Emotional experience and metacognition among people with schizophrenia: Analysis of session by session and outcome of metacognitive-oriented psychotherapy

Libby Igra; Haran Sened; Adi Lavi-Rotenberg; Marieke Pijnenborg; Paul H Lysaker; Ilanit Hasson-Ohayon

doi:10.1016/j.jpsychires.2022.10.048

Emotional experience and metacognition among people with schizophrenia: Analysis of session by session and outcome of metacognitive-oriented psychotherapy

J Psychiatr Res. 2022 Dec:156:460-466. doi: 10.1016/j.jpsychires.2022.10.048. Epub 2022 Oct 21.

Authors

Libby Igra¹, Haran Sened², Adi Lavi-Rotenberg³, Marieke Pijnenborg⁴, Paul H Lysaker⁵, Ilanit Hasson-Ohayon³

Affiliations

¹ Department of Psychology, Bar-Ilan University, Ramat Gan, Israel. Electronic address: igralib@biu.ac.il.
² Department of Psychology, University of Haifa, Haifa, Israel.
³ Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.
⁴ Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands.
⁵ Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.

PMID: 36335836
DOI: 10.1016/j.jpsychires.2022.10.048

Abstract

Background: Research suggests that in-session emotional experiences in psychotherapy promote both session and treatment outcomes across different clinical samples and treatment approaches. However, little is known about how this notion applies to clients with schizophrenia, who experience particular deficits related to emotional experience. To explore this question, we investigated the association between clients' emotional experience and their session outcome evaluations and metacognitive growth in a metacognitively-oriented treatment, Metacognitive Reflection and Insight Therapy (MERIT). MERIT is a recovery-oriented treatment approach for psychosis that focuses on recapturing a coherent sense of self and personal agency by enhancing metacognitive capacity.

Method: Five-hundred-and-sixty-three sessions of 37 clients with schizophrenia who took part in an ongoing MERIT trial were analyzed. The Emotional Experience Self-Report (EE-SR) and Outcome Rating Scale (ORS) were collected on a session-by-session basis. Levels of metacognition ware assessed pre- and post-treatment using the Metacognitive Assessment Scale-Abbreviated (MAS-A) coding system. We used multilevel modeling to test our session-level predictions, and linear regression analysis for treatment-level predictions.

Results: Greater emotional experience, expression, and regulation within a session were associated with better session outcome. Regarding treatment level, greater emotional experience was associated with improvement in metacognitive mastery.

Conclusions: Our findings reveal that experiencing emotions in MERIT has significant implications for clients' subjective well-being during therapy sessions and for their ability to respond to psychological challenges using metacognitive knowledge. These findings lend weight to the idea that emotional experience is a key mechanism of change in metacognitive therapy for schizophrenia.

Keywords: Change mechanism; Emotions; Metacognition; Psychotherapy; Schizophrenia.

MeSH terms

Humans
Outcome Assessment, Health Care
Schizophrenia* / complications
Schizophrenia* / therapy