Metacognition reflects a spectrum of activities that includes discrete acts in which persons form ideas about specific thoughts and feelings, and synthetic acts in which persons integrate discrete thoughts and feelings into complex representations of themselves and others. This article reviews literature suggesting that persons with schizophrenia and related psychosis experience deficits across the spectrum of metacognitive activities and that these deficits play a key role in dysfunction, often mediating and moderating the impact of symptoms and social adversity on daily life. Treatment approaches including metacognitive training and adaptations of psychotherapy are still in their infancy. Future work is needed to study the etiology of deficits in discrete and synthetic metacognition, as well as their overlap with related constructs such as mentalization and social cognition.

Metacognitive deficits are a stable feature of schizophrenia related with negative symptoms.

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While alexithymia, or difficulties identifying and describing affect, has been commonly observed in schizophrenia, little is known about its causes and correlates. To test the hypothesis that deficits in emotion identification and expression result from, or are at least related to, deficits in neurocognition and affective symptoms, we assessed alexithymia using the Toronto Alexithymia Scale (TAS-20), symptoms using the Positive and Negative Syndrome Scale (PANSS), and neurocognition using the MATRICS battery among 65 adults with schizophrenia spectrum disorders in a non-acute phase of illness. Partial correlations controlling for the effects of social desirability revealed that difficulty identifying feelings and externally oriented thinking were linked with greater levels of neurocognitive deficits, while difficulty describing feelings was related to heightened levels of emotional distress. To explore whether neurocognition and affective symptoms were uniquely related to alexithymia, a multiple regression was conducted in which neurocognitive scores and affective symptoms were allowed to enter to predict overall levels of alexithymia after controlling for social desirability. Results revealed both processing speed and anxiety uniquely contributed to the prediction of the total score on the TAS-20. Results suggest that dysfunctions in both cognitive and affective processes may be related to alexithymia in schizophrenia independently of one another.

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