Evolution of Linguistic Markers of Agency, Centrality and Content During Metacognitive Therapy for Psychosis: A Pilot Exploratory Study

Aim: Metacognitive Reflection and Insight Therapy (MERIT) is a form of person-centred psychotherapy that promotes recovery-oriented outcomes by targeting metacognitive capacity. Previous research has shown the feasibility and clinical benefits of MERIT. However, it is not clear whether and how the specific processes targeted by MERIT (e.g., improved sense of agency, self-reflectivity, awareness of others, etc.) are manifested in the patient-therapist communications. In this study, we used natural language processing (NLP) to explore objective linguistic markers of change during MERIT for early psychosis.

Methods: Five patients underwent 24 sessions each of MERIT, which were recorded and transcribed verbatim. The transcripts underwent NLP to determine the patterns of pronoun use and the frequency of semantic categories related to temporality and mental processing. Mixed linear regressions were used to examine how NLP features evolve over the course of psychotherapeutic sessions.

Results: Analyses detected shifts in specific language signals over time including (1) changes in patterns of pronoun usage with more active and central first-person plural pronoun (We); (2) transition in temporal focus of speech from past-focus towards present- and future-focus and (3) increased words representing perceptual and cognitive processes.

Conclusion: Our findings suggest NLP can objectively quantify meaningful signals consistent with expected subjective changes in MERIT and potentially other psychotherapeutic interventions.