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

Published online by Cambridge University Press:  25 April 2018

S. de Jong Open the ORCID record for S. de Jong [Opens in a new window] ,
R. J. M. van Donkersgoed ,
M. E. Timmerman ,
M. aan het Rot ,
L. Wunderink ,
J. Arends ,
M. van Der Gaag ,
A. Aleman ,
P. H. Lysaker  and
G. H. M. Pijnenborg
S. de Jong*
Affiliation:
GGZ Noord-Drenthe, Department of Psychotic Disorders, Dennenweg 9, 9404 LA Assen, the Netherlands Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B 1018 WT Amsterdam, the Netherlands Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
R. J. M. van Donkersgoed
Affiliation:
Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands Parnassia Dijk en Duin, Westzijde 120 1505 GB Zaandamthe Netherlands
M. E. Timmerman
Affiliation:
Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
M. aan het Rot
Affiliation:
Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
L. Wunderink
Affiliation:
GGZ Friesland, PO Box 932 8901 BS Leeuwarden, the Netherlands
J. Arends
Affiliation:
GGZ Noord-Drenthe, Department of Psychotic Disorders, Dennenweg 9, 9404 LA Assen, the Netherlands
M. van Der Gaag
Affiliation:
Parnassia Psychiatric Institute, Zoutkeetsingel 40 2512 HN Den Haag, the Netherlands Department of Clinical Psychology, VU University and Amsterdam Public Mental Health Research Institute, van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
A. Aleman
Affiliation:
Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands Department of Neuroscience, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, the Netherlands
P. H. Lysaker
Affiliation:
Roudeboush VA Medical Center, 1481 West 10th Street, Indianapolis, IN 46202, USA Indiana University School of Medicine, 340 West 10th Street Suite 6200, Indianapolis, IN 46202, USA
G. H. M. Pijnenborg
Affiliation:
GGZ Noord-Drenthe, Department of Psychotic Disorders, Dennenweg 9, 9404 LA Assen, the Netherlands Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
*
Author for correspondence: S. de Jong, E-mail: misterdejong@gmail.com
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Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.

Keywords

Mentalizingmetacognitionpsychosispsychosocial interventionpsychotherapyrandomized controlled trialschizophreniatheory of mind
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 2 , January 2019 , pp. 303 - 313
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

*

These authors contributed equally to the study and manuscript

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