Igra Libby, Sened Haran, Lavi-Rotenberg Adi, Pijnenborg Marieke, Lysaker Paul H, Hasson-Ohayon Ilanit
Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.
Department of Psychology, University of Haifa, Haifa, Israel.
J Psychiatr Res. 2022 Dec;156:460-466. doi: 10.1016/j.jpsychires.2022.10.048. Epub 2022 Oct 21.
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.
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.
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.
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.
研究表明，心理治疗中的即时情绪体验能促进不同临床样本和治疗方法的治疗过程及治疗效果。然而，对于这一概念如何适用于患有精神分裂症的患者，人们却知之甚少，因为这类患者在情绪体验方面存在特殊缺陷。为了探究这个问题，我们在一种以元认知为导向的治疗方法——元认知反思与洞察疗法（MERIT）中，研究了患者的情绪体验与其治疗过程结果评估以及元认知成长之间的关联。MERIT是一种针对精神病的以康复为导向的治疗方法，它通过增强元认知能力来重新获得连贯的自我意识和个人能动性。
对参与一项正在进行的MERIT试验的37名精神分裂症患者的563次治疗过程进行了分析。逐次收集了情绪体验自我报告（EE-SR）和治疗结果评定量表（ORS）。使用元认知评估量表简版（MAS-A）编码系统在治疗前和治疗后评估元认知水平。我们使用多层次模型来检验我们的治疗过程水平预测，并使用线性回归分析进行治疗水平预测。
一次治疗过程中更强的情绪体验、表达和调节与更好的治疗过程结果相关。在治疗水平方面，更强的情绪体验与元认知掌握的改善相关。
我们的研究结果表明，在MERIT中体验情绪对患者在治疗过程中的主观幸福感以及他们运用元认知知识应对心理挑战的能力具有重要意义。这些发现支持了情绪体验是精神分裂症元认知治疗中关键的改变机制这一观点。
