Predicting therapy success from the outset: The moderating effect of insight into the illness on metacognitive psychotherapy outcome among persons with schizophrenia

An International Survey of the Concept of Effective Psychodynamic Treatment During the Pandemic

Introduction: Most psychotherapists had no choice during the COVID-19 pandemic but to offer teletherapy in order to provide needed treatment. Several psychoanalytic theorists wondered if the very concept of treatment would change without an embodied relationship in an office setting. Methods: To attempt to understand the current concept of effective psychodynamic treatment in the new norm of teletherapy, we surveyed practitioners from 56 countries and regions who remotely treated patients psychodynamically during the beginning months of the pandemic. We asked the practitioners to rank six factors felt to be important to psychodynamic treatment: use of the couch during sessions, session in-office or via teletherapy, cultural similarity between therapist and patient, number of sessions a week, patient factors (motivation, insightfulness, and high functioning) and therapist factors (empathy, warmth, wisdom, and skillfulness). Results: We received 1,490 survey responses. As predicted, we found that the therapist and patient variables were considered much more important (both tied as highest rankings) to effective treatment than any of the other variables, including if the therapy was in-office or by teletherapy. Discussion: Psychodynamic practitioners worldwide confirmed that the empathy, warmth, wisdom, and skillfulness of the therapist and the motivation, insightfulness, and level of functioning of the patient are most important to treatment effectiveness regardless if the treatment is remote or embodied.

Living beyond the limitation: Rehabilitation, life and productivity of individuals with schizophrenia in South-West Nigeria

INTRODUCTION

Schizophrenia, the most chronic and stigmatized form of mental illness, can be described as a brain disorder that affects an individual's cognition. Individuals with schizophrenia exhibit socially unacceptable symptoms that affect their psychosocial lives. They suffer from reduced productivity due to the debilitating effect of the illness, and the negative symptoms impede their employability; such symptoms and effects aggravate the stigma around mental illness. However, when rehabilitation is successfully achieved, so is productivity, and this decreases the associated stigma. Thus, this study describes the rehabilitation experiences and productivity of individuals with schizophrenia in South-West Nigeria.

METHODS AND ANALYSIS

A descriptive qualitative approach with semi-structured interviews was used to gather information from mental health service users. The discharged users in this study received in-hospital or outpatient rehabilitation care at four outpatient units within two specialist mental health-care facilities in South-West Nigeria. These facilities offer vocational training and rehabilitation services for individuals with schizophrenia. Twenty-nine mental health service users were interviewed. The data from the interviews were independently analysed by two researchers through a content analysis approach using NVIVO version 11. The researchers compared the results of the analysis and reached an agreement on the conclusion.

FINDINGS AND RECOMMENDATIONS

The rehabilitation services availed by patients in the research setting are of three types. Some attend occupational rehabilitation to learn a trade; they depend on professionals for the choice of skill but at a cost that is not affordable to many. Some stay in rehabilitation units linked to the hospital, rendering their services at a cost, and their living expenses and skill acquisition processes are based on the remuneration they get from the services rendered to the institution. Others depend on their family members' efforts to afford rehabilitation services but set up on job by family or employed in family business. The mental health service users in this study who offered their services to the institutions were able to make informed decisions and showed better performance with their chosen occupation than those who depended on their family or health professionals for the choice of rehabilitation service or vocational career. Therefore, this study concludes that prioritizing mental health facility users' preferences in terms of productive activities (sales, services, vocation) or rehabilitation goals should be encouraged.

Single-session Comprehend, Cope, and Connect intervention in acute and crisis psychology: A feasibility and acceptability study

Comprehend, Cope, and Connect (CCC) is a third-wave cognitive behavioural approach developed for acute mental health services. The aim of this study was to assess feasibility and acceptability of a newly developed, manualized single-session CCC intervention delivered face-to-face with service users in acute and crisis psychology services in South London. The study adopted a within-subjects pre-post-test design. Participants (N = 23) were recruited from five acute psychiatric wards and a crisis resolution home treatment team. Service users had a range of diagnoses of complex and severe mental health conditions, in particular mood, personality, and psychotic disorders. Feasibility data were gathered for number of times the CCC formulation was accepted, duration of CCC intervention, clinician adherence to manualised protocol, and frequency of goal-based activity completion. Acceptability data on pre- and post-CCC mood and post-CCC helpfulness were self-reported by participants. Findings indicated a significant increase in positive mood (large effect) and moderate-high helpfulness rating postintervention. Most participants reported goal-based activity completion. There was high fidelity to the protocol, high percentage of acceptance of the formulation and formulation components completed, and frequent single-session completion. Single-session CCC appears feasible and acceptable in acute and crisis psychology services and yields formulation-driven goal-based activities intended to stabilize mental health crisis. High fidelity to formulation protocol suggests broader applications for single-session CCC, for example, to support clinical staff to manage crisis situations in their work environment or to train nonpsychologist clinicians to deliver the intervention for service users. A randomized controlled trial of single-session CCC would increase validity and generalisability of findings.

Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis

Recent research has suggested that recovery from psychosis is a complex process that involves recapturing a coherent sense of self and personal agency. This poses important challenges to existing treatment models. While current evidence-based practices are designed to ameliorate symptoms and skill deficits, they are less able to address issues of subjectivity and self-experience. In this paper, we present Metacognitive Insight and Reflection Therapy (MERIT), a treatment approach that is explicitly concerned with self-experience in psychosis. This approach uses the term metacognition to describe those cognitive processes that underpin self-experience and posits that addressing metacognitive deficits will aid persons diagnosed with psychosis in making sense of the challenges they face and deciding how to effectively manage them. This review will first explore the conceptualization of psychosis as the interruption of a life and how persons experience themselves, and then discuss in more depth the construct of metacognition. We will next examine the background, practices and evidence supporting MERIT. This will be followed by a discussion of how MERIT overlaps with other emerging treatments as well as how it differs. MERIT's capacity to engage patients who reject the idea that they have mental illness as well as cope with entrenched illness identities is highlighted. Finally, limitations and directions for future research are discussed.