Evolution of linguistic markers of agency, centrality and content during metacognitive therapy for psychosis

Recovery from psychosis involves deep and subjective personal changes such as regained sense of agency and purpose. Metacognitive Reflection and Insight Therapy (MERIT) is a form of person-centred psychotherapy that promotes recovery-oriented outcomes by enhancing metacognitive capacity, i.e. one’s ability to monitor and regulate cognition and behavior. Previous research has shown the feasibility, acceptability and clinical benefits of MERIT. However, it is not clear whether and how the subjective outcomes of MERIT are objectively manifested in the patient-therapist communications during therapy sessions. In this study, we used natural language processing (NLP) to detect and quantify objective markers of change in the psychotherapy transcripts of five participants diagnosed with psychosis across 24 sessions of MERIT. As hypothesized, analyses detected shifts in specific speech signals over time within psychotherapy transcripts 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. Our findings suggest that the speech of participants over MERIT reflected increasingly complex ways of thinking about themselves and others such as an increased sense of agency and a more goal-oriented mode of thinking. Results also suggest NLP can objectively quantify meaningful signals consistent with expected changes during psychotherapeutic interventions.