Journal of Contemporary Psychotherapy

, Volume 46, Issue 4, pp 197–206 | Cite as

Metacognitive Therapy Focused on Psychosocial Function in Psychosis

  • Julien Dubreucq
  • Claire Delorme
  • Rocio Roure
Original Paper


Metacognitive Insight and Reflection Therapy is a manual-based individual psychotherapy aimed at enhancing four metacognitive processes through patient’s personal narratives which may promote recovery by helping individuals suffering from schizophrenia to develop a richer and more integrated sense of self. This study is a single case analysis of the effects of a meta-cognitively oriented CBT on residual psychotic symptoms and functional targets. Outcome measures (PANNS, PDI 21, BAVQ-R, PSP, MAS-A) were collected at two different times: pre-CBT and 1-year. Results showed reductions in the distress, preoccupation and conviction associated with delusions and improvements in metacognitive abilities, social functioning, hopefulness and of the sense of self-confidence to cope with the psychotic symptoms. Adopting a metacognitive perspective during psychotherapy had several benefits: to foster the development of therapeutic alliance, to allow the patient to assess the efficacy and acknowledge the consequences of the different strategies he could use to cope with his symptoms and to question the predominance of his delusions in his life. To conclude, Metacognitive Reflection and Insight Therapy seem particularly adapted to address psychosocial issues, such as social or work functioning.


Metacognitive oriented psychotherapy CBT Psychosocial functioning Recovery Schizophrenia 



We would like to specially thank JL Roulin (University of Chambéry) for his precious advices concerning the statistical analyses and P Lysaker (Roudebush VA Medical Center) for his advices in multiple occasions.


No additional funding was received for this study

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent for the release of confidential material was obtained from the individual participant included in the study.


  1. Bargenquast, R., Schweitzer, R. D., & Drake, S. (2015). Reawakening reflective capacity in the psychotherapy of schizophrenia: A case study. Journal of Clinical Psychology, 71(2), 136–145.CrossRefPubMedGoogle Scholar
  2. Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.Google Scholar
  3. Brüne, M., Dimaggio, G., & Lysaker, P. H. (2011). Metacognition and social functioning in schizophrenia: evidence, mechanisms of influence and treatment implications. Current Psychiatry Reviews, 7(3), 239–247.CrossRefGoogle Scholar
  4. Buck, K. D., & Lysaker, P. H. (2009). Addressing metacognitive capacity in the psychotherapy for schizophrenia: A case study. Clinical Case Studies, 8(6), 463–472.CrossRefGoogle Scholar
  5. Buck, K. D., Warman, D. M., Huddy, V., & Lysaker, P. H. (2012). The relationship of metacognition with jumping to conclusions among persons with schizophrenia spectrum disorders. Psychopathology, 45(5), 271–275.CrossRefPubMedGoogle Scholar
  6. Chadwick, P., Lees, S., & Birchwood, M. (2000). The revised beliefs about voices questionnaire (BAVQ). British Journal of Psychiatry, 177(3), 229–232.CrossRefGoogle Scholar
  7. Crawford, J., & Howell, D. (1998). Comparing an individual’s test score against norms derived from small samples. The Clinical Neuropsychologist, 12, 482–486.CrossRefGoogle Scholar
  8. De Jong, S., Renard, S. B., van Donkersgoed, R. J. M., van der Gaag, M., & Lysaker, P. H. (2014). The influence of adjunctive treatment and metacognitive deficits in schizophrenia on the experience of work. Schizophrenia Research, 157(1–3), 107–111.CrossRefPubMedGoogle Scholar
  9. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
  10. Hamm, J. A., Hasson-Ohayon, I., Kukla, M., & Jysaker, P. H. (2012). Individual psychotherapy for schizophrenia: trends and developments in the wake of the recovery movement. Psychology Research and Behavior Management, 6, 45–54.Google Scholar
  11. Hasson-Ohayon, I. (2012). Integrating cognitive behavioral-based therapy with an intersubjective approach: Addressing metacognitive deficits among people with schizophrenia. Journal of Psychotherapy Integration, 22(4), 356–374.CrossRefGoogle Scholar
  12. Hasson-Ohayon, I., Kravetz, S., & Roe, D. (2010). The relation between metacognition and empathy: The dialogical core of a metacognitive approach to psychiatric rehabilitation. In G. Dimaggio & P. H. Lysaker (Eds.), Metacognition and severe adult mental disorders: From basic research to treatment (pp. 233–246). London: Bruner Routledge.Google Scholar
  13. Hillis, J. D., Leonhardt, B. L., Vohs, J. L., Buck, K. D., Salvatore, G., Popolo, R., et al. (2015). Metacognitive reflective and insight therapy for people in early phase of a schizophrenia spectrum disorder. Journal of Clinical Psychology, 71(2), 125–135.CrossRefPubMedGoogle Scholar
  14. Kay, S., Fiszbein, A., & Opler, L. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276.CrossRefPubMedGoogle Scholar
  15. Kern, R. S., Glynn, S. M., Horan, W. P., & Marder, S. R. (2009). Psychosocial treatments to promote functional recovery in schizophrenia. Schizophrenia Bulletin, 35, 347–361.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Khazaal, Y., Chatton, A., Dieben, K., Huguelet, P., Boucherie, M., Monney, G., et al. (2015). Reducing delusional conviction through a cognitive-based group training game: a multicentre randomized controlled trial. Frontiers in Psychiatry, 6, 66.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Lysaker, P. H., Buck, K. D., Carcione, A., Procacci, M., Salvatore, G., Nicolò, G., et al. (2011a). Addressing metacognitive capacity for self reflection in the psychotherapy for schizophrenia: A conceptual model of the key tasks and processes. Psychology and Psychotherapy, 84, 58–69.CrossRefPubMedGoogle Scholar
  18. Lysaker, P. H., Clements, C. A., Plascak-Hallberg, C. D., Knipscheer, S. J., & Wright, D. E. (2002). Insight and personal narratives of illness in schizophrenia. Psychiatry, 65, 197–206.CrossRefPubMedGoogle Scholar
  19. Lysaker, P. H., Davis, L. W., Lightfoot, J., Hunter, N., & Stasburger, A. (2005). Association of neurocognition, anxiety, positive and negative symptoms with coping preference in schizophrenia spectrum disorders. Schizophrenia Research, 80, 163–171.CrossRefPubMedGoogle Scholar
  20. Lysaker, P. H., & Dimaggio, G. (2014). Metacognitive capacities for reflection in schizophrenia: implications for developing treatments. Schizophrenia Bulletin, 40(3), 487–491.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Lysaker, P. H., Dimaggio, G., Buck, K. D., Callaway, S. S., Salvatore, G., Carcione, A., et al. (2011b). Poor insight in schizophrenia: Links between different forms of metacognition with awareness of symptoms, treatment need, and consequences of illness. Comprehensive Psychiatry, 52(3), 253–260.CrossRefPubMedGoogle Scholar
  22. Lysaker, P. H., Dimaggio, G., Carcione, A., Procacci, M., Buck, K. D., Davis, L. W., et al. (2010a). Metacognition and schizophrenia: the capacity for self reflectivity as a predictor for prospective assessment of work performance over six months. Schizophrenia Research, 122(1–3), 124–130.CrossRefPubMedGoogle Scholar
  23. Lysaker, P. H., Dimaggio, G., Daroyani, P., Buck, K. D., Larocco, V. A., Carcione, A., et al. (2010b). Assessing metacognition in schizophrenia with the metacognition assessment scale: associations with the social cognition and object relations scale. Psychology and Psychotherapy, 83(3), 303–315.CrossRefPubMedGoogle Scholar
  24. Lysaker, P. H., Glynn, S. M., Wilkniss, S. M., & Silverstein, S. M. (2010c). Psychotherapy and recovery from schizophrenia: A review of potential applications and need for future study. Psychological Services, 7(2), 75–91.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Lysaker, P. H., McCormick, B. P., Snethen, G., Buck, K. D., Hamm, J. A., Grant, M., et al. (2011c). Metacognition and social function in schizophrenia: Associations of mastery with functional skills competence. Schizophrenia Research, 131(1–3), 214–218.CrossRefPubMedGoogle Scholar
  26. Mellenbergh, G. J., & van den Brink, W. P. (1998). The measurement of individual change. Psychological Methods, 3, 470–485.CrossRefGoogle Scholar
  27. Monestés, J. L., Vavasseur-Desperriers, J., Villatte, M., Denizot, L., Loas, G., & Rusinek, S. (2015). Influence of resistance to voices on depression. L’Encéphale, 41(1), 25–31.CrossRefPubMedGoogle Scholar
  28. Nasrallah, H., Morosini, P. L., & Gagnon, D. D. (2008). Reliability, validity and ability to detect change of the personal and social performance scale in patients with stable schizophrenia. Psychiatry Research, 161, 213–224.CrossRefPubMedGoogle Scholar
  29. Nicolò, G., Dimaggio, G., Popolo, R., Carcione, A., Procacci, M., Hamm, J., et al. (2012). Associations of metacognition with symptoms, insight, and neurocognition in clinically stable outpatients with schizophrenia. The Journal of Nervous and Mental Disease, 200(7), 644–647.CrossRefPubMedGoogle Scholar
  30. Peters, E., Joseph, S., Day, S., & Garety, P. (2004). Measuring delusional ideation: The 21-Item Peters et al. Delusions Inventory (PDI). Schizophrenia Bulletin, 30(4), 1005–1022.CrossRefPubMedGoogle Scholar
  31. Peters, E., Landau, S., McCrone, P., Cooke, M., Fisher, P., Steel, C., et al. (2010). A randomised controlled trial of cognitive behaviour therapy for psychosis in a routine clinical service. Acta Psychiatrica Scandinavica, 122(4), 302–318.CrossRefPubMedGoogle Scholar
  32. Randjibar, S., Veckenstedt, R., Vitzhum, F., Hottenrott, B., & Mortiz, S. (2011). Attributional biases in paranoid schizophrenia: Further evidence for a decreased sense of self-causation in paranoia. Psychosis, 3, 74–85.CrossRefGoogle Scholar
  33. Van Donkersgoed, R. J. M., De Jong, S., Van der Gaag, M., Aleman, A., Lysaker, P. H., Wunderink, L., et al. (2014). A manual individual therapy to improve metacognition in schizophrenia: protocol of a multi-center RCT. BMC Psychiatry, 14, 27.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Julien Dubreucq
    • 1
    • 2
  • Claire Delorme
    • 1
  • Rocio Roure
    • 1
    • 2
  1. 1.Reference Centre for Psychosocial Rehabilitation and Cognitive Remediation (C3R)Alpes Isère HospitalGrenobleFrance
  2. 2.Psychiatric Disability Network (RéHPsy)GrenobleFrance

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