Working through the body in metacognitive interpersonal therapy to change relational patterns in dependent personality disorder: The case of Lia.

Persons with dependent personality disorder (DPD) have difficulties describing their inner world, and in realizing their negative ideas about the self, such as being weak, unworthy or powerless are just ideas. As a consequence, they tend to over-rely on others and may lose control over their emotions. Treating these persons can gain benefits from including body-focused techniques as they can promote a) awareness of internal states, b) better emotion regulation, c) the capacity to consider their negative ideas about themselves as not necessarily true, and d) gain power of and agency. We will describe the therapist used body-focused techniques in the context of Metacognitive Interpersonal Therapy when treating Lia, a 40-year-old woman suffering from DPD who also suffered from generalized anxiety disorder and had difficulties in making autonomous choices. She had a romantic relationship with a man she described as distant and judgmental so she felt lonely and not entitled to express her discomfort or capable to break up. The therapist used body-focused techniques, together with behavioural exposure, mindfulness and guided imagery, to let Lia be more aware of her thoughts and feelings, and then to regulate affects and realize she had previously capacities. At therapy termination anxiety diminished and she could break up with the partner and start a new one where she felt free to express herself. We suggest how bodily-focused techniques can be used to enhance therapy effectiveness in DPD.

Metacognitive Awareness and the Subjective Experience of Remembering in Aphantasia.

Individuals with aphantasia, a nonclinical condition typically characterized by mental imagery deficits, often report reduced episodic memory. However, findings have hitherto rested largely on subjective self-reports, with few studies experimentally investigating both objective and subjective aspects of episodic memory in aphantasia. In this study, we tested both aspects of remembering in aphantasic individuals using a custom 3-D object and spatial memory task that manipulated visuospatial perspective, which is considered to be a key factor determining the subjective experience of remembering. Objective and subjective measures of memory performance were taken for both object and spatial memory features under different perspective conditions. Surprisingly, aphantasic participants were found to be unimpaired on all objective memory measures, including those for object memory features, despite reporting weaker overall mental imagery experience and lower subjective vividness ratings on the memory task. These results add to newly emerging evidence that aphantasia is a heterogenous condition, where some aphantasic individuals may lack metacognitive awareness of mental imagery rather than mental imagery itself. In addition, we found that both participant groups remembered object memory features with greater precision when encoded and retrieved in the first person versus third person, suggesting a first-person perspective might facilitate subjective memory reliving by enhancing the representational quality of scene contents.

Longitudinal evidence for differential plasticity of cognitive functions: Mindfulness-based mental training enhances working memory, but not perceptual discrimination, response inhibition, and metacognition.

Recent decades have witnessed an increasing interest in effects of meditation-based interventions on the improvement of cognitive abilities, ranging from perceptual discrimination to metacognition. However, intervention studies face numerous conceptual and methodological challenges, and results are fairly inconsistent. In a large-scale 9-month mental training study, we investigated differential changes in different facets of cognitive functioning after training of three distinct types of mental training modules focusing on attention, socioemotional, and sociocognitive skills. We found enhanced working memory performance specifically after the mindfulness-based attention module, an effect that was positively related to training intensity, but not paralleled by reduced effects of encoding time, memory load, or proactive interference. By contrast, none of the training modules altered perceptual threshold, response inhibition, or metacognition. These findings provide benchmarks for effect-sizes in training-induced change and specify the most promising practice type as well as the underlying processes for improvements in working memory performance. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Decreased emotional reactivity after 3-month socio-affective but not attention- or meta-cognitive-based mental training: A randomized, controlled, longitudinal fMRI study.

Meditation-based mental training interventions show physical and mental health benefits. However, it remains unclear how different types of mental practice affect emotion processing at both the neuronal and the behavioural level. In the context of the ReSource project, 332 participants underwent an fMRI scan while performing an emotion anticipation task before and after three 3-month training modules cultivating 1) attention and interoceptive awareness (Presence); 2) socio-affective skills, such as compassion (Affect); 3) socio-cognitive skills, such as theory of mind (Perspective). Only the Affect module led to a significant reduction of experienced negative affect when processing images depicting human suffering. In addition, after the Affect module, participants showed significant increased activation in the right supramarginal gyrus when confronted with negative stimuli. We conclude that socio-affective, but not attention- or meta-cognitive based mental training is specifically effective to improve emotion regulation capabilities when facing adversity.

The Metacognitive Processes of Decentering Scale: Development and initial validation of trait and state versions.

The ability to decenter from internal experiences is important for mental health. Consequently, improving decentering is a common therapeutic target, particularly for mindfulness-based interventions. However, extant decentering measures are limited as they fail to directly assess all 3 metacognitive processes recently theorized to subserve decentering. We thus conducted 4 studies to develop and test the Metacognitive Processes of Decentering-Trait (MPoD-t) and State (MPoD-s) scales. Consistent with the metacognitive processes model, exploratory factor analysis (N = 355) and then bifactor exploratory structural equation modeling (N = 275) indicated the MPoD-t was composed of three independent yet interrelated lower-order factors, metaawareness, (dis)identification with internal experience, and (non)reactivity to internal experience, which subserved an emergent, higher-order, decentering factor. We next found evidence of the MPoD-t's convergent validity; as well as known-groups criterion validity, wherein mindfulness practitioners reported higher MPoD-t scores than nonpractitioners. Item response theory analyses were then used to identify a subset of 3 MPoD-t items for the MPoD-s. Finally, we found evidence that the MPoD-s was sensitive to changes in state decentering following a brief mindfulness induction relative to an active control condition; and that MPoD-s changes mediated the effect of mindfulness on levels of pain and related outcomes among a sample of preoperative surgery patients (N = 82). These studies indicate the trait and state versions of the MPoD may prove useful for the study of decentering and its constituent metacognitive processes. As such, the MPoD may help advance our understanding of how the metacognitive processes of decentering support mental health and well-being. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Metacognitive Interpersonal Mindfulness-Based Training for Worry About Interpersonal Events: A Pilot Feasibility and Acceptability Study.

Individuals with personality disorders experience worry and repetitive thoughts regarding interpersonal scenarios. Mainstream mindfulness-based approaches may be insufficient to soothe these individual's distress due to difficulties in letting thoughts go and refocusing attention to the present moment. For this reason, we devised an adapted form of mindfulness-based program called Metacognitive Interpersonal Mindfulness-Based Training (MIMBT) for personality disorders. In this pilot study, 28 individuals attended nine weekly sessions to evaluate the feasibility and acceptability, and to establish preliminary outcomes. All individuals completed the program. Attendance was very high (96%). Significant changes were observed on the primary outcome of reduction in repetitive thinking, measured using the Metacognition Questionnaire-30. We also observed a decrease in depression severity. Despite important limitations, this pilot study suggests that MIMBT has the potential to be a viable and well-accepted option for increasing positive outcomes in the treatment of personality disorders. Clinical considerations and directions for future research are discussed.

Mindful meta-awareness: sustained and non-propositional.

Meta-awareness appears to be essential to nearly all forms of mindfulness practice, and it plays a key role in processes that are central to therapeutic effects of mindfulness training, including decentering - shifting one's experiential perspective onto an experience itself - and dereification or metacognitive insight - experiencing thoughts as mental events, and not as the things that they seem to represent. Important advances in the conceptualization of meta-awareness in mindfulness have recently been made, yet more clarity is required in order to characterize the type of meta-awareness implicated in the ongoing monitoring of attention and affect, even while attention itself is focused on an explicit object of awareness such as the breath. To enhance research on this form of meta-awareness cultivated in at least some styles of mindfulness, a construct of sustained, non-propositional meta-awareness is proposed.

Psychological intervention (ConquerFear) for treating fear of cancer recurrence: mediators and moderators of treatment efficacy.

PURPOSE: ConquerFear is an efficacious intervention for fear of cancer recurrence (FCR) that demonstrated greater improvements than an attention control (relaxation training) in a randomized controlled trial. This study aimed to determine mediators and moderators of the relative treatment efficacy of ConquerFear versus relaxation. METHODS: One hundred and fifty-two cancer survivors completed 5 therapy sessions and outcome measures before and after intervention and at 6 months' follow-up. We examined theoretically relevant variables as potential mediators and moderators of treatment outcome. We hypothesized that metacognitions and intrusions would moderate and mediate the relationship between treatment group and FCR level at follow-up. RESULTS: Only total FCR score at baseline moderated treatment outcome. Participants with higher levels of FCR benefited more from ConquerFear relative to relaxation on the primary outcome. Changes in metacognitions and intrusive thoughts about cancer during treatment partially mediated the relationship between treatment group and FCR. CONCLUSIONS: These results show that ConquerFear is relatively more effective than relaxation for those with overall higher levels of FCR. The mediation analyses confirmed that the most likely mechanism of treatment efficacy was the reduction in unhelpful metacognitions and intrusive thoughts during treatment, consistent with the theoretical framework underpinning ConquerFear. IMPLICATIONS FOR CANCER SURVIVORS: ConquerFear is a brief, effective treatment for FCR in cancer survivors with early-stage disease. The treatment works by reducing intrusive thoughts about cancer and changing beliefs about worry and is particularly helpful for people with moderate to severe FCR.

A neurobehavioral account for decentering as the salve for the distressed mind.

Distress is commonly characterized by prolonged internal suffering that can range from self-focused processing of negative emotions and stressors, to highly intensely aversive and prolonged emotional states, thereby, worsening or complicating emotional and physical conditions. Decentering represents a metacognitive capacity thought to reflect three interrelated processes: meta-awareness, disidentification from internal experience, and reduced reactivity to thought content-which is reliably increased with mindfulness-based interventions. In this essay, we seek to link the clinical presentation of distress disorders to known or hypothesized disruptions in neural networks that underlie emotion, cognition, and goal directed behavior, and offer a neurobehavioral account for how and why treatments imbued with mindfulness meditation might ameliorate these conditions, in part through increases in decentering.

Time perception and the experience of agency in meditation and hypnosis.

Mindfulness meditation and hypnosis are related in opposing ways to awareness of intentions. The cold control theory of hypnosis proposes that hypnotic responding involves the experience of involuntariness while performing an actually intentional action. Hypnosis therefore relies upon inaccurate metacognition about intentional actions and experiences. Mindfulness meditation centrally involves awareness of intentions and is associated with improved metacognitive access to intentions. Therefore, mindfulness meditators and highly hypnotizable people may lie at opposite ends of a spectrum with regard to metacognitive access to intention-related information. Here we review the theoretical background and evidence for differences in the metacognition of intentions in these groups, as revealed by chronometric measures of the awareness of voluntary action: the timing of an intention to move (Libet's "W" judgments) and the compressed perception of time between an intentional action and its outcome ("intentional binding"). We review these measures and critically evaluate their proposed connection to the experience of volition and sense of agency.

Metacognitive processes model of decentering: emerging methods and insights.

We previously proposed that three metacognitive processes - meta-awareness, disidentification from internal experience, and reduced reactivity to thought content - together constitute decentering. We review emerging methods to study these metacognitive processes and the novel insights they provide regarding the nature and salutary function(s) of decentering. Specifically, we review novel psychometric studies of self-report scales of decentering, as well as studies using intensive experience sampling, novel behavioral assessments, and experimental micro-interventions designed to target the metacognitive processes. Findings support the theorized inter-relations of the metacognitive processes, help to elucidate the pathways through which they may contribute to mental health, and provide preliminary evidence of their salutary roles as mechanisms of action in mindfulness-based interventions.

It matters what you practice: differential training effects on subjective experience, behavior, brain and body in the ReSource Project.

Mindfulness interventions have gained much attraction, also due to their promise to improve health and wellbeing. However, not enough attention is devoted to the differentiation between various mental practice types. Here, we summarize findings from the ReSource Project, a 9-month longitudinal mental training study comparing practices focusing on (a) present-moment attention and interoception, (b) socio-emotional processes such as compassion and loving kindness and (c) meta-cognitive processes and perspective-taking on self and others. We find evidence for differential training effects of these practice types on all levels of observation, ranging from distinct phenomenological fingerprints and structural brain plasticity to selective improvements in social cognition, altruism and peripheral physiology, including the cortisol response to psychosocial stress. We argue for a more differentiated view on the concept of mindfulness and meditation.

Banning pre-event rumination in social anxiety: A preliminary randomized trial.

BACKGROUND AND OBJECTIVES: Pre-event rumination has a clear role in maintaining social anxiety according to cognitive models. However, it is unclear what specific strategies can address pre-event rumination for individuals diagnosed with SAD. The current study aimed to determine the effectiveness of a brief intervention on multiple aspects of pre-event rumination, state anxiety and performance and threat appraisals. Additionally, the trajectory of pre-event rumination was investigated over four days. METHODS: Participants with SAD were informed they would be required to complete a speech task in four days' time and were randomised to an intervention (n = 27) or a non-active control group (n = 25). The intervention group were instructed to "ban" pre-event rumination using a metacognitive therapy technique known as detached mindfulness. All participants completed daily measures of pre-evet rumination that assessed frequency, uncontrollability, engagement and distress associated with pre-event rumination. On the day of the speech task, participants also completed state and cognitive measures before delivering the speech task. RESULTS: The intervention group reported reduced frequency, uncontrollability and distress associated with pre-event rumination, compared to the control group. There was no difference between groups for performance and threat appraisals as well as state anxiety. Rumination is a stable and robust process, with an increase in frequency and associated distress 24 hours before a feared social situation. LIMITATIONS: The lack of an active control group precludes comparisons to more traditional cognitive-behavioural therapy strategies for pre-event rumination. CONCLUSIONS: Pre-event rumination is a durable process but banning pre-event rumination using metacognitive therapy techniques shows promise for specifically addressing this maladaptive process.

The attention training technique causally reduces self-focus following worry provocation and reduces cognitive anxiety among self-focused individuals.

BACKGROUND AND OBJECTIVES: The attention training technique (ATT) is a component of metacognitive therapy developed to interrupt self-focused, threat-based processing underlying anxiety disorders. Whereas extant research supports the benefits of ATT, including in relation to anxiety reduction, study findings lead to equivocal conclusions as to whether ATT causally interrupts self-focused attention (SFA) as intended. An additional gap in the literature relates to investigating if ATT is especially effective for reducing anxiety among individuals experiencing a heightened self-focused state. The present study sought to address those two gaps in the literature. METHOD: Participants scoring high on a measure of general worry severity completed a worry provocation that increased SFA and then were randomized to ATT (n = 45), a mindfulness task (n = 44), or a distraction task (n = 44). RESULTS: ATT caused large reductions in SFA, whereas there were no changes in focus of attention following the mindfulness or distraction task. Anxiety reduction was found in relation to all three tasks; however, ATT, relative to distraction, was found to cause greater reduction in cognitive anxiety for individuals highly self-focused before the task. LIMITATIONS: The present study used an analogue sample and the design did not allow for an examination of the long-term benefit of ATT. CONCLUSIONS: Results support ATT causally interrupting self-focused states and that ATT is particularly effective in reducing cognitive anxiety among individuals who are self-focused.

The Attention Training Technique improves Children's ability to delay gratification: A controlled comparison with progressive relaxation.

The ability to delay gratification at a young age is a predictor of psychological, cognitive, health, and academic later-life outcomes. This study aimed to extend earlier research and explore whether a metacognitive intervention, Wells' (1990) Attention Training Technique (ATT), could improve young children's ability to delay gratification compared to an active-control (Progressive Muscle Relaxation: PMR), and no-intervention group. One hundred and one children aged 5-6 years old were recruited from schools. Classes of children were randomly allocated to receive the ATT, PMR or no-intervention and tested at pre- and post-intervention on measures of delay of gratification (the Marshmallow Test) and verbal inhibition (Day/Night Task). Results showed that, even when covariates were controlled for, following ATT, children delayed gratification significantly longer than after PMR or no-intervention. ATT also improved verbal inhibition compared with the no-intervention group, whilst PMR did not. The results add to earlier findings; ATT appears to provide a simple and effective way of improving young children's ability to delay gratification which has previously been shown to predict positive outcomes in later-life.

[Modulation of Metacognition with Decoded Neurofeedback].

Humans often assess their confidence in their own perception, e.g., feeling "confident" or "certain" of having seen a friend, or feeling "uncertain" about whether the phone rang. The neural mechanism underlying the metacognitive function that reflects subjective perception still remains under debate. We have previously used decoded neurofeedback (DecNef) to demonstrate that manipulating the multivoxel activation patterns in the frontoparietal network modulates perceptual confidence without affecting perceptual performance. The results provided clear evidence for a dissociation between perceptual confidence and performance and suggested a distinct role of the frontoparietal network in metacognition.

Towards evidence-based practices in voice pedagogy / Prácticas vocales basadas en la evidencia

Voice pedagogy was initially based on an orally transmitted master-apprentice teaching-learning model, applying observational type of learning centred in the final artistic product. Since then, this model has been continuously replaced. Nowadays, the social organization of work in globalized economies has called for the need of rethinking education so that future generations can meet the demands of lifelong learners, who are skilful at using systems of information, who are flexible and adapt to the lack of stability at work, and who are able to make their own career opportunities. How can this be applied to voice pedagogy? This work aims at finding answers to these questions, further contributing to the discussion raised at the voice pedagogy round table of the 10th Pan-European Voice Conference, "Vocal Pedagogy - What do we need?". The rationale for reflective practices in voice education and for enhancing metacognitive skills in student's using evidence-based guided awareness is discussed. The provision of meaningful feedback and the use of a holistic approach to voice teaching are presented as means to meet individual needs of different types of learners. Problem-solving and student-centred teaching–learning models are proposed as key elements in developing reflective voice practitioners (AU)

Tradicionalmente la pedagogía de la voz se ha basado en un modelo de enseñanza-aprendizaje a partir de dominar la práctica transmitida oralmente, en la que se aplicaba un tipo de aprendizaje observacional centrado en el producto artístico final. Este modelo se ha ido sustituyendo constantemente con el tiempo. Actualmente, la organización social del trabajo en las economías globalizadas ha visto la necesidad de replantear la educación de forma que las generaciones futuras pueden responder a las necesidades de alumnos que aprenden de por vida, que destacan en el uso de habilidades de sistemas de información, que son flexibles y se adaptan a la falta de estabilidad en el trabajo, y que son capaces de manejar sus propias oportunidades de emprendimiento. ¿Cómo se puede aplicar todo esto a la pedagogía vocal? Este trabajo tiene como objetivo la búsqueda de respuestas a estas cuestiones, además de contribuir a la discusión que se generó en la 10th Pan European Voice Conference, «Pedagogía Vocal. ¿Qué necesitamos?». Se expone la lógica de usar prácticas reflexivas en la educación vocal y que realcen las habilidades metacognitivas del estudiante, al utilizar el conocimiento basado en la evidencia. La provisión de feedback significativo y el uso de un enfoque holístico en la enseñanza de la voz se presentan como los medios necesarios para responder a las necesidades individuales de los distintos aprendices. Los modelos de enseñanza basados en la resolución de problemas y en el aprendizaje centrado en el alumno se proponen como elementos clave a la hora de desarrollar profesionales de la voz conscientes, que son los que mejor cumplen con las demandas de conocimiento de las sociedades del siglo xxi (AU)

Distinguishing the cognitive processes of mindfulness: Developing a standardised mindfulness technique for use in longitudinal randomised control trials.

A capacity model of mindfulness is adopted to differentiate the cognitive faculty of mindfulness from the metacognitive processes required to cultivate this faculty in mindfulness training. The model provides an explanatory framework incorporating both the developmental progression from focussed attention to open monitoring styles of mindfulness practice, along with the development of equanimity and insight. A standardised technique for activating these processes without the addition of secondary components is then introduced. Mindfulness-based interventions currently available for use in randomised control trials introduce components ancillary to the cognitive processes of mindfulness, limiting their ability to draw clear causative inferences. The standardised technique presented here does not introduce such ancillary factors, rendering it a valuable tool with which to investigate the processes activated in mindfulness practice.

The Power of Suggestion: Posthypnotically Induced Changes in the Temporal Binding of Intentional Action Outcomes.

The sense of agency is the experience of initiating and controlling one's voluntary actions and their outcomes. Intentional binding (i.e., when voluntary actions and their outcomes are perceived to occur closer together in time than involuntary actions and their outcomes) is increased in intentional action but requires no explicit reflection on agency. The reported experience of involuntariness is central to hypnotic responding, during which strategic action is experienced as involuntary. We report reduced intentional binding in a hypnotically induced experience of involuntariness, providing an objective correlate of reports of involuntariness. We argue that this reduced binding results from the diminished influence of motor intentions in the generation of the sense of agency when beliefs about whether an action is intended are altered. Thus, intentional binding depends on awareness of intentions. This finding shows that changes in metacognition of intentions affect perception.

Hypnosis and top-down regulation of consciousness.

Hypnosis is a unique form of top-down regulation in which verbal suggestions are capable of eliciting pronounced changes in a multitude of psychological phenomena. Hypnotic suggestion has been widely used both as a technique for studying basic science questions regarding human consciousness but also as a method for targeting a range of symptoms within a therapeutic context. Here we provide a synthesis of current knowledge regarding the characteristics and neurocognitive mechanisms of hypnosis. We review evidence from cognitive neuroscience, experimental psychopathology, and clinical psychology regarding the utility of hypnosis as an experimental method for modulating consciousness, as a model for studying healthy and pathological cognition, and as a therapeutic vehicle. We also highlight the relations between hypnosis and other psychological phenomena, including the broader domain of suggestion and suggestibility, and conclude by identifying the most salient challenges confronting the nascent cognitive neuroscience of hypnosis and outlining future directions for research on hypnosis and suggestion.