The putative key to improved insight self-monitoring There may be several different pathways to improved awareness of symptoms and behaviour. Previous research has suggested that better self-esteem (Cella, Swan, & Medin, 2014; Paul H Lysaker et al., 2011), improved mood, lower positive and negative symptoms (Palmier-Claus, Taylor, & Gooding, 2012) and metacognitive training (Moritz et al., 2014) are associated with higher clinical and cognitive insight. Reeder, Rexhepi- Johansson, & Wykes (2010) suggested that what is important for an individual’s functional outcome is not necessarily the metacognitive belief that an individual holds (i.e. I have a poor memory) but how this affects real life functioning (i.e. I should rehearse and monitor my memory). Metacognitive regulation and the process of actively monitoring your own cognition, may guide behavior and cognitive resources more efficiently (Cella et al., 2014; David et al., 2012; Flavell, 1979). David et al., (2012) suggests that the act of monitoring may reveal abilities or impairments that lead to an adjustment of self-knowledge. Increasingly there is support for the role of self-reflection in relapse prevention and recovery (Henriksen & Parnas, 2014; Lysaker, McCormick, & Snethen, 2011). Lysaker has criticized the traditional approach to recovery and relapse prevention as focusing mainly on the reduction of observable symptoms whereas equally important is the capacity to understand the self and others (Lysaker & Dimaggio, 2014). Pitt et al., (2007) found, from a service user perspective, recovery meant a better understanding of oneself and feelings of empowerment. Meaningful recovery goes beyond a decrease in measureable symptoms and entails the ability to recapture a coherent understanding of oneself (Connell et al., 2015). It is important to consider that recovery may have different meanings for different individuals; it could mean a decrease in symptoms for some or the ability to understand and live with symptoms for others. The key mechanism may be self-reflection and the development of an integrated understanding of experiences (Lysaker et al., 2015).
