Tracing Metacognition in Psychotherapy: Associations with Symptoms of General Distress and Depression

Nitzan Arnon-Ribenfeld, Dana Atzil-Slonim, Eran Bar-Kalifa, Yosef Silber, Hadar Fisher, Tuvia Peri, Paul H. Lysaker, Ilanit Hasson-Ohayon

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Deficits in metacognition have often been identified as a central feature in various forms of psychopathology. The current study explores changes in metacognition and symptoms during the process of psychodynamic-oriented psychotherapy conducted in a community setting among people with diverse psychological challenges. We examined the associations between metacognition and symptoms at both the within-client and the between-clients level. Nine good-outcome and nine poor-outcome cases of psychodynamic treatment were analyzed. In terms of metacognitive abilities, results showed that clients who were part of the good-outcome group had higher levels of decentration than did clients who were part of the poor-outcome group. In addition, clients' ability to understand the other's mind improved significantly only for clients in the good-outcome group. Furthermore, sessions in which clients' self-reflectivity was higher were followed by increased symptom levels (in the next session) beyond group (poor or good outcome group). Clinical implications regarding the improvement of metacognitive abilities and their associations with outcome measures are discussed.

Original languageEnglish
Pages (from-to)936-943
Number of pages8
JournalJournal of Nervous and Mental Disease
Issue number11
StatePublished - 1 Nov 2019


  • Metacognition
  • community clinic
  • psychotherapy
  • within-client and between-clients effects

ASJC Scopus subject areas

  • Psychiatry and Mental health


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