One of the key foundations for health human function is the capacity to recognize our mental states and to realize how certain somatic reactions are correlates of psychological experience, grasping and reflecting on what we think and feel, what the others think and feel, and understanding the processes that led up to those thoughts and feelings we and others are experiencing. Also foundational for mental health is the capacity to use our reflections and awareness of ourselves and others to solve psychosocial problems and cope with diverse life challenges. For example, reflective psychological knowledge of oneself can be used, for recognizing our typical patterns of thinking, feeling and acting including our own reasoning and attentional biases. This can then allow us to recognize and to replace maladaptive ways of habitually responding to psychosocial challenges with healthier ways. Ultimately, they can supply us with the kinds of larger meanings that form the context for making the choices we do in life.
One label for our capacities to reflect on mental states and use our knowledge of those mental states to respond to psychosocial challenge is metacognition. Admittedly, this is an umbrella term that describes many different kinds of activities which have been viewed by differently by different scholars. While metacognition generally encompasses our reflections about what makes up our minds or psyche, some aspects are more related to noticing specific things and others to integrating experience into a larger picture. Some of metacognitive activities that have been broadly studied, for example are more related to awareness of cognitive biases and impairments and allow us to contrast subjective versus objective performance (Fischer et al., 2021; Moritz et al., 2016). Some scholars have focused specially on beliefs about own beliefs, and divided metacognitive beliefs into positive metacognitions, such as “It is good that I focus a lot on potential dangers so I prevent them) and negative metacognitions “Once I worry I can’t control myself” (Wells, 2008). Other aspects of metacognition can include awareness of basic elements of our experience of ourselves, such as “I know I am experiencing, sadness or guilt.” Still other scholars have focused on aspects of metacognition that allow for the synthesis of individual thoughts, feeling and embodied states into a an evolving understanding of our larger purposes, multiple facets, possibilities and positions in relationships with others, ultimately laying the foundation for our sense of self (Dimaggio et al., 2015; Semerari et al., 2003; Lysaker et al., 2020a). Others have emphasized how metacognition must always occur in the context of actual or imagined relationships with others and people and emphasized the intersubjective nature of metacognitive acts delineating clearer links between metacognition and community membership (Hasson-Ohayon et al. 2020).
While there are scientific and theoretical divisions yet to be resolved among those studying metacognition, these different perspectives share much common ground. First all emphasize how it is not just what we think that is at issue in human function but our capacity to make meaning of our experience of ourselves and others and on the basis of that to live in ways that healthier socially and psychologically. Second, all are also interested in practical application and in particular to developing treatments that targets, metacognition, often with the goal of reaching persons with some of the most complex mental health conditions. Given the integrative nature of the metacognitive approaches, practitioners trained in different orientation may be easily able to incorporate elements from metacognitively oriented treatments into their clinical practice.
In the last few years, as these approaches have been steadily gaining momentum and research support. We think therefore the time is ripe to create an international society. This society, the Metacognitive Oriented Treatments – International Society (MOTIS), has thus been founded by a network of scholars focused of three approaches to addressing disturbances in metacognition: Metacognitive Training (MCT, Moritz et al., 2013; 2014), Metacognitive Reflection and Insight Therapy (MERIT, Lysaker & Klion, 2017; Lysaker et al., 2020b) and Metacognitive Interpersonal Therapy (MIT, Dimaggio et al., 2007; 2015; 2020). Moreover, a few attempts have been made to implement integrative forms of psychotherapy based on the same focus on metacognition (Cheli et al., 2023). It is our hope that this will serve as a hub where persons interested in these approaches could find a home where to share ideas, publications, initiative and learn about the developments of this field, ultimately helping to further disseminate these ideas.
Simone Cheli, Giancarlo Dimaggio, Ilanit Hasson-Ohayon, Stefen Moritz, Paul H. Lysaker and Raffaele Popolo (Members of MOTIS Board of Directors).
Cheli, S., Cavalletti, V., Lysaker, P. H., Dimaggio, D., Petrocchi, N., Chiarello, F., Enzo, C., Velicogna, F., Mancini, F., & Goldzweig, G. (2023). A pilot randomized controlled trial comparing a novel compassion and metacognition approach for schizotypal personality disorder with a combination of cognitive therapy and psychopharmacological treatment. BMC Psychiatry, In Press.
Dimaggio, G., Montano, A., Popolo, R. & Salvatore, G. (2015). Metacognitive Interpersonal Therapy for Personality Disorders: A treatment manual. Routledge.
Dimaggio, G., Ottavi, P., Popolo, R., & Salvatore, G. (2020). Metacognitive interpersonal therapy: Body, imagery and change. Routledge.
Dimaggio, G., Semerari, A., Carcione, A., Nicolò, G. & Procacci, M. (2007). Psychotherapy of Personality Disorders: Metacognition, States of Mind and Interpersonal Cycles. Routledge
Fischer, R., Scheunemann, J., & Moritz, S. (2021). Coping strategies and subjective well-being: Context matters. Journal of Happiness Studies: An Interdisciplinary Forum on Subjective Well-Being. Advance online publication. https://doi.org/10.1007/s10902-021-00372-7
Hasson-Ohayon, I., Gumley, A., McLeod, H., & Lysaker, P. H. (2020). Metacognition and intersubjectivity: Reconsidering their relationship following advances from the study of persons with psychosis. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.00567
Lysaker PH, Gagen EC, Klion R, Zalzala AB, Vohs J, Faith LA, Leonhardt BL, Hamm JA & Hasson-Ohayon. I. (2020) Metacognitive Reflection and Insight Therapy: A recovery oriented treatment approach for psychosis. Psychology Research and Behavior Management 13, 331-341. https://dx.doi.org/10.2147%2FPRBM.S198628
Lysaker PH, Klion R. (2017). Recovery, meaning making, and severe mental illness: A comprehensive guide to Metacognitive and Reflection Insight Therapy. Routledge.
Lysaker PH, Minor KS, Lysaker JT, Hasson-Ohayon I, Bonfils K, Hochheiser J & Vohs JL (2020). Metacognitive function and fragmentation in schizophrenia: Relationship to cognition, self-experience and developing treatments. Schizophrenia Research Cognition. 19 https://doi.org/10.1016/j.scog.2019.100142
Moritz S., Andreou, C., Schneider, B. C, Wittekind, C. E., Menon, M., Balzan, R. P. & Woodward, T. S. (2014). Sowing the seeds of doubt: A narrative review on metacognitive training in schizophrenia. Clinical Psychology Review, 34, 358-366. https://doi.org/10.1016/j.cpr.2014.04.004
Moritz, S., Veckenstedt, R., Bohn. F., Köther, U. & Woodward, T. S. (2013). Metacognitive training in schizophrenia: Theoretical rationale and administration. In D. L. Roberts & D. L. Penn (Eds.), Social cognition in schizophrenia. From evidence to treatment (pp. 358-383). Oxford University Press.
Moritz, S., Jahns, A. K., Schröder, J., Berger, T., Lincoln, T. M., Klein, J. P., & Göritz, A. S. (2016). More adaptive versus less maladaptive coping: What is more predictive of symptom severity? Development of a new scale to investigate coping profiles across different psychopathological syndromes. Journal of Affective Disorders, 191, 300–307. https://doi.org/10.1016/j.jad.2015.11.027
Wells, A. (2008). Metacognitive Therapy for Anxiety and Depression. The Guildford Press.