Comparing Metacognition and Mentalization and Their Implications for Psychotherapy for Individuals with Psychosis
Over the past couple of decades, researchers have investigated the relationship between psychosis and social cognitive deficits and how these deficits might be targets for psychosocial treatments. Two important constructs related to social cognition are metacognition and mentalization, which have been developed into distinct therapeutic models for individuals with psychosis. Though metacognition and mentalization are conceptually similar, this review aims to provide a clearer delineation of each term by reviewing the definition and the application to the treatment of individuals with psychosis. We examined key theoretical papers, case studies, and clinical trials on mentalization and metacognition. Metacognition and mentalization share much in common though subtle conceptual distinction reveal key differences theoretically that have therapeutic implications. While emerging from divergent intellectual traditions, mentalization and metacognition complement one another and more trials are needed to examine the technical differences between these therapeutic approaches and the possibilities for both theoretical and technical integration.
KeywordsPsychosis Schizophrenia Psychotherapy Metacognition Mentalization Social Cognition
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- Bateman, A., & Fonagy, P. (Eds.). (2012). Handbook of mentalizing in mental health practice. Washington, DC: American Psychiatric Association.Google Scholar
- Brent, B. K., & Fonagy, P. (2014). A mentalization-based treatment approach to disturbances of social understanding in schizophrenia. In: P. H. Lysaker, G. Dimaggio, M. Brune (Eds.), Social cognition and metacognition in schizophrenia: Psychopathology and treatment approaches (pp. 245–259). Gurgaon: Elsevier Science and Technology.CrossRefGoogle Scholar
- de Jong, S., van Donkersgoed, R. J. M., Aleman, A., van der Gaag, M., Wunderink, L., Arends, J., Lysaker, P. H., & Pijnenborg, M. (2016). Practical implications of metacognitively oriented psychotherapy in psychosis: Findings from a pilot study. Journal of Nervous and Mental Disease, 204(9), 713–716.CrossRefPubMedGoogle Scholar
- Dimaggio, G., Montano, A., Popolo, R., & Salvatore, G. (2015). Metacognitive interpersonal therapy for personality disorders: A treatment manual. London: Routledge.Google Scholar
- Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. New York, NY: Other Press.Google Scholar
- Frith, C. D. (1992). The cognitive neuropsychology of schizophrenia. Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
- Hagelquist, J. O. (2017). The mentalization guidebook. London: Karnac Books.Google Scholar
- Hillis, J. D., Leonhardt, B. L., Vohs, J. L., Buck, K. D., Salvatore, G., Popolo, R., Dimaggio, G., & Lysaker, P. H. (2015). Metacognitive reflective and insight therapy for people in early phase of a schizophrenia spectrum disorder. Journal of Clinical Psychology, 71(2), 125–135.CrossRefPubMedGoogle Scholar
- Lysaker, P. H., Buck, K. D., Leonhardt, B. L., Buck, B. E., Hamm, J., Hasson-Ohayon, I., Vohs, J. L., & Dimaggio, G. (2014). Metacognitively focused psychotherapy for persons with schizophrenia: Eight core elements that define practice. In P. H. Lysaker, G. Dimaggio & M. Brune (Eds.), Metacognition and social cognition in schizophrenia. New York: Elsevier Press.CrossRefGoogle Scholar
- Lysaker, P. H., Dimaggio, G., Carcione, A., Procacci, M., Buck, K. D., Davis, L. W., & Nicolò, G. (2010). Metacognition and schizophrenia: The capacity for self-reflectivity as a predictor for prospective assessments of work performance over six months. Schizophrenia Research, 122(1), 124–130.CrossRefPubMedGoogle Scholar
- Lysaker, P. H., Kukla, M., Belanger, E., White, D. A., Buck, K. D., Luther, L., Firmin, R. L., & Leonhardt, B. L. (2016). Individual psychotherapy and changes in self-experience in schizophrenia: A qualitative comparison of patients in metacognitively focused and supportive psychotherapy. Psychiatry, 78(4), 305–316.CrossRefGoogle Scholar
- Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., Read, J., van Os, J., & Bentall, R. P. (2012). Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective-and cross-sectional cohort studies. Schizophrenia Bulletin, 38(4), 661–671.CrossRefPubMedCentralPubMedGoogle Scholar
- Vohs, J. L., Lysaker, P. H., Francis, M., Hamm, J., Buck, K. D., Olesek, K., Outcalt, J., Dimaggio, G., Leonhardt, B., Liffick, E., Mehdiyoun, N., & Breier, A. (2014). Metacognition, social cognition, and symptoms in patients with first episode and prolonged psychosis. Journal of Psychiatric Research, 219(1), 79–85.CrossRefGoogle Scholar