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Individuals with personality disorders (PDs) have difficulties in modulating mental states and in coping with interpersonal problems according to a mentalistic formulation of the problem. In this article we analyzed the first 16 psychotherapy sessions of 14 PD patients in order to explore whether their abilities to master distress and interpersonal problems were actually impaired and how they changed during the early therapy phase. We used the Mastery Section of the Metacognition Assessment Scale, which assesses the use of mentalistic knowledge to solve problems and promote adaptation. We explored the hypotheses that a) PD patients had problems in using their mentalistic knowledge to master distress and solve social problems; b) the impairments were partially stable and only a minimal improvement could be observed during the analyzed period; c) patients' mastery preferences differed from one another; d) at the beginning of treatment the more effective strategies were those involving minimal knowledge about mental states. Results seemed to support the hypotheses; the patients examined had significant difficulties in mastery abilities, and these difficulties persisted after 16 sessions. Moreover, the attitudes towards problem-solving were not homogenous across the patients. Lastly, we discuss implications for assessment and treatment of metacognitive disorders in psychotherapy., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This study uses the Grid of Problematic States (GPS) to examine Lisa's case, one of the most successful in the York Psychotherapy Depression Project. This study tried to assess whether the contents of mental experience form stable clusters consistent with a diagnosis of depression. It was possible with the GPS to pinpoint problematic states typical of depression and trace the transitional states occurring in Lisa between two different mental states: depressive and well-being. The GPS analysis suggested that the treatment successfully managed to deal with symptoms and to change the patient's thought themes and emotions. At the end of treatment, Lisa was less sad and displayed some anger, and a state of being nurtured emerged.

The authors analyzed the successful case of Lisa, a client with major depression, using the Metacognitive Assessment Scale (MAS). Consistently with the literature on depression, the authors hypothesize that Lisa's ability to reflect on mental states--here metacognition--is marginally affected. The authors found that Lisa was better at describing her own mind rather than understanding the mind of the others. Furthermore, the most severe impairment was in using metacognition to cope with mental state source of distress and to enact strategies to solve interpersonal problems. During the therapy such difficulties improved progressively. Limitations and implications of these findings are discussed.

Objective: Metacognition is a multi-component psychological construct, characterised by the ability to identify and describe one's own mental states and those of others. Evidence has been found for an association between deficits in metacognitive abilities and poor social functioning, low quality of life, psychopathology, and symptoms in Personality Disorders (PDs). However, to date, there are few psychometrically validated instruments available for assessing the different components of metacognition. A semi-structured interview, the Metacognition Assessment Interview (MAI), has been developed to evaluate different domains of metacognition. In the present study, we investigated the psychometric properties of the MAI in an outpatient clinical sample. Method: The MAI was administered to a clinical population of 306 outpatients attending a private clinical centre. Exploratory factor analysis, confirmatory factor analysis and correlation with instruments assessing alexithymia and interpersonal problems were carried out to examine the dimensionality and validity of the MAI. Result: Explorative and confirmatory factor analyses revealed a good fit for both a two-factor model and a four-factor model of metacognition. The two-factor model yielded two main dimensions, which we named: Self domain, defined as self-reflection, and Other domain, defined as critical distancing from one's own mental state and that of others. The four-factor solution is composed of four sub-domains: monitoring, integration, differentiation and decentration. Moreover, the MAI showed good convergent validity, with significant correlations with both alexithymia and interpersonal problems. Conclusions: These results confirm that the MAI is a reliable instrument for measuring metacognition and its different sub-domains. In particular, the MAI represents a useful and flexible instrument for the assessment of metacognition impairments in different psychopathologies and it can provide useful indications for the focus of psychotherapy treatment. [ABSTRACT FROM AUTHOR]

Deficits in the ability to make sense of mental states both of oneself and others, which we term metacognition, is a key difficulty in persons with schizophrenia and psychotherapy needs to address this deficit in order to be effective. We describe here the steps in the treatment of a young woman meeting the criteria for paranoid schizophrenia. Treatment was aimed at helping her to progressively improve her ability to comprehend mental states in order to reduce the intensity of her delusional beliefs and social withdrawal. She was treated with an adapted version of Metacognitive Interpersonal Therapy, the aims of which were to (a) encourage the reconstruction of autobiographical episodes in order to place symptoms in the context of life episodes; (b) stimulate an understanding of the link between problematic feelings and onset of symptoms; (c) build up psychological links between feelings, inability to understand others' intentions and delusional reasoning; and (d) prevent social withdrawal. Implications for considering poor metacognition a key target of psychotherapy of schizophrenia are discussed. [ABSTRACT FROM AUTHOR]

Background: There is growing support for the idea that an impaired understanding of others' mental states is an underlying feature of personality disorder (PD). Only recently has there begun to be evidence of impairments to subjects' ability to infer and reason about others' intentions and emotions, and detach from their own perspective when doing so. Method: We analysed the transcripts from the first 16 psychotherapy sessions of 14 PD patients. Scales for understanding others' minds from the Metacognition Assessment Scale were used. Results: Patients were generally able to describe others' mental states, although, at times, they had problems. There was, on the other hand, an inability to decentre while reasoning about others, and this was common to all the patients. Conclusions: PDs indeed feature a poor decentration, which is not easily identified with the usual lab tasks. Implications for further research and treatment are discussed. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: • Patients with personality disorders have substantial difficulties in adopting others' point of view and standing back from their own, and grasping that they are not the center of other peoples' thoughts. [ABSTRACT FROM AUTHOR]

Personality Disorders (PDs) are hypothesized to involve a decrement in the capacity to understand one's own thoughts and feelings. Patients may not, for example, recognize their own emotions or put together integrated representations of self with other. Some researchers have suggested that this deficit varies between the different PDs. However, empirical evidence that might confirm or disconfirm this hypothesis is scarce. The goal of the present research is to evaluate the metacognitive capacity in four participants, two with Narcissistic Personality Disorder and two with Avoidant Personality Disorder. Using the Metacognition Assessment Scale to analyse the transcripts of their first year of psychotherapy, we have found that three of the four participants displayed difficulties in recognizing their inner states and in linking them to the environmental and psychological causes behind them. There was, additionally, a milder deficit in the ability to integrate multiple images of self with other. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

It is possible to portray patients suffering from personality disorders using Horowitz's States of Mind Theory, according to which each disorder features its own particular set of forms of subjective experience (states of mind) and the shifting from one state to another is done under compulsion. If we want to define personality disorders correctly we need to define the rules causing inter-state shifts and, as a result, creating personality organization. The prime candidates to acting as these rules constraining the shifts are interpersonal patterns and shortfalls in the ability to metarepresent internal experience and others' psychological worlds. We shall illustrate these hypotheses with some session transcript extracts involving patients suffering from personality disorders. In the transcripts we have pinpointed the initial state of mind, the cause of the shift and the state of mind the patient has moved into. The discussion of the theory that personality disorders are organizations of states of mind in which the inter-state shifts are constrained will be on the basis of some clinical examples. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]