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Pattison ML, Leonhardt BL, Abate JF, Huling KS, Belanger EA, O'Connor HM, Lysaker PH. Emergence of insight in psychotherapy for early psychosis: A qualitative analysis of a single case study. Psychiatr Rehabil J 2020; 43:327-334. [PMID: 32406705 DOI: 10.1037/prj0000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Engaging individuals experiencing early psychosis (EP) in mental health treatment is broadly recognized as a challenging endeavor, especially when persons with EP experience impaired insight or relative unawareness of the psychiatric challenges they face. With limited insight they may see little point to treatment and have difficulties forming an alliance with providers. Tackling the issues of poor insight in EP is further complicated by a lack of knowledge of the processes within psychosocial interventions that lead to improved insight. METHOD To explore this, qualitative methods were used to identify content, process, and therapist factors that appeared before and seemed to support insight in a patient experiencing EP as well as the frequency with which insight and psychological problems emerged. The case examined was a 6-month psychotherapy from a pilot study examining the use of metacognitive reflection and insight therapy in EP. RESULTS Five prominent codes were identified across 24 psychotherapy transcripts that appeared to support the development of insight: narrative details, interpersonal relationships, therapist curiosity, therapist support, and therapist challenges. These appear to have allowed for the emergence of psychological problems first and then finally insight into mental health needs. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Addressing metacognitive capacity in psychotherapy may allow persons with low insight to recognize psychological problems and then develop a complex idea about their psychiatric challenges. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Michelle L Pattison
- Department of Psychiatry, Louis Stokes Cleveland Veterans Affairs Medical Center
| | | | | | - Kelsey S Huling
- School of Psychological Sciences, University of Indianapolis
| | | | | | - Paul H Lysaker
- Department of Psychiatry, Roudebush Veterans Affairs Medical Center
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Lysaker PH, Kukla M, Dubreucq J, Gumley A, McLeod H, Vohs JL, Buck KD, Minor KS, Luther L, Leonhardt BL, Belanger EA, Popolo R, Dimaggio G. Metacognitive deficits predict future levels of negative symptoms in schizophrenia controlling for neurocognition, affect recognition, and self-expectation of goal attainment. Schizophr Res 2015; 168:267-72. [PMID: 26164820 DOI: 10.1016/j.schres.2015.06.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 01/19/2023]
Abstract
The recalcitrance of negative symptoms in the face of pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. Accordingly, this study investigated whether deficits in metacognition, or the ability to form integrated ideas about oneself, others, and the world, prospectively predicted levels of negative symptoms independent of deficits in neurocognition, affect recognition and defeatist beliefs. Participants were 53 adults with a schizophrenia spectrum disorder. Prior to entry into a rehabilitation program, all participants completed concurrent assessments of metacognition with the Metacognitive Assessment Scale-Abbreviated, negative symptoms with the Positive and Negative Syndrome Scale, neurocognition with the MATRICS battery, affect recognition with the Bell Lysaker Emotion Recognition Task, and one form of defeatist beliefs with the Recovery Assessment Scale. Negative symptoms were then reassessed one week, 9weeks, and 17weeks after entry into the program. A mixed effects regression model revealed that after controlling for baseline negative symptoms, a general index of neurocognition, defeatist beliefs and capacity for affect recognition, lower levels of metacognition predicted higher levels of negative symptoms across all subsequent time points. Poorer metacognition was able to predict later levels of elevated negative symptoms even after controlling for initial levels of negative symptoms. Results may suggest that metacognitive deficits are a risk factor for elevated levels of negative symptoms in the future. Clinical implications are also discussed.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA; Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA.
| | - Marina Kukla
- Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA; Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA.
| | - Julien Dubreucq
- Center of Reference for Psychosocial Rehabilitation, CH Alpes Isère, Grenoble, France; Réseau Handicap Psychique (RéHPsy), Grenoble, France.
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Hamish McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jenifer L Vohs
- Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA; Prevention and Recovery Center for Early Psychosis, Midtown Community Mental Health Centers, Wishard Hospital, Indianapolis, IN, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA.
| | - Kelly D Buck
- Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA.
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA.
| | - Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA.
| | - Bethany L Leonhardt
- Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA.
| | - Elizabeth A Belanger
- School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, GH 109, Indianapolis, IN 46227, USA.
| | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, via Ravenna 9/c, 00161, Rome, Italy.
| | - Giancarlo Dimaggio
- Center for Metacognitive Interpersonal Therapy, via Ravenna 9/c, 00161, Rome, Italy.
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