Metacognition and Severe Adult Mental Disorders: From Research to Treatment

340 Pages·2010·17.28 MB·English

by  Giancarlo Dimaggio

Metacognition and Severe Adult Mental
Disorders
Many adults who experience severe mental illness also suffer from deficits
inmetacognition – putsimply,thinkingaboutone’sownthoughtprocesses
– limiting their abilities to recognize, express and manage naturally occur-
ring painful emotions and routine social problems as well as to fathom the
intentions of others.
This book presents an overview of the field, showing how current research
can inform clinical practice. An international range of expert contributors
provide chapters which look at the role of metacognitive deficit in per-
sonality disorders, schizophrenia and mood disorders, and the implications
for future psychotherapeutic treatment.
Divided into three parts areas covered include:
• howmetacognitivedeficitsmayariseandthedifferentformstheymight
take
• the psychopathology of metacognition in different forms of mental
illness
• whether specific deficits in metacognition might help us understand the
difficulties seen in differing forms of severe mental illness.
Offering varying perpsectives and including a wealth of clinical material,
this book will be of great interest to all mental health professionals,
researchers and practitioners.
Giancarlo Dimaggio is a psychiatrist and psychotherapist at the Third
Center of Cognitive Psychotherapy in Rome. He is currently involved in
clinical work and research on pathology and treatment of personality
disorders.
Paul H. Lysaker is a clinical psychologist at the Roudebush VA Medical
Center in Indianapolis, Indiana and an Associate Professor of Clinical
Psychology in the Department of Psychiatry, Indianapolis School of Medi-
cine.Hiscurrentresearchinterestsincludethedevelopmentofmetacognitive
capacitythrough individual psychotherapy for persons withschizophrenia.
‘‘Traditional cognitive domains, such as language, memory or perception,
do not properly capture the problems experienced by people with severe
mental disorders like schizophrenia. Their problems lie rather with insight
and with the ability to monitor the mental and emotional states of them-
selves and others. In this book the editors have recognised that these
disparate problems can be brought together under the heading of Meta-
cognition. As the contents of the book so admirably show, this very
important insight provides a framework for guiding both theory and
practice in the study of severe mental disorders.’’
Chris Frith, UCL & University of Aarhus
‘‘Dimaggio and Lysaker have assembled a stellar cast of contributors who
apply the latest developments in theory and research on metacognition to
our understanding of the both the development and treatment of severe
mentaldisorders.Althoughallofthecontributionsaresubsumedunderthe
generaltopicofmetacognition,theauthorsareinfactaddressinganumber
of vitally important and timely areas. These include: theory of mind,
reflective functioning, mentalization, attachment, affect regulation, and the
therapeutic relationship. The end result is a lively, engaging and thought
provoking collection of essays that will be of tremendous interest to
theorists, researchers and psychotherapists of all orientations.’’
Jeremy D. Safran, Professor and Director of Clinical Psychology, New
School for Social Research; President, International Association for
Relational Psychoanalysis and Psychotherapy
Metacognition and Severe Adult
Mental Disorders
From research to treatment
Edited by Giancarlo Dimaggio and
Paul H. Lysaker
Firstpublished2010
byRoutledge
27ChurchRoad,Hove,EastSussexBN32FA
SimultaneouslypublishedintheUSAandCanada
byRoutledge
270MadisonAvenue,NewYork,NY10016
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This edition published in the Taylor & Francis e-Library, 2010.
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Copyright(cid:216) 2010 Selection and editorial matter Giancarlo Dimaggio &
PaulH.Lysaker;individualchapters,theContributors
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Allrightsreserved.Nopartofthisbookmaybereprintedorreproducedor
utilisedinanyformorbyanyelectronic,mechanical,orothermeans,now
knownorhereafterinvented,includingphotocopyingandrecording,orin
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BritishLibraryCataloguinginPublicationData
AcataloguerecordforthisbookisavailablefromtheBritishLibrary
Libraryof CongressCataloging-in-PublicationData
Metacognitionandsevereadultmentaldisorders:fromresearchto
treatment/editedbyGiancarloDimaggio&PaulH.Lysaker.
p.;cm.
Includesbibliographicalreferences.
ISBN978-0-415-48423-7(hardback)
1.Mentalillness.2.Metacognition.I.Dimaggio,Giancarlo.
II.Lysaker,PaulH.
[DNLM:1.Mentaldisorders.2.Adult.3.Awareness.4.Cognition.
WM140M5872010]
RC454.M4742010
616.89–dc22
2009032563
ISBN 0-203-85578-7 Master e-book ISBN
ISBN:978-0-415-48423-7(hbkonly)
Contents
List of illustrations viii
List of contributors x
Introduction 1
GIANCARLODIMAGGIOANDPAULH.LYSAKER
PART I
Theory: the neural and social basis for
metacognition and its disorders 11
1 Seeing ourselves: what vision can teach us about metacognition 13
REBECCASAXEANDSHANIOFFEN
2 Social understanding through social interaction 30
JEREMYI.M.CARPENDALEANDCHARLIELEWIS
3 The developmental roots of compromised mentalization in
complex mental health disturbances of adulthood: an
attachment-based conceptualization 45
ANDREWGUMLEY
PART II
Metacognitive disorders in different clinical
populations: its relation with symptoms,
interpersonal functioning and adaptation 63
4 Metacognition in schizophrenia spectrum disorders: methods of
assessing metacognition within narrative and links with
neurocognition 65
PAULH.LYSAKER
vi Contents
5 Schizophrenia and social functioning: the role of impaired
metacognition 83
DANIELASCHAUB,MONAABDEL-HAMIDANDMARTINBRU¨NE
6 Awareness is not the same as acceptance: exploring the
thinking behind insight and compliance 95
KEVIND.MORGANANDANTHONYS.DAVID
7 The assessment of theory of mind in schizophrenia 115
ELLIOTM.BELL,ROBYNLANGDON,RICHARDJ.SIEGERTAND
PETEM.ELLIS
8 Commonsense, disembodiment and delusions in schizophrenia 134
GIOVANNISTANGHELLINI
9 Deficit of theory of mind in depression and its correlation
with poor clinical outcomes 150
SHIGENOBUKANBA,KAZUOYAMADAANDYUMIKOINOUE
10 Interpersonal problems in alexithymia: a review 161
STIJNVANHEULE,RUTHINSLEGERS,REITSKEMEGANCK,ELSOOMS
ANDMATTIASDESMET
11 Different profiles of metacognitive dysfunctions in personality
disorders 177
LIVIACOLLE,STEFANIAD’ANGERIO,RAFFAELEPOPOLOAND
GIANCARLODIMAGGIO
12 Metacognitive deficits in trauma-related disorders: contingent on
interpersonal motivational contexts? 196
GIOVANNILIOTTIANDELENAPRUNETTI
PART III
Treatment of metacognitive disturbances in
severe adult disorders 215
13 Metacognitive capacity as a focus of individual psychotherapy
in schizophrenia 217
PAULH.LYSAKERANDKELLYD.BUCK
14 Empathic and theory of mind processes: the dialogical core of
a metacognitive approach to psychiatric rehabilitation 233
ILANITHASSON-OHAYON,SHLOMOKRAVETZANDDAVIDROE
Contents vii
15 Enhancing mental state understanding in over-constricted
personality disorder using metacognitive interpersonal therapy 247
GIANCARLODIMAGGIO,GIAMPAOLOSALVATORE,GIUSEPPENICOLO`,
DONATELLAFIOREANDMICHELEPROCACCI
16 The impact of metacognitive dysfunctions in personality
disorders on the therapeutic relationship and intervention
technique 269
ANTONIOSEMERARI
17 Change in post traumatic stress disorder: an assimilation
model account 285
KATERINEOSATUKEANDWILLIAMB.STILES
Conclusion 301
PAULH.LYSAKERANDGIANCARLODIMAGGIO
Index 310
Illustrations
Figures
1.1 The Adelson plaid illusion 16
1.2 A Kanizsa triangle 17
6.1 Decision-making sequence 97
6.2 Cognition across the compliance profile groups 110
9.1 Theory of Mind (TOM) battery 154
13.1 Modified metacognition assessment total score over
51 months: case of Grieg 231
Tables
6.1 Sample background characteristics 99
7.1 Operationalizing theory of mind (TOM): classification of
TOM tasks used in research on schizophrenia and related
psychotic illnesses of adulthood 117
7.2 Areas of coverage in a proposed approach to clinical
evaluation of schizophrenia, with focus on a brief
assessment of theory of mind 128
9.1 Theory of mind (TOM) and relapse 156
17.1 Assimilation of Problematic Experiences Scale (APES) 288
Dialogue tables
6.1 Presence of illness not accepted – no clear evidence of
metacognition 101
6.2 Presence of illness accepted – no clear evidence of
metacognition 102
6.3 Accounts of illness status with evidence of metacognition 103
6.4 Accounts of illness status when presented with hypothetical
contradiction 104
Figures and tables ix
6.5 Mismatch between treatment attitudes and treatment
behaviour 106
6.6 The impact of compulsion and deference to medical
professionals on attitudes toward treatment 107
6.7 Experiences and expectations of medication side effects
on treatment attitudes and behaviour 108