Wiser, better, stronger? The Effect of Metacognitive Insight on Functional Recovery in Patients Suffering from Early Psychosis.

Abstract

It has been argued that functional recovery of patients in the first period of psychosis (Early Psychosis) is a predictor for long-term recovery. To facilitate functional recovery in work and education, vocational interventions are the main used treatments. Wykes and Reeder (2006) argued that the addition of cognitive remediation therapy facilitates higher functional recovery. Metacognitive insight, the awareness of one’s own cognitive abilities, is one of the essential elements in this cognitive remediation therapy. To date the relation between metacognitive insight and functional recovery has not yet been investigated. The variable metacognitive insight was composed of the difference between objective cognitive functioning and subjective cognitive functioning. Subjective cognitive functioning is the self-perceived cognitive functioning, based on the complaints that people report on their own cognitive functioning, whereas objective cognitive functioning is based on standardized cognitive tests scores. The current study investigated the relation between objective cognitive functioning and subjective cognitive functioning, assessed the effect of cognitive remediation therapy on metacognitive insight and assessed the influence of metacognitive insight on functional recovery in work and education. Sixty-eight early psychotic patients were recruited from Dutch healthcare intuitions and were treated with a vocational intervention plus cognitive remediation therapy. Patients were tested on a set of neuropsychological tasks, cognitive complaints, and vocational activity at three measurement occasions (at baseline, after 6 months and after 18 months). There was no association between objective and subjective cognitive functioning, there was no effect of cognitive remediation therapy on metacognitive insight, and there was no effect of metacognitive insight on functional recovery. Findings suggest that metacognitive insight does not have impact on functional recovery. The present study is especially relevant because it contributes to the knowledge about the role of metacognitive insight in cognitive remediation therapies in early psychotic patients.