Metacognitive Capacity Research Articles

Psychotherapy to emphasize self-directed recovery for persons with serious mental illness: Contributions from metacognitive reflection and insight therapy (MERIT).

Recovery from serious mental illness (SMI) is a complex process that can be supported by different levels of mental health care, for example, individual psychotherapy. Current individual evidence-based psychotherapy for persons with SMI is often focused on specific objective recovery outcomes, including symptom reduction and functional improvement, and requires a minimum level of insight. Less common but also important are broader, more flexible approaches that allow clients to explore their needs and challenges, without predetermined goals or a certain level of insight. The current article aims to describe (1) the development of metacognitive reflection and insight therapy (MERIT), an evidence-based psychotherapy that is focused on self-determination, or self-directed recovery, and (2) how MERIT advances care for persons with SMI by addressing a significant gap in the field for the treatment of people with SMI with limited metacognitive capacity and insight, offering an adaptable approach emphasizing self-directed recovery. MERIT utilizes a metacognitive framework that is guided by flexible key elements and an interpersonal environment. Training MERIT therapists early in their careers may be helpful in providing a holistic view of SMI to promote self-directed recovery in ways that are personalized and meaningful for each person. MERIT training has been completed in multiple countries across different levels of training (e.g., internship and psychology practicum). Professionals such as psychologists and social workers have effectively played a role in MERIT development and dissemination, which ultimately strives to advance psychotherapy for a wide range of individuals with SMI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Recovery-Oriented Approach: Application of Metacognitive Reflection and Insight Therapy (MERIT) for Youth with Clinical High Risk (CHR) for Psychosis.

Clinical High Risk for psychosis (CHR) refers to a phase of heightened risk for developing overt psychosis. CHR often emerges during adolescence or early adulthood. CHR has been identified as a group to target for intervention, with the hope that early intervention can both stave off prolonged suffering and intervene before mental health challenges become part of an individual's identity. However, there are few treatment modalities that can address some of the specific needs of CHR. Metacognitive Reflection and Insight Therapy (MERIT) is an integrative psychotherapy that can be applied to the CHR population. MERIT offers unique advantages to working with the CHR population as it aims to improve self-direction and recovery through stimulation of metacognitive capacity, a phenomenon that has been associated with recovery. This paper explores unique aspects of the CHR population and how MERIT can address barriers to recovery for individuals experiencing psychosis-like symptoms. Several case examples and a clinical vignette using MERIT to support patients with CHR are offered to exemplify this approach. MERIT offers a way to assist persons with CHR to address barriers to their personal recovery and to develop nuanced understandings of ways to master challenges.

Narrative-Derived Indices of Metacognition among People with Schizophrenia: Associations with Self-Reported and Performance-Based Social Functioning.

Metacognitive functioning-which broadly encompasses the mental processes involved in thinking about the thinking of one's self and the thinking of others-is often impaired among individuals living with schizophrenia and may contribute to difficulties in social and interpersonal functioning. Although the majority of studies assessing metacognition among individuals with schizophrenia use standardized, laboratory-based measurements, an increasing number of studies have measured metacognitive capacity using natural language produced by individuals living with mental illness. At the same time, less is known about how language-derived indices of metacognitive function relate to key social outcomes among people with schizophrenia. The primary objective of this study was to employ a validated language coding system (the Metacognition Assessment Scale, Abbreviated; MAS-A) to assess metacognitive functioning from the spoken life narratives of individuals with schizophrenia (n = 32) and community controls (n = 15). Among individuals with schizophrenia, we also examined the associations between language-derived metacognition and measures of self-reported and performance-based social functioning. Our results suggest that most aspects of metacognition in our sample were not significantly diminished in people with schizophrenia compared to community controls. Unexpectedly, the MAS-A subscale related to one's ability to master psychological difficulties was rated higher among individuals with schizophrenia. Further, our results suggest that among people with schizophrenia, higher metacognitive functioning in the domain of self-reflectivity was associated with poorer self-reported social functioning, while a greater metacognitive awareness of other individuals' minds was associated with better scores on aspects of performance-based social functioning. Collectively, these results underscore the utility of assessing metacognitive functioning via life-story narratives to understand social outcomes and highlight possible aspects of resiliency among individuals who have experienced a serious mental illness.

Translating an integrative metacognitive model of psychotherapy for serious mental illness into a group format: A pilot investigation on feasibility.

Metacognitive reflection and insight therapy (MERIT) is an one-on-one intervention that targets insight with the aim to help people with serious mental illness develop more integrated ideas about themselves and others in order to respond to their psychological and social challenges more adaptively. There is a growing body of evidence on MERIT's effectiveness. Considering the clinical demand for more cost-effective group psychotherapies, we modified the original individual MERIT format to a group-based intervention (MERITg) for application in inpatient and outpatient psychiatric settings. Thirty-one participants (inpatient = 10; outpatient = 21) with serious mental illness were surveyed on their experience of MERITg, which was offered adjunctively to their routine clinical care. Program evaluation measures were used to assess the feasibility and acceptance of the group. Across locations, more than half of all participants attended more than one group. Participants reported attending the group initially because they thought writing would be helpful, and further reported that they liked the group because they enjoyed writing and the discussion, and that they found it interesting to hear the perspectives and writings of others. Findings further support the need for future research on the efficacy and effectiveness of the group and its relationship to changes in metacognitive capacity and recovery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring the Relationship Between Metacognition, Emotional Regulation and Perceived Stress Among College Students

Students experience stress because of difficult and demanding situations, which are related to metacognitive abilities and emotional control techniques. College students experience negative emotions frequently, which affect their capacity for metacognition. The purpose of the study was to examine the relationship between college students' perceptions of stress, metacognition, and emotional control. 226 college students in all, ranging in age from 18 to 35, participated in the cross-sectional study (M = 24.8, SD = 4.87). Participants completed a sociodemographic form, the Perceived Stress Scale, the Emotional Regulation Questionnaire, and the Metacognitive Awareness Inventory. The study's findings showed that the majority of participants experienced moderate stress (Male= M = 32.4, SD = 5.3, Female= M = 28.7, SD = 4.9), and male students reported less mastery of metacognitive processes than female students. Additionally, a negative link between perceived stress and emotional regulation was discovered, suggesting that a low degree of emotional regulation was associated with a high level of stress. The findings further showed that higher levels of stress were associated with weaker metacognitive capacity and lower use of reappraisal as an emotional regulation method, respectively (r(224)=-.182). These results demonstrated a relationship between perceived stress, metacognitive abilities, and emotional regulation that might have significant consequences for supporting and promoting college student performance.

Conceptual disorganization as a mediating variable between visual learning and metacognition in schizophrenia.

The aim of this study was to evaluate the relative contributions of visual learning and conceptual disorganization to specific metacognitive domains in a sample of outpatients with stable schizophrenia. A total of 92 consecutive outpatients with stable schizophrenia were recruited in a cross-sectional study. We analyzed the data with five path analyses based on multiple regressions to analyze the specific effect of visual learning on metacognitive capacity and metacognitive domains and the possible mediating role of conceptual disorganization. We found that (i) visual learning was negatively correlated to metacognitive capacity and its domains on the one hand and conceptual disorganization on the other hand; (ii) conceptual disorganization was negatively associated with metacognition and its domains; and (iii) when the mediation effect was considered, conceptual disorganization fully mediated the relationship between visual learning and mastery, whereas it served as a partial mediator of the effect of visual learning on the other metacognition domains, i.e., self-reflectivity, understanding others' mind, and decentration. These results delineate an articulated panorama of relations between different dimensions of metacognition, visual learning, and conceptual disorganization. Therefore, studies unable to distinguish between different components of metacognition fail to bring out the possibly varying links between neurocognition, disorganization, and metacognition.

The Influences of Mind-Map on Cultivating Students' Metacognitive Capacity

Mind mapping is an effective graphic thinking tool for expressing divergent thinking proposed by Tony Buzan, a world-renowned psychologist and educator. It is a practical thinking tool that is simple, yet effective and efficient at the same time. Mind mapping develops students thinking skills, logical skills, etc. This study aims to investigate the development of metacognitive ability of students through the production of mind mapping. Through a review of related literature, the study found that mind mapping can promote students categorization and organization skills, help students discover and understand new relationships, improve problem-solving skills, and facilitate the deposition of learning outcomes. In addition, mind mapping production requires student participation, thereby improving students metacognitive ability. The literature access suggests that the production of mind mapping has a significant effect on the development of students metacognitive ability, and it should be introduced into education. In the future, the production method of mind mapping should be further optimized, and its application scenarios should be studied to improve students learning effectiveness and metacognitive ability development.

Decision Making in Moral Judgment Context is Modulated by Individual Metacognition

Metacognition refers to the human capacity to access and monitor one's own mental states. Recent research suggests that this capacity expands to the social world, e.g., when individuals explicitly share their cognitive processes with others. Additionally, metacognition is also linked to cognitive flexibility, and the latter to ideologically radical behaviors. Indeed, the absence of control over one's own mental activity could be at the base of different phenomena linked to social cognition. We investigate the metacognitive capacity of individuals in relation to the radicality with which they make a moral choice (utilitarian vs. deontological). For this purpose, 76 participants were submitted to 24 hypothetical situations, with the aim of evaluating the consistency (i.e., the radicality) of their moral choices. Then, in an independent experimental session, we evaluated the participants' metacognitive efficiency. We managed to demonstrate that individual metacognition scores are correlated with the radicality of a moral choice. We discussed the impact and relevance of metacognition in ecological contexts, particularly where subjective evaluation of the environment involves individual choices with social consequences.

Metacognitive Beliefs and Metacognitive Capacity: Do They Assess Related Phenomena?

Metacognition has been defined several ways across different fields. In schizophrenia, two primary approaches to assessing metacognition focus on measuring metacognitive beliefs and metacognitive capacity. The degree of association between these two approaches is unclear. In this pilot study, schizophrenia (n = 39) and control (n = 46) groups were assessed using metacognitive beliefs (Metacognition Questionnaire-30) and metacognitive capacity (Metacognition Assessment Scale-Abbreviated) scales. We also examined how these two approaches predicted quality of life. Results showed anticipated differences for metacognitive beliefs, metacognitive capacity, and quality of life when comparing schizophrenia and healthy control groups. However, metacognitive beliefs and metacognitive capacity were not significantly related and only predicted quality of life in the healthy control group. Although preliminary, these findings suggest that these two approaches have a limited relationship with one another. Future studies should test these findings in larger samples and focus on examining associations at different levels of metacognitive functioning in those with schizophrenia.

Contrasting Metacognitive, Emotion Recognition and Alexithymia Profiles in Bulimia, Anorexia, and Schizophrenia.

Alexithymia, or deficits in emotion recognition, and metacognitive capacity have been noted both in psychosis and eating disorders and potentially linked to psychopathology. This study sought to compare levels of impairments in these phenomena and their associations with psychopathology in groups with eating disorders and psychosis. Participants with diagnoses of a schizophrenia spectrum disorder (SSD; n = 53), anorexia (n = 40), or bulimia (n = 40) were recruited from outpatient clinics. Alexithymia was measured with the Toronto Alexithymia Scale; emotion recognition, with the Ekman Faces Test; and metacognition, with the Metacognitive Assessment Scale-Abbreviated. Psychopathology was measured with the Eating Attitudes Test, Body Image Questionnaire, and Positive and Negative Syndrome Scale. Results indicated that the SSD group had significantly poorer metacognitive function than either eating disorder group. Metacognition was related to body image in the anorexia group and a range of different forms of general psychopathology in the bulimia group. Alexithymia was related to eating disorder behaviors in the bulimia group.

Classroom interaction and metacognition by ‘enculturation’ of thinking in early education

ABSTRACT This case study explores the impact of a thinking-based teacher training and professional development programme on the quality of classroom interactions and on students’ metacognitive capacity in early childhood education and elementary first-grade classrooms. The study was conducted in a Spanish school, and the sample comprised 13 educators and 117 students aged 4 to 7 years old. The self-assessment scale of cultural forces for the promotion of thinking was used to analyze the change in the self-perception of teachers after the completion of the thinking-based training programme. The Classroom Assessment Scoring System (CLASS) was used to assess teacher–student interactions, and the drawing-telling technique was used to analyze students’ metacognitive capacity. The results reveal that the thinking-based teacher training improved their self-assessment as teachers that promote thinking, enhance the quality of classroom interactions (organisation and learning support), and develop children’s metacognitive processes. These findings indicate that a culture of thinking helps to develop key skills for twenty-first-century teachers and students.

Peer assessment, self-assessment, and resultant feedback: an examination of feasibility and reliability

ABSTRACT Self and peer assessments have been identified as effective strategies to develop a deeper understanding of complex concepts, enhance meta-cognitive capacity, and support learner self-efficacy. This study examines data related to peer and self-assessment exercises completed within a university engineering programme (n=61). Data related to peer-assessment scores, self-assessment scores, and expert assessor scores are analysed. Quality of feedback generated during the peer assessment activity is also considered. An open data set is included within the manuscript and hosted on the Open Science Framework. The results of this study suggest relatively high peer-assessment reliability when compared to expert assessments, although peer scoring tends to be consistently overestimated. In contrast, self-assessment scores demonstrate relatively low reliability when compared with expert assessor scores. The quality of feedback provided during the peer assessment exercise demonstrated a strong relationship with student performance. Recommendations for further refinement and implementation with larger cohorts are discussed.

Metacognition, emotional dysregulation, psychosocial functioning and subjective well-being after 6 months of CBT treatment in pharmacologically stabilized schizophrenic patients

IntroductionPsychoses represent serious psychiatric disorders in which an individual perceptions, thoughts, mood and behavior are significantly altered. Each person who develops a psychosis lives a unique set of symptoms and experiences that may widely vary depending on life circumstances. Although cognitive behavioral psychotherapy (CBT) for psychosis is recommended by main international guidelines, its effectiveness in real-world is still a subject of controversy.ObjectivesThe aim of this study was to evaluate, in an Italian outpatient clinical setting, eventual improvements induced by a 6 months intensive CBT specific programme focused on metacognition and emotional regulation and its consequences on psychosocial functioning and subjective well-being in pharmacologically stabilized psychotic patients.MethodsEight patients with schizophrenia spectrum disorders (DSM-V), clinically and pharmacologically stabilized, were included in a 6-month program of weekly CBT sessions with focus on metacognition, emotional dysregulation, social functioning and subjective well-being. Patients were assessed with the Metacognitions Questionnaire-30, Difficulties in Emotion Regulation Scale, Heinrichs Quality of Life Scale, The Psychological General Well-Being Index, Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale at baseline and at 3 and 6 months, to verify any improvement on these specific domains and, possibly, on general psychopathology.ResultsIn this study CBT showed to be effective on all domains evaluated, most notably for younger patients with a short history of disease (<5 years). Metacognitive capacity was the dimension with most evident improvements, followed by the ability to modulate emotions and the consequent improvement in psychosocial functioning and perceived subjective well-being. During the 6 months follow-up none of the enrolled patients experienced symptoms exacerbation or psychotic relapses.ConclusionsIn conclusion, the 6-month CBT treatment showed to be effective for stabilized psychotic patients, improving metacognitive functions, emotional regulation, psychosocial functioning, and subjective well-being. In addition, insight, adherence and the therapeutic alliance improved. The absence of psychotic relapses is not attributable with certainty to the effect of CBT since, for this purpose, longer duration studies on larger case series and with RCT methods are required. However, it is plausible that the improvement obtained in disease awareness and adherence may be a facilitating factor in relapse reduction.Disclosure of InterestNone Declared

What Constitutes a ‘Classroom Problem’ for Today's Teacher?: An Exploratory Study

<p style="text-align:justify">Teachers face situations that are difficult to solve, which affect their practices in the classroom. Teachers´ability to face problematic situations been related to educators' adaptive and metacognitive capacity. This study aimed to contrast the recent literature on classroom problems with reports from Chilean teachers regarding what they mean today as critical situations in the classroom. The major problems with the highest prevalence were categorized based on a literature review. Subsequently, teachers from three educational levels (pre-school, primary and secondary) were asked to relate situations in which they had experienced a crisis in their profession. After a filtering based on the relevance and textual richness present, the stories (n=145) were subjected to a thematic analysis and contrasted with the categories obtained from the reviewed literature. The results show a low proportion of problems associated with learning management in the classroom and, on the other hand, a high proportion of behavioral problems in students focused on situations of aggression towards the teacher. These conclusions are discussed to reconsider the concept of "classroom problem situations" and, based on this, questioning the role of teacher training in the development of skills for the management of authentic problem situations.</p>

Mnemicity: A Cognitive Gadget?

Episodic representations can be entertained either as “remembered” or “imagined”—as outcomes of experience or as simulations of such experience. Here, we argue that this feature is the product of a dedicated cognitive function: the metacognitive capacity to determine the mnemicity of mental event simulations. We argue that mnemicity attribution should be distinguished from other metacognitive operations (such as reality monitoring) and propose that this attribution is a “cognitive gadget”—a distinctively human ability made possible by cultural learning. Cultural learning is a type of social learning in which traits are inherited through social interaction. In the case of mnemicity, one culturally learns to discriminate metacognitive “feelings of remembering” from other perceptual, emotional, action-related, and metacognitive feelings; to interpret feelings of remembering as indicators of memory rather than imagination; and to broadcast the interpreted feelings in culture- and context-specific ways, such as “I was there” or “I witnessed it myself.” We review evidence from the literature on memory development and scaffolding, metacognitive learning and teaching, as well as cross-cultural psychology in support of this view before pointing out various open questions about the nature and development of mnemicity highlighted by our account.

Identifying cultural differences in metacognition.

Some aspects of human metacognition, such as the ability to consciously evaluate our beliefs and decisions, are hypothesized to be culturally acquired. However, direct evidence for this claim is lacking. As an initial step toward answering this question, here we examine differences in metacognitive performance between populations matched for occupation (students), income, demographics and general intelligence but drawn from 2 distinct cultural milieus (Beijing, China and London, U.K.). Chinese participants showed more efficient metacognitive evaluation of perceptual decision-making task performance compared to U.K. participants. These differences manifested in boosts to postdecisional processing following error trials, despite no differences in first-order performance. In a second experiment, we directly replicate these findings and show that a metacognitive advantage generalizes to a task that replaces postdecision evidence with equivalent social advice. Together, our results are consistent with a proposal that metacognitive capacity is shaped via sociocultural interactions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mild vs. moderate: How behavioral speech measures predict metacognitive capacity across different levels of formal thought disorder

Disorganized speech is a key component of formal thought disorder (FTD) in schizophrenia. Recent work has tied disorganized speech to deficits in metacognition, or one's ability to integrate experiences to form complex mental representations. The level of FTD at which differences in metacognitive capacity emerge remains unclear. Across two studies, using different cut scores to form FTD groups, we aimed to 1) explore the relationship between disorganized speech and metacognition and 2) compare trained rater and automated analysis methods. Clinical interviews were coded for disorganized speech and metacognition using the Communication Disturbances Index (CDI), Coh-Metrix multidimensional indices, and Metacognition Assessment Scale. In Study 1, we examined CDI and Coh-Metrix's ability to predict metacognition in FTD (n = 16) and non-FTD (n = 29) groups. We hypothesized the FTD group would have lower metacognition and that both CDI and Coh-Metrix would account for significant variance in metacognition. In Study 2, we conducted the same analyses with an independent sample using more stringent FTD cut scores (FTD: n = 23; non-FTD: n = 23). Analyses indicated that at a moderate but not mild cutoff: 1) automated methods differentiated FTD and non-FTD groups, 2) differences in metacognition emerged, and 3) behavioral measures accounted for significant variance (34%) in metacognition. Results emphasize the importance of setting the FTD cutoff at a moderate level and using samples that contain high levels of FTD. Findings extend research linking FTD and metacognition and demonstrate the benefit of pairing trained rater and automated speech measures.

Emotional experience and metacognition among people with schizophrenia: Analysis of session by session and outcome of metacognitive-oriented psychotherapy

BackgroundResearch suggests that in-session emotional experiences in psychotherapy promote both session and treatment outcomes across different clinical samples and treatment approaches. However, little is known about how this notion applies to clients with schizophrenia, who experience particular deficits related to emotional experience. To explore this question, we investigated the association between clients' emotional experience and their session outcome evaluations and metacognitive growth in a metacognitively-oriented treatment, Metacognitive Reflection and Insight Therapy (MERIT). MERIT is a recovery-oriented treatment approach for psychosis that focuses on recapturing a coherent sense of self and personal agency by enhancing metacognitive capacity. MethodFive-hundred-and-sixty-three sessions of 37 clients with schizophrenia who took part in an ongoing MERIT trial were analyzed. The Emotional Experience Self-Report (EE-SR) and Outcome Rating Scale (ORS) were collected on a session-by-session basis. Levels of metacognition ware assessed pre- and post-treatment using the Metacognitive Assessment Scale-Abbreviated (MAS-A) coding system. We used multilevel modeling to test our session-level predictions, and linear regression analysis for treatment-level predictions. ResultsGreater emotional experience, expression, and regulation within a session were associated with better session outcome. Regarding treatment level, greater emotional experience was associated with improvement in metacognitive mastery. ConclusionsOur findings reveal that experiencing emotions in MERIT has significant implications for clients' subjective well-being during therapy sessions and for their ability to respond to psychological challenges using metacognitive knowledge. These findings lend weight to the idea that emotional experience is a key mechanism of change in metacognitive therapy for schizophrenia.

Finding the Person in the Disorder: Adapting Metacognitive Reflection and Insight Therapy for Bipolar Mood Disorder (MERIT-BD)

Metacognitive Reflection and Insight Therapy (MERIT) was originally developed as an integrative recovery-oriented therapeutic approach to address the needs of people with a diagnosis of schizophrenia and other forms of severe mental illness. The approach, conceptualized as transtheoretical, aims to promote a more coherent and synthetic sense of self, through stimulating insight, sense of coherence, and metacognitive capacity. We argue that MERIT therapy, designed to facilitate peoples’ ability to form complex ideas about themselves and others and to use this knowledge to respond to psychological problems, has application in addressing deficits associated with bipolar disorder (BD), where there may be a significant injury to the person’s sense of self. That is, the therapy addresses the nascent sense of self in a context where disturbance of mood is dominant, and in relation to the experience of episodic manic episodes which may be understood as dissociative events, often associated with shame. The application of the therapeutic approach, which we term MERIT-BD draws upon MERIT’s primary principle of facilitating complexity and integration of the self, and additionally addresses shame, allowing for the facilitation of metacognitive capacity and insight in the context of finding the person. This approach will be illustrated with case vignettes illustrating the application of key components of MERIT-BD. Early findings drawn from a series of case studies are encouraging.

Meaning-making processes across the lifespan: An investigation of the developmental course of metacognitive capacity

Deficits in metacognitive capacity (i.e., the ability to integrate knowledge of oneself and others into a cohesive whole) have been shown to lead to poor functional outcome in psychosis. However, there is a gap in the literature concerning the role of metacognition in typically developing populations, which makes it difficult to define what level of metacognition is normative and at what point deficits in metacognition suggest pathology. To explore this issue, we utilized cross-sectional design to assess metacognitive capacities among 69 neurotypical adults whose ages varied from 18 to 65 using the Metacognitive Assessment Scale – Abbreviated (MAS-A) and then compared those with MAS-A scores from a second previously gathered sample of 360 adults diagnosed with psychosis across four key developmental windows: emerging adulthood, early adulthood, middle adulthood, and late adulthood. Our findings suggest that in our overall sample, individuals with psychosis had significantly lower levels of metacognitive capacity across all domains assessed by the MAS-A in comparison to neurotypical individuals. Additionally, our data suggest a deleterious effect of psychosis such that individuals with psychosis showed significantly lower metacognition in each developmental stage. Additionally, these differences were largest in emerging and late adulthood and for both groups awareness of others stood out as the single metacognitive domain which was significantly less impaired among older groups. Our results suggest a developmental course for metacognitive capacity such that awareness of others is the sole domain that grows over the lifespan.