Metacognitive reflection and insight therapy (MERIT) for patients with schizophrenia

• Published in: Psychological medicine 2019-01, Vol.49 (2), p.303-313
• Main Authors: de Jong, S., van Donkersgoed, R. J. M., Timmerman, M. E., aan het Rot, M., Wunderink, L., Arends, J., van Der Gaag, M., Aleman, A., Lysaker, P. H., Pijnenborg, G. H. M.
• Format: Article
• Language: English
• Subjects: Adult; Attrition; Clinical trials; Cognition; Cognitive ability; Dropping out; Empathy; Empathy - physiology; Female; Follow-Up Studies; Humans; Interpersonal Relations; Male; Mental disorders; Metacognition; Metacognition - physiology; Middle Aged; Original Articles; Otherness; Outcome Assessment, Health Care; Patients; Psychosis; Psychotherapy - methods; Quality of life; Questionnaires; Schizophrenia; Schizophrenia - physiopathology; Schizophrenia - therapy; Self Concept; Self esteem; Selfreflection; Social Behavior; Social functioning; Social Perception; Stigma; Theory of mind; Theory of Mind - physiology; Therapists; Therapy
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291718000855

Impaired metacognition is associated with difficulties in the daily functioning of people with psychosis. Metacognition can be divided into four domains: Self-Reflection, Understanding the Other's Mind, Decentration, and Mastery. This study investigated whether Metacognitive Reflection and Insight Therapy (MERIT) can be used to improve metacognition. This study is a randomized controlled trial. Patients in the active condition (n = 35) received forty MERIT sessions, the control group (n = 35) received treatment as usual. Multilevel intention-to-treat and completers analyses were performed for metacognition and secondary outcomes (psychotic symptomatology, cognitive insight, Theory of Mind, empathy, depression, self-stigma, quality of life, social functioning, and work readiness). Eighteen out of 35 participants finished treatment, half the drop-out stemmed from therapist attrition (N = 5) or before the first session (N = 4). Intention-to-treat analysis demonstrated that in both groups metacognition improved between pre- and post-measurements, with no significant differences between the groups. Patients who received MERIT continued to improve, while the control group returned to baseline, leading to significant differences at follow-up. Completers analysis (18/35) showed improvements on the Metacognition Assessment Scale (MAS-A) scales Self Reflectivity and metacognitive Mastery at follow-up. No effects were found on secondary outcomes. On average, participants in the MERIT group were, based on MAS-A scores, at follow-up more likely to recognize their thoughts as changeable rather than as facts. MERIT might be useful for patients whose self-reflection is too limited to benefit from other therapies. Given how no changes were found in secondary measures, further research is needed. Limitations and suggestions for future research are discussed.