Effects of early trauma on metacognitive functioning in psychosis
Background: Empirical evidence suggests a relationship between early trauma and psychosis. However, the underlying mechanisms for this relationship remain unclear. Research into metacognitive functioning in psychosis indicates higher levels of metacognitive dysfunctional beliefs within this patient group. The potential effects of early trauma on metacognitive functioning in psychosis has to date been scarcely researched. Reflective functioning (RF) is believed to be affected by early trauma and leading to psychopathology, particularly borderline personality disorder. However, to date no studies have investigated the effects of early trauma on RF within psychosis. Objectives: The primary aim of this study was to establish core links between the effects of early trauma and metacognitive and reflective functioning in psychosis. A secondary aim was to test the clinical applicability of a brief, newly developed attachment-based measure for RF. Furthermore, the study aimed to explore potential overlaps between the concepts of metacognition and reflective functioning. Method: A quantitative methodology was employed, using a combination of semi-structured interviews and self-report questionnaire, and group comparisons were conducted. Twenty-seven patients with psychosis or bipolar disorder were recruited. Participants were grouped into early trauma versus no early trauma; trauma versus no trauma; and in-patient versus out-patient, and exploratory analyses were completed. Results: No significant effects were found for early trauma but for trauma in general, indicating higher level of dysfunctional beliefs in patients with trauma (early plus adult trauma) history. No significant effect between groups were found for RF. Inpatients, however, showed significantly lower levels of RF when compared with outpatients, and outpatients significantly higher levels of cognitive self-focus(thinking about thoughts). Moreover, a modest positive correlation was found between both measures. Discussion: The findings of the present study suggest core links between the effects of trauma on metacognitive functioning in psychosis. This highlights the importance of routine trauma assessment with psychotic patients. The limitations of the metacognitive model within psychosis are discussed. Further research is implicated to investigate any potential effects of early trauma on RF in psychosis. Low level of RF in in-patients highlights the importance to integrate therapeutic techniques to improve RF functioning in this patient group since high RF is associated with resilience and better therapy outcome. The correlation between metacognition and RF measure indicates construct-validity for the RF measure. The differences between both concepts are considered. Furthermore, the limitations of this study and clinical utility are discussed along with suggestions for future research.