Implementation of Metacognitive Reflection and Insight Therapy for Occupational Therapy (MERIT-OT) to Support Veterans Receiving Occupational Therapy Mental Health Services

Importance Metacognitive Reflection and Insight Therapy for Occupational Therapy (MERIT-OT) is a novel adaptation of an evidence-based psychotherapy model designed to enhance metacognitive capacity and support recovery. Its philosophical alignment with occupational therapy—particularly the emphasis on meaning-making and life participation—makes it a promising intervention for Veterans with serious mental illness. However, to date no implementation studies of MERIT-OT have been conducted. Objective To evaluate the implementation of MERIT-OT within a Veterans Affairs (VA) occupational therapy setting and to explore preliminary findings regarding clinical effectiveness. Design Pilot study evaluating the implementation and preliminary effectiveness of MERIT-OT when delivered by occupational therapists in a VA setting. Setting One VA Medical Center across four occupational therapy practice areas: psychosocial rehabilitation, outpatient mental health, home health, and women's health. Participants Five occupational therapists; three implemented MERIT-OT with nine Veterans over 37 sessions. Outcomes and Measures Implementation outcomes were assessed using the Consolidated Framework for Implementation Research when analyzing interviews and chart review data. Clinical outcomes were measured using the Metacognition Assessment Scale–Abbreviated (MAS-A). Results Facilitators included perceived relative advantage and tension for change. Barriers included competing priorities and documentation challenges. Quantitative analysis showed early gains in metacognitive mastery; other subscales showed limited change. Conclusions and Relevance Preliminary findings suggest ongoing consultation, additional training, and improved tools and resources may facilitate MERIT-OT implementation in VA outpatient mental health. What This Article Adds MERIT-OT offers a structured, recovery-oriented approach aligned with occupational therapy values and shows promise for enhancing metacognitive outcomes in mental health settings.