OBJECTIVE When clients' lives are not reflected in therapy, they struggle to apply the skills learned in treatment to everyday situations. In this pilot study, we determined if using clients' real-world interactions in therapy could effectively target metacognitive capacity-yielding improved symptoms and social functioning-by tailoring treatment to focus on issues faced by clients in daily life. METHOD Using a randomized controlled trial design, schizophrenia subjects with metacognitive deficits completed 24 sessions of: (a) Standard Metacognitive Reflection and Insight Therapy (MERIT); or (b) Tailored MERIT. Real-world interactions were captured via the Electronically Activated Recorder (EAR), a smartphone application that passively records audio in daily life. All subjects wore the EAR; however, real-world interactions were only used to personalize sessions in Tailored MERIT. RESULTS Feasibility and acceptability were shown; those in Tailored MERIT wore the EAR 84% of their waking hours and reported minimal burden. When compared to Standard MERIT, Tailored MERIT participants showed large pre-post reductions in negative metacognitive beliefs and disorganized symptoms. Small, but nonsignificant, improvements in social functioning were also observed. CONCLUSIONS Compared to an evidence-based benchmark, we observed that real-world interactions can be used to tailor metacognitive therapy and improve outcomes in schizophrenia. Tailored MERIT has the potential to impact practice by personalizing treatment to account for individual variations in environment and lifestyle-aligning with the Precision Medicine Initiative-in a way that is not possible with current therapy. This is particularly salient in schizophrenia, where limited insight and cognitive deficits often make subjective reporting unreliable. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译：

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使用现实世界的交互进行个性化干预：通过量身定制的元认知疗法改善精神分裂症的症状和社会功能。

目标 当客户的生活没有反映在治疗中时，他们很难将在治疗中学到的技能应用到日常生活中。在这项试点研究中，我们确定在治疗中使用客户与现实世界的互动是否可以通过调整治疗以关注客户在日常生活中面临的问题来有效地瞄准元认知能力——产生改善的症状和社会功能。方法 使用随机对照试验设计，具有元认知缺陷的精神分裂症受试者完成了 24 个疗程：(a) 标准元认知反思和洞察力治疗 (MERIT)；(b) 量身定制的 MERIT。现实世界的互动是通过电子激活录音机 (EAR) 捕获的，这是一种智能手机应用程序，可以在日常生活中被动记录音频。所有受试者都佩戴 EAR；然而，真实世界的交互仅用于个性化 Tailored MERIT 中的会话。结果显示了可行性和可接受性；Tailored MERIT 中的那些人在 84% 的醒着时间里都戴着 EAR，并且报告的负担最小。与标准 MERIT 相比，量身定制的 MERIT 参与者在消极元认知信念和混乱症状方面表现出大量的前后减少。还观察到社会功能的小幅但不显着的改善。结论 与基于证据的基准相比，我们观察到现实世界的交互可用于定制元认知疗法并改善精神分裂症的结果。量身定制的 MERIT 有可能通过个性化治疗来影响实践，以考虑环境和生活方式的个体差异——与精准医学倡议保持一致——这是目前治疗无法实现的方式。这在精神分裂症中尤为突出，因为有限的洞察力和认知缺陷常常使主观报告不可靠。（PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。