[[Metacognition]] **This paper compared treatment modality, CBT vs ESTS (a metacognitively oriented, compassion-focused and evolutionary approach) and results shows that it can work** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9942388/ - Metacognition has been demonstrated to be related to symptoms and interpersonal problems in both personality disorders [[13](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9942388/#CR13)] and psychosis [[14](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9942388/#CR14), [15](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9942388/#CR15)] and to predict psychosocial functioning and severity of psychopathology in those diagnosed with personality disorders and schizophrenia spectrum and other psychotic disorders [[16](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9942388/#CR16), [17](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9942388/#CR17)]. - Patient with Schizotypal Personality Disorder have this well-known vicious cycle "This process would foster the well-known vicious cycle between perceived threat, reduced intra-personal safeness, poor metacognition, and difficulty in regulating negative feelings [[26](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9942388/#CR26)]" - Therefore if they can intervene and improve metacognition - Control group go for CBT for PD, Experimental group go for ESTS --- **Metacognitive function and fragmentation in schizophrenia: Relationship to cognition, self-experience and developing treatments** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/ ### 6.5. Evidence supporting MERIT Two randomized, controlled trials, lasting eight and six months respectively, have demonstrated an acceptance rate for MERIT of over two thirds of patients with prolonged and first episode schizophrenia, with participation in MERIT also leading to meaningful metacognitive or clinical gains ([de Jong et al., 2019a](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0215); [Vohs et al., 2018](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0575)). Similar rates of improvement and participation in treatment were also reported in an open trial of a 12 week version of MERIT ([de Jong et al., 2016a](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0200)) and 1–2 years of metacognitively focused, individual psychotherapies offered to 11 persons with schizophrenia that conformed to the elements of MERIT and lasted between 11 and 26 months ([Bargenquast and Schweitzer, 2014](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0035)). Of note, a three year follow-up of participants in the latter, open trial revealed persistent gains in metacognition and function ([Schweitzer et al., 2017](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0505)). From a different vantage point, qualitative studies have offered preliminary evidence of the usefulness of MERIT. In two studies comparing patients who had received MERIT vs. more supportive therapy experiences, patients who received MERIT were more likely to describe how the treatment {i} helped them develop a deeper sense of personal agency and {ii} enabled them to use their unique, personal history to make sense of their challenges and emotional pain ([Lysaker et al., 2015b](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0385); [de Jong et al., 2019b](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0220)). Finally, detailed case studies of patients in real-life, clinical settings have illustrated how MERIT can be applied to patients with widely varying and often quite complex clinical presentations. These include studies of patients who initially suffered from mixtures of severe levels of negative symptoms, substance misuse, disorganization, emotional distress and lack of insight whose metacognition and function were observed to improve ([Arnon-Ribenfeld et al., 2018](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0015); [de Jong et al., 2016b](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0205); [Dubreucq et al., 2016](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0095); [Hamm and Firmin, 2016](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0140); [Hasson-Ohayon et al., 2017](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0160); [James et al., 2018b](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0185); [Leonhardt et al., 2018](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0280); [Leonhardt et al., 2016](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0275); [Van Donkersgoed et al., 2016](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0545)). In an effort to synthesize the findings of these diverse case studies, [Hamm and Lysaker (2018)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889776/#bb0135) have suggested a three-stage process which recurs across these reports: {i} a sense of agency was observed to emerge, {ii} followed by the development of a more coherent sense of self, {iii} followed by action and management of one's own recovery.