Aligning Treatment with Mechanism: A Scoping Review of Integrated Neurocognitive and Metacognitive Interventions for Schizophrenia Spectrum Disorders

Neurocognitive deficits are central to schizophrenia spectrum disorders (SSDs) and predict functional outcomes; yet interventions such as cognitive remediation show limited effects on real-world recovery. Metacognitive deficits have also been proposed as central to functional deficits and personal recovery in SSDs. Emerging evidence suggests that metacognitive capacity, or the ability to reflect on and integrate one’s own and others’ mental states, may mediate the relationship between neurocognition and functioning. This scoping review maps psychosocial interventions for SSDs that target both neurocognitive and metacognitive processes. We examine how these interventions conceptualize and integrate these domains and their impact on related outcomes, including neurocognitive performance, metacognition, and functional recovery. Across studies, improvements were reported most consistently for neurocognitive outcomes, while findings for metacognitive, functional, and clinical outcomes were more variable. Metacognition was consistently conceptualized within a cognitive-regulatory framework and no included intervention explicitly targeted integrative metacognitive capacities. Interpretation is limited by substantial methodological heterogeneity, including several uncontrolled or small-sample studies. Findings highlight the promise of integrated treatment approaches while suggesting that future interventions may benefit from incorporating broader, recovery-oriented models of metacognition.