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Introduction: Psychological distress may result in impairment and difficulty understanding oneself and others. Thus, addressing metacognitive issues in psychotherapy may improve psychopathology in adolescents and young adults (AYAs). We aimed to compare metacognitive interpersonal therapy (MIT)-informed psychotherapy with other treatment-as-usual (TAU) therapies. Methods: We administered the Global Assessment of Functioning (GAF) scale, the Clinical Global Impressions-Severity (CGI-S) scale, and the Brief Psychiatric Rating Scale (BPRS) at baseline (BL) and at treatment termination (the endpoint was at 6 months and any last results obtained before that term were carried forward in analyzes). Patients received concomitant psychiatric and psychological treatment. Results: Sixty AYAs were involved in the study. There was a significant reduction in symptomatology after the intervention. Twelve patients (17%) dropped out; treatment adherence was 83%. In the MIT group, 2 patients dropped out (11%), and in the TAU group, 9 patients dropped out (19%). All scales showed a significant reduction in symptoms between baseline (BL) and the 6-month endpoint: GAF (Χ² = 6.61, p < 0.001), BPRS (Χ² = 6.77, p < 0.001), and CGI (Χ² = 7.20, p < 0.001). There was a greater efficacy for the MIT group in terms of symptom reduction on the BPRS (t = 2.31; p < 0.05). Conclusion: The study confirmed the efficacy of early and integrated care in adolescence and suggested greater symptom reduction for a psychotherapeutic intervention focused on stimulating mentalization skills. The study indicates the usefulness of this type of approach in the treatment of adolescent psychopathology. Due to the small sample size, the results need replication. [ABSTRACT FROM AUTHOR]

Experiential techniques can be used to address maladaptive interpersonal patterns in patients with personality disorders (PDs) as long as they are delivered minding about the therapeutic relationship. We present the case study of Laura, a 38‐year‐old woman presenting with covert narcissism, generalized anxiety disorder, depression, and complicated grief treated with metacognitive interpersonal therapy. Laura initially refused to engage in any experiential work out of fear of being judged and abandoned by her therapist. To navigate this therapeutic obstacle, the therapist focused on exploring and eventually repairing early alliance ruptures. Thereafter, Laura engaged in experiential work, which helped her address her narcissistic interpersonal patterns. After 2 years, Laura's symptoms and narcissistic problematic behaviors decreased. This case study can help us understand how experiential techniques can be successfully used in PD psychotherapy as long as attention to the therapy relationship is paid. [ABSTRACT FROM AUTHOR]

Introduction: Early intervention studies for adolescents and early adults are required to explore the acceptability and effectiveness of psychological therapies across the full range of personality disorders (PDs) beyond just borderline PD. The main aim of the current paper was to describe a Metacognitive Interpersonal Therapy group adaptation for adolescents (MIT‐GA) presenting with PDs featuring overcontrol and social inhibition, and in particular Avoidant PD characteristics. Methods: We report findings from a single case of a female adolescent diagnosed with Avoidant PD providing preliminary data on feasibility and the possible effectiveness of MIT‐GA. Results: Evidence of acceptability and meaningful clinical gains are described. Conclusions: Results suggest that MIT‐GA could be a powerful treatment option in patients with generalized social avoidance who do not currently receive gold‐standard psychotherapeutic treatments. This intervention also appears to be effective and cost‐effective in initiating significant clinical changes in profiles of young patients with non‐borderline PD symptoms. [ABSTRACT FROM AUTHOR]

Paranoid personality disorder (PPD) is a severe condition, lacking specialized and empirically supported treatment. To provide the clinician with insights into how to treat this condition, we present a case study of a 61‐year‐old man with severe PPD who presented with ideas of persecution, emotionally charged hostility, and comorbid antisocial personality disorder. The client was treated with 6 months of Metacognitive Interpersonal Therapy, which included: creating a shared formulation of his paranoid attitudes; trying to change his inner self‐image of self‐as‐inadequate and his interpersonal schemas where he saw the others as threatening. Guided imagery and rescripting techniques, coupled with behavioral experiments, were used to promote a change. At the end of the therapy the client reported a reliable change in general symptomatology and, specifically, in interpersonal sensitivity, hostility, and paranoid ideation; he could no longer be diagnosed as PPD and only some paranoid and antisocial characteristics remained. [ABSTRACT FROM AUTHOR]

Individuals experiencing avoidant personality disorder (AvPD) tend to make sense of social interactions via maladaptive self‐and other attributions. They also experience difficulties in recognizing emotions. A further feature of AvPD psychopathology is the tendency to resort to maladaptive coping strategies, such as behavioral avoidance and perfectionism. Despite its impact, psychological treatments for AvPD remains poorly investigated. Herein, we describe the first five sessions of Metacognitive Interpersonal Therapy with a 28‐year‐old woman, whose treatment goal was to reduce social avoidance. We describe how this goal was achieved through a combination of working through the therapeutic relationship, alongside experiential techniques such as guided imagery, rescripting, and bodily work. Through this treatment configuration, the patient was able to increase self‐awareness of her own emotions, enabling her to realize that she was guided by rigid schemas; specifically seeing herself as inadequate and others as judgmental. Finally, implications for the treatment of AvPD are discussed. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is a severe disease, characterized by severe instabilities in identity, affect and relationships. Clinical improvement of BPD can be facilitated by psychotherapy aimed at tackling multiple specific cross-modality impairments and their patterns of interaction: impaired sense of self, maladaptive interpersonal schemas, impaired metacognition, emotion dysregulation and impulsivity. Herein, we describe the steps in the treatment of a young woman meeting the criteria for with BPD with paranoid traits, successfully treated with Metacognitive Interpersonal Therapy, a treatment based on comprehensive assessment of domains. In the initial phase, treatment focused on promoting emotion regulation, integrating opposing patient representations of the therapist, enhancing metacognition, and increasing focus on the maladaptive schema that elicited dysregulated behaviors. Later in therapy, treatment focused on supporting the patient to realize her ideas about self and others were schema-driven; and improving metacognitive capacity to understand others' minds. General implications for psychotherapy of BPD are discussed. [ABSTRACT FROM AUTHOR]

Psychotherapy for obsessive‐compulsive personality disorder (OCPD), where perfectionism is a defining criterion, is understudied. Despite a high prevalence few evidence‐based treatments are available for the presentation. Here we describe the course of a 6‐month program of metacognitive interpersonal therapy with an OCPD patient with prominent perfectionism and self‐criticism, which were considered primary outcomes of the case study. Therapy aimed initially at increasing awareness of maladaptive interpersonal schemas and promoting a healthy self. First, behavioral experiments were used to try and counteract perfectionism. Second, experiential techniques, such as guided imagery and rescripting, were used to help the client in connect with different, healthier aspects of the self, thus increasing personal and interpersonal wellbeing. Qualitative and quantitative outcomes at the intervention end and at 1‐month follow‐up are summarized. Finally, we reflect on how this case study can inform treatment of perfectionism in OCPD. [ABSTRACT FROM AUTHOR]

Patients with personality disorders (PDs) other than borderline, with prominent features of social inhibition and over-regulation of emotions, are in need of specialized treatments. Individuals present with poor metacognition, that is the capacity to understand mental states and use psychological knowledge for the sake of purposeful problem solving; and are guided by maladaptive interpersonal schemas. We developed a short-term group intervention, Metacognitive Interpersonal Therapy in Groups (MIT-G), incorporating psychoeducational and experiential elements, to help these individuals become more aware of their drives when interacting with others; and to help them adopt more flexible behaviors via improvements in metacognition. We present results of an effectiveness study, evaluating whether we could replicate the initial positive results of our first pilot randomized controlled trial. Seventeen young adults outpatients with personality disorders were included in the 16 session program. Effect sizes were calculated for change from baseline to treatment end for the primary outcome, symptoms and functioning (Clinical Outcomes in Routine Evaluation Outcome Measure) and then for one putative mechanism of change - metacognition. Emotional dysregulation and alexithymia were also assessed. Qualitative evaluations of the acceptability and subjective impact of the treatment were also performed. MIT-G was acceptable to participants. There were medium to large magnitude changes from pre- to post- treatment on wellbeing, emotion dysregulation, alexithymia and metacognition. These gains were maintained at follow-up. There was evidence of clinically significant change on key variables. MITG appears acceptable to patients, as evidenced by the absence of drop-out from treatment. In light of the positive outcomes of this study and the expanding evidence base, MIT-G is a candidate for dissemination and investigations in larger trials as a possible effective intervention for PDs characterized by tendencies to overcontrol. [ABSTRACT FROM AUTHOR]

We describe here a narrative-based psychotherapy for a woman in her 40s who had been HIV+ since the age of 21 and who suffered from posttraumatic symptoms related to having received the diagnosis. She had also suffered from self-stigma and had lost the capacity to envision a future filled with hope. Treating individuals with HIV who face posttraumatic symptoms and stigma can be challenging for the clinician. A narrative approach to therapy can be helpful for these persons, in order to overcome symptoms, build a more benevolent self-image, feel accepted by society, and promote posttraumatic growth. Current evidence indicates that such an approach is mostly lacking. We describe how we applied metacognitive interpersonal therapy—an approach rooted in narrative constructivism. By using this treatment, the patient could overcome posttraumatic symptoms, participate in social activities after years of avoidance and isolation, and recover her sense of being a person able to make plans for the future with strength and dignity. Discussion includes ideas of how to generalize some of the mechanisms that have likely been effective in this therapy to other individuals with HIV. [ABSTRACT FROM AUTHOR]

Many patients with personality disorders (PD) display emotional inhibition or over-regulation (EOR); others display emotional dysregulation (ED)-heightened sensitivity to emotional stimuli with difficulty toning down arousal. To date, most treatments focus on patients with ED, particularly those with borderline disorders, though some focus on EOR. Patients with complex PD often swing from periods of EOR to ED. In this paper, we describe an adaptation of metacognitive interpersonal therapy (MIT), which has been manualized for treating PD with prominent EOR and is aimed at dealing with patients fluctuating from EOR to ED. We first describe the MIT model of personality pathology and offer a summary of the procedures used in MIT to treat patients with prominent EOR. Then, through the analysis of the case of a patient swinging between EOR and ED, we describe how to adapt these procedures to complex cases. [ABSTRACT FROM AUTHOR]

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Auditory verbal hallucinations (AVHs) are perceptive-like experiences happening without appropriate stimuli that in individuals with schizophrenia very often feature distressing contents. AVH frequently interfere with social relationships or result in dangerous behaviours. We hypothesize that in schizophrenia several vulnerability factors, especially when a subject is engaged in real or represented interpersonal transactions, lead to the appearance of AVHs, and favour their self-perpetuation over time. We analyse the different psychological factors that, according to empirical studies and clinical experience with persons with schizophrenia, seem involved in the genesis of AVHs. Several vulnerability factors appear to interact with situational ones to trigger AVHs: a) a facilitation of neural transmission from the premotor regions to the perceptual ones; b) a difficulty attuning with others, c) interpersonal schemas, provoking emotional suffering, intrusive thoughts and rumination; d) metacognitive dysfunctions. Once AVHs have appeared, further factors promote their perpetuation over time: a) cognitive factors like ruminative processing on AVHs, b) metacognitive beliefs about AVHs. An integrated theoretical model of AVHs is described and ideas for its empirical testing are suggested. [ABSTRACT FROM AUTHOR]

The resistance of negative symptoms to pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. However, little is understood about the psychological processes that reinforce and sustain the negative symptoms domain of diminished expression. Prior research has shown that higher levels of diminished expression relate to deficits in metacognitive capacity. We propose a more complex model in which diminished expression occurs when impairments in metacognitive self-reflectivity, alterations in higher-order language structure, and cognitive symptoms interact and thus interfere with persons' ability to understand and express emotions in ways others can recognize. Individuals with schizophrenia-spectrum disorders (N = 201) provided personal narratives detailing their life story and reflections about their mental illness. Self-reflectivity was measured with the Metacognition Assessment Scale-Abbreviated, and situation models were extracted from participants' personal narratives via Coh-Metrix 3.0, an automated program that calculates language indices. Diminished expression and cognitive symptoms were measured with the Positive and Negative Syndrome Scale. Structural equation models (SEM) examined whether self-reflectivity mediated the impact of cognitive symptoms and situation models on diminished expression. Results of the SEM revealed that self-reflectivity partially mediated the impact of situation models on diminished expression (β = −.073, p =.008, ±95% CI [-0.126, −0.019]). and fully mediated the influence of cognitive symptoms in diminished expression (β = 0.099, p =.001, ±95% CI [0.038, 0.160]). In conclusion, results suggest that self-reflectivity, linguistic cohesion, and cognitive symptoms may be useful targets for intervention in efforts to treat diminished expression in psychosis. [ABSTRACT FROM AUTHOR]

A persecutory delusion (PD) is a person's false belief that others are focusing their attention on him or her with malevolent intentions, which often results in intense anxiety and significant disruption of daily life. PDs are common in schizophrenia, and many patients with schizophrenia do not respond well to current pharmacological treatments. Therefore, effective psychological treatments are needed. The most well-known intervention for PDs continues to be cognitive-behavioral therapy. It aims to reduce patients' stigma and then help them to question the delusional meaning they attribute to events. The authors hypothesized that it is possible to reinforce the clinical approach to PDs on the basis of two important considerations: delusions have a meaning that is connected to a fundamental experiencing of the self as being ontologically vulnerable, and PDs seem to be correlated to dysfunctions in metacognition, a spectrum of mental activities involving thinking about one's own and others' mental states. The authors describe the treatment with metacognitive interpersonal therapy of a young man with paranoid schizophrenia and pervasive PD. The four main stages described are: regulating the therapeutic relationship to avoid potential rupture; reducing the emotional suffering caused by the PD and teaching the patient behavioral strategies for coping with this suffering, promoting the patient's ability to reflect on his own mind and thereby to develop a more sophisticated metacognitive mastery of the PD, and promoting a more nuanced understanding of the other's mind. [ABSTRACT FROM AUTHOR]