This study will collect life story narratives from individuals with psychotic disorders undergoing psychiatric inpatient hospitalization. The overall goal of the project is to identify potential mechanisms of how people experiencing psychosis integrate thoughts about their mental health challenges and recovery through measurement of metacognitive capacity, language cohesion, and semantic search processes.

This project explores how metacognition, the ability to reflect on oneself, others, and the broader world, differs in individuals with personality pathology. By mapping metacognitive profiles, we aim to better understand self and interpersonal difficulties, identify metacognitive capacities, and inform more personalized treatments in personality pathology.

Despite the apparent relevance of metacognition to understanding addiction and treatment needs in the context of the global opioid epidemic, the concept has never been studied in opioid maintenance treatment (OMT). Our study showed widespread performance of metacognition, including low levels of Mastery, a complex relationship to executive function and psychiatric comorbidity and evidence of chronic impairment in OMT patients. The 25th World Congress of Psychiatry in Prague in 2025, themed “The Role of Psychiatry in the Changing World,” offers an opportunity to present original research of metacognition in OMT and represent MERIT in a global forum.

This project tests whether metacognitive capacities can buffer the tendency of negative emotion to fragment contextual/associative memory—a mechanism thought to weaken illness awareness and narrative coherence in psychosis. Using an ecologically valid triad-association task (face–object–scene) with neutral versus negatively valenced events, we will compare 40 clinically stable individuals with schizophrenia to 40 matched controls and quantify both associative memory and metacognition. We expect that greater metacognitive capacity will counter emotion-related memory fragmentation and support insight, informing MERIT-inspired tools that help people reconnect their life stories in recovery.

Although metacognition appears highly relevant for understanding addiction and informing treatment strategies amidst the global opioid crisis, it remains an unexplored area within opioid maintenance treatment (OMT). Our research highlights a broad presence of metacognitive processes among OMT patients, characterized by notably low Mastery scores, a nuanced interplay with executive functioning and psychiatric comorbidities, and signs of persistent cognitive dysfunction. The upcoming 25th World Congress of Psychiatry in Prague (2025), themed “The Role of Psychiatry in the Changing World,” presents an ideal platform to share this pioneering research on metacognition in OMT and showcase MERIT’s work on an international stage.

This project examined the nature of the relationship between metacognition and disorganized speech. Disorganized speech was found to be most strongly associated with mastery, which has implications for tailoring metacognitive therapies for patients with higher levels of disorganization.