Changes in Emotion Regulation and Attachment Patterns Across 24 Sessions of Metacognitive Reflection and Insight Therapy (MERIT): A Mixed Methods Case Study of a Person with Schizoaffective Disorder in a Rural Midwestern Community in the United State

Preliminary evidence has indicated that attachment style may be an important variable that can influence emotion regulation among individuals with experiences of psychosis. Yet there is a dearth of therapeutic approaches examined that address both constructs. More integrative approaches, such as Metacognitive Reflection and Insight Therapy (MERIT), may be well suited to address these concerns given its integrative approach to increasing insight. To explore this, this article presents a case report of an individual diagnosed with schizoaffective disorder who completed 24 sessions of MERIT. This individual presented with constricted affect and limited ability to access emotional content. Emotion regulation was measured before, during, and after treatment, while attachment security to the therapist was measured during and after treatment. Reliable change index (RCI) analyses of the individual’s scores revealed significant changes in domains of subjective emotion regulation abilities and attachment security to the therapist. A qualitative analysis of session transcripts is presented as well. Treatment was found to be feasible and acceptable to the client, and improvements were noted in the areas of emotion regulation and attachment security to the therapist. Clinical implications and limitations are also discussed.