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Paul H Lysaker,1,2 Emily Gagen,3 Reid Klion,4 Aieyat Zalzala,5 Jenifer Vohs,2 Laura A Faith,1,6 Bethany Leonhardt,2,7 Jay Hamm,7 Ilanit Hasson-Ohayon8 1Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; 2Indiana University School of Medicine, Indianapolis, IN, USA; 3Providence VA Medical Center Department of Psychology, Providence, RI, USA; 4MERIT Institute, Boulder, CO, USA; 5Institute of Living, Hartford, CT, USA; 6University of Missouri - Kansas City, KS, USA; 7Eskenazi Health- Midtown Community Mental Health, Indianapolis, IN, USA; 8Bar Ilan University, Ramat-Gan, IsraelCorrespondence: Paul H LysakerRichard L. Roudebush VA Medical Center, Department of Psychiatry 116A, 1481 West 10th Street, Indianapolis, IN IN 46202, USAEmail plysaker@iupui.eduAbstract: Recent research has suggested that recovery from psychosis is a complex process that involves recapturing a coherent sense of self and personal agency. This poses important challenges to existing treatment models. While current evidence-based practices are designed to ameliorate symptoms and skill deficits, they are less able to address issues of subjectivity and self-experience. In this paper, we present Metacognitive Insight and Reflection Therapy (MERIT), a treatment approach that is explicitly concerned with self-experience in psychosis. This approach uses the term metacognition to describe those cognitive processes that underpin self-experience and posits that addressing metacognitive deficits will aid persons diagnosed with psychosis in making sense of the challenges they face and deciding how to effectively manage them. This review will first explore the conceptualization of psychosis as the interruption of a life and how persons experience themselves, and then discuss in more depth the construct of metacognition. We will next examine the background, practices and evidence supporting MERIT. This will be followed by a discussion of how MERIT overlaps with other emerging treatments as well as how it differs. MERIT’s capacity to engage patients who reject the idea that they have mental illness as well as cope with entrenched illness identities is highlighted. Finally, limitations and directions for future research are discussed.Keywords: schizophrenia, psychosis, metacognition, rehabilitation, psychotherapy, recovery

Infiltration of ceramic materials into a pre-formed ceramic scaffold is an effective way of fabricating a solid oxide fuel cell with nano-structured ceramic electrodes by avoiding detrimental interfacial reactions through low-temperature processing for achieving high performance using hydrogen as well as a carbonaceous fuel. However, there are significant concerns about the applicability of this method because of the difficulty in fabricating a large-area gas-tight but thin electrolyte between two highly porous ceramic and the multiple repetitions of infiltration process. Here, a large-area (5 cm by 5 cm) scaffold with a thin yttria-stabilized zirconia (YSZ) electrolyte sandwiched between two identical porous structures is prepared by tape casting and co-firing, and then solution precursors are impregnated into the porous scaffolds to prepare nano-structured La0.8Sr0.2FeO3 (LSF) and La0.7Sr0.3VO3−δ (LSVred). The thus prepared solid oxide fuel cell with 10 wt% ceria + 1 wt% Pd as a catalyst in anodes shows a peak power of 489 mW cm−2 (∼6 W per cell) at 800 °C using H2 as a fuel and air as an oxidant. This large-area fuel cell retained the integrity of the thin electrolyte and high performance after the reducing-oxidation cycle at 900 °C, showing superiority over the conventional Ni(O)-YSZ based support. [ABSTRACT FROM AUTHOR]

Aim: Metacognitive Reflection and Insight Therapy (MERIT) is a form of person-centred psychotherapy that promotes recovery-oriented outcomes by targeting metacognitive capacity. Previous research has shown the feasibility and clinical benefits of MERIT. However, it is not clear whether and how the specific processes targeted by MERIT (e.g., improved sense of agency, self-reflectivity, awareness of others, etc.) are manifested in the patient-therapist communications. In this study, we used natural language processing (NLP) to explore objective linguistic markers of change during MERIT for early psychosis., Methods: Five patients underwent 24 sessions each of MERIT, which were recorded and transcribed verbatim. The transcripts underwent NLP to determine the patterns of pronoun use and the frequency of semantic categories related to temporality and mental processing. Mixed linear regressions were used to examine how NLP features evolve over the course of psychotherapeutic sessions., Results: Analyses detected shifts in specific language signals over time including (1) changes in patterns of pronoun usage with more active and central first-person plural pronoun (We); (2) transition in temporal focus of speech from past-focus towards present- and future-focus and (3) increased words representing perceptual and cognitive processes., Conclusion: Our findings suggest NLP can objectively quantify meaningful signals consistent with expected subjective changes in MERIT and potentially other psychotherapeutic interventions., (© 2024 John Wiley & Sons Australia, Ltd.)

Objectives: Both dysfunctional self-appraisal and metacognitive deficits, or impairments in the ability to form complex and integrated ideas about oneself and others, may contribute to social deficits in schizophrenia. Little is known, however, about how they interact with each other. In this study, we examined the hypothesis that both higher metacognition and more positive self-appraisal are necessary for increased social functioning., Methods: Concurrent assessments of self-appraisal, metacognition, and social functioning were gathered from 66 adults with schizophrenia in a non-acute phase of disorder. Three forms of self-appraisal were used: self-esteem, hope and self-efficacy. Metacognition was assessed using the Metacognitive Assessment Scale-Abbreviated, and social functioning with the Quality of Life Scale. Measures of psychopathology, neurocognition and social cognition were also gathered for use as potential covariates., Results: A single index of self-appraisal was generated from subjecting the assessments of self-appraisal to a principal components analysis. Linear regression analyses revealed that after controlling for severity of psychopathology, metacognition moderated the effect of the self-appraisal factor score upon social functioning. A median split of metacognition and the self-appraisal index yielded four groups. ANCOVA analyses revealed that participants with higher levels of metacognition and more positive self-appraisal had greater capacities for social relatedness than all other participants, regardless of levels of positive and negative symptoms. Correlational analyses revealed that metacognition but not self-appraisal was related to the frequencies of social contact independent of the effects of psychopathology. Assessments of social cognition and neurocognition were not significantly linked with social dysfunction., Conclusion: Greater social functioning is made possible by a combination of both more positive self-appraisals and greater metacognitive capacity. Individuals with schizophrenia who struggle to relate to others may benefit from interventions which address both their beliefs about themselves and their capacity for metacognition., (Published by Elsevier Inc.)

Early formulations of schizophrenia suggested that the disorder involves a loss of ability to form integrated ideas about oneself, others, and the world, resulting in reductions in complex goal-directed behaviors. Exploring this position, the current review describes evidence that persons with schizophrenia experience decrements in their ability to form complex ideas about themselves and to ultimately use that knowledge to respond to psychological and social challenges. Studies are detailed that find greater levels of these impairments, defined as metacognitive deficits, in persons with schizophrenia in both early and later phases of illness as compared with other clinical and community groups. Furthermore, studies linking metacognitive deficits with poorer psychosocial functioning and other variables closely linked to outcomes are summarized. Clinical implications are also discussed.

Background: Addiction is a massive public health problem in which a person's occupational life is compromised and metacognition is impaired. Occupational therapists may play a critical role in addiction rehabilitation, but more information about patterns of metacognitive deficit co-occurring with addictive behaviour is needed to develop interventions that specifically target these impairments., Purpose: This study examined whether persons with addiction(s) demonstrated specific patterns of metacognitive deficit on four subscales of metacognition measuring self-reflectivity, understanding others' thoughts, decentration, and mastery., Method: Using a mixed-methods design, qualitative data were obtained via the Indiana Psychiatric Illness Interview, which was then rated using a quantitative scale, the Metacognition Assessment Scale-Abbreviated., Findings: Persons with addiction(s) demonstrated significant impairments in metacognitive mastery but not other areas of metacognition., Implications: Occupational therapy interventions for addiction should focus on improving metacognitive mastery. Future efficacy studies of interventions to improve mastery and overall outcomes are warranted.

Among persons with posttraumatic stress disorder (PTSD), the severity of symptoms and concurrent distress are not fully explained by trauma severity. Interest has consequently arisen in the psychological processes that cause distress and heighten PTSD symptoms. This study accordingly sought to examine whether differences in metacognitive capacity are related to levels of emotional distress, avoidance/numbing, and hyperarousal. Participants were 48 adults with a confirmed diagnosis of PTSD. Comparison groups included 51 adults with HIV and 183 with schizophrenia. Metacognition, emotion recognition, depression, and emotional distress and levels of avoidance/numbing and hyperarousal were assessed concurrently using the Metacognition Assessment Scale-Abbreviated, the Bell Lysaker Emotion Recognition Test, the Beck Depression Inventory, and the Clinician-Administered PTSD Scale. Results revealed that the PTSD group had better ratings of overall metacognitive capacity than the schizophrenia group and specifically poorer levels of metacognitive mastery, or the ability to use metacognitive knowledge to respond to challenges, than the HIV group. Within the PTSD group, poorer metacognitive mastery was linked with greater distress and higher hyperarousal when depression was controlled for statistically. Emotion recognition was not linked with distress or symptom severity. Results are consistent with models in which symptom severity in PTSD is related to the extent to which persons can use knowledge of themselves and others to find ways to respond to distress that match their own unique needs.