Enhancing sense of recovery and self-reflectivity in people with schizophrenia: a pilot study of Metacognitive Narrative Psychotherapy.

Objectives: This study investigated the effectiveness of an innovative, manualized psychotherapy aimed at enhancing recovery and self-experience in people with schizophrenia, Metacognitive Narrative Psychotherapy.

Design: Treatment effects were assessed using a mixed methodology. Data were quantitatively assessed using a single-sample, pre- and post-therapy design and qualitatively assessed using a case-study methodology.

Methods: Eleven patients diagnosed with schizophrenia received Metacognitive Narrative Psychotherapy over the course of 11-26 months. Therapists were seven supervised postgraduate psychology students. On average patients attended 49 sessions over the course of therapy. Patients completed interview-based and self-report measures for general and treatment-specific outcomes at pre-, mid-, and post-treatment.

Results: Quantitative analyses showed that patients significantly improved on the general outcome of subjective recovery, as well as the treatment-specific outcome of self-reflectivity, with medium to large effect sizes. Case-study evidence also showed improvements for some patients in symptom severity, and narrative coherence and complexity.

Conclusions: These results are consistent with previous case-study evidence and suggest that this manualized version of Metacognitive Narrative Psychotherapy produces general and approach-specific improvements for people with schizophrenia. Replication is needed to ascertain its effectiveness with a larger sample size and within a controlled design.

Practitioner Points: People with psychotic symptoms experience disruptions in self-disturbance that are amenable to psychological interventions. A focus on enhancing metacognitive capacity in people with psychotic symptoms may contribute to enhancing sense of recovery. The current findings support the use of interventions that target capacity for meaningful storytelling in people with psychotic symptoms.