Guest Scientist: Psychotic Disorders and Metacognitive Remediation – Dr. Nicholas Breitborde

Psychotic disorders, such as schizophrenia, are devastating illnesses that are characterized by symptoms such as hallucinations, delusions, and disorganized thought and speech.  Yet, growing research has suggested that the greatest barrier faced by individuals in their recovery from psychotic disorders is declines in cognitive functioning. Unexplained worsening of skills such as memory, problem-solving, and attention is often one of the early warnings signs of a burgeoning psychotic disorder and declines in these cognitive domains are the most significant barrier that many individuals with psychosis face when trying to participate in work or school or maintain satisfying relationships with peers.

In response to these findings, there has been growing interest in developing cognition-enhancing interventions for individuals with psychotic disorders.  One such promising treatment is metacognitive remediation therapy (MCR)—a form of individual psychotherapy developed by Dr. Nicholas Breitborde and colleagues.  MCR is among a growing catalog of individual psychotherapies for individuals with serious mental illness that seeks to promote therapeutic gains by helping individuals improve their metacognitive abilities (i.e., knowledge of and the ability to regulate one’s thoughts, learning, and ability to solve problems). Within MCR, individuals with psychosis and their therapist complete activities designed to improve four key skills: (i) knowledge of how, when, and why to use different problem-solving skills; (ii) the ability to monitor the success of a specific problem-solving strategies before, during, and after their use; (iii) recognition of factors that may interfere with successful task completion (e.g., increased anxiety) and mastery of behavioral strategies to cope with or address these factors; and (iv) transfer of skills learned in MCR to real-world situations.

Evaluations of MCR have demonstrated the benefits of this intervention for individuals with psychotic disorders. Research on this treatment has demonstrated that MCR produces improvements in metacognitive abilities among individuals with psychosis as well as gains in health related-quality of life, social, vocational, and educational functioning.  Although improvement of cognition is not the primary aim of MCR, subsequent research by Dr. Breitborde and colleagues has demonstrated that this treatment produces downstream improvements in cognitive functioning that exceed those produce by cognition-focused interventions such as computerized cognitive remediation. 

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