Lysaker Paul H, Gagen Emily, Moritz Steffen, Schweitzer Robert D
Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA,
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA,
Psychol Res Behav Manag. 2018 Sep 5;11:341-351. doi: 10.2147/PRBM.S146446. eCollection 2018.
In light of increasing interest in metacognition and its role in recovery from psychosis, a range of new treatments focused on addressing metacognitive deficits have emerged. These include Metacognitive Therapy, Metacognitive Training, metacognitive insight and reflection therapy, and metacognitive interpersonal therapy for psychosis. While each of these treatments uses the term metacognitive, each differs in terms of their epistemological underpinnings, their structure, format, presumed mechanisms of action, and primary outcomes. To clarify how these treatments converge and diverge, we first offer a brief history of metacognition as well as its potential role in an individual's response to and recovery from complicated mental health conditions including psychosis. We then review the background, practices, and supporting evidence for each treatment. Finally, we will offer a framework for thinking about how each of these approaches may ultimately complement rather than contradict one another and highlight areas for development. We suggest first that each is concerned with something beyond what people with psychosis think about themselves and their lives. Each of these four approaches is interested in how patients with severe mental illness think about themselves. Each looks at immediate reactions and ideas that frame the meaning of thoughts. Second, each of these approaches is more concerned with why people make dysfunctional decisions and take maladaptive actions rather than what comprised those decisions and actions. Third, despite their differences, each of these treatments is true to the larger construct of metacognition and is focused on person's relationships to their mental experiences, promoting various forms of self-understanding which allow for better self-management. Each can be distinguished from other cognitive and skills-based approaches to the treatment of psychosis in their emphasis on sense-making rather than learning a new specific thing to say, think, or do in a given situation.
鉴于对元认知及其在精神病康复中的作用的兴趣日益增加，一系列专注于解决元认知缺陷的新疗法应运而生。这些疗法包括元认知疗法、元认知训练、元认知洞察与反思疗法以及针对精神病的元认知人际疗法。虽然这些疗法都使用了“元认知”这个术语，但它们在认识论基础、结构、形式、假定的作用机制和主要结果方面各不相同。为了阐明这些疗法的异同，我们首先简要介绍一下元认知的历史及其在个体应对包括精神病在内的复杂心理健康状况并从中康复的过程中的潜在作用。然后，我们将回顾每种疗法的背景、实践和支持证据。最后，我们将提供一个框架，以思考这些方法如何最终相互补充而非相互矛盾，并突出发展领域。我们首先建议，每种疗法所关注的都不仅仅是患有精神病的人如何看待自己和他们的生活。这四种方法中的每一种都关注重度精神疾病患者如何看待自己。每一种都着眼于构成思想意义的即时反应和想法。其次，这些方法中的每一种都更关注人们做出功能失调的决定和采取适应不良行为的原因，而不是这些决定和行为的构成要素。第三，尽管它们存在差异，但这些疗法中的每一种都符合更大的元认知概念，并且都关注个体与他们的心理体验的关系，促进各种形式的自我理解，从而实现更好的自我管理。与其他基于认知和技能的精神病治疗方法相比，每种疗法都可以通过强调意义建构而不是在特定情况下学习新的具体内容来表达、思考或行动而得以区分。
