Metacognitive and Related Approaches in the Treatment of Schizophrenia-Spectrum Disorders

Schizophrenia-spectrum disorders (SSD) are characterized by interruptions in one's sense of self, cognitive dysfunction, disorganized thinking, belief inflexibility, and unusual experiences such as hallucinations and delusions. Disruptions in metacognition-skill in reflecting upon one's own and other's thought processes-have increasingly been viewed as a core foundation of these features of SSD. We focus this review on Metacognitive Reflection and Insight Therapy (MERIT) and Metacognitive Training (MCT), two metacognitive therapies for SSD designed to improve integration in perceptions of self and others, and to gain greater awareness of biases and the fallibility of cognitions, respectively. We explicate their theoretical underpinnings, treatment targets, and commonly used techniques and summarize their evidence base. We also provide a brief overview of two related therapies, cognitive remediation and cognitive behavioral therapy, with a focus on identifying their metacognitive components, and we compare mechanisms of action, efficacy, and evidence base across these different approaches.