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Key points
- People with schizophrenia often lack insight into their condition.
- In a recent study, people with schizophrenia received metacognitive training or metacognitive reflection. Insight increased post-treatment.
- Metacognitive training in particular improved cognitive insight, self-reflectiveness, illness awareness, and awareness of psychotic phenomena.
People with schizophrenia are known for lacking insight into their condition. It’s what makes people with the disorder refuse to adhere to a medication regimen, speak irrationally about their disorder, and avoid accepting their hallucinations and delusions as products of their own minds instead of reality.
The level of insight of patients with psychotic disorders is as heterogenous as the symptoms that present themselves between each person. Each person shows different reactions to their symptoms. Sometimes patients can be talked down from their psychotic episodes, and sometimes they can’t. Often the perception is that psychotic patients can’t, which can result in involuntary treatment.
What about therapeutic training for patients with schizophrenia? Does metacognitive training help develop insight for patients with schizophrenia? The evidence is slim, but a study published in Psychological Medicine might offer some indication that it could be possible.
The Science of Insight Interventions
A meta-analysis was conducted on the effect of Metacognitive Training (MCT) and Metacognitive Reflection and Insight Therapy (MERIT). Participants were selected from 12 studies (which totaled 713 participants) that met the selection criteria for patients that underwent MCT or MERIT. Results varied.
Attrition rates for increased insight after therapeutic interventions ranged from 0 percent to 27 percent. Seven of those studies followed up with patients after six months. Attrition rates from those studies ranged anywhere from 0 percent to 41.4 percent.
MCT was seen as the more favorable treatment method for producing cognitive insight. Awareness of delusions in one study produced significant levels of cognitive insight both post-treatment and at a six-month follow-up. MCT was also shown to be more effective than a control method like cognitive remediation. Insight scores across both groups appeared to increase post-treatment, with a larger effect size for the MCT method versus the control group. Cognitive insight reduced in both groups at a six-month follow-up, but was only shown to be significant in the control group.
Overall, MCT improved cognitive insight, self-reflectiveness, illness awareness, and awareness of psychotic phenomena like hallucinations and delusions. The effects of the treatment was generally larger post-treatment than at the six-month follow-ups, interestingly.
So it looks like cognitive insight into a psychotic disorder might be possible with intervention. Given the higher rates of effectiveness for post-treatment than at the six-month follow-ups, perhaps this indicates that patients need routine upkeep of practicing these insight strategies. Without regular practice, patients might lose that ability significantly.
References
Lopez-Morinigo, J. D., Ajnakina, O., Martínez, A. S. E., Escobedo-Aedo, P. J., Ruiz-Ruano, V. G., Sánchez-Alonso, S., ... & David, A. S. (2020). Can metacognitive interventions improve insight in schizophrenia spectrum disorders? A systematic review and meta-analysis. Psychological medicine, 50(14), 2289-2301.
