Key points
- Metacognition is our ability to reflect on how we and others think
- Individuals living with serious mental illness often struggle with metacognition
- MERIT is a unique psychotherapy that focuses on improving these capacities and mental health recovery
Last week, I attended a training on MEtacognitive Reflection and Insight Therapy (MERIT). That first word, metacognition, is one I hear referenced fairly often in psychotherapy circles, yet I had never received any kind of training in it. As I logged on, I realized I wasn't sure what the word meant despite the number of times I had heard it. Yet, the description of the intervention and the accompanying book captivated me. I felt eager to learn more.
Meta-Cog-What?
Metacognition is a word utilized in fields ranging from education to mental health, often with subtle differences in meaning. Cognition means thinking, and meta would be self-referential. Therefore, the simplest definition of metacognition might be understanding how we and others think. It involves self-reflection, understanding others, considering greater trends, and using all this information to make meaning and move toward our valued goals.
Psychosis often involves an alteration in how we integrate information, perceptions, and sensations. It deeply affects every aspect of how we decipher who we are, what aspirations we have, our relationships, and the greater world. Even more so than other mental health conditions.
A study comparing metacognition capacity in individuals diagnosed with schizophrenia and bipolar disorder found that those living with schizophrenia struggled more with self-reflectivity than those with bipolar (Tas et al., 2014).
MERIT
MERIT is a psychotherapy designed to support individuals with serious mental illness (Lysaker and Klion, 2017). Rather than focusing on reducing symptoms or challenging unwanted thoughts, MERIT takes a deeper perspective into what it is like behind the eyes of someone living with a mental health condition. Following eight core elements, the approach leans strongly into how a client is making sense of their world (both internal and external) and what they wish to create in it.
In a randomized trial of 54 adults living with schizophrenia, it was found that those who received MERIT were better able to use reflection to cope with their challenges (Hasson‐Ohayon et al., 2024). Another study found that when delivered as a group intervention, MERIT improved recovery-oriented beliefs in participants with a schizophrenia diagnosis (Musket et al., 2024). This is especially meaningful as having a sense of hope makes a significant difference in how someone might move forward.
Conclusion
While data is still early, and larger trials are needed, MERIT shows promise as a psychotherapy for schizophrenia and psychosis. I am appreciative to have learned a bit more about it.
References
Hasson‐Ohayon, I., Igra, L., Lavi‐Rotenberg, A., Goldzweig, G., & Lysaker, P. H. (2024). Findings from a randomized controlled trial of Metacognitive Reflection and Insight Therapy for people with schizophrenia: Effects on metacognition and symptoms. Psychology and Psychotherapy: Theory, Research and Practice, 97, 75-90.
Lysaker, P. H., & Klion, R. E. (2018). Recovery, meaning-making, and severe mental illness: A comprehensive guide to metacognitive reflection and insight therapy. Routledge/Taylor & Francis Group.
Musket, C. W., Bullock, J., Fiszdon, J. M., Stacy, M., Martino, S., James, A., ... & Schnakenberg Martin, A. M. (2024). Group-Based Metacognitive Reflection and Insight Therapy (MERITg) and Its Relationship to Recovery-Oriented Beliefs in Serious Mental Illness. Behavioral Sciences, 14(7), 520.
Tas, C., Brown, E. C., Aydemir, O., Brüne, M., & Lysaker, P. H. (2014). Metacognition in psychosis: Comparison of schizophrenia with bipolar disorder. Psychiatry Research, 219(3), 464-469.
Van Donkersgoed, R. J., De Jong, S., Van der Gaag, M., Aleman, A., Lysaker, P. H., Wunderink, L., & Pijnenborg, G. H. M. (2014). A manual-based individual therapy to improve metacognition in schizophrenia: protocol of a multi-center RCT. BMC psychiatry, 14, 1-8.
