Metacognitive Therapy Research Articles

Effects of attention training technique on brain function in high- and low-cognitive-attentional syndrome individuals: Regional dynamics before, during, and after a single session of ATT

ObjectiveAttention Training Technique (ATT) is a key therapeutic tool in metacognitive therapy. There are numerous studies on the behavioral effects of ATT, however the neural mechanisms at work in the training are yet to be uncovered. To date there have been no controlled fMRI studies of ATT. MethodWe conducted a randomized double-blind controlled study of two groups with varying levels of cognitive-attentional syndrome (CAS). Groups with high (n = 43) and low (n = 46) levels of CAS underwent a single session of ATT or a control condition (CON) in an MRI scanner. Participants underwent resting state functional MRI (rsfMRI) sessions and rumination induction sessions both pre- and post-intervention Functional connectivity analyses and inter-subject correlations analyses were computed. We also collected data on emotion and attention functioning pre- and post-intervention. ResultsWe did not observe any behavioral effects of ATT. However, direct comparison between ATT and CON sessions revealed greater inter-subject correlations in almost all hubs belonging to the studied functional networks. Moreover, subjects who received ATT showed diminished connectivity in the fronto-parietal network during ruminations and diminished connectivity of the precuneus with lateral occipital cortices and the intraparietal sulcus in abstract thinking and rsfMRI, respectively. Furthermore, some of the observed effects in functional connectivity and inter-subject correlations were specific to different levels of CAS. ConclusionsOur results may support a proposed neural mechanism for ATT: disengagement of attention from CAS-type processing in either low- or high-CAS individuals. It is also possible that some neural effects of ATT are specific to individuals with different levels of CAS.

Establishing the Feasibility of Group Metacognitive Therapy for Anxiety and Depression in Cardiac Rehabilitation: A Single-Blind Randomized Pilot Study

BackgroundAnxiety and depression are common in cardiac rehabilitation (CR) patients. However, CR programs which incorporate psychological techniques achieve modest reductions in emotional distress. More efficacious interventions that can be easily integrated within services are required. A promising alternative to current psychological interventions is metacognitive therapy (MCT). The aim was to evaluate the acceptability and feasibility of delivering Group-MCT to CR patients experiencing symptoms of anxiety and depression.Method and ResultsFifty-two CR patients with elevated anxiety and/or depression were recruited to a single-blind randomized feasibility trial across three UK National Health Service Trusts and randomized to usual CR or usual CR plus six weekly sessions of group-MCT. Acceptability and feasibility of adding group-MCT to CR was based on recruitment rates, withdrawal, and drop-out by the primary end-point of 4 months; number of MCT and CR sessions attended; completion of follow-up questionnaires; and ability of the outcome measures to discriminate between patients. The study was also used to re-estimate the required sample size for a full-scale trial. We also examined the extent by which non-specialists adhered to the Group-MCT protocol. Group-MCT was found to be feasible and acceptable for CR patients with anxiety and depression. Recruitment and retention of participants was high, and attendance rates at CR were similar for both groups.ConclusionThe results suggest the addition of MCT to CR did not have a negative impact on retention and support a full-scale trial of Group-MCT for cardiac patients.

반복적 부정 사고에 초점을 맞춘 단기 인지치료프로그램의 우울 및 불안 완화 효과 및 그 기제 : 상위인지치료와 인지행동치료의 비교

본 연구는 우울 및 불안에 대한 범진단적 취약성 요인인 반복적 부정사고를 변화시키기 위해 기존의 인지행동치 료와 최근 대두되고 있는 상위인지치료를 나란히 시행해서 그 효과를 비교하고 변화기제를 밝히고자 했다. 이를 위해 사이버대학생 888명을 대상으로 반복적 사고 설문지 단축판(RTQ-10), 한국판 보속적 사고 질문지(K-PTQ), 한국판 벡불안 척도(BAI), 통합적 한국판 역학연구 우울척도(CES-D) 등을 실시했다. 연구 참여자로는 RTQ-10과 K-PTQ의 점수가 모두 상위 30%에 속하는 사람 중 연구 참여에 동의한 66명이 선별되었다. 우울과 불안 각각을 종속측정치로 하여 집단(피험자간 변인: 상위인지집단, 인지행동집단, 대기통제 집단) X 시기(피험자내 변인: 사 전, 사후, 추수)의 반복측정 분산분석을 하였다. 이에 더해 MEMORE(Mediation and Moderation for Repeated Measures; Mnotoya & Hayes, 2017)로 반복측정 설계 내에서 매개효과를 검증하여 효과의 기제를 분석하였다. 먼저 상위인지 집단(MCT)과 인지행동집단(CBT) 모두 사전에 비해 사후와 추수에 우울이 감소하였으나 사후 및 추수시점에서 두 치료 집단 간 우울의 차이는 없었다. 또한 반복적 부정사고의 감소가 상위인지 처치와 우울의 관계를 완전 매개 하는 것으로 나타났다. 한편, 불안은 MCT의 경우 사전에 비해 사후에 그리고, 사후에 비해 추수에 모두 유의하 게 감소하였으나, CBT에서는 사후에 불안 감소가 유의하지 않았고, 추수에 비로소 유의하였다. 기제 분석에서 반 복적 부정사고의 감소가 MCT와 불안의 관계를 완전 매개하는 것으로 나타났다. 반복적 부정사고와 이로 인한 정서 장애를 돕기 위한 치료적 시사점과 함께, 본 연구의 한계와 후속 연구의 방향에 대해 논의했다.

Comparison of the Effectiveness of Mindfulness-Based Cognitive Therapy and Metacognitive Therapy on Psychological Well-Being, Mental Vitality and Resilience among Mothers of Children with Cerebral Palsy

Comparison of the Effectiveness of Mindfulness-Based Cognitive Therapy and Metacognitive Therapy on Psychological Well-Being, Mental Vitality and Resilience among Mothers of Children with Cerebral Palsy

Metacognition in Cardiac Patients With Anxiety and Depression: Psychometric Performance of the Metacognitions Questionnaire 30 (MCQ-30).

The evaluation of effective psychological therapies for anxiety and depression in cardiac patients is a priority, and progress in this area depends on the suitability and validity of measures. Metacognitive Therapy is a treatment with established efficacy in mental health settings. It postulates that anxiety and depression are caused by dysfunctional metacognitions, such as those assessed with the Metacognitions Questionnaire 30 (MCQ-30), which impair effective regulation of repetitive negative thinking patterns. The aim of this study was to examine the psychometric properties of the MCQ-30 in a cardiac sample. A sample of 440 cardiac patients with co-morbid anxiety and/or depression symptoms completed the MCQ-30 and the Hospital Anxiety and Depression Scale. Confirmatory factor analysis (CFA) was used to test established factor structures of the MCQ-30: a correlated five-factor model and a bi-factor model. The five-factor model just failed to meet our minimum criteria for an acceptable fit on Comparative Fit Index (CFI) = 0.892 vs. criterion of ≥ 0.9; but was acceptable on the Root Mean Square Error of Approximation (RMSEA) = 0.061 vs. ≤ 0.08; whereas the bi-factor model just met those criteria (CFI = 0.913; RMSEA = 0.056). These findings suggest that the bi-factor solution may carry additional information beyond the five subscale scores alone. However, such a model needs to be evaluated further before widespread adoption could be recommended. Meantime we recommend cautious continued use of the five-factor model. Structural issues aside, all five subscales demonstrated good internal consistency (Cronbach alphas > 0.7) and similar relationships to HADS scores as in other patient populations. The MCQ-30 accounted for additional variance in anxiety and depression after controlling for age and gender.

Metacognitive Therapy versus Cognitive Behaviour Therapy in Adults with Major Depression: A Parallel Single-Blind Randomised Trial

In the last forty years therapy outcomes for depression have remained the same with approximately 50% of patients responding to treatments. Advances are urgently required. We hypothesised that a recent treatment, metacognitive therapy (MCT), might be more effective, by targeting mental control processes that directly contribute to depression. We assessed the clinical efficacy of MCT compared to current best psychotherapy practice, CBT, in adults with major depressive disorder. A parallel randomized single-blind trial was conducted in a primary care outpatient setting. This trial is registered with the ISCRTN registry, number ISRCTN82799488. In total 174 adults aged 18 years or older meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for major depressive disorder were eligible and consented to take part. 85 were randomly allocated to MCT and 89 to CBT. Randomisation was performed independently following pre-treatment assessment and was stratified for severity of depression (low < 20 vs high > =20) on the Hamilton Depression Rating Scale (HDRS) and on sex (male/female). Assessors and trial statisticians were blind to treatment allocation. Each treatment arm consisted of up to 24 sessions of up to 60 minutes each, delivered by trained clinical psychologists. The co-primary outcome measures were assessor rated symptom severity on the HDRS and self-reported symptom severity on the Beck Depression Inventory II (BDI-II) at post treatment. Secondary outcomes were scores six months post treatment on these measures and a range of symptom and mechanism variables. A key trial design feature was that each treatment was implemented to maximize individual patient benefit; hence time under therapy and number of sessions delivered could vary. Treated groups in the trial were very similar on most baseline characteristics. Data were analyzed on the basis of intention to treat (ITT). No differences were found on the HDRS at post treatment or follow-up (−0.95 [−2.88 to 0.98], p = 0.336; and −1.61 [−3.65 to 0.43], p = 0.122), but floor effects on this outcome were high. However, a significant difference favouring MCT was found on the BDI-II at post treatment (−5.49 [95% CI −8.90 to −2.08], p = 0.002), which was maintained at six-month follow-up (−4.64 [−8.21 to −1.06], p = 0.011). Following MCT 74% of patients compared with 52% in CBT met formal criteria for recovery on the BDI-II at post treatment (odds-ratio=2.42 [1.20 to 4.92], p = 0.014). At follow-up the proportions were 74% compared to 56% recovery (odds-ratio=2.19 [1.05 to 4.54], p = 0.036). Significant differences favouring MCT, also maintained over time, were observed for most secondary outcomes. The results were robust against controlling for time under therapy and when outcomes were assessed at a common 90 day mid-term time-point. Limitations of the study include the use of only two therapists where one treated 69% of patients, possible allegiance effects as the study was conducted in an established CBT clinic and the chief investigator is the originator of MCT and group differences in time under therapy. Never the less evidence from this study suggests that MCT had considerable beneficial effects in treating depression that may exceed CBT.

Metacognitive and Mentalization Based Concepts and Treatment Models: Implications for Child and Adolescent Psychiatry

Metacognitive and Mentalization Based Concepts and Treatment Models: Implications for Child and Adolescent Psychiatry The aim of this article is to provide a survey of metacognitive and mentalization-based therapeutic approaches and possible applications in the field of child and adolescent psychiatry. Firstly areas of metacognition are described and the concept of mentalization is introduced. Next, the treatments Mentalization Based Treatment (MBT), Metacognitive Interpersonal Therapy (MIT) and Metacognitive Therapy (MCT) are presented. Treatment models, theoretical backgrounds, the most important treatment steps, and typical interventions are explained. The treatment modalities are discussed concerning their conceptual similarities and differences as well as their applications in child and adolescent psychiatry. Finally the treatments are subsumed under the aspect of therapeutic change processes. An outlook for an integrative approach matching the level of metacognitive competency is given.

The Recovery Process for Individuals With Schizophrenia in the Context of Evidence-Based Psychotherapy and Rehabilitation

Abstract. This systematic review aimed to evaluate the efficacy of Cognitive Behavioral Therapy (CBT), META Cognitive Therapy (MCT), Metacognitive Training (MCTR), Metacognitive Reflection and Insight Therapy (MERIT), of various rehabilitation programs and of recovery programs in schizophrenia. Medline/Pubmed was searched for studies published in English from January 2010 to August 2018, which were screened against inclusion criteria by two reviewers. The methodological quality of the included studies was evaluated by two independent raters, which are the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies and the fidelity criteria. The study included 41 RCTs and 12 case studies with n = 3,059 persons with schizophrenia. Cognitive Behavioral Therapy (CBT) proved to be superior in terms of the improvement of primary and secondary outcomes. MCT decreased positive symptoms and improved metacognitive capacity and insight. MCTR reduced positive symptoms and socially disruptive behavior. MERIT improved metacognitive capacity and insight. Rehabilitation programs were efficacious in the improvement of cognition, symptoms, and functional outcome. The recovery programs enhanced illness-management knowledge, attitudes toward medication and insights related to negative symptoms. It is recommended to combine the above evidence based psychotherapeutic interventions. Limitations of this systematic review are discussed toward the end of the essay. Some important factors have to be considered in the future have been mentioned.

One Step Ahead-Attention Control Capabilities at Baseline Are Associated With the Effectiveness of the Attention Training Technique.

BackgroundAttentional control has been observed to play an important role in affective disorders by impacting information processing, the ability to exert top–down control in response to distracting stimuli, and by affecting emotional regulation. Prior studies demonstrated an association between attentional control and response to psychotherapy, thereby identifying attentional control as an interesting prognostic pre-treatment factor. Improving attentional control and flexibility is a cornerstone in metacognitive therapy (MCT), which is trained by the use of the Attentional Training Technique (ATT). However, as of yet, it remains unclear if pre-treatment attentional control is related to the effect of ATT.MethodsAn aggregated sample of 139 healthy participants [study 1: 85 participants, mean age 23.7 years, previously published (Barth et al., 2019); study 2: 54 participants, mean age 33.7 years, not previously published] performed an attentional performance test battery before and after applying ATT. Before ATT was administered, attentional control was measured using a well-established self-report instrument, i.e., the Attentional Control Scale (ACS; Derryberry and Reed, 2002). ATT was given in 2, 4, or 15 doses and compared to sham ATT. The test battery comprised a selection of established neurocognitive tasks: emotional dot probe, Stroop, 2-back, and dichotic listening.ResultsSham ATT showed no interaction with ACS score on performance outcome in all tests. At four doses of ATT, ACS score was associated with training response, i.e., subjects with high self-reported attentional control before training showed the largest improvements post-training (all P-values <0.05; see Figure 3). At 2 and 15 doses of ATT, the ACS score was unrelated to training response.ConclusionThis is a first attempt in understanding the optimal dosage in which ATT should be administered dependent on the individual characteristics of each subject pre-training. The current data suggest self-reported attentional control pre-training as a marker to determine an optimal individual ATT training profile. Future studies should investigate if other domains of metacognitions also interact with training outcome and evaluate the extent to which this relationship transfers to clinical samples. If successful, assessing attentional control prior to treatment in clinical samples could be of use regarding personalized therapy plans and treatment outcome.

Assessing metacognitive beliefs in test anxiety: Psychometric properties of the metacognitions questionnaire, 30 (MCQ-30) among university students

The Metacognitions Questionnaire-30 (MCQ-30) measures maladaptive metacognitive beliefs considered central to the metacognitive model of psychopathology. However, the psychometric properties of the MCQ-30 in test anxiety (TA) among university students are unknown. This study examined the MCQ-30 factor structure and concurrent validity in both trait and state TA. Confirmatory and exploratory factor analyses support the previously established five-factor structure of the MCQ-30 in both state and trait TA, with factors having good internal consistency. Structural equation modeling of the relationships between MCQ-30 subscales and TA found ‘Negative beliefs about uncontrollability and danger of worry’ to have the strongest association. The MCQ-30 appears a robust measure of metacognitive beliefs in TA and provides a basis for further testing of the validity of the metacognitive model in TA. Extending the reach of metacognitive therapy, which is based upon the metacognitive model, to TA could help to improve both student wellbeing and academic performance.

Efficacy of third wave cognitive therapies in the treatment of psychosis: a meta-review

The therapeutic approaches of the so-called "third wave" of clinical cognitivism have assumed increasing relevance in recent years alongside cognitive-behavioral therapy in the treatment of psychosis. To evaluate the efficacy of some of the most relevant third wave cognitive-behavioral approaches (metacognitive interventions and therapies based on mindfulness and acceptance) in the treatment of psychosis. A systematic research was carried out for systematic reviews and meta-analysis on the efficacy of metacognitive interventions and mindfulness- and acceptance-based therapies in the treatment of psychosis, published from 1 January 2009 to 31 December 2018. The selected studies were evaluated using AMSTAR 2, a valid and reliable tool composed of 16 items to measure the methodological quality of systematic reviews and meta-analysis. 7 meta-analysis were selected: 4 for metacognitive therapies (3 of low quality, 1 of critically low quality) and 3 for mindfulness- and acceptance-based therapies (1 of medium quality, 2 of low quality). Among metacognitive therapies, metacognitive training has shown promising results on positive symptoms and in particular on the psychopathology of delusions. Mindfulness- and acceptance-based therapies have shown mild to moderate effects on general and positive symptoms as well as some effects on negative symptoms, depressive symptoms, hospitalization rates and length. However, further research is needed to confirm overall the encouraging results of both metacognitive training and mindfulness- and acceptance-based therapies as the small number of randomized controlled trials and the low methodological quality of most meta-analysis realized up to date does not allow to draw yet sufficiently solid conclusions on their efficacy in the treatment of psychosis.

Metacognitive Therapy for Individuals at High Risk of Developing Psychosis: A Pilot Study.

Developing effective interventions for preventing first episode psychosis have been an important research focus in the last decade. Cognitive behavioral therapy is a currently indicated treatment for people at ultra-high risk of psychosis, however, access and resource issues limit its delivery within the NHS. Treatments which partial out potential active ingredients and are aimed at a range of psychological difficulties seen within this population have the potential to be more efficacious and efficient. We conducted a single-arm exploratory pilot trial, designed to investigate the feasibility and acceptability of Metacognitive therapy for individuals at ultra-high risk (UHR) of developing psychosis. Trial uptake was good, with 11 out of 12 referred individuals meeting for an eligibility assessment (one individual was excluded prior to the assessment). Of these, 10 individuals were eligible and included in the trial. Retention to treatment was high with 80% treatment adherence gained and an overall average of 8 sessions completed. All participants were offered follow-up assessments immediately post-treatment and at 6 months, which comprised measures of psychotic like experiences, anxiety and depression, and metacognitive processes implicated in the model. Retention to the post-treatment (12-week) follow-up was good, with 80% completion; however retention to the 6-month follow-up was lower at 60%. Clinically significant results were observed in psychotic like experiences, anxiety, depression and functioning with medium to large effect sizes. Measures related to beliefs and processes targeted within MCT showed clinically significant change with medium to large effect sizes. Our results suggest that MCT based upon a specific metacognitive model for individuals meeting ARMS criteria may be an important treatment target and warrants further attention. Limitations and possible focuses for future research are discussed.Registration: ISRCTN53190465 http://www.isrctn.com/ISRCTN53190465.

Group metacognitive therapy for adolescents with anxiety and depressive disorders: A pilot study.

The metacognitive model suggests that beliefs about cognition maintain repetitive negative thinking (RNT), a transdiagnostic process that underlies commonly comorbid, emotional disorders. To date, there has been the limited application of metacognitive therapy (MCT) to adolescents. This study aimed to evaluate a six-session group transdiagnostic MCT program for adolescents with anxiety and/or depressive disorders. Participants (N = 10; 3 male, 7 female; average age 15.2 years) completed measures of metacognition and RNT at assessment, baseline period, during treatment, and at 1- and 3-month follow-ups. Nine participants attended all six treatment sessions and one discontinued after four sessions. At posttreatment and follow-ups, the majority of participants no longer met diagnostic criteria for anxiety or depressive disorders and evidenced a clinically significant or reliable change in metacognitions and RNT. Results suggest that group MCT is promising in terms of acceptability and effectiveness for adolescents with anxiety and/or depressive disorders.

Citalopram and metacognitive therapy for depressive symptoms and cognitive emotion regulation in patients with major depressive disorder: A randomized controlled trial.

BACKGROUND:Metacognitive therapy (MCT) is a new psychotherapy for depression. This study was conducted to compare the effectiveness of citalopram and MCT on major depressive disorders (MDDs).MATERIALS AND METHODS:A total of 36 patients with MDD were randomly assigned into three groups of citalopram (n = 12), MCT (n = 16), and control (n = 8). MCT group received ten sessions of metacognition therapy. Citalopram group received 20–40 mg citalopram, and the control group did not receive any interventions. Outcomes were measured using the Beck Depression Inventory-II, Metacognition Questionnaire-30, and Cognitive-Emotion Regulation (CER) Questionnaire. Data were analyzed with ANCOVA using SPSS version 18.RESULTS:Depression score reduction was significant in both citalopram and metacognitive groups (P < 0.05). However, there was only a statistically significant difference between MCT and control group in CER and metacognition.CONCLUSION:MCT and citalopram both are effective in symptom reduction in MDD. Furthermore, MCT could lead to more improvement in metacognition, depression symptoms, and CER than citalopram, when treating MDDs.

The effectiveness of metacognition therapy on the marital quality of the women.

INTRODUCTION:Marital quality is an important predictor of marital continuity, which can lead to mental health, well-being, and happiness for couples, and marital quality is equivalent to marital satisfaction and adjustment. This study was carried out to purpose the effectiveness of metacognition therapy on marital quality of women in the city of Isfahan.MATERIALS AND METHODS:The research method was quasi-experimental with a pretest–posttest and control group design. The study population included all married women visiting consultation centers in the city of Isfahan during March 2018–March 2019. The sampling method was nonrandom voluntary sampling used to select 30 participants who were then randomly divided into experiment and control groups (15 individuals each). The research tool was the Revised Dyadic Adjustment Scale(RDAS). The experiment group participated in eight sessions of metacognition therapy, each lasting 90 min. Covariance analysis method was used to analyze the data via SPSS21.RESULTS:The result of covariance analysis showed that metacognition therapy has been effective in improving the marital quality of the women in the city of Isfahan (P < 0.01).CONCLUSION:The results of this study emphasize that metacognition therapy is effective on the marital quality of the women in the city of Isfahan. Using this treatment plan can result in improved marital quality and marital satisfaction and therefore improve the relationship of couples. Therefore, the results of the current study can provide empirical support for the use of metacognition therapy to improve marital quality.

Efficacy analysis of the third generation of cognitive-behavioral therapies – a narrative literature review

Cognitive-behavioral therapies (CBTs) do not represent a single, conceptual and practical, psychosocial intervention, but a developing group of directive, structured, collaborative psychotherapies, which benefit from an important level of evidence, according to the results of many randomized clinical trials. As a consequence, these therapies are recommended by clinical guidelines and international best practice guidelines for a wide range of mental disorders. Due to their format that allows the operationalization of key concepts and structured application in clinical settings, CBTs allow for monitoring the evolution of symptoms through psychometric tools and validation of results through statistical analysis. CBTs have evolved over time, starting from interventions based on operant conditioning and classical, Pavlovian, learning, passing through the influence of cognitivism, to the holistic paradigm, which incorporates oriental techniques, along with classical methods. The focus of the therapeutic approach also changed, from the content of thinking to the thought process. Metacognitive therapy, acceptance and commitment therapy, dialectical behavior therapy, compassion-based therapy and cognitive therapy based on mindfulness are the most important representatives of the new generation of cognitive-behavioral therapies. Their area of ​​applicability is wide and their effectiveness is variable, being proven especially for depressive and anxiety spectrum disorders, but with some peculiarities in the field of personality disorders (especially borderline for dialectical behavior therapy), psychotic disorders, eating disorders, stress-related pathology, ADHD etc. It is important to encourage the research in the field of CBTs, especially because of the need to support adjuvant therapies in pharmacotherapy-resistant cases. CBTs may also be recommended as first-line therapy in patients who request an evidence-based psychosocial intervention, when certain psychiatric disorders are of mild intensity (e.g. anxiety, stress-related or depressive disorders) or when there are clear contraindications for the use of another treatment.

Review of previous research on the role of metacognitive beliefs and metacognitive therapies in schizophrenic patients

Present research reviews previous studies on metacognitive beliefs and the role of metacognitive therapies in the treatment of the patients suffering from Schizophrenia which is one of the most important psychological disorders. Patients suffering from schizophrenia have shown a serious change in perception, emotion, cognition, thinking, and also behavior. Harmful metacognitive beliefs, cognitive biases, inability to perceive other people’s points of view, repetitive and dysfunctional thinking processes, etc. are just a few drawbacks of Schizophrenia. Additionally, some studies have shown more specific metacognitive beliefs in schizophrenic patients, however, there were differences between the results of various studies. This research highlights the results of some previous studies on metacognitive beliefs and the effect of metacognitive therapies in the treatment of patients being subjected to schizophrenia disorders. This may be a sparkle of hope in diagnosing psychological conditions affecting schizophrenia, and also paves the way to effective psychological therapies for schizophrenic patients. It should be emphasized that the diversity of the results from previous researches in this field was probably due to the chronic, under-treated, acute status of the patients, the number of patients, culture role, the degree of the resilience, and so on.

CHANGING EMBODIED RELATIONAL PATTERNS IN METACOGNITIVE INTERPERSONAL THERAPY

Individuals with personality disorders tend to attribute meaning according to stereotyped relationship patterns which prevent them from achieving social adaptation and fulfilment. These mental patterns are more than mere cognitive representations of the self and others. They are embodied and laden with affect, behavioral dispositions, and somatic experiences. The main purpose of this work is to present how metacognitive interpersonal therapy provides a platform for changing embodied patterns, via imagery and sensorimotor work. As discussed, these techniques facilitate the revision of the embodied component of maladaptive patterns and promote the emergence of new and healthier patterns. These new patterns comprise more adaptive aspects and correspondingly impede the enactment of previous maladaptive coping strategies that were driven by pathological schemas. We note how experiential work is best performed in a context of constant regulation of the therapeutic relationship, in order to detect any possible relational impasses and ruptures, reflecting on them until they are repaired. We also show the use of techniques in the initial phase of therapy to allow a more dynamic and rich case formulation. Finally, we discuss the implications of how experiential work might be a crucial component in psychotherapy for persons experiencing severe interpersonal problems such as personality disorders

La relazione terapeutica nella terapia metacognitiva interpersonale

La ricerca empirica mostra un'associazione stretta tra buon funzionamento della relazione terapeutica e buon esito del trattamento. L'attenzione alla relazione terapeutica è uno dei fulcri della terapia metacognitiva interpersonale (TMI). In questo articolo, dopo aver sintetizzato gli aspetti fondamentali del modello, descriveremo come in TMI il lavoro sulla relazione si intrecci con l'utilizzo di tecniche esperienziali quali immaginazione guidata e role playing, finalizzate a promuovere nel paziente la comprensione del suo mondo interno e il cambiamento clinico. Forniremo una serie di esemplificazioni cliniche al fine di descrivere come la relazione sia nel contempo: 1) strumento per favorire l'accesso ai contenuti psicologici rilevanti; 2) strumento per favorire un'esperienza emozionale correttiva; per esempio, in molti casi l'utilizzo di una tecnica esperienziale mette il paziente in condizione di contattare parti di sé libere dalla patologia, e di sperimentare la relazione terapeutica come fonte di speranza e sostegno all'autonomia; 3) oggetto di intervento in caso di rotture della relazione, anche nei casi in cui tali rotture sono la conseguenza dell'utilizzo di tecniche esperienziali. Nel complesso, mostreremo come il processo terapeutico in TMI sia mosso dalla capacità del terapeuta di muoversi agilmente tra l'utilizzo di tecniche volte a esplorazione e cambiamento, e focus sulla relazione

Comparison of the effectiveness of Metacognitive Therapy and its Techniques, and acceptance and commitment therapy on the mind wandering adolescent

Comparison of the effectiveness of Metacognitive Therapy and its Techniques, and acceptance and commitment therapy on the mind wandering adolescent