Abstract
BackgroundMetacognitive dysfunction has been widely recognized as a feature of schizophrenia. As it is linked with deficits in several aspects of daily life functioning, improvement of metacognition may lead to improvement in functioning. Individual psychotherapy might be a useful form of treatment to improve metacognition in patients with schizophrenia; multiple case reports and a pilot study show promising results. The present study aims to measure the effectiveness of an individual, manual-based therapy (Metacognitive Reflection and Insight Therapy, MERIT) in improving metacognition in patients with schizophrenia. We also want to examine if improvement in metacognitive abilities is correlated with improvements in aspects of daily life functioning namely social functioning, experience of symptoms, quality of life, depression, work readiness, insight and experience of stigma.Methods/DesignMERIT is currently evaluated in a multicenter randomized controlled trial. Thirteen therapists in six mental health institutions in the Netherlands participate in this study. Patients are randomly assigned to either MERIT or the control condition: treatment as usual (TAU).DiscussionIf proven effective, MERIT can be a useful addition to the care for schizophrenia patients. The design brings along some methodological difficulties, these issues are addressed in the discussion of this paper.Trial registrationCurrent Controlled Trials: ISRCTN16659871.
Highlights
Metacognitive dysfunction has been widely recognized as a feature of schizophrenia
If proven effective, Metacognitive Reflection and Insight Therapy (MERIT) can be a useful addition to the care for schizophrenia patients
The present paper presents the design of a randomized controlled multicenter trial that aims to measure the effectiveness of the Metacognitive Reflection and Insight Therapy (MERIT) in improving metacognition
Summary
With this multicenter randomized controlled trial, we intend to investigate the effectiveness of a manual-based psychotherapy aimed at improving metacognition and daily life functioning of patients with schizophrenia. MERIT tries to enhance these synthetic metacognitive processes through constant reflection in the interpersonal relationship In this way, the patient learns to reflect on him/herself in ever more complex ways. The patient learns to reflect on him/herself in ever more complex ways We hope this will result in structural changes in metacognitive processes in patients with schizophrenia, and hope this in turn will lead to structural, lasting improvements of daily life functioning of the patient. This design brings along some methodological difficulties, especially the risk of drop-out over time.
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