Metacognitive Interpersonal Therapy Research Articles

Experiential techniques and therapeutic relationship in metacognitive interpersonal therapy: A contribution to the unified protocol.

Experiential techniques and therapeutic relationship in metacognitive interpersonal therapy: A contribution to the unified protocol.

Metacognition as a transdiagnostic factor across eating disorders: a latent profile analysis study.

Metacognition is a crucial aspect of understanding and attributing mental states, playing a key role in the psychopathology of eating disorders (EDs). This study aims to explore the diverse clinical profiles of metacognition among patients with EDs using latent profile analysis (LPA). A total of 395 patients with a DSM-5 diagnosis of ED (116 AN-R, 30 AN/BP, 100 BN, 149 BED) participated in this study. They completed self-report measures assessing metacognition, eating psychopathology, depression, emotional dysregulation, personality traits, and childhood adversities. LPA and Welch ANOVAs were conducted to identify profiles based on metacognition scores and examine psychological differences between them. Logistic regression models were employed to explore associations between personal characteristics and different profiles. A 3-class solution had a good fit to the data, revealing profiles of high functioning (HF), intermediate functioning (IF), and low functioning (LF) based on levels of metacognitive impairments. Participants in the IF group were older and had a higher BMI than those in the HF and LF groups. Individuals with BN were largely categorized into HF and LF profiles, whereas participants with BED were mainly included in the IF profile. Participants in the LF group reported an impaired psychological profile, with high levels of depression, emotional dysregulation, childhood adversity, and personality dysfunction. Multinomial logistic regression analyses showed significant associations between metacognitive profiles and emotional and neglect abuse, emotion dysregulation, and detachment. This exploratory study unveils distinct metacognitive profiles in EDs, providing a foundation for future research and targeted interventions. In this light, metacognitive interpersonal therapy could be a valid and effective treatment for EDs, as suggested by the initial promising results for these patients.

Working through the body in metacognitive interpersonal therapy to change relational patterns in dependent personality disorder: The case of Lia.

Persons with dependent personality disorder (DPD) have difficulties describing their inner world, and in realizing their negative ideas about the self, such as being weak, unworthy or powerless are just ideas. As a consequence, they tend to over-rely on others and may lose control over their emotions. Treating these persons can gain benefits from including body-focused techniques as they can promote a) awareness of internal states, b) better emotion regulation, c) the capacity to consider their negative ideas about themselves as not necessarily true, and d) gain power of and agency. We will describe the therapist used body-focused techniques in the context of Metacognitive Interpersonal Therapy when treating Lia, a 40-year-old woman suffering from DPD who also suffered from generalized anxiety disorder and had difficulties in making autonomous choices. She had a romantic relationship with a man she described as distant and judgmental so she felt lonely and not entitled to express her discomfort or capable to break up. The therapist used body-focused techniques, together with behavioural exposure, mindfulness and guided imagery, to let Lia be more aware of her thoughts and feelings, and then to regulate affects and realize she had previously capacities. At therapy termination anxiety diminished and she could break up with the partner and start a new one where she felt free to express herself. We suggest how bodily-focused techniques can be used to enhance therapy effectiveness in DPD.

The double-strand bond between metacognition and schizophrenia: actual impact and future directions

Controlling, monitoring, and modulating cognitive processes is what is known as metacognition: it guides behavior through several types of mental activities that range in complexity from discrete activities, such as recognizing others' judgment, to more integrated ones, such as recognizing oneself and others' cognitive processes. There is an increasing body of research examining the impact of schizophrenia on metacognition, underlining their double-strand link, especially on a wide range of mental processes, including reasoning, autobiographical memory, cognitive beliefs, and clinical insight. Metacognition is intimately linked to the severity of symptoms as well as specific symptomatic sub-domains, such as positive symptoms, negative symptoms, or disorganization. Recently, cognitive-derived psychotherapies have been developed to treat metacognitive deficits in schizophrenia. While all these treatments share a metacognitive component, each one targets different aspects. In metacognitive therapy, false or unhelpful beliefs are treated; in metacognitive training, cognitive biases are the main focus; in cognitive-behavioral therapy for psychoses, the core is represented by schematic dysfunctional beliefs; in metacognitive reflection insight therapy, metacognitive knowledge and self-identity are addressed; and in metacognitive interpersonal therapy for psychosis, interpersonal ideas or events may trigger delusional thinking. Future directions should address the need for more refined knowledge of metacognition processes and the need for growing mental health professionals’ expertise in the field. Moreover, the evaluation of metacognition-based intervention effectiveness in real-world populations and in high-risk psychosis and their enforceability in mental health facilities should become a critical issue.

The ongoing rewriting of the therapeutic contract in Metacognitive Interpersonal Therapy for narcissistic personality disorder: The case of Mark.

In order to effectively treat individuals suffering from Narcissistic Personality Disorder (NPD), it is crucial to establish therapeutic goals and identify tasks to achieve them. However, this is a challenging process with NPD patients because they often struggle to find meaningful goals beyond the pursuit of status. Moreover, in order to change Furthermore, to promote change, they must confront painful emotions such as shame, guilt, or fear, which they habitually try to avoid. Additionally, they face difficulties in forming a positive perception of their therapists and cooperating towards mutually agreed-upon goals and tasks. As a consequence, NPD patients ask for change but hardly engage themselves in the work necessary to achieve it. Therapists therefore need to pay the uttermost attention to drafting, negotiating and continuously updating a reasonable and realistic therapeutic contract. In this paper we describe the story of a man in his thirties with NPD who was ridden with depression, guilt, envy and anger and did not find ways to pursue the healthy and adaptive behaviors he would need to pursue in order to leave a richer social life. The therapist overcame ruptures in the therapeutic alliance and then involved the patient in a process where they set the steps to follow, making sure the patient was convinced they made sense. After a contract was reached progress became possible. Implications for the role of the therapeutic contract in NPD treatment are discussed.

Outpatient care for adolescents' and young adults' mental health: promoting self- and others' understanding through a metacognitive interpersonal therapy-informed psychological intervention.

Psychological distress may result in impairment and difficulty understanding oneself and others. Thus, addressing metacognitive issues in psychotherapy may improve psychopathology in adolescents and young adults (AYAs). We aimed to compare metacognitive interpersonal therapy (MIT)-informed psychotherapy with other treatment-as-usual (TAU) therapies. We administered the Global Assessment of Functioning (GAF) scale, the Clinical Global Impressions-Severity (CGI-S) scale, and the Brief Psychiatric Rating Scale (BPRS) at baseline (BL) and at treatment termination (the endpoint was at 6 months and any last results obtained before that term were carried forward in analyzes). Patients received concomitant psychiatric and psychological treatment. Sixty AYAs were involved in the study. There was a significant reduction in symptomatology after the intervention. Twelve patients (17%) dropped out; treatment adherence was 83%. In the MIT group, 2 patients dropped out (11%), and in the TAU group, 9 patients dropped out (19%). All scales showed a significant reduction in symptoms between baseline (BL) and the 6-month endpoint: GAF (χ2 = 6.61, p < 0.001), BPRS (χ2 = 6.77, p < 0.001), and CGI (χ2 = 7.20, p < 0.001). There was a greater efficacy for the MIT group in terms of symptom reduction on the BPRS (t = 2.31; p < 0.05). The study confirmed the efficacy of early and integrated care in adolescence and suggested greater symptom reduction for a psychotherapeutic intervention focused on stimulating mentalization skills. The study indicates the usefulness of this type of approach in the treatment of adolescent psychopathology. Due to the small sample size, the results need replication.

Clinical supervision over complex cases of personality disorders according to metacognitive interpersonal therapy

Treating patients with Personality Disorders (PDs) means dealing with what are often referred to as complex cases. The complexity of cases stems from several variables and in particular: the high percentage of diagnostic co-occurrences, patients' difficulty in reflecting on their own and others' mental states (i.e., metacognitive impairments), and the strong emotional pressure experienced by therapists. All this results in difficulties in building the therapeutic alliance and high drop-out rates. For these reasons, therapists often need supervision, with a more experienced therapist or even among peers. This article proposes the structured supervision model according to Metacognitive Interpersonal Therapy (MIT), which is an evidence-based treatment model for PDs.

Metacognitive interpersonal therapy-eating disorders versus cognitive behavioral therapy for eating disorders for non-underweight adults with eating disorders: study protocol for a pilot pre-registered randomized controlled trial.

Eating disorders (ED) are serious disorders characterized by an alteration of eating habits and excessive concern about weight and body shapes (Fairburn, 2002), accompanied by significant impairment inequality of life, high mortality rates and serious organic consequences (Jenkins et al., 2011; Treasure et al., 2015; 2020). Although evidence-based psychological therapies for nonunderweight ED presentations such as cognitive behavioral therapy for eating disorders (CBT-ED) are widely available, there is substantial scope for improvements, particularly in terms of efficacy and adherence. One option is to develop interventions to address elements of pathology not fully addressed by existing empirical supported treatments, such as incorporating techniques aimed at addressing interpersonal problems and personality disorder features into existing treatment delivery. We adapted Metacognitive Interpersonal Therapy, a psychological intervention supported by evidence for treating personality disorders and integrated it with existing CBT techniques for eating disorders (MIT-ED). MIT-ED targets aspects of ED that are not included in the transdiagnostic CBT-E model such as poor metacognition, or maladaptive interpersonal schemas. This is a pre-registered (Protocol number: 0000781) pilot randomized clinical trial aimed at assessing acceptability and feasibility of MIT-ED and establishing preliminary evidence of effectiveness for future larger studies. Twenty patients (10 in each arm) will be randomized to 20 sessions of individual psychotherapy, either MIT-ED or CBTE. Repeated follow-ups will be collected up to 24 months. Participants are recruited at a private outpatient clinic for ED treatment. Acceptability will be assessed via session attendance, completion rates and preliminary outcomes. The primary outcome is ED pathology assessed with the Eating Disorder Examination Questionnaire-6. Other ED outcomes assessed will be eating disorder attitudes, clinical impairment and binge eating pathology. Secondary treatment outcomes are anxiety, depression, and global symptomatology. We will also assess emotional awareness, emotion regulation and therapeutic alliance. Based on previous studies of MIT for personality disorders we hypothesize that MIT-ED will be acceptable to patients, evidenced by high treatment adherence and retention. We hypothesize that MIT-ED will be associated with reductions in eating disorder pathology, at least equivalent to CBT-E. Results will be used to inform the study design, sampling, likely effect sizes and choice of outcome measures for future larger trials of MIT-ED in ED samples.

Combined group and individual therapy for patients with avoidant personality disorder-A pilot study.

Avoidant personality disorder (AvPD) is a common disorder within mental health services, associated with significant psychosocial impairment. The disorder has been neglected in research. There are currently no evidence-based treatments for AvPD, and there is a need for treatment studies focusing particularly on this form of personality pathology. The present study was a pilot study of combined group and individual therapy for patients with AvPD, based on mentalization-based and metacognitive interpersonal therapy. The aim was to investigate the feasibility of the treatment program and the course of symptoms and personality functioning during treatment and 1-year follow-up. The study included 28 patients. Clinical evaluation at baseline comprised structured diagnostic interviews and patients' self-report of symptoms, psychosocial function, interpersonal problems, personality functioning, alexithymia, self-esteem, attachment style, therapeutic alliance, and client satisfaction. Patients' self-report were repeated at the end of treatment and 1-year follow-up. The drop-out rate was 14%. Average treatment length among the 22 treatment completers was 17 months. Mean levels of therapeutic alliance and client satisfaction were satisfactory. Effect sizes were large for global symptom distress, depression, anxiety, and psychosocial adjustment, and in the moderate range for aspects of personality functioning. Yet, the results showed a wide range of outcomes among the patients. This pilot study shows promising results for combined group- and individual therapy for AvPD patients with moderate to severe impairment. Larger scale studies should be conducted to increase empirically based knowledge to guide development of differentiated treatments adapted to patients' various levels of AvPD severity and profiles of personality dysfunction.

Literature Review of Psychological Treatments among Victims of Intimate Partner Violence

The paper has provided an extensive review on the subject matter of the psychological treatments that are commonly used among the victims of Intimate Partner Violence. The individuals in the mentioned population are known to experience IPV in the form of physical, psychological and sexual abuse, mostly. In turn, it affects their mental health, and hence the need for them to receive psychological treatment based on specific symptoms being experienced. The review has given consideration to the psychological treatments that are supported by empirical evidence. The psychological treatments included in this review include Interpersonal Psychotherapy, Cognitive Behavioural Therapy, Meta-cognitive Interpersonal Therapy, Cognitive Processing Therapy, Acceptance and Commitment Therapy, and Eye Movement Desensitization and Reprocessing. In addition, in the review, relevant recommendations have been made to ensure that victims of IPV are able to benefit significantly from the psychological treatments. There is also a need for researchers to come up with other interventions or treatment modalities for other none common adverse effects of IPV. Keywords: Intimate Partner Violence, Psychological Treatments, Victims, Sexual Abuse, Psychological Abuse, Physical Abuse, Depressive, Anxiety, Post-Traumatic Symptoms, Post-Traumatic Disorder.

Recovery-Focused Metacognitive Interpersonal Therapy (MIT) for Adolescents with First-Episode Psychosis

Recovery-Focused Metacognitive Interpersonal Therapy (MIT) for Adolescents with First-Episode Psychosis

Treating Avoidant Personality Disorder With Combined Individual Metacognitive Interpersonal Therapy and Group Mentalization-Based Treatment: A Pilot Study.

Avoidant personality disorder (AvPD) is a severe but understudied condition. The current pilot project reports data on acceptability and outcomes of a novel treatment combining biweekly individual metacognitive interpersonal therapy (MIT) and weekly mentalization-based therapy (MBT) group therapy. A total of 30 patients with AvPD were consecutively included in the program. The primary outcome was AvPD-specific personality functioning measured by self-report after treatment. Secondary outcomes were symptom distress, interpersonal problems, quality of life, and psychosocial functioning. Twenty-two patients completed treatment, with a mean duration of 13 months. On the primary outcome, effect sizes were generally moderate to large (effect size range: 0.59-1.10). On secondary outcomes, effect sizes were large (effect size range: 0.77-2.3). Both in terms of acceptability and outcomes, results are promising for the combination of MIT and MBT for AvPD. The approach is a strong candidate for further investigation in future large-scale randomized controlled trial.

Metacognition and emotion regulation as treatment targets in binge eating disorder: a network analysis study

BackgroundThis study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA) in order to identify key variables that may be considered the target for psychotherapeutic interventions.MethodsA total of 155 patients with BED completed measures of eating psychopathology, affective symptoms, emotion regulation and metacognition. A cross-sectional network was inferred by means of Gaussian Markov random field estimation using graphical LASSO and the extended Bayesian information criterion (EBIC-LASSO), and central symptoms of BED were identified by means of the strength centrality index.ResultsImpaired self-monitoring metacognition and difficulties in impulse control emerged as the symptoms with the highest centrality. Conversely, eating and affective features were less central. The centrality stability coefficient of strength was above the recommended cut-off, thus indicating the stability of the network.ConclusionsAccording to the present NA findings, impaired self-monitoring metacognition and difficulties in impulse control are the central nodes in the psychopathological network of BED whereas eating symptoms appear marginal. If further studies with larger samples replicate these results, metacognition and impulse control could represent new targets of psychotherapeutic interventions in the treatment of BED. In light of this, metacognitive interpersonal therapy could be a promising aid in clinical practice to develop an effective treatment for BED.

Metacognitive Interpersonal Therapy for Intimate Partner Violence: A Single Case Study

Intimate partner violence (IPV) is responsible for significant social, psychological, and financial costs. The challenges in developing approaches that result in long-term change has been well documented. Outcome research into perpetrator treatment often portray varying degrees of success or otherwise. Metacognitive Interpersonal Therapy (MIT) offers an alternative approach to working with perpetrators of IPV in focusing on maladaptive interpersonal schemes as the antecedents of acts of violence and aggression. This article outlines a single case study utilizing MIT as the primary approach in working with a 28-year-old male perpetrator of IPV. The patient completed 24 sessions of MIT and results indicated a significant reduction in acts of violence and control. Follow-up at 2 months posttreatment indicated sustained improvement from the beginning of psychotherapy. Enhancing metacognitive capacity can help in reducing the potential for violence against an intimate partner. By focusing on maladaptive schemas, MIT provides a viable approach in the treatment of IPV.

Metacognitive Interpersonal Therapy for Borderline Personality Disorder: A Single Case Study

Borderline personality disorder (BPD) is a severe disease, characterized by severe instabilities in identity, affect and relationships. Clinical improvement of BPD can be facilitated by psychotherapy aimed at tackling multiple specific cross-modality impairments and their patterns of interaction: impaired sense of self, maladaptive interpersonal schemas, impaired metacognition, emotion dysregulation and impulsivity. Herein, we describe the steps in the treatment of a young woman meeting the criteria for with BPD with paranoid traits, successfully treated with Metacognitive Interpersonal Therapy, a treatment based on comprehensive assessment of domains. In the initial phase, treatment focused on promoting emotion regulation, integrating opposing patient representations of the therapist, enhancing metacognition, and increasing focus on the maladaptive schema that elicited dysregulated behaviors. Later in therapy, treatment focused on supporting the patient to realize her ideas about self and others were schema-driven; and improving metacognitive capacity to understand others’ minds. General implications for psychotherapy of BPD are discussed.

The role of self-monitoring metacognition sub-function and negative urgency related to binge severity.

This study aims to test a model where low self-monitoring (a sub-function of first-person domain of metacognition) and high negative urgency lead to a worsening of binge severity through the mediation of emotional dysregulation in patients with binge eating disorder (BED). Forty non-BED-obese and 46 BED-obese patients completed a battery of tests assessing metacognition and psychopathology. To test our hypothesized model, a structural equation model (SEM) using maximum likelihood estimation was conducted. BED-obese patients had significantly higher scores in BES, UPPS-P Negative urgency, and DERS total score, and lower MSAS self-monitoring than non-BED-obese, while no differences emerged in the MSAS others-monitoring subscale. The structural model demonstrated very good fit indexes (χ2 = 1.377, df = 2; p = .502, CMIN/DF = 0.688, CFI = 1.000, RMSEA = 0.000, TLI = 1.047) and all paths were significant in the predicted directions. These preliminary findings show that, low self-monitoring and high negative urgency lead BED-obese patients to express the worsening of binge severity through the mediation of emotional dysregulation. This knowledge may be helpful in the clinical practice to develop a tailor-made treatment. Accordingly, an approach through Metacognitive Interpersonal Therapy could be attempted in BED-obese patients with these characteristics. Highlights Patients with BED exhibited low self-monitoring and high negative urgency. Binge severity was mediated by high level of emotional dysregulation. Metacognitive Interpersonal Therapy may be useful for BED patients.

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.

Metacognitive Interpersonal Therapy in Group for Personality Disorders: Preliminary Results from a Pilot Study in a Public Mental Health Setting

To build the evidence for a randomized controlled trial, a pilot study was conducted to investigate the feasibility, acceptability and effectiveness of a group-psychotherapy based on Metacognitive Interpersonal Therapy (MIT-G) for patients with personality disorders (PDs). Ten outpatients with PD diagnoses were offered 16 sessions of MIT-G delivered in group format. Effect sizes were calculated for changes from baseline to treatment end for clinical symptoms, interpersonal difficulties, and metacognition. Nine patients finished the full treatment protocol with nonsignificant large effect sizes obtained for change in depression, metacognition, impulsiveness and interpersonal problems measures. This is the first study suggesting that MIT-G is acceptable to outpatients across the spectrum of PDs and is associated with improvements in clinical symptoms, social functioning and metacognition. Despite the limitations of a pilot study, evidence of MIT-G effectiveness was sufficient to warrant further investigation.

Changing Embodied Dialogical Patterns in Metacognitive Interpersonal Therapy

According to proponents of Dialogical Self Theory (DST), the self is made up of a series of I-positions, which continuously interact, negotiating potential courses of action, and attributing meaning to events. Individuals with personality disorders tend to attribute meaning according to stereotyped dialogical relationship patterns which prevent them from achieving social adaptation and fulfillment. Of note, in our perspective, we do not necessarily take dialogical relationship as healthy. We refer to dialogical thinking as a form of thoughts about interpersonal interactions, but the very dialogue may itself be stuck and repetitive as in the case of patients with personality disorders (Dimaggio et al., 2003, 2010; Schacter et al., 2012). These patterns do not just take the form of verbal discourse, but are instead embodied and rooted within internalized processes; which are themselves laden with affect, behavioral dispositions and somatic experiences. Using a case study we demonstrate how Metacognitive Interpersonal Therapy (MIT) provides a platform for changing embodied dialogical patterns, via imagery and body work. These techniques enable revision of the embodied component of the dialogical pattern, promoting the emergence of new I-positions. These new patterns comprise more adaptive aspects and correspondingly impede the enactment of previous maladaptive coping strategies, that were driven by pathological I-positions. Finally, we discuss the implications of experiential work in this context, as a crucial component of dialogical oriented therapies for people experiencing severe interpersonal problems such as personality disorders.

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