Date of Award


Document Type


Degree Name

Doctor of Psychology (PsyD)


Graduate Department of Clinical Psychology

First Advisor

Rodger K. Bufford, PhD

Second Advisor

Marilyn Charles, PhD

Third Advisor

Nancy S. Thurston, PsyD


Objectives. Metacognitive deficits are thought to be closely related to functional impairment in a variety of mental health disorders. Understanding metacognitive differences between groups may provide insight into etiology and treatment of mental illness. This study sought to investigate group differences in metacognition and metacognitive changes over time in response to long-term psychodynamic psychotherapy amidst a population with severe mental illness diagnoses, specifically borderline personality disorder (BPD), narcissistic personality disorder (NPD), and schizoid personality disorder (SPD).

Methods. Twenty-eight participants meeting inclusion criteria were selected from amongst participants in the Austen Riggs Center’s (ARC) 11-year Follow-Along Study (FAS). For each participant, two archived transcripts of Dynamic Interviews administered at least six months apart were rated using the abbreviated Metacognitive Assessment Scale (MAS-a), which provides scores for metacognitive functioning across four separate but interdependent domains of functioning. Raters had experience and training on the MAS-a and were blinded to personality disorder group assignment of the FAS participants. Group differences and change over time were assessed using a general linear model regression with metacognitive scores for occasion one as a covariate and scores for occasion two as the dependent variable.

Results. Metacognitive scores improved over time in response to treatment for the sample as a whole. Treatment effect sizes were medium to large. However, group differences were negligible. Effect sizes for individual groups indicate possible differences in the way that groups change over time. NPD group exhibited no change in Awareness of Others, but had a large effect size in the category of Mastery. Large effect sizes in the category of Self-Reflectivity were found for SPD and BPD groups. BPD demonstrated lower Mastery scores than NPD or SPD.

Conclusions. Evidence for metacognitive improvement over time for the sample as a whole suggests treatment at ARC is effective. Differences in effect sizes in change over time between groups may suggest that personality disorder diagnosis influences treatment outcomes, a hypothesis that may be more readily testable with a larger sample. Generalizability of results is limited by the relatively small size of sample subgroups and by the unique patient population and unique treatment setting of ARC.