Abstract
Synthetic metacognition is defined by integrative and contextualizing processes of discrete reflexive moments. These processes are supposed to be needed to meet intrapsychic as well as interpersonal challenges and to meaningfully include psychotic experience in a personal life narrative. A substantial body of evidence has linked this phenomenon to psychosocial functioning and treatment options were developed. The concept of synthetic metacognition, measured with the Metacognition Assessment Scale-Abbreviated (MAS-A), rises hope to bridge gaps between therapeutic orientations and shares valuable parallels to modern psychodynamic constructs, especially the ‘levels of structural integration’ of the Operationalized Psychodynamic Diagnosis (OPD-2). As theoretical distinctions remain, aim of this study was to compare the predictive value of both constructs with regard to psychosocial functioning of patients with non-affective psychoses, measured with the International Classification of Functioning, Disability and Health (MINI-ICF-APP). It was further explored if levels of structural integration (OPD-LSIA) would mediate the impact of metacognition (MAS-A) on function (MINI-ICF-APP). Expert ratings of synthetic metacognition (MAS-A), the OPD-2 ‘levels of structural integration’ axis (OPD-LSIA), psychosocial functioning (MINI-ICF-APP) and assessments of general cognition and symptoms were applied to 100 individuals with non-affective psychoses. Whereas both, MAS-A and OPD-LSIA, significantly predicted MINI-ICF-APP beyond cognition and symptoms, OPD-LSIA explained a higher share of variance and mediated the impact of MAS-A on MINI-ICF-APP. Levels of structural integration, including the quality of internalized object representations and unconscious interpersonal schemas, might therefore be considered as valuable predictors of social functioning and as one therapeutic focus in patients with non-affective psychoses. Structural integration might go beyond and form the base of a person’s actual reflexive and metacognitive capabilities. Psychotherapeutic procedures specific for psychoses may promote and challenge a patient’s metacognitive capacities, but should equally take the need for maturing structural skills into account. Modern psychodynamic approaches to psychosis are shortly presented, providing concepts and techniques for the implicit regulation of interpersonal experience and aiming at structural integration in this patient group.
Highlights
As psychotherapeutic treatment options for individuals with psychotic disorders are growing, many of them focus on metacognition as one potential target of intervention
Cognitive variables entered first (AVLT, WST; model 1), followed by adding symptom factors 1–4, metacognition measured with the Metacognition Assessment Scale-Abbreviated (MAS-A) and psychic structure measured with the OPD-LSIA
bias-corrected and accelerated (BCa) confidence intervals were reported for regression weights in order to provide a consistent presentation of results and to deal with single violations of homoscedasticity
Summary
As psychotherapeutic treatment options for individuals with psychotic disorders are growing, many of them focus on metacognition as one potential target of intervention. Synthetic metacognition implies semi-independent subfunctions (Semerari et al, 2003; Dimaggio et al, 2008), like self and other reflection, decentration or the capacity to change perspective, and mastery as the ability to use this knowledge (in terms of cognitive acts, emotions as well as their intercorrelations) in order to meet intrapsychic as well as interpersonal challenges. These sub-functions were initially integrated in the Metacognition Assessment Scale (MAS; Semerari et al, 2003, 2007), a tool to assess frequency of metacognitive acts within psychotherapy transcripts. Considering that sub-dimensions of psychic structure reflect internalized representations of the self, others and unconscious attachment patterns that might set the frame for the development and actual performance of metacognition, it was further assumed that psychic structure underlies or mediates the impact of metacognition on functioning
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