals experiencing psychosis-like symptoms. Several case examples and a clinical vignette using MERIT to support patients with CHR are offered to exemplify this approach. MERIT offers a way to assist persons with CHR to address barriers to their personal recovery and to develop nuanced understandings of ways to master challenges.
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Affiliation(s)
- Bethany L. Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.C.V.); (J.L.V.)
- Sandra Eskenazi Mental Health Center, Indianapolis, IN 46202, USA;
| | - Andrew C. Visco
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.C.V.); (J.L.V.)
- Sandra Eskenazi Mental Health Center, Indianapolis, IN 46202, USA;
| | - Jay A. Hamm
- Sandra Eskenazi Mental Health Center, Indianapolis, IN 46202, USA;
- College of Pharmacy Practice, Purdue University, West Lafayette, IN 47907, USA
| | - Jenifer L. Vohs
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.C.V.); (J.L.V.)
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Hamm JA, Leonhardt BL. Reading fiction together to support reflective practice and recovery in serious mental illness: The value of book club. Psychiatr Rehabil J 2023; 46:293-298. [PMID: 38166255 DOI: 10.1037/prj0000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
OBJECTIVE To illustrate the value of reading fiction as a group supervision practice focused on supporting recovery-oriented psychotherapy for individuals experiencing serious mental illness (SMI). METHOD Detailed practical description of the practice and conceptual analysis of the proposed value of using fiction as a group supervision method. FINDINGS Authors suggest that the supervisory practice is a novel component of clinical supervision, and offers value in its ability to promote reflective practice, to establish intersubjectivity among peers and supervisory relationships, and may serve for some to counter risks of clinician burnout. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Participating in a book club that reads fiction as an adjunctive experience to supervision can promote recovery-oriented psychotherapy in four key ways: including its promotion of reflection on self, patients, and the experience of therapy for psychosis, its promotion of reflection on recovery and barriers to recovery, its ability to offer an experiential model of intersubjectivity, and its value in supporting peer consultation and helping offset clinician burnout. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Jay A Hamm
- Eskenazi Health, Sandra Eskenazi Mental Health Center
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Hamm JA, Leonhardt BL, Wiesepape C, Lysaker PH. Supervision of psychotherapy for psychosis: A meaning-making approach. Psychol Serv 2022; 20:326-334. [PMID: 35604696 DOI: 10.1037/ser0000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite its importance in the provision of mental health treatment, the availability of high-quality clinical supervision faces numerous threats in the public sector. Access to high-quality supervision may be especially important for therapists providing services to persons with psychosis. Here, we detail one supervisory approach that has been developed with these considerations in mind; namely, the supervision approach associated with the recovery-oriented integrative therapy metacognitive reflection and insight therapy. We detail three aspects of this approach that have broad appeal and could be easily incorporated into other psychotherapy approaches which include (a) reflecting with supervisees about their experience of the patient, themselves, and the therapeutic relationship, (b) helping supervisees respond to patients' pain and fragmentation with interventions that promote challenge and joint meaning-making, and (c) dealing with threats to this process from both internal pressures within supervisees as well as those posed externally from their agencies. Limitations of this approach and future directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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García-Mieres H, Lysaker P, Leonhardt BL. A Comparison of Personal Recovery in Adults with Early Psychosis and Prolonged Schizophrenia. Psicothema 2022; 34:35-40. [PMID: 35048893 DOI: 10.7334/psicothema2021.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND We aimed to investigate whether personal recovery levels differ between those in early vs prolonged phases of psychosis and if there are different associations with objective outcomes of recovery (i.e., symptom severity and level of functioning). METHOD Participants included 131 patients with early psychosis and 83 patients with prolonged psychosis. The Recovery Assessment Scale was used to assess personal recovery in both samples. The MIRECC-GAF and the CGI-S were used as measures of objective recovery in the early psychosis group. The PANSS and QoL scales were used as measures of objective recovery in the prolonged psychosis group. RESULTS People with early psychosis reported better personal recovery scores in all domains, except willingness to ask for help, compared to individuals with prolonged psychosis. Markers of objective recovery were not correlated with personal recovery in the early psychosis sample but were significantly correlated in the prolonged sample. Depressive symptoms were negatively correlated with personal recovery in the prolonged psychosis group. CONCLUSIONS The relationship between personal and objective recovery may change over time and be dependent on the phase of an individual's illness. In addition, as individuals experience dysfunction over time, they may be more likely to become demoralized and experience lesser degrees of personal recovery.
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Beasley RE, Kivisto AJ, Leonhardt BL, Waldron JS. Childhood Maltreatment and Psychosis: A Comparative Validity Study of Maltreatment Indices. Child Maltreat 2021; 26:228-237. [PMID: 32462923 DOI: 10.1177/1077559520927475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Childhood maltreatment is a robust risk factor for psychosis, but it remains unclear whether different measurement methods provide equivalent validity in predicting psychotic symptoms. This study compared the predictive validity of two common indices of maltreatment at age 12-children's self-report and Child Protective Services (CPS) reports-on the development of psychotic symptoms at age 18 using data from a large, multisite longitudinal study (N = 629). Consistent with prior research, agreement was low between indices, with the prevalence of self-reported maltreatment being 2-3 times higher. A quarter of the sample endorsed at least one psychotic symptom at age 18, most commonly delusions. While CPS-indicated maltreatment was generally not associated with later psychotic symptoms, all forms of self-reported maltreatment were. Sexual abuse demonstrated a particularly strong relationship with psychosis, especially hallucinations. These results suggest that self-reports may provide stronger predictive validity than CPS indications of maltreatment in the assessment of psychosis risk, indicating that a child's interpretation of trauma matters more than the traumatic event itself in this regard.
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Affiliation(s)
- Rhianna E Beasley
- 216442School of Psychological Sciences, University of Indianapolis, IN, USA
- The Institute of Living, Hartford, CT, USA
| | - Aaron J Kivisto
- 216442School of Psychological Sciences, University of Indianapolis, IN, USA
| | - Bethany L Leonhardt
- Prevention and Recovery Center, Sandra Eskenazi Mental Health Center, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jordan S Waldron
- 216442School of Psychological Sciences, University of Indianapolis, IN, USA
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Lysaker PH, Kukla M, Leonhardt BL, Hamm JA, Schnakenberg Martin A, Zalzala AB, Gagen EC, Hasson-Ohayon I. Meaning, integration, and the self in serious mental illness: Implications of research in metacognition for psychiatric rehabilitation. Psychiatr Rehabil J 2020; 43:275-283. [PMID: 32790437 DOI: 10.1037/prj0000436] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE It has been established that recovery is a common outcome for adults diagnosed with serious mental illness which involves objective and subjective phenomenon. While considerable work has examined objective aspects of recovery, it remains difficult to know how to quantify the processes which support more subjective aspects of recovery related to sense of self. This article explores the potential of recent research on metacognition to offer new avenues to measure the processes which make a sense of self available within the flow of life. METHOD Emerging definitions of metacognition using an integrative model of metacognition are reviewed. Research is presented suggesting adults diagnosed with serious mental illness are often confronted by metacognitive deficits which interfere with their ability to make sense of their psychiatric challenges and effectively direct their own recovery. FINDINGS Metacognitive capacity may be a quantifiable phenomenon which contributes to certain aspects of recovery related to meaning making, agency and self-direction. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Promoting metacognitive capacity may be a previously unrecognized active element of existing rehabilitative interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Marina Kukla
- Indianapolis Center of Innovation, Health Services Research and Development, Richard L. Roudebush Veterans Affairs Medical Center
| | | | - Jay A Hamm
- Eskenazi Health Midtown Community Mental Health
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Pattison ML, Leonhardt BL, Abate JF, Huling KS, Belanger EA, O'Connor HM, Lysaker PH. Emergence of insight in psychotherapy for early psychosis: A qualitative analysis of a single case study. Psychiatr Rehabil J 2020; 43:327-334. [PMID: 32406705 DOI: 10.1037/prj0000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Engaging individuals experiencing early psychosis (EP) in mental health treatment is broadly recognized as a challenging endeavor, especially when persons with EP experience impaired insight or relative unawareness of the psychiatric challenges they face. With limited insight they may see little point to treatment and have difficulties forming an alliance with providers. Tackling the issues of poor insight in EP is further complicated by a lack of knowledge of the processes within psychosocial interventions that lead to improved insight. METHOD To explore this, qualitative methods were used to identify content, process, and therapist factors that appeared before and seemed to support insight in a patient experiencing EP as well as the frequency with which insight and psychological problems emerged. The case examined was a 6-month psychotherapy from a pilot study examining the use of metacognitive reflection and insight therapy in EP. RESULTS Five prominent codes were identified across 24 psychotherapy transcripts that appeared to support the development of insight: narrative details, interpersonal relationships, therapist curiosity, therapist support, and therapist challenges. These appear to have allowed for the emergence of psychological problems first and then finally insight into mental health needs. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Addressing metacognitive capacity in psychotherapy may allow persons with low insight to recognize psychological problems and then develop a complex idea about their psychiatric challenges. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Michelle L Pattison
- Department of Psychiatry, Louis Stokes Cleveland Veterans Affairs Medical Center
| | | | | | - Kelsey S Huling
- School of Psychological Sciences, University of Indianapolis
| | | | | | - Paul H Lysaker
- Department of Psychiatry, Roudebush Veterans Affairs Medical Center
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Leonhardt BL, Vohs JL, Bartolomeo LA, Visco A, Hetrick WP, Bolbecker AR, Breier A, Lysaker PH, O'Donnell BF. Relationship of Metacognition and Insight to Neural Synchronization and Cognitive Function in Early Phase Psychosis. Clin EEG Neurosci 2020; 51:259-266. [PMID: 31241355 DOI: 10.1177/1550059419857971] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Metacognition is the process of thinking about one's own mental states. It involves a range of faculties that allow an individual to integrate information and form understanding of self and others, and use this understanding to respond to life challenges. Clinical insight is the awareness of one's mental illness, its consequences, and the need for treatment. Persons with psychotic disorders show impaired metacognition and insight, but the neurobiological bases for these impairments are not well characterized. We hypothesized that metacognition and insight may depend on capacity of neural circuits to synchronize at gamma frequencies, as well as the integrity of underlying cognitive processes. In order to test these hypotheses, 17 adults with early phase psychosis were evaluated. Metacognition was assessed with the Metacognition Assessment Scale-Abbreviated, and insight was assessed with the Scale of Unawareness of Illness-Abbreviated. The auditory steady state response (ASSR) to gamma range stimulation (40 Hz) was used as an index of neural synchronization. Cognitive function was assessed using the Brief Assessment of Cognition in Schizophrenia. Increases in ASSR power were associated with poorer metacognition and insight. Higher cognitive performance was associated with higher levels of metacognitive function and insight. These findings suggest that altered neural synchronization and constituent cognitive processes affect both metacognition and insight in early phase psychosis and may offer targets for both pharmacological and psychotherapeutic interventions.
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Affiliation(s)
- Bethany L Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jenifer L Vohs
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Indianapolis, IN, USA
| | - Lisa A Bartolomeo
- Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Indianapolis, IN, USA
| | - Andrew Visco
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - William P Hetrick
- Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Indianapolis, IN, USA
| | - Amanda R Bolbecker
- Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Indianapolis, IN, USA
| | - Alan Breier
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Paul H Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.,Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Brian F O'Donnell
- Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Indianapolis, IN, USA
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Pec O, Lysaker PH, Probstova V, Leonhardt BL, Hamm JA, Bob P. The Psychotherapeutic Treatment of Schizophrenia: Psychoanalytical Explorations of the Metacognitive Movement. J Contemp Psychother 2020. [DOI: 10.1007/s10879-020-09452-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lysaker PH, Dimaggio G, Hamm JA, Leonhardt BL, Hochheiser J, Lysaker JT. Disturbances in Self-Experience in Schizophrenia: Metacognition and the Development of an Integrative Recovery-Oriented Individual Psychotherapy. Psychopathology 2019; 52:135-142. [PMID: 30537720 DOI: 10.1159/000495297] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022]
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.
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Affiliation(s)
- Paul H Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, Indiana, USA,
| | | | - Jay A Hamm
- Department of Psychiatry, Midtown Mental Health Center, Purdue University, Indianapolis, Indiana, USA
| | - Bethany L Leonhardt
- Department of Psychiatry, Midtown Mental Health Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jesse Hochheiser
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - John T Lysaker
- Department of Philosophy, Emory University, Atlanta, Georgia, USA
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Lysaker PH, Hamm JA, Vohs J, Kukla M, Pattison ML, Leonhardt BL, Lysaker JT. Understanding the Course of Self-disorders and Alterations in Self- Experience in Schizophrenia: Implications from Research on Metacognition. ACTA ACUST UNITED AC 2018. [DOI: 10.2174/1573400514666180816113159] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Paul H. Lysaker
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, United States
| | - Jay A. Hamm
- Purdue University College of Education, West Lafayette, IN 46202, United States
| | - Jenifer Vohs
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, United States
| | - Marina Kukla
- Roudebush VA Medical Center, Indianapolis, IN 46202, USA; 2Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, United States
| | - Michelle L. Pattison
- University of Indianapolis, College of Applied Behavioral Sciences, Indianapolis, IN 46227, United States
| | - Bethany L. Leonhardt
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, United States
| | - John T. Lysaker
- Emory University, Department of Philosophy, Atlanta, GA 30322, United States
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Abstract
Despite historically pessimistic views from both the professional community and lay public, research is emerging that recovery from psychosis is possible. Recovery has evolved to include not only a reduction in symptoms and return to functioning, but a sense of agency and connection to meaningful roles in life. The development of a more comprehensive conceptualization of recovery has particular importance in the treatment of first-episode psychosis, because early intervention may avoid some of the prolonged dysfunction that may make recovery difficult. As the mental health field moves to intervene early in the course of psychosis and to support recovery for individuals with severe mental illness, it is essential to develop and assess interventions that may promote a more comprehensive recovery. This case illustration offers an account of a type of integrative psychotherapy that may assist individuals in achieving recovery: metacognitive reflection and insight therapy (MERIT).
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Affiliation(s)
- Bethany L Leonhardt
- Prevention and Recovery Center, Eskenazi Health/Midtown Community Mental Health, Indianapolis (Leonhardt, Ratliff, Vohs); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Leonhardt, Vohs)
| | - Kristen Ratliff
- Prevention and Recovery Center, Eskenazi Health/Midtown Community Mental Health, Indianapolis (Leonhardt, Ratliff, Vohs); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Leonhardt, Vohs)
| | - Jenifer L Vohs
- Prevention and Recovery Center, Eskenazi Health/Midtown Community Mental Health, Indianapolis (Leonhardt, Ratliff, Vohs); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Leonhardt, Vohs)
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James AV, Leonhardt BL, Buck KD. Metacognitive Reflection and Insight Therapy for Schizophrenia: Case Study of a Patient With a Co-Occurring Substance Use Disorder. Am J Psychother 2018; 71:155-163. [PMID: 30400766 DOI: 10.1176/appi.psychotherapy.20180038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Decrements in metacognitive functioning, or the ability to form complex and integrated representations of oneself and others, have been identified as a core feature of schizophrenia. These deficits have been observed to be largely independent of the severity of psychopathology and neurocognitive functioning and are linked to poor outcomes for those with the disorder. This study is a case illustration of the efficacy of metacognitive reflection and insight therapy (MERIT) in increasing the metacognitive capacity of an individual diagnosed as having co-occurring schizophrenia and a substance use disorder during three years of individual therapy. The eight elements of MERIT, which promote metacognitive growth, are presented as they apply to the present case. Case conceptualization, outcomes, and prognosis are also presented. These eight elements enabled the patient to move from a state of gross disorganization-unable to identify his thoughts or present them in a linear fashion-to one in which he was able to develop increasingly complex ideas about himself and others and integrate this understanding into a richer sense of himself, of his psychological challenges, and of the role that substance use played in his life. Results of the study also illustrate the foundational necessity of self-reflectivity in order to facilitate understanding of the mind of others and the relationship between psychological pain and the emergence of disorganization.
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Affiliation(s)
- Alison V James
- Department of Psychiatry, Kaiser Permanente, Redwood City, California (James); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Leonhardt); Richard L. Roudebush VA Medical Center, Indianapolis (Buck)
| | - Bethany L Leonhardt
- Department of Psychiatry, Kaiser Permanente, Redwood City, California (James); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Leonhardt); Richard L. Roudebush VA Medical Center, Indianapolis (Buck)
| | - Kelly D Buck
- Department of Psychiatry, Kaiser Permanente, Redwood City, California (James); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Leonhardt); Richard L. Roudebush VA Medical Center, Indianapolis (Buck)
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Hamm JA, Leonhardt BL, Ridenour J, Lysaker JT, Lysaker PH. Phenomenological and recovery models of the subjective experience of psychosis: discrepancies and implications for treatment. Psychosis 2018. [DOI: 10.1080/17522439.2018.1522540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jay A. Hamm
- Midtown Community Mental Health, Eskenazi Health, Indianapolis IN, USA
- College of Pharmacy, Purdue University, Indianapolis IN, USA
| | - Bethany L. Leonhardt
- Midtown Community Mental Health, Eskenazi Health, Indianapolis IN, USA
- School of Medicine, Indiana University, Indianapolis IN, USA
| | | | | | - Paul H. Lysaker
- School of Medicine, Indiana University, Indianapolis IN, USA
- Roudebush VA Medical Center, Indianapolis IN, USA
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Lysaker PH, Zalzala AB, Ladegaard N, Buck B, Leonhardt BL, Hamm JA. A Disorder by Any Other Name: Metacognition, Schizophrenia, and Diagnostic Practice. Journal of Humanistic Psychology 2018. [DOI: 10.1177/0022167818787881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Humanistic psychology has made us aware that any understanding of schizophrenia must see persons diagnosed with this condition as whole persons who are making sense of what wellness and recovery mean to them. This has raised questions about what the diagnosis of schizophrenia means and whether the diagnostic label of schizophrenia is helpful when we try to conceptualize the actions and aims of treatment. To examine this issue we propose it is essential to consider what is systematically occuring psychologicaly in recovery when persons experience, interpret and agentically respond to emerging challenges. We then review how the integrated model of metacognition provides a systematic, person-centered, evidence-based approach to understanding psychological processes which impact recovery, and discuss how this guides a form of psychotherapy, metacognitive reflection and insight therapy, which promotes metacognitive abilities and support recovery. We suggest this work indicates that metacognitive capacity is something that can be diagnosed without stigmatizing persons. It can be used to meaningfully inform clinical practice across various theoretical models and offers concrete implications for rehabilitation.
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Affiliation(s)
- Paul H. Lysaker
- Roudebush VA Medical Center, Indianapolis IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Aieyat B. Zalzala
- Roudebush VA Medical Center, Indianapolis IN, USA
- Purdue University, West Lafayette, IN, USA
| | | | - Benjamin Buck
- Puget Sound VA Health Care System, Seattle, WA, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bethany L. Leonhardt
- Indiana University School of Medicine, Indianapolis, IN, USA
- Eskenazi Health—Midtown Community Mental Health, Indianapolis, IN, USA
| | - Jay A. Hamm
- Purdue University, West Lafayette, IN, USA
- Eskenazi Health—Midtown Community Mental Health, Indianapolis, IN, USA
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Bonfils KA, Minor KS, Leonhardt BL, Lysaker PH. Metacognitive self-reflectivity moderates the relationship between distress tolerance and empathy in schizophrenia. Psychiatry Res 2018; 265:1-6. [PMID: 29679792 PMCID: PMC6309172 DOI: 10.1016/j.psychres.2018.04.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/30/2018] [Accepted: 04/12/2018] [Indexed: 10/17/2022]
Abstract
Deficits in empathy seen in schizophrenia are thought to play a major role in the social dysfunction seen in the disorder. However, little work has investigated potential determinants of empathic deficits. This study aimed to fill that gap by examining the effects of two variables on empathy - distress tolerance and metacognitive self-reflectivity. Fifty-four people with schizophrenia-spectrum disorders receiving services at an urban VA or community mental health center were assessed for empathy, metacognition, and distress tolerance. Bivariate correlations and moderation methods were used to ascertain associations amongst these variables and examine interactions. Results revealed that, against hypotheses, empathy was not related at the bivariate level to either distress tolerance or metacognitive self-reflectivity. However, consistent with hypotheses, moderation analyses revealed that participants with higher self-reflectivity showed no relationship between distress tolerance and empathy, while those with lower self-reflectivity showed a relationship such that reduced ability to tolerate distress predicted reduced empathy. Taken together, results of this study suggest that lack of distress tolerance can negatively affect empathy in people with schizophrenia with lesser capacity for metacognitive self-reflection; thus, fostering self-reflectivity may help overcome that negative impact. Future work is needed investigating the impact of metacognitively-tailored interventions on empathy in this population.
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Affiliation(s)
- Kelsey A. Bonfils
- Psychology Department, Indiana University-Purdue University Indianapolis
| | - Kyle S. Minor
- Psychology Department, Indiana University-Purdue University Indianapolis
| | | | - Paul H. Lysaker
- Psychiatry Department, Indiana University School of Medicine,Psychiatry Department, Richard L. Roudebush VA Medical Center,Correspondence concerning this article should be addressed to Paul H. Lysaker, Roudebush VA Medical Center 1481 West 10th St., Indianapolis. IN 46202.
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Belanger EA, Leonhardt BL, George SE, Firmin RL, Lysaker PH. Negative symptoms and therapeutic connection: A qualitative analysis in a single case study with a patient with first episode psychosis. Journal of Psychotherapy Integration 2018. [DOI: 10.1037/int0000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hamm JA, Buck KD, Leonhardt BL, Luther L, Lysaker PH. Self-directed recovery in schizophrenia: Attending to clients’ agendas in psychotherapy. Journal of Psychotherapy Integration 2018. [DOI: 10.1037/int0000070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vohs JL, Leonhardt BL, James AV, Francis MM, Breier A, Mehdiyoun N, Visco AC, Lysaker PH. Metacognitive Reflection and Insight Therapy for Early Psychosis: A preliminary study of a novel integrative psychotherapy. Schizophr Res 2018; 195:428-433. [PMID: 29108671 DOI: 10.1016/j.schres.2017.10.041] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 10/26/2017] [Accepted: 10/28/2017] [Indexed: 12/23/2022]
Abstract
Poor insight impedes treatment in early phase psychosis (EPP). This manuscript outlines preliminary findings of an investigation of the novel metacognitively oriented integrative psychotherapy, Metacognitive Reflection and Insight Therapy, for individuals with early phase psychosis (MERIT-EP). Twenty adults with EPP and poor insight were randomized to either six months of MERIT-EP or treatment as usual (TAU). Therapists were trained and therapy was successfully delivered under routine, outpatient conditions. Insight, assessed before and after treatment, revealed significant improvement for the MERIT-EP, but not TAU, group. These results suggest MERIT-EP is feasible to deliver, accepted by patients, and leads to clinically significant improvements in insight.
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Affiliation(s)
- Jenifer L Vohs
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Eskenzai Health, Midtown Community Mental Health Centers, Prevention and Recovery Center for Early Psychosis, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA.
| | - Bethany L Leonhardt
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Eskenzai Health, Midtown Community Mental Health Centers, Prevention and Recovery Center for Early Psychosis, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA
| | - Alison V James
- San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA
| | - Michael M Francis
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Eskenzai Health, Midtown Community Mental Health Centers, Prevention and Recovery Center for Early Psychosis, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA
| | - Alan Breier
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Eskenzai Health, Midtown Community Mental Health Centers, Prevention and Recovery Center for Early Psychosis, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA
| | - Nikki Mehdiyoun
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Eskenzai Health, Midtown Community Mental Health Centers, Prevention and Recovery Center for Early Psychosis, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA
| | - Andrew C Visco
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Eskenzai Health, Midtown Community Mental Health Centers, Prevention and Recovery Center for Early Psychosis, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA
| | - Paul H Lysaker
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Richard L Roudebush VA Medical Center, 1481 W 10th St, Indianapolis, IN 46202, USA
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Leonhardt BL, Lysaker PH, Vohs JL, James AV, Davis LW. The experience and expression of anger in posttraumatic stress disorder: the relationship with metacognition. J Ment Health 2018; 27:432-437. [PMID: 29698063 DOI: 10.1080/09638237.2018.1466036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anger experience and expression are a common issue in those experiencing PTSD. However, it remains unclear what variables affect anger and its expression in PTSD. AIMS To explore the relationships of synthetic forms of metacognition and metacognitive beliefs with anger experience and expression in PTSD, independent of the effects hyperarousal and depression symptoms. METHOD Participants were 51 veterans with diagnosed with PTSD. Metacognition was assessed using the Metacognition Assessment Scale-Abbreviated (MAS-A) and the Metacognitions Questionnaire (MCQ). Depression, PTSD symptom severity, and seven domains of anger expression were also assessed. RESULTS Correlations showed after controlling for overall levels of hyperarousal, higher MAS-A total scores were related to lower levels of State Anger, Feeling Angry, Expressing Anger Physically, and Anger Expression in. Lower MCQ scores were related to lower State anger, Expressing anger verbally, and Expressing anger physically. Higher levels of depression were related to higher levels of Trait anger, Expressing anger physically, Anger expression out, and Anger expression in. Multiple regressions suggested that the MAS-A and MCQ predicted unique portions of the variance in anger experience and expression. CONCLUSIONS Metacognitive deficits may affect anger experience and expression in those with PTSD and may be an important treatment target.
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Affiliation(s)
- Bethany L Leonhardt
- a Department of Psychiatry , Indiana School of Medicine , Indianapolis , IN , USA.,b Larue D. Carter Memorial Hospital, Indiana University Psychotic Disorders Program , Indianapolis , IN , USA
| | - Paul H Lysaker
- a Department of Psychiatry , Indiana School of Medicine , Indianapolis , IN , USA.,c Roudebush Veteran Affairs Medical Center , Indianapolis , IN , USA , and
| | - Jenifer L Vohs
- a Department of Psychiatry , Indiana School of Medicine , Indianapolis , IN , USA.,b Larue D. Carter Memorial Hospital, Indiana University Psychotic Disorders Program , Indianapolis , IN , USA
| | - Alison V James
- c Roudebush Veteran Affairs Medical Center , Indianapolis , IN , USA , and.,d Department of Psychology , Indiana State University , Terre Haute , IN , USA
| | - Louanne W Davis
- c Roudebush Veteran Affairs Medical Center , Indianapolis , IN , USA , and
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Lysaker PH, Hamm JA, Hasson-Ohayon I, Pattison ML, Leonhardt BL. Promoting recovery from severe mental illness: Implications from research on metacognition and metacognitive reflection and insight therapy. World J Psychiatry 2018; 8:1-11. [PMID: 29568726 PMCID: PMC5862649 DOI: 10.5498/wjp.v8.i1.1] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/04/2017] [Accepted: 01/07/2018] [Indexed: 02/05/2023] Open
Abstract
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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Affiliation(s)
- Paul Henry Lysaker
- Department of Psychiatry, Roudebush VA Med Ctr and the Indiana Univeristy School of Medicine, Indianapolis, IN 46254, United States
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46254, United States
| | - Jay A Hamm
- Department of Psychiatry, Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN 46202, United States
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN 46202, United States
| | - Ilanit Hasson-Ohayon
- Department of Psychology, Hasson-Ohayon, I, Bar Ilan Univ, Dept Psychol, Ramat Gan 5290002, Israel
| | - Michelle L Pattison
- Department of Psychology, University of Indianapolis, College of Applied Behavioral Sciences, Indianapolis, IN 46227, United States
| | - Bethany L Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46254, United States
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN 46202, United States
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Lysaker PH, Pattison ML, Leonhardt BL, Phelps S, Vohs JL. Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry 2018; 17:12-23. [PMID: 29352540 PMCID: PMC5775127 DOI: 10.1002/wps.20508] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michelle L Pattison
- College of Applied Behavioral Sciences, University of Indianapolis, Indianapolis, IN, USA
| | - Bethany L Leonhardt
- Indiana University School of Medicine, Eskenazi Health-Midtown Community Mental Health, Indianapolis, IN, USA
| | | | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, IN, USA
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Lysaker PH, George S, Chaudoin-Patzoldt KA, Pec O, Bob P, Leonhardt BL, Vohs JL, James AV, Wickett A, Buck KD, Dimaggio G. Contrasting metacognitive, social cognitive and alexithymia profiles in adults with borderline personality disorder, schizophrenia and substance use disorder. Psychiatry Res 2017; 257:393-399. [PMID: 28826064 DOI: 10.1016/j.psychres.2017.08.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/21/2017] [Accepted: 08/01/2017] [Indexed: 01/28/2023]
Abstract
Deficits in the ability to recognize and think about mental states are broadly understood to be a root cause of dysfunction in Borderline Personality Disorder (PD). This study compared the magnitude of those deficits relative to other forms of serious mental illness or psychiatric conditions. Assessments were performed using the metacognition assessment scale-abbreviated (MAS-A), emotion recognition using the Bell Lysaker Emotion Recognition Test and alexithymia using the Toronto Alexithymia Scale among adults with schizophrenia (n = 65), Borderline PD (n = 34) and Substance Use disorder without psychosis or significant Borderline traits (n = 32). ANCOVA controlling for age revealed the Borderline PD group had significantly greater levels of metacognitive capacity on the MAS-A than the schizophrenia group and significantly lower levels of metacognitive capacity than the Substance Use group. Multiple comparisons revealed the Borderline PD group had significantly higher self-reflectivity and awareness of the other's mind than the schizophrenia group but lesser mastery and decentration on the MAS-A than substance use group, after controlling for self-report of psychopathology and overall number of PD traits. The Borderline PD and Schizophrenia group had significantly higher levels of alexithymia than the substance use group. No differences were found for emotion recognition. Results suggest metacognitive functioning is differentially affected in different mental disorders.
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Affiliation(s)
- Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Day Hospital 116H, 1481 W. 10th Street, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA.
| | - Sunita George
- School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, GH109, Indianapolis, IN 46227, USA
| | - Kelly A Chaudoin-Patzoldt
- School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, GH109, Indianapolis, IN 46227, USA
| | - Ondrej Pec
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry, First Faculty of Medicine, Charles University, Ovocný trh 3-5, 116 36 Praha 1-Staré Město, Prague, Czech Republic; Psychotherapeutic and Psychosomatic Clinic ESET, Prague, Czech Republic
| | - Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry, First Faculty of Medicine, Charles University, Ovocný trh 3-5, 116 36 Praha 1-Staré Město, Prague, Czech Republic
| | - Bethany L Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA
| | - Jenifer L Vohs
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA
| | - Alison V James
- Department of Psychology, Indiana State University, B-207 Root Hall, 200 N. Seventh Street, Terre Haute, IN 47809, USA
| | - Amanda Wickett
- Richard L. Roudebush VA Medical Center, Day Hospital 116H, 1481 W. 10th Street, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA
| | - Kelly D Buck
- Richard L. Roudebush VA Medical Center, Day Hospital 116H, 1481 W. 10th Street, Indianapolis, IN 46202, USA
| | - Giancarlo Dimaggio
- Center for Metacognitive Psychotherapy, Piazza dei Martiri di Belfiore 4, 00195 Rome, Italy
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Leonhardt BL, Huling K, Hamm JA, Roe D, Hasson-Ohayon I, McLeod HJ, Lysaker PH. Recovery and serious mental illness: a review of current clinical and research paradigms and future directions. Expert Rev Neurother 2017; 17:1117-1130. [PMID: 28885065 DOI: 10.1080/14737175.2017.1378099] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Recovery from serious mental illness has historically not been considered a likely or even possible outcome. However, a range of evidence suggests the courses of SMI are heterogeneous with recovery being the most likely outcome. One barrier to studying recovery in SMI is that recovery has been operationalized in divergent and seemingly incompatible ways: as an objective outcome versus a subjective process. Areas covered: This paper offers a review of recovery as a subjective process and recovery as an objective outcome; contrasts methodologies utilized by each approach to assess recovery; reports rates and correlates of recovery; and explores the relationship between objective and subjective forms of recovery. Expert commentary: There are two commonalities of approaching recovery as a subjective process and an objective outcome: (i) the need to make meaning out of one's experiences to engage in either type of recovery and (ii) there exist many threats to engaging in meaning making that may impact the likelihood of moving toward recovery. We offer four clinical implications that stem from these two commonalities within a divided approach to the concept of recovery from SMI.
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Affiliation(s)
- Bethany L Leonhardt
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.,b Midtown Community Mental Health , Eskenazi Health , Indianapolis , IN , USA
| | - Kelsey Huling
- c School of Psychological Sciences , University of Indianapolis , Indianapolis , IN , USA
| | - Jay A Hamm
- b Midtown Community Mental Health , Eskenazi Health , Indianapolis , IN , USA
| | - David Roe
- d Department of Community Mental Health, Faculty of Social Welfare and Health Sciences , University of Haifa , Haifa , Israel
| | | | - Hamish J McLeod
- f Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences , University of Glasgow , Glasgow , UK
| | - Paul H Lysaker
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.,g Department of Psychiatry , Richard L. Roudebush Veteran Affairs Medical Center , Indianapolis , IN , USA
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Francis MM, Hummer TA, Leonhardt BL, Vohs JL, Yung MG, Mehdiyoun NF, Lysaker PH, Breier A. Association of medial prefrontal resting state functional connectivity and metacognitive capacity in early phase psychosis. Psychiatry Res Neuroimaging 2017; 262:8-14. [PMID: 28208070 DOI: 10.1016/j.pscychresns.2016.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 11/08/2016] [Accepted: 12/08/2016] [Indexed: 02/07/2023]
Abstract
Metacognition refers to a range of cognitive processes that allow one to form complex ideas of self and others and to use this information to navigate psychosocial challenges. Several studies in both early-phase and prolonged schizophrenia have demonstrated not only that significant deficits in metacognitive ability are present, but importantly that they are associated with significant functional impairment and decreased quality of life. In spite of the importance of metacognitive impairment in schizophrenia, relatively little is known about the biological substrates that may contribute to this dysfunction. In this study, we examined the relationship between resting state functional connectivity of the medial prefrontal cortex (mPFC), a structure shown in prior voxel-based morphometry studies to be associated with metacognition, with metacognitive function in an early-phase psychosis cohort (n=18). Analyses revealed a positive association of resting state functional connectivity between the mPFC and precuneus and posterior cingulate structures and metacognitive ability. These results provide evidence of disrupted resting state connectivity in structures relevant to metacognitive dysfunction in early-phase psychosis, which may have implications for pathophysiological models of complex cognitive deficits in this illness.
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Affiliation(s)
- Michael M Francis
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
| | - Tom A Hummer
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA.
| | - Bethany L Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
| | - Jenifer L Vohs
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
| | - Matt G Yung
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA.
| | - Nicole F Mehdiyoun
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
| | - Paul H Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Roudebush VA Medical Hospital, 1481 W 10th St., Indianapolis, IN 46202, USA.
| | - Alan Breier
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
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Hamm JA, Buck B, Leonhardt BL, Wasmuth S, Lysaker JT, Lysaker PH. Overcoming fragmentation in the treatment of persons with schizophrenia. Journal of Theoretical and Philosophical Psychology 2017. [DOI: 10.1037/teo0000054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Leonhardt BL, Kukla M, Belanger E, Chaudoin-Patzoldt K, Buck KD, Minor KS, Vohs J, Hamm JA, Lysaker PH. Emergence of psychotic content in psychotherapy: An exploratory qualitative analysis of content, process, and therapist variables in a single case study. Psychother Res 2016; 28:264-280. [DOI: 10.1080/10503307.2016.1219421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Bethany L. Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Psychotic Disorders Program, Indianapolis, IN, USA
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Marina Kukla
- Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Elizabeth Belanger
- School of Psychological Sciences, University of Indianapolis, Indianapolis, IN, USA
| | | | | | - Kyle S. Minor
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Psychotic Disorders Program, Indianapolis, IN, USA
| | - Jenifer L. Vohs
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Psychotic Disorders Program, Indianapolis, IN, USA
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Jay A. Hamm
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Paul H. Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Roudebush VA Medical Center, Indianapolis, IN, USA
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James AV, Hasson-Ohayon I, Vohs J, Minor KS, Leonhardt BL, Buck KD, George S, Lysaker PH. Metacognition moderates the relationship between dysfunctional self-appraisal and social functioning in prolonged schizophrenia independent of psychopathology. Compr Psychiatry 2016; 69:62-70. [PMID: 27423346 DOI: 10.1016/j.comppsych.2016.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/06/2016] [Accepted: 05/10/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Both dysfunctional self-appraisal and metacognitive deficits, or impairments in the ability to form complex and integrated ideas about oneself and others, may contribute to social deficits in schizophrenia. Little is known, however, about how they interact with each other. In this study, we examined the hypothesis that both higher metacognition and more positive self-appraisal are necessary for increased social functioning. METHODS Concurrent assessments of self-appraisal, metacognition, and social functioning were gathered from 66 adults with schizophrenia in a non-acute phase of disorder. Three forms of self-appraisal were used: self-esteem, hope and self-efficacy. Metacognition was assessed using the Metacognitive Assessment Scale-Abbreviated, and social functioning with the Quality of Life Scale. Measures of psychopathology, neurocognition and social cognition were also gathered for use as potential covariates. RESULTS A single index of self-appraisal was generated from subjecting the assessments of self-appraisal to a principal components analysis. Linear regression analyses revealed that after controlling for severity of psychopathology, metacognition moderated the effect of the self-appraisal factor score upon social functioning. A median split of metacognition and the self-appraisal index yielded four groups. ANCOVA analyses revealed that participants with higher levels of metacognition and more positive self-appraisal had greater capacities for social relatedness than all other participants, regardless of levels of positive and negative symptoms. Correlational analyses revealed that metacognition but not self-appraisal was related to the frequencies of social contact independent of the effects of psychopathology. Assessments of social cognition and neurocognition were not significantly linked with social dysfunction. CONCLUSION Greater social functioning is made possible by a combination of both more positive self-appraisals and greater metacognitive capacity. Individuals with schizophrenia who struggle to relate to others may benefit from interventions which address both their beliefs about themselves and their capacity for metacognition.
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Affiliation(s)
- Alison V James
- Indiana State University, Department of Psychology, Terre Haute, IN, USA
| | | | - Jenifer Vohs
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Bethany L Leonhardt
- Indiana University School of Medicine, Department of Psychiatry, Indiana University Psychotic Disorders Program
| | - Kelly D Buck
- Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Sunita George
- University of Indianapolis, School of Psychological Science, Indianapolis, IN, USA
| | - Paul H Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA; Roudebush VA Medical Center, Indianapolis, IN, USA.
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Vohs JL, George S, Leonhardt BL, Lysaker PH. An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments. Expert Rev Neurother 2016; 16:1193-204. [PMID: 27278672 DOI: 10.1080/14737175.2016.1199275] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Poor insight, or unawareness of some major aspect of mental illness, is a major barrier to wellness when it interferes with persons seeking out treatment or forming their own understanding of the challenges they face. One barrier to addressing impaired insight is the absence of a comprehensive model of how poor insight develops. AREAS COVERED To explore this issue we review how poor insight is the result of multiple phenomena which interfere with the construction of narrative accounts of psychiatric challenges, rather than a single social or biological cause. Expert commentary: We propose an integrative model of poor insight in schizophrenia which involves the interaction of symptoms, deficits in neurocognition, social cognition, metacognition, and stigma. Emerging treatments for poor insight including therapies which focus on the development of metacognition are discussed.
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Affiliation(s)
- Jenifer L Vohs
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Sunita George
- b School of Psychological Sciences , University of Indianapolis , Indianapolis , IN , USA
| | - Bethany L Leonhardt
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Paul H Lysaker
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.,c Roudebush VA Medical Hospital , Indianapolis , IN , USA
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Vohs JL, Leonhardt BL, Francis MM, Westfall D, Howell J, Bolbecker AR, O’Donnell BF, Hetrick WP, Lysaker PH. A Preliminary Study of the Association Among Metacognition and Resting State EEG in Schizophrenia. J PSYCHOPHYSIOL 2016. [DOI: 10.1027/0269-8803/a000153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract. Metacognition refers to a spectrum of activities that range from the consideration of discrete mental experiences, such as a specific thought or emotion, to the synthesis of discrete perceptions into integrated representations of the self and others as unique agents in the world. Metacognitive deficits have been observed in schizophrenia and linked with a number of behavioral correlates and outcomes. Less is known however about the neural systems associated with such processes. Establishing the link between brain activity and metacognition therefore is an essential next step. Resting state electroencephalography (EEG) provides one possible avenue for investigating this link. EEG studies in schizophrenia suggest that the gamma frequency range may have functional significance and be related to the disturbed information processing often observed in the disorder. In the present investigation, we assessed metacognition among 20 individuals with prolonged schizophrenia using the Metacognition Assessment Scale Abbreviated, who also participated in resting state EEG recording. We hypothesized that gamma activity would be associated with those domains of metacognition that require the most integration to perform, Decentration and Mastery. We then examined the association among gamma power and each metacognitive domain. Additional exploratory analyses were conducted across a spectrum of EEG activity. We found that increased gamma activity at rest was linked with decreased decentration. This suggests that hyperactivity in the gamma range may index disrupted processing and integration, and ultimately the metacognitive processes needed to form complex ideas about oneself and others and to see the world from multiple perspectives. This link provides additional evidence of how the biological roots of schizophrenia may culminate in a disrupted life.
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Affiliation(s)
- Jenifer L. Vohs
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN, USA
- Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA
| | - Bethany L. Leonhardt
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN, USA
| | - Michael M. Francis
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN, USA
- Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA
| | - Daniel Westfall
- Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA
- Indiana University Bloomington, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - Josselyn Howell
- Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA
- Indiana University Bloomington, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - Amanda R. Bolbecker
- Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA
- Indiana University Bloomington, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - Brian F. O’Donnell
- Indiana University Bloomington, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - William P. Hetrick
- Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA
- Indiana University Bloomington, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - Paul H. Lysaker
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN, USA
- Roudebush VA Medical Hospital, Indianapolis, IN, USA
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Davis LW, Leonhardt BL, Siegel A, Brustuen B, Luedtke B, Vohs JL, James AV, Lysaker PH. Metacognitive capacity predicts severity of trauma-related dysfunctional cognitions in adults with posttraumatic stress disorder. Psychiatry Res 2016; 237:182-7. [PMID: 26837477 DOI: 10.1016/j.psychres.2016.01.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/17/2015] [Accepted: 01/21/2016] [Indexed: 11/18/2022]
Abstract
Deficits in metacognition have been proposed as a barrier to adaptive responding to trauma. However, little is known about how different aspects of metacognitive capacity relate to responses to trauma and whether their potential link to such responses is independent of the overall level of psychopathology. To explore both issues, negative trauma-related cognitions about the self, the world, and self-blame, as measured by the Posttraumatic Cognitions Inventory (PTCI), were correlated with concurrent measures of depression, posttraumatic stress disorder symptoms, and two forms of metacognition; the Metacognitions questionnaire (MCQ-30), which focuses on specific thoughts, and the Metacognition Assessment Scale Abbreviated (MAS-A) which focuses on the degree to which persons can form complex representations of self and other. Participants were 51 veterans of the wars in Iraq and Afghanistan who had a PTSD diagnosis primarily involving a combat-related index trauma. Correlations revealed that being younger and more depressed were linked with greater levels of negative cognitions about self and the world. Lower levels of self-reflectivity on the MAS-A and higher levels of cognitive self-consciousness on the MCQ-30 were uniquely related to greater levels of self-blame even after controlling for age, level of depression, and PTSD. Implications for research and treatment are discussed.
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Affiliation(s)
- Louanne W Davis
- Psychiatry Department, Roudebush VA Medical Center, 1481 West 10th Street, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, Goodman Hall, 355 W. 16th St, Suite 4800, Indianapolis, IN 46202, USA.
| | - Bethany L Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, Goodman Hall, 355 W. 16th St, Suite 4800, Indianapolis, IN 46202, USA
| | - Alysia Siegel
- School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Ave GH109, Indianapolis, IN 46227, USA
| | - Beth Brustuen
- School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Ave GH109, Indianapolis, IN 46227, USA
| | - Brandi Luedtke
- Department of Psychology, Carl T. Hayden VA Medical Center, 650 E Indian School Rd, Phoenix, AZ 85012, USA
| | - Jennifer L Vohs
- Department of Psychiatry, Indiana University School of Medicine, Goodman Hall, 355 W. 16th St, Suite 4800, Indianapolis, IN 46202, USA
| | - Alison V James
- Department of Psychology, Indiana State University, Root Hall B-202,Terre Haute, IN 47809, USA
| | - Paul H Lysaker
- Psychiatry Department, Roudebush VA Medical Center, 1481 West 10th Street, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, Goodman Hall, 355 W. 16th St, Suite 4800, Indianapolis, IN 46202, USA
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Hamm JA, Leonhardt BL. The Role of Interpersonal Connection, Personal Narrative, and Metacognition in Integrative Psychotherapy for Schizophrenia: A Case Report. J Clin Psychol 2015; 72:132-41. [PMID: 26662610 DOI: 10.1002/jclp.22247] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The recovery movement has not only challenged traditional pessimism regarding schizophrenia but also presented opportunities for the possibilities for psychotherapy for people with the disorder. Though in the past psychotherapy models were often pitted against one another, recently there have been emergent reports of a range of integrative models sharing an emphasis on recovery and a number of conceptual elements. These shared elements include attention to the importance of interpersonal processes, personal narrative, and metacognition, with interest in their role in not only the disorder but also the processes by which people pursue recovery. This article explores one application of this framework in the psychotherapy of a woman with prolonged experience of schizophrenia and significant functional impairments.
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Affiliation(s)
- Jay A Hamm
- Midtown Community Mental Health Center, Eskenazi Health
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Lysaker PH, Kukla M, Dubreucq J, Gumley A, McLeod H, Vohs JL, Buck KD, Minor KS, Luther L, Leonhardt BL, Belanger EA, Popolo R, Dimaggio G. Metacognitive deficits predict future levels of negative symptoms in schizophrenia controlling for neurocognition, affect recognition, and self-expectation of goal attainment. Schizophr Res 2015; 168:267-72. [PMID: 26164820 DOI: 10.1016/j.schres.2015.06.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 01/19/2023]
Abstract
The recalcitrance of negative symptoms in the face of pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. Accordingly, this study investigated whether deficits in metacognition, or the ability to form integrated ideas about oneself, others, and the world, prospectively predicted levels of negative symptoms independent of deficits in neurocognition, affect recognition and defeatist beliefs. Participants were 53 adults with a schizophrenia spectrum disorder. Prior to entry into a rehabilitation program, all participants completed concurrent assessments of metacognition with the Metacognitive Assessment Scale-Abbreviated, negative symptoms with the Positive and Negative Syndrome Scale, neurocognition with the MATRICS battery, affect recognition with the Bell Lysaker Emotion Recognition Task, and one form of defeatist beliefs with the Recovery Assessment Scale. Negative symptoms were then reassessed one week, 9weeks, and 17weeks after entry into the program. A mixed effects regression model revealed that after controlling for baseline negative symptoms, a general index of neurocognition, defeatist beliefs and capacity for affect recognition, lower levels of metacognition predicted higher levels of negative symptoms across all subsequent time points. Poorer metacognition was able to predict later levels of elevated negative symptoms even after controlling for initial levels of negative symptoms. Results may suggest that metacognitive deficits are a risk factor for elevated levels of negative symptoms in the future. Clinical implications are also discussed.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA; Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA.
| | - Marina Kukla
- Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA; Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA.
| | - Julien Dubreucq
- Center of Reference for Psychosocial Rehabilitation, CH Alpes Isère, Grenoble, France; Réseau Handicap Psychique (RéHPsy), Grenoble, France.
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Hamish McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jenifer L Vohs
- Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA; Prevention and Recovery Center for Early Psychosis, Midtown Community Mental Health Centers, Wishard Hospital, Indianapolis, IN, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA.
| | - Kelly D Buck
- Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA.
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA.
| | - Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA.
| | - Bethany L Leonhardt
- Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA.
| | - Elizabeth A Belanger
- School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, GH 109, Indianapolis, IN 46227, USA.
| | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, via Ravenna 9/c, 00161, Rome, Italy.
| | - Giancarlo Dimaggio
- Center for Metacognitive Interpersonal Therapy, via Ravenna 9/c, 00161, Rome, Italy.
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Wasmuth SL, Outcalt J, Buck K, Leonhardt BL, Vohs J, Lysaker PH. Metacognition in persons with substance abuse: Findings and implications for occupational therapists. Can J Occup Ther 2015; 82:150-9. [DOI: 10.1177/0008417414564865] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Addiction is a massive public health problem in which a person’s occupational life is compromised and metacognition is impaired. Occupational therapists may play a critical role in addiction rehabilitation, but more information about patterns of metacognitive deficit co-occurring with addictive behaviour is needed to develop interventions that specifically target these impairments. Purpose This study examined whether persons with addiction(s) demonstrated specific patterns of metacognitive deficit on four subscales of metacognition measuring self-reflectivity, understanding others’ thoughts, decentration, and mastery. Method Using a mixed-methods design, qualitative data were obtained via the Indiana Psychiatric Illness Interview, which was then rated using a quantitative scale, the Metacognition Assessment Scale–Abbreviated. Findings Persons with addiction(s) demonstrated significant impairments in metacognitive mastery but not other areas of metacognition. Implications Occupational therapy interventions for addiction should focus on improving metacognitive mastery. Future efficacy studies of interventions to improve mastery and overall outcomes are warranted.
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Lysaker PH, Dimaggio G, Wickett-Curtis A, Kukla M, Luedtke B, Vohs J, Leonhardt BL, James AV, Buck KD, Davis LW. Deficits in Metacognitive Capacity Are Related to Subjective Distress and Heightened Levels of Hyperarousal Symptoms in Adults With Posttraumatic Stress Disorder. J Trauma Dissociation 2015; 16:384-98. [PMID: 26011671 DOI: 10.1080/15299732.2015.1005331] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Among persons with posttraumatic stress disorder (PTSD), the severity of symptoms and concurrent distress are not fully explained by trauma severity. Interest has consequently arisen in the psychological processes that cause distress and heighten PTSD symptoms. This study accordingly sought to examine whether differences in metacognitive capacity are related to levels of emotional distress, avoidance/numbing, and hyperarousal. Participants were 48 adults with a confirmed diagnosis of PTSD. Comparison groups included 51 adults with HIV and 183 with schizophrenia. Metacognition, emotion recognition, depression, and emotional distress and levels of avoidance/numbing and hyperarousal were assessed concurrently using the Metacognition Assessment Scale-Abbreviated, the Bell Lysaker Emotion Recognition Test, the Beck Depression Inventory, and the Clinician-Administered PTSD Scale. Results revealed that the PTSD group had better ratings of overall metacognitive capacity than the schizophrenia group and specifically poorer levels of metacognitive mastery, or the ability to use metacognitive knowledge to respond to challenges, than the HIV group. Within the PTSD group, poorer metacognitive mastery was linked with greater distress and higher hyperarousal when depression was controlled for statistically. Emotion recognition was not linked with distress or symptom severity. Results are consistent with models in which symptom severity in PTSD is related to the extent to which persons can use knowledge of themselves and others to find ways to respond to distress that match their own unique needs.
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Affiliation(s)
- Paul H Lysaker
- a Roudebush Veterans Administration Medical Center , Indianapolis , Indiana , USA
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Leonhardt BL, Hamm JA, Fogley RL, Buck KD, Roe D, Lysaker PH. Allowing for Psychosis to be Approachable and Understandable as a Human Experience: A Role for the Humanities in Psychotherapy Supervision. Am J Psychother 2015; 69:35-51. [PMID: 26241798 DOI: 10.1176/appi.psychotherapy.2015.69.1.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bethany L. Leonhardt
- School of Psychological Sciences, University of Indianapolis, Indianapolis, Indiana
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jay A. Hamm
- Midtown Community Mental Health Center, Indianapolis, Indiana
| | - Rebecca L. Fogley
- School of Psychological Sciences, University of Indianapolis, Indianapolis, Indiana
| | - Kelly D. Buck
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Roudebush VA Medical Center, Indianapolis, Indiana
| | | | - Paul H. Lysaker
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Roudebush VA Medical Center, Indianapolis, Indiana
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
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Hillis JD, Leonhardt BL, Vohs JL, Buck KD, Salvatore G, Popolo R, Dimaggio G, Lysaker PH. Metacognitive reflective and insight therapy for people in early phase of a schizophrenia spectrum disorder. J Clin Psychol 2014; 71:125-35. [PMID: 25557425 DOI: 10.1002/jclp.22148] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Schizophrenia often involves a loss of metacognitive capacity, the ability to form complex and integrated representations of self and others. Independent of symptoms and neurocognition, deficits in synthetic metacognition are related to difficulties of engaging in goal-directed activities in social and vocational settings. Within this backdrop, we provide a case report of the effects of Metacognitive Reflective Insight Therapy (MERIT) that assisted a patient suffering from first episode schizophrenia during 2 years of individual psychotherapy. A total of 8 elements of MERIT that stimulate and promote metacognitive capacity are presented. As illustrated in this report, these procedures helped the patient move from a state in which he had virtually no complex ideas about himself or others to one in which he had developed integrated and realistic ideas about his own identity and the identity of others. He then could use these representations to understand and effectively respond to life challenges.
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Hamm JA, Leonhardt BL, Fogley RL, Lysaker PH. Literature as an exploration of the phenomenology of schizophrenia: disorder and recovery in Denis Johnson's Jesus' Son. Med Humanit 2014; 40:84-89. [PMID: 24567424 DOI: 10.1136/medhum-2013-010464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
When read as a fictional psychosis narrative, Jesus' Son, a collection of short stories by Denis Johnson, reveals important elements of the phenomenology of schizophrenia and recovery. It is possible that Jesus' Son, as a work of fiction, may be able to uniquely add depth and nuance to an understanding of the phenomenology of schizophrenia involving a state of psychological fragmentation, an ever-changing interpersonal field and a loss of personal agency. In addition, by following the protagonist in Jesus' Son as he begins to resolve some of his difficulties, the book also offers an individualised account of recovery. The authors detail how the book reveals these insights about schizophrenia and recovery and suggest that these elements are intertwined in such a manner that leads to a profound disruption of self-experience, characterised by a collapse of metacognitive processes. Jesus' Son may add depth to our understanding of the subjective experience of schizophrenia and recovery, and also may serve as one example in which the study of humanities offers an opportunity to explore the human elements in the most profound forms of suffering.
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Affiliation(s)
- Jay A Hamm
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, Indiana, USA
| | - Bethany L Leonhardt
- School of Psychological Sciences, University of Indianapolis, Indianapolis, Indiana, USA
| | - Rebecca L Fogley
- School of Psychological Sciences, University of Indianapolis, Indianapolis, Indiana, USA
| | - Paul H Lysaker
- Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Leonhardt BL, Hamm JA, Belanger EA, Lysaker PH. Childhood sexual abuse moderates the relationship of self-reflectivity with increased emotional distress in schizophrenia. Psychosis 2014. [DOI: 10.1080/17522439.2014.968858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lysaker PH, James AV, Leonhardt BL. Life Chart Methodology: risks associated with failing to assess patient preferences and the sources of poor insight for patients with bipolar disorder. J Am Psychiatr Nurses Assoc 2014; 20:386-8. [PMID: 25502642 DOI: 10.1177/1078390314562248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul H Lysaker
- Paul H. Lysaker, PhD, Roudebush VA Medical Center, Indianapolis; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alison V James
- Alison James, MS, Indiana State University, Terre Haute, IN, USA
| | - Bethany L Leonhardt
- Bethany L. Leonhardt, PsyD, Indiana University Purdue University Indianapolis; Indiana University School of Medicine, Indianapolis, IN, USA
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Lysaker PH, Leonhardt BL, Brüne M, Buck KD, James A, Vohs J, Francis M, Hamm JA, Salvatore G, Ringer JM, Dimaggio G. Capacities for theory of mind, metacognition, and neurocognitive function are independently related to emotional recognition in schizophrenia. Psychiatry Res 2014; 219:79-85. [PMID: 24863863 DOI: 10.1016/j.psychres.2014.05.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 04/28/2014] [Accepted: 05/04/2014] [Indexed: 12/28/2022]
Abstract
While many with schizophrenia spectrum disorders experience difficulties understanding the feelings of others, little is known about the psychological antecedents of these deficits. To explore these issues we examined whether deficits in mental state decoding, mental state reasoning and metacognitive capacity predict performance on an emotion recognition task. Participants were 115 adults with a schizophrenia spectrum disorder and 58 adults with substance use disorders but no history of a diagnosis of psychosis who completed the Eyes and Hinting Test. Metacognitive capacity was assessed using the Metacognitive Assessment Scale Abbreviated and emotion recognition was assessed using the Bell Lysaker Emotion Recognition Test. Results revealed that the schizophrenia patients performed more poorly than controls on tests of emotion recognition, mental state decoding, mental state reasoning and metacognition. Lesser capacities for mental state decoding, mental state reasoning and metacognition were all uniquely related emotion recognition within the schizophrenia group even after controlling for neurocognition and symptoms in a stepwise multiple regression. Results suggest that deficits in emotion recognition in schizophrenia may partly result from a combination of impairments in the ability to judge the cognitive and affective states of others and difficulties forming complex representations of self and others.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center (116H), 1481 West 10th Street, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bethany L Leonhardt
- Roudebush VA Medical Center (116H), 1481 West 10th Street, Indianapolis, IN, USA
| | - Martin Brüne
- Research Department of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, LWL University Hospital, Bochum, Germany
| | - Kelly D Buck
- Roudebush VA Medical Center (116H), 1481 West 10th Street, Indianapolis, IN, USA
| | - Alison James
- Indiana State University, Department of Psychology, Terre Haute, IN, USA
| | - Jenifer Vohs
- Indiana University School of Medicine, Indianapolis, IN, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA
| | - Michael Francis
- Indiana University School of Medicine, Indianapolis, IN, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA
| | - Jay A Hamm
- Midtown Community Mental Health Center/Eskenazi Health, Indianapolis, IN, USA
| | | | - Jamie M Ringer
- Roudebush VA Medical Center (116H), 1481 West 10th Street, Indianapolis, IN, USA
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Lysaker PH, Vohs J, Hamm JA, Kukla M, Minor KS, de Jong S, van Donkersgoed R, Pijnenborg MHM, Kent JS, Matthews SC, Ringer JM, Leonhardt BL, Francis MM, Buck KD, Dimaggio G. Deficits in metacognitive capacity distinguish patients with schizophrenia from those with prolonged medical adversity. J Psychiatr Res 2014; 55:126-32. [PMID: 24811777 DOI: 10.1016/j.jpsychires.2014.04.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/20/2014] [Accepted: 04/10/2014] [Indexed: 12/31/2022]
Abstract
Research has suggested that many with schizophrenia experience decrements in synthetic metacognition, or the abilities to form integrated representations of oneself and others and then utilize that knowledge to respond to problems. Although such deficits have been linked with functional impairments even after controlling for symptoms and neurocognition, it is unclear to what extent these deficits can distinguish persons with schizophrenia from others experiencing significant life adversity but without psychosis. To explore this issue we conducted logistic regression analysis to determine whether assessment of metacognition could distinguish between 166 participants with schizophrenia and 51 adults with HIV after controlling for social cognition and education. Metacognition was assessed with the Metacognitive Assessment Scale Abbreviated (MAS-A), and social cognition with the Bell Lysaker Emotion Recognition Test. We observed that the MAS-A total score was able to correctly classify 93.4% of the schizophrenia group, with higher levels of metacognition resulting in increased likelihood of accurate categorization. Additional exploratory analyses showed specific domains of metacognition measured by the MAS-A were equally able to predict membership in the schizophrenia group. Results support the assertion that deficits in the abilities to synthesize thoughts about oneself and others into larger representations are a unique feature of schizophrenia.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Med Center (116H), Roudebush VA Medical Center, 1481 West 10th St, Indianapolis, IN 46202, USA; Indiana University School of Medicine Indianapolis, IN, USA.
| | - Jenifer Vohs
- Indiana University School of Medicine Indianapolis, IN, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA
| | - Jay A Hamm
- Midtown Community Mental Health Center/Eskenazi Health, Indianapolis, IN, USA
| | - Marina Kukla
- Roudebush VA Med Center (116H), Roudebush VA Medical Center, 1481 West 10th St, Indianapolis, IN 46202, USA
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Steven de Jong
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands; Department of Clinical and Experimental Psychopathology, Rijksuniversiteit Groningen, The Netherlands
| | - Rozanne van Donkersgoed
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Marieke H M Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands; Department of Clinical and Experimental Psychopathology, Rijksuniversiteit Groningen, The Netherlands
| | - Jerillyn S Kent
- Indiana University, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - Sean C Matthews
- Indiana University, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - Jamie M Ringer
- Roudebush VA Med Center (116H), Roudebush VA Medical Center, 1481 West 10th St, Indianapolis, IN 46202, USA
| | - Bethany L Leonhardt
- University of Indianapolis, School of Psychological Science, Indianapolis, IN, USA
| | - Michael M Francis
- Midtown Community Mental Health Center/Eskenazi Health, Indianapolis, IN, USA; Indiana University School of Medicine Indianapolis, IN, USA
| | - Kelly D Buck
- Roudebush VA Med Center (116H), Roudebush VA Medical Center, 1481 West 10th St, Indianapolis, IN 46202, USA
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Lysaker PH, Olesek K, Buck K, Leonhardt BL, Vohs J, Ringer J, Dimaggio G, Popolo R, Outcalt J. Metacognitive mastery moderates the relationship of alexithymia with cluster C personality disorder traits in adults with substance use disorders. Addict Behav 2014; 39:558-61. [PMID: 24300836 DOI: 10.1016/j.addbeh.2013.11.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/16/2013] [Accepted: 11/04/2013] [Indexed: 11/19/2022]
Abstract
Cluster C personality disorder traits have been observed in substance use disorders and linked with poorer outcome. One potential factor which may cause these disturbances in personality function is alexithymia, or the inability to name and express emotion. There may be other proximate factors which moderate the impact of alexithymia on the expression of cluster C traits, such as metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems. To examine the possibility that mastery mediated the effects of alexithymia on cluster C traits, we assessed each of these constructs using the Metacognitive Assessment Scale Abbreviated, Toronto Alexithymia Scale and SCID II among 58 adults in an early phase of recovery from substance misuse disorders in a residential setting. Results of a multiple regression revealed that, after controlling for symptom severity and severity of substance misuse history, metacognitive mastery moderated the effect of alexithymia on number of cluster C traits. A median split and subsequent ANCOVA revealed that participants with higher levels of alexithymia and poorer metacognitive mastery had more cluster C traits than the other groups. These findings may have clinical implications, suggesting that patients with substance use disorders may benefit from treatment which addresses metacognitive mastery.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
| | - Kyle Olesek
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Indianapolis, IN 46202, USA
| | - Kelly Buck
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Indianapolis, IN 46202, USA
| | - Bethany L Leonhardt
- School of Psychological Science, University of Indianapolis, Indianapolis, IN, USA
| | - Jenifer Vohs
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Jamie Ringer
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | | | - Jared Outcalt
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Lysaker PH, Leonhardt BL, Pijnenborg M, van Donkersgoed R, de Jong S, Dimaggio G. Metacognition in schizophrenia spectrum disorders: methods of assessment and associations with neurocognition, symptoms, cognitive style and function. Isr J Psychiatry Relat Sci 2014; 51:54-62. [PMID: 24858635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Deficits in metacognitive capacity in schizophrenia can be conceptualized as existing along a spectrum from more discrete to more synthetic activities. While each represents an equally important focus of study, synthetic metacognitive activities may be more difficult to measure given they are more a matter of assessing complexity of thought rather than concrete accuracy; and therefore have received less attention. This review summarizes research on synthetic metacognition using a paradigm in which metacognitive capacity is rated within personal narratives. Results across the work reviewed here provides evidence that these deficits are detectable in patients with schizophrenia and that deficits are related to, but not reducible to, symptom severity and poorer neurocognitive function. Independent of symptoms and neurocognition, deficits in synthetic metacognition are related to a range of mental activities including reasoning style, learning potential and insight. These deficits may also play a role in long term outcome via their impact on the ability to function in work settings and to think about and sustain social connections.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center and Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Bethany L Leonhardt
- School of Psychological Science University of Indianapolis, Indianapolis, Indiana, U.S.A
| | | | | | | | - Giancarlo Dimaggio
- Centro di Terapia Metacognitiva Interpersonale and Clinical Psychology Specialization Program, La Sapienza University, Rome, Italy
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Lysaker PH, Gumley A, Luedtke B, Buck KD, Ringer JM, Olesek K, Kukla M, Leonhardt BL, Popolo R, Dimaggio G. Social cognition and metacognition in schizophrenia: evidence of their independence and linkage with outcomes. Acta Psychiatr Scand 2013; 127:239-47. [PMID: 22967227 DOI: 10.1111/acps.12012] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Research suggests that many with schizophrenia experience deficits in the ability to make discrete judgments about the thoughts and feelings of others as well as to form larger integrated representations of themselves and others. Little is known about whether these difficulties may be distinguished from one another and whether they are linked with different outcomes. METHOD We administered three assessments of social cognition which tapped the ability to identify emotions and intentions and two metacognitive tasks which called for the formation of more integrated and flexible representations of the self and others. We additionally assessed symptoms, social functioning and neurocognition. Participants were 95 individuals with a schizophrenia spectrum disorder. RESULTS A principle components analysis followed by a varimax rotation revealed two factors which accounted for 62% of the variance. The first factor was comprised of the three social cognition tests and the second of two tasks that tapped the ability to create representations of oneself and others which integrate more discreet information. The first factor was uniquely correlated with negative symptoms, and the second was uniquely correlated with social function. CONCLUSION Results suggest that deficits in social cognition and metacognition represent different forms of dysfunction in schizophrenia.
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Affiliation(s)
- P H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN 46202, USA.
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Hamm JA, Renard SB, Fogley RL, Leonhardt BL, Dimaggio G, Buck KD, Lysaker PH. Metacognition and social cognition in schizophrenia: stability and relationship to concurrent and prospective symptom assessments. J Clin Psychol 2012; 68:1303-12. [PMID: 22886716 DOI: 10.1002/jclp.21906] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Schizophrenia has been linked with deficits in the ability to form complex representations about oneself and others. Less clear is whether these deficits are stable over time, and whether they are related to symptoms. METHOD We assessed metacognition capacity, affect recognition, executive function, and symptoms at baseline and 6 months later for 49 adults with schizophrenia. RESULTS Paired t tests revealed assessments of metacognition and affect recognition were stable across measurements points. Metacognition was related to concurrent assessments of positive, negative and disorganized symptoms. Multiple regressions revealed metacognition was related to prospective assessments of negative symptoms after controlling for baseline negative symptoms and executive function. CONCLUSIONS Metacognitive deficits are a stable feature of schizophrenia related with negative symptoms.
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Affiliation(s)
- Jay A Hamm
- University of Indianapolis, Indiana, USA
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