Lysaker Paul H, Gagen Emily, Klion Reid, Zalzala Aieyat, Vohs Jenifer, Faith Laura A, Leonhardt Bethany, Hamm Jay, Hasson-Ohayon Ilanit
Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
Indiana University School of Medicine, Indianapolis, IN, USA.
Psychol Res Behav Manag. 2020 Apr 2;13:331-341. doi: 10.2147/PRBM.S198628. eCollection 2020.
Recent research has suggested that recovery from psychosis is a complex process that involves recapturing a coherent sense of self and personal agency. This poses important challenges to existing treatment models. While current evidence-based practices are designed to ameliorate symptoms and skill deficits, they are less able to address issues of subjectivity and self-experience. In this paper, we present Metacognitive Insight and Reflection Therapy (MERIT), a treatment approach that is explicitly concerned with self-experience in psychosis. This approach uses the term metacognition to describe those cognitive processes that underpin self-experience and posits that addressing metacognitive deficits will aid persons diagnosed with psychosis in making sense of the challenges they face and deciding how to effectively manage them. This review will first explore the conceptualization of psychosis as the interruption of a life and how persons experience themselves, and then discuss in more depth the construct of metacognition. We will next examine the background, practices and evidence supporting MERIT. This will be followed by a discussion of how MERIT overlaps with other emerging treatments as well as how it differs. MERIT's capacity to engage patients who reject the idea that they have mental illness as well as cope with entrenched illness identities is highlighted. Finally, limitations and directions for future research are discussed.
近期研究表明，从精神病中康复是一个复杂的过程，涉及重新获得连贯的自我意识和个人能动性。这对现有的治疗模式提出了重大挑战。虽然当前基于证据的实践旨在改善症状和技能缺陷，但它们在解决主观性和自我体验问题方面能力较弱。在本文中，我们介绍元认知洞察与反思疗法（MERIT），这是一种明确关注精神病患者自我体验的治疗方法。这种方法使用元认知一词来描述那些支撑自我体验的认知过程，并假定解决元认知缺陷将有助于被诊断患有精神病的人理解他们所面临的挑战并决定如何有效应对这些挑战。本综述将首先探讨将精神病概念化为生活中断以及人们如何体验自己，然后更深入地讨论元认知的概念。接下来，我们将研究支持MERIT的背景、实践和证据。随后将讨论MERIT与其他新兴治疗方法的重叠之处以及不同之处。重点强调了MERIT吸引那些拒绝承认自己患有精神疾病的患者以及应对根深蒂固的疾病身份认同的能力。最后，讨论了局限性和未来研究的方向。
