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Lessons learnt? The importance of metacognition and its implications for
Cognitive Remediation in schizophrenia
#MMPMID26388797
Cella M
; Reeder C
; Wykes T
Front Psychol
2015[]; 6
(?): 1259
PMID26388797
show ga
The cognitive problems experienced by people with schizophrenia not only impede
recovery but also interfere with treatments designed to improve overall
functioning. Hence there has been a proliferation of new therapies to treat
cognitive problems with the hope that improvements will benefit future
intervention and recovery outcomes. Cognitive remediation therapy (CR) that
relies on intensive task practice can support basic cognitive functioning but
there is little evidence on how these therapies lead to transfer to real life
skills. However, there is increasing evidence that CR including elements of
transfer training (e.g., strategy use and problem solving schemas) produce higher
functional outcomes. It is hypothesized that these therapies achieve higher
transfer by improving metacognition. People with schizophrenia have metacognitive
problems; these include poor self-awareness and difficulties in planning for
complex tasks. This paper reviews this evidence as well as research on why
metacognition needs to be explicitly taught as part of cognitive treatments. The
evidence is based on research on learning spanning from neuroscience to the field
of education. Learning programmes, and CRT, may be able to achieve better
outcomes if they explicitly teach metacognition including metacognitive knowledge
(i.e., awareness of the cognitive requirements and approaches to tasks) and
metacognitive regulation (i.e., cognitive control over the different task
relevant cognitive requirements). These types of metacognition are essential for
successful task performance, in particular, for controlling effort, accuracy and
efficient strategy use. We consider metacognition vital for the transfer of
therapeutic gains to everyday life tasks making it a therapy target that may
yield greater gains compared to cognition alone for recovery interventions.