Metacognitive Reflection and Insight Therapy (MERIT) with a Patient with Persistent Negative Symptoms

Metacognition comprises a spectrum of mental activities involving thinking about thinking. Metacognitive impairments may sustain and trigger negative symptoms in people with schizophrenia. Without complex ideas of the self and others, there may be less reason to pursue goal-directed activities and less ability to construct meaning in daily activities, leading to the experience of negative symptoms. As these symptoms tend to be nonresponsive to pharmacotherapy and other kinds of treatment metacognition might be a novel treatment target; improvement of metacognition might lead to improvements in negative symptoms. One therapy that seeks to promote metacognition is the Metacognitive Reflection and Insight Therapy (MERIT). In this study, a case is presented in which a first episode patient with severe negative symptoms is treated with MERIT. A case illustration and the eight core principles of MERIT are presented. Independent assessments of metacognition and negative symptoms before and after therapy show a significant increase of metacognition and decrease of negative symptoms over the course of 40 weeks

An Integrative-Relational Approach in Schizophrenia: From Philosophical Principles to Mentalization-Based Practice

In this paper, we explore psychosis and schizophrenia as prototype disturbances, where mentalizing failures are widely seen. We attempt to describe how the process of rekindling mentalizing within attachment relationships (here, the patient-therapist relationship) can have a protective effect not just on the onset of the disturbance, but also when psychosis is already actively installed. We start by discussing mentalizing in training, practice and supervision. We also try to understand it contextually, as a relational concept, within the history of psychological therapies

Clinical High-Risk for Psychosis Syndromes among Swiss and German Youth and Young Adults: Early Identification and Intervention

In Germany, clinical considerations of using patients’ self-reported early subtle disturbances for an early detection of developing psychosis before its first episode date back to the early twentieth century. These resulted in the formulation of the basic symptom concept that assumes that subtle, self-perceivable, but rarely externally perceivable disturbances in mental processes—the so-called basic symptoms—are the first psychopathological correlate of neurobiological processes underlying the development of psychoses, while attenuated and frank psychotic symptoms develop later in the course of the disorder as a result of inadequate coping with basic symptoms as well as other symptoms and stressors. Thus, both in Germany and Switzerland, systematic research on early detection and intervention in psychosis has mainly considered both basic symptom and ultrahigh risk criteria. Their combined consideration resulted in the first-ever staging model setting out an early and a late risk stage and, relatedly, a staged intervention model much in line with recent recommendations for intervention in a clinical high risk state by the European Psychiatric Association. Based on a first meta-analysis of single risk criteria, the basic symptom criterion cognitive disturbances and the symptomatic ultrahigh risk criteria were alternatively recommended for the detection of a clinical high risk syndrome by the European Psychiatric Association. Furthermore, research in Switzerland and Germany has focused on developmental issues and the general population, indicating that an onset-revised Attenuated Psychosis Syndromes might have clinical meaning in the general population, in particular in adults, in whom, however, it is infrequent