Disorganization and Individual Psychotherapy for Schizophrenia: A Case Report of Metacognitive Reflection and Insight Therapy

Despite being a characteristic symptom of schizophrenia, implications for therapy with persons experiencing prominent disorganization have received less attention in the psychotherapy literature than have other aspects of the disorder. As such, formal thought disorder may be viewed largely as a barrier to effective participation in therapy. In contrast, though, a range of writers from varied traditions have stressed that this feature of schizophrenia is meaningful and improved coherence of speech is an important and viable component of treatment and recovery. This paper suggests that an emergent integrative psychotherapy, metacognitive reflection and insight therapy (MERIT), may be well-suited for work with persons experiencing disorganization symptoms. A brief overview of MERIT is provided, followed by a case report of an 18-month course of therapy with a man with severely disorganized speech.     

Targeting Insight in First Episode Psychosis: A Case Study of Metacognitive Reflection Insight Therapy (MERIT)

One aspect of schizophrenia contributing to its complexity is the lack of insight individuals often have into their illness. While poor insight is prevalent throughout the course of the illness, more severe levels are associated with first-episode psychosis (FEP). Interventions addressing insight are necessary but current treatments have been shown to have limited effectiveness. Thus, a novel intervention, Metacognitive Reflection and Insight Therapy (MERIT), is being studied for its efficacy of improving insight in individuals with schizophrenia spectrum disorders. MERIT is an integrative metacognitive therapy consisting of eight elements to assist clients in improving their ability to form complex ideas about themselves and others and to use this knowledge to respond to psychological problems. The present study is a case illustration of the implementation of MERIT to improve insight in FEP. Clinical outcomes were assessed and results showed that the client improved in both metacognition and insight. With replication, these results suggest that integrative metacognitive psychotherapy may serve as an intervention that improves insight in FEP, which marks an important step toward improved interventions for individuals with psychosis.     

Willful ignorance and self-deception

Willful ignorance is an important concept in criminal law and jurisprudence, though it has not received much discussion in philosophy. When it is mentioned, however, it is regularly assumed to be a kind of self-deception. In this article I will argue that self-deception and willful ignorance are distinct psychological kinds. First, some examples of willful ignorance are presented and discussed, and an analysis of the phenomenon is developed. Then it is shown that current theories of self-deception give no support to the idea that willful ignorance is a kind of self-deception. Afterwards an independent argument is adduced for excluding willful ignorance from this category. The crucial differences between the two phenomena are explored, as are the reasons why they are so easily conflated.     

Gentzenization of Trilattice Logics

Sequent calculi for trilattice logics, including those that are determined by the truth entailment, the falsity entailment and their intersection, are given. This partly answers the problems in Shramko-Wansing (J Philos Logic 34:121–153, 2005).     

Continuous Response Monitoring of Relative Time-to-Contact Judgments: Does Effective Information Change During an Approach Event?

In many previous studies of time-to-contact (TTC) judgments of approaching objects, a response was measured after observers viewed the entire event and was used to infer the informational basis for the judgment. Such measures primarily reflect the information used at the end of the approach event and may not reveal whether observers used different information at different times during the event. Evidence indicates that observers use multiple information sources and that the effectiveness of information varies with distance. We introduce a method in which observers continuously report which of 2 approaching objects would reach them first, throughout the approach. We identified the occurrence and time of response reversals. Most observers changed their relative TTC judgments during the event. The pattern of responses indicated that observers did not use tau early during the approach when objects were far and did not use optical size later when the objects were closer. Most observers relied on either optical size or optical expansion rate early during the approach and expansion rate later during the event, although there were individual differences. A single relative TTC judgment measured after observers view an approach event may not reflect judgments or their informational basis throughout the entire event.     

Adolescent Egocentrism and the Illusion of Transparency: Are Adolescents as Egocentric as we Might Think?

The illusion of transparency, or people’s tendency to believe their thoughts and feelings as more apparent to others than they actually are, was used to investigate adolescent egocentrism. Contrary to previous research demonstrating heightened adolescent egocentrism, adolescents exhibited similar levels of egocentrism to adults. In experiment 1, 13-14 year-olds and adult participants both truthfully described and lied about a series of pictures. Both adolescent and adult liars indicated that they were more confident that other participants would know when they were lying, than other participants actually indicated. In experiment 2, 13-14 year-olds, 15-16 year-olds and adult participants read to an audience. The illusion of transparency effect manifested itself differently according to gender: Female participants indicating that they looked more nervous than audiences thought, whilst male participants indicating that they were more entertaining than audiences thought. Results were interpreted using simulation theory, and suggested that adolescents might not be as egocentric as previously thought.     

Grabbing Your Bootstraps: Threats to Economic Order Boost Beliefs in Personal Control

Individuals are motivated to maintain perceptions of order and predictability in the social environment. Compensatory control theory proposes that when an individual’s perception of her or his own control is threatened, the individual can turn to external systems that may provide a perception of control (e.g., organized government). Conversely, the theory also predicts that when external systems of control are threatened, individuals may respond by exaggerating perceptions of personal control, although this effect has received relatively little empirical support. In the present study, we examined how a threat to an external system of economic control affects individual perceptions of personal control. Specifically, we found that a threat to the perceived distribution of economic resources based on hard work and effort (i.e., meritocracy) led to greater perceptions of personal control. Moreover, this increase in personal control directly increased participants’ optimism about their future economic outcomes. This study provides important insight into the broad influence of external systems on individuals' perceptions of personal control and assessment of future action.     

Psychological Inflexibility and Child Anxiety

Psychological flexibility is the main outcome of acceptance commitment therapy. Insight into the usefulness of measuring psychological flexibility is an important step to enable studies on the effectiveness of acceptance commitment therapy in middle-aged children (8–10 years). For this purpose, we examined the factor structure, the construct validity and the reliability of the Avoidance and Fusion Questionnaire for Youth. The Avoidance and Fusion Questionnaire for Youth taps psychological inflexibility (the opposite of psychological flexibility) in children and adolescents. Although the questionnaire has been extensively validated in older children, this is not the case for middle-aged children. The Avoidance and Fusion Questionnaire for Youth contains 17 items and is constituted of the subscales cognitive fusion, experiential avoidance and behavioral ineffectiveness. A shortened 8-item version also exists, the Avoidance and Fusion Questionnaire for Youth-8, which does not distinguish between these subscales. We performed a confirmatory factor analysis. Additionally, we assessed the relationship between psychological flexibility and child anxiety. Children, aged 8–10 years, were recruited via regular primary schools. Of the 459 approached children, 267 (58?%) parents signed informed consents for their children (Age: M?=?9.18; SD?=?.79; Sex: n _boys?=?137, 51?%). Children completed the questionnaires during regular classes. In this sample, the 17-item version of the Avoidance and Fusion Questionnaire for Youth was less appropriate for measuring psychological inflexibility than the 8-item version. Furthermore, we found a significant positive relationship between psychological inflexibility and child anxiety. We argue that acceptance commitment therapy would be an interesting candidate for intervening early on in dysfunctional child anxiety, as acceptance commitment therapy’s cognitive elements require cognitive skills that children are likely to master early on.     

Acceptability and Feasibility of Peer Assisted Supervision and Support for Intervention Practitioners: A Q-methodology Evaluation

Evidence-based interventions often include quality improvement methods to support fidelity and improve client outcomes. Clinical supervision is promoted as an effective way of developing practitioner confidence and competence in delivery; however, supervision is often inconsistent and embedded in hierarchical line management structures that may limit the opportunity for reflective learning. The Peer Assisted Supervision and Support (PASS) supervision model uses peer relationships to promote the self-regulatory capacity of practitioners to improve intervention delivery. The aim of the present study was to assess the acceptability and feasibility of PASS amongst parenting intervention practitioners. A Q-methodology approach was used to generate data and 30 practitioners volunteered to participate in the study. Data were analyzed and interpreted using standard Q-methodology procedures and by-person factor analysis yielded three factors. There was consensus that PASS was acceptable. Participants shared the view that PASS facilitated an environment of support where negative aspects of interpersonal relationships that might develop in supervision were not evident. Two factors represented the viewpoint that PASS was also a feasible model of supervision. However, the third factor was comprised of practitioners who reported that PASS could be time consuming and difficult to fit into existing work demands. There were differences across the three factors in the extent to which practitioners considered PASS impacted on their intervention delivery. The findings highlight the importance of organizational mechanisms that support practitioner engagement in supervision.