Therapeutics Advances
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Mar 22, 2018; 8(1): 1-11
Published online Mar 22, 2018. doi: 10.5498/wjp.v8.i1.1
Promoting recovery from severe mental illness: Implications from research on metacognition and metacognitive reflection and insight therapy
Paul Henry Lysaker, Jay A Hamm, Ilanit Hasson-Ohayon, Michelle L Pattison, Bethany L Leonhardt
Paul Henry Lysaker, Department of Psychiatry, Roudebush VA Med Ctr and the Indiana Univeristy School of Medicine, Indianapolis, IN 46254, United States
Paul Henry Lysaker, Bethany L Leonhardt, 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
Jay A Hamm, Bethany L Leonhardt, 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
Author contributions: Lysaker PH performed the literature review; all authors contributed to the writing of the manuscript and approved the final version.
Conflict-of-interest statement: The authors of this study have no conflict of interests to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paul Henry Lysaker, PhD, Professor, Department of Psychiatry, Roudebush VA Med Ctr and the Indiana Univeristy School of Medicine, 1481 West 10th Street, Indianapolis, IN 46202, United States. plysaker@iupui.edu
Telephone: +1-317-931788-2546 Fax: +1-317-9885391
Received: October 30, 2017
Peer-review started: October 31, 2017
First decision: November 20, 2017
Revised: December 4, 2017
Accepted: January 7, 2018
Article in press: January 7, 2018
Published online: March 22, 2018
Processing time: 142 Days and 2.1 Hours
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.

Keywords: Schizophrenia; Rehabilitation; Self; Psychosis; Metacognition; Recovery; Psychotherapy; Social cognition

Core tip: Impairments in metacognitive processes challenge the abilities of individuals with schizophrenia to form and sustain an integrated sense of self and others. These deficits in metacognition compromise individuals’ abilities to manage their lives and mental health challenges. Treatments which help individuals with schizophrenia recapture metacognitive abilities can assist those individuals to regain access to the kinds of integrated ideas about themselves and others which assists them to meaningfully direct their own recovery. Metacognitive Reflection and Insight Therapy is an example of this kind of treatment.