Evaluating the Impact of Metacognitive Reflection and Insight Therapy on Social Functioning in Schizophrenia

Indiana University-Purdue University Indianapolis (IUPUI)Objective: Social functioning encompasses interactions with people across situations of varying complexity. Given the frequency of observed social impairments in individuals with schizophrenia, there is a need to identify mechanisms that influence social functioning impairments. One proposed mechanism is metacognition, a mental process that enables the integration and interpretation of mental states and experiences. Impaired metacognition can inhibit one’s ability to engage and navigate through our social world. In individuals with schizophrenia, both social functioning and metacognitive deficits are profound. This study examined three hypotheses. Following Metacognitive Reflection and Insight Therapy (MERIT), (1) individuals will show improvements in social functioning; (2) individuals will show improvements in metacognitive abilities; and (3) improvements in social functioning will be associated with improved metacognitive abilities. Method: Using secondary data from a MERIT therapy feasibility study, data collected from the active condition groups (e.g., individuals with schizophrenia, n =16) at pre-and post-assessment were analyzed using paired samples t-tests for primary outcomes and hierarchical linear regressions to assess metacognition as an underlying mechanism of change. Results: Paired samples t-tests found no significant improvement in social functioning or metacognition. In contrast to the hypothesis, metacognitive abilities significantly declined. When subscales were examined, two subscales (self-reflectivity and awareness of others) significantly decreased. The post-hoc analysis found significant improvements in overall symptoms and disorganization. Lastly, metacognition did not significantly predict post-intervention social functioning. Conclusions: Measurement modality and the length of intervention may help explain the null findings observed in this study. The improvement in overall and disorganized symptoms could indicate that symptom reductions precede social functioning and metacognition changes. Given that the results from this trial were not aligned with previous studies, further research is needed to determine the effectiveness of MERIT on social functioning and metacognition in schizophrenia

Evaluating the Impact of Metacognitive Reflection and Insight Therapy on Social Functioning in Schizophrenia

Objective: Social functioning encompasses interactions with people across situations of varying complexity. Given the frequency of observed social impairments in individuals with schizophrenia, there is a need to identify mechanisms that influence social functioning impairments. One proposed mechanism is metacognition, a mental process that enables the integration and interpretation of mental states and experiences. Impaired metacognition can inhibit one’s ability to engage and navigate through our social world. In individuals with schizophrenia, both social functioning and metacognitive deficits are profound. This study examined three hypotheses. Following Metacognitive Reflection and Insight Therapy (MERIT), (1) individuals will show improvements in social functioning; (2) individuals will show improvements in metacognitive abilities; and (3) improvements in social functioning will be associated with improved metacognitive abilities. Method: Using secondary data from a MERIT therapy feasibility study, data collected from the active condition groups (e.g., individuals with schizophrenia, n =16) at pre-and post-assessment were analyzed using paired samples t-tests for primary outcomes and hierarchical linear regressions to assess metacognition as an underlying mechanism of change. Results: Paired samples t-tests found no significant improvement in social functioning or metacognition. In contrast to the hypothesis, metacognitive abilities significantly declined. When subscales were examined, two subscales (self-reflectivity and awareness of others) significantly decreased. The post-hoc analysis found significant improvements in overall symptoms and disorganization. Lastly, metacognition did not significantly predict post-intervention social functioning. Conclusions: Measurement modality and the length of intervention may help explain the null findings observed in this study. The improvement in overall and disorganized symptoms could indicate that symptom reductions precede social functioning and metacognition changes. Given that the results from this trial were not aligned with previous studies, further research is needed to determine the effectiveness of MERIT on social functioning and metacognition in schizophrenia

Do People With Schizophrenia Enjoy Social Activities as Much as Everyone Else? A Meta-analysis of Consummatory Social Pleasure

Background: The "emotion paradox" of schizophrenia suggests people with schizophrenia demonstrate deficits when reporting anticipated and retrospective pleasure; yet, in-the-moment, consummatory pleasure is largely intact. It is uncertain how these findings extend to social situations. This meta-analysis aimed to (1) determine the mean difference in consummatory social pleasure between people with schizophrenia and healthy controls, and (2) examine moderators of this effect, including study design and clinical characteristics of participants. Design: A literature search using PsycINFO, Web of Science, Pubmed, and EMBASE databases was conducted. Studies measuring consummatory social pleasure using experience sampling methods and laboratory social simulations were included. Random effects meta-analyses were conducted using Hedge's g. Results: Meta-analysis of 26 studies suggests people with schizophrenia exhibited a small, significant deficit in consummatory social pleasure (g = -0.38, 90% CI [-0.53, -0.22]). There was significant heterogeneity in effect sizes; magnitude was moderated by study design and type of measure used to assess social pleasure. Conclusions: Overall, people with schizophrenia seem to exhibit less consummatory social pleasure than controls. However, this deficit is smaller than in studies of anticipated and retrospective pleasure. Thus, consummatory social pleasure may not be quite as impaired in people with schizophrenia as traditional anhedonia research suggests. Moreover, pleasure deficits observed in people with schizophrenia may result from differences in the quality of their daily social experiences rather than differences in their capacity for social pleasure. Results have important implications for clinical interventions that address barriers to social engagement, low-pleasure beliefs, and cognitive remediation to treat schizophrenia

Stuck Inside: How Social Functioning in Schizophrenia Changed During the COVID-19 Pandemic

Social distancing policies enacted during the COVID-19 pandemic altered our social interactions. People with schizophrenia, who already exhibit social deficits, may have been disproportionally impacted. In this pilot study, we a) compared prepandemic social functioning to functioning during the pandemic in people with schizophrenia ( n = 21) who had data at both time points; and b) examined if patterns of decline in schizophrenia differed from healthy controls ( n = 21) across a series of repeated-measures analyses of variance. We observed larger declines in social functioning in schizophrenia (η 2 = 0.07, medium effect size) during the pandemic compared with the control group. Between-group declines did not extend to other domains, suggesting that declines are specific to social functioning. Our findings signal that treatments focusing on reconnecting people with schizophrenia to their social networks should be prioritized. Future studies should continue tracking social functioning after the pandemic to illustrate patterns of recovery

Metacognitive Beliefs and Metacognitive Capacity: Do They Assess Related Phenomena?

Metacognition has been defined several ways across different fields. In schizophrenia, two primary approaches to assessing metacognition focus on measuring metacognitive beliefs and metacognitive capacity. The degree of association between these two approaches is unclear. In this pilot study, schizophrenia (n = 39) and control groups (n = 46) were assessed using metacognitive beliefs (Metacognition Questionnaire-30) and metacognitive capacity (Metacognition Assessment Scale-Abbreviated) scales. We also examined how these two approaches predicted quality of life. Results showed anticipated differences for metacognitive beliefs, metacognitive capacity, and quality of life when comparing schizophrenia and healthy control groups. However, metacognitive beliefs and metacognitive capacity were not significantly related and only predicted quality of life in the healthy control group. Although preliminary, these findings suggest these two approaches have a limited relationship with one another. Future studies should test these findings in larger samples and focus on examining associations at different levels of metacognitive functioning in those with schizophrenia

Social Activity in Schizotypy: Measuring Frequency and Enjoyment of Social Events

Improving social functioning deficits—a core characteristic of schizophrenia-spectrum disorders—is often listed by patients as a key recovery goal. Evidence suggests that social deficits also extend to people with schizotypy, a group at heightened risk for psychotic and other psychopathological disorders. One challenge of social functioning research in schizotypy is understanding whether social deficits arise from receiving less pleasure from social activities or from participating less in high-pleasure activities. However, limited information exists on what constitutes highly pleasurable, common social activities. In this study, 357 college students rated the frequency and enjoyment of 38 social activities. Our aims were to categorize activities based on their frequency and enjoyment, and whether these correlated with validated social functioning and schizotypy measures. We found that social activities could be characterized based on their frequency and enjoyment and created a frequency–enjoyment matrix that could be useful for future studies. Activities were correlated with social functioning, generally reaching a small effect size level, with increasing frequency and enjoyment showing associations with greater social functioning. Further, negative and disorganized—but not positive—traits were associated with less engagement and pleasure. Although follow-up studies in community samples are needed, our findings have the potential to help researchers and clinicians better understand which activities participants are more likely to engage in and derive pleasure from. The findings may also illustrate the extent to which social deficits may be due to less engagement or less pleasure from social activities, as well as which aspects of schizophrenia-spectrum disorders are associated with these facets of social functioning

Social Activity in Schizotypy: Measuring Frequency and Enjoyment of Social Events

Improving social functioning deficits-a core characteristic of schizophrenia-spectrum disorders-is often listed by patients as a key recovery goal. Evidence suggests that social deficits also extend to people with schizotypy, a group at heightened risk for psychotic and other psychopathological disorders. One challenge of social functioning research in schizotypy is understanding whether social deficits arise from receiving less pleasure from social activities or from participating less in high-pleasure activities. However, limited information exists on what constitutes highly pleasurable, common social activities. In this study, 357 college students rated the frequency and enjoyment of 38 social activities. Our aims were to categorize activities based on their frequency and enjoyment, and whether these correlated with validated social functioning and schizotypy measures. We found that social activities could be characterized based on their frequency and enjoyment and created a frequency-enjoyment matrix that could be useful for future studies. Activities were correlated with social functioning, generally reaching a small effect size level, with increasing frequency and enjoyment showing associations with greater social functioning. Further, negative and disorganized-but not positive-traits were associated with less engagement and pleasure. Although follow-up studies in community samples are needed, our findings have the potential to help researchers and clinicians better understand which activities participants are more likely to engage in and derive pleasure from. The findings may also illustrate the extent to which social deficits may be due to less engagement or less pleasure from social activities, as well as which aspects of schizophrenia-spectrum disorders are associated with these facets of social functioning

Differential Risk: Gender and Racial Differences in the Relationship between Trauma, Discrimination, and Schizotypy

Traumatic experiences are associated with increased experiences of positive schizotypy. This may be especially important for People of Color, who experience higher rates of trauma and racial discrimination. No study to date has examined how racial disparities in traumatic experiences may impact schizotypy. Furthermore, of the studies that have examined the relationship between trauma and schizotypy, none have examined racial discrimination as a potential moderator. The present study examined if racial discrimination moderates the relationship between trauma and multidimensional (positive, negative, and disorganized) schizotypy. In a sample of 770 college students, we conducted chi-squared analyses, analyses of variance, and stepwise regressions. We found that Black students experienced significantly higher racial discrimination and trauma than Latinx and Asian students. Furthermore, Black and Latinx students experienced significantly more multidimensional schizotypy items than Asian students. Trauma and racial discrimination explained 8 to 23% of the variance in each dimension of schizotypy. Racial discrimination did not moderate the relationships between trauma and multidimensional schizotypy. Our findings suggest that we need to examine risk factors that may prevent recovery from psychotic disorders. Additionally, disorganized schizotypy showed the most robust associations and may be a critical site of intervention