Metacognition Is Uniquely Related to Concurrent and Prospective Assessments of Negative Symptoms Independent of Verbal Memory in Serious Mental Illness

Abstract

The inability to synthesize information into experience of self and others could be one significant cause of negative symptoms. To explore this possibility, we examined the relationships between baseline metacognition and concurrent and prospective negative symptoms controlling for verbal memory. The participants were 62 adults diagnosed with serious mental illness enrolled in outpatient treatment. Metacognition was measured with the Metacognitive Assessment Scale–Abbreviated, symptoms were assessed using the Brief Psychiatric Rating Scale, and verbal memory was assessed using the California Verbal Learning Test. Significant correlations were found, indicating that poorer overall metacognition was associated with greater levels of negative symptoms assessed concurrently (r = 0.39) and 1 month later (r = 0.36). A significant relationship persisted after controlling for verbal memory and education. These findings support the idea that metacognitive deficits are related to negative symptoms and point to the potential of metacognitive interventions to positively influence negative symptoms.

Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

“…Other studies have found that alterations in metacognition are linked to changes in neurocognition and, in a formal network analysis, metacognition was found to be a central node in a network that included social cognition, neurocognition and symptoms [ 43 ]. Concerning clinical phenomena, a substantial number of cross-cultural studies have linked metacognition with negative symptoms [ 44 – 46 ], in particular with expressive negative symptoms [ 47 , 48 ], and issues related to clinical insight [ 8 ], motivation [ 49 ], and intrapsychic function [ 50 ].…”

Metacognitive training modified for negative symptoms: A feasibility study

“…There is evidence that suggests a link between metacognition and negative symptoms as limitations in complex metacognitive processes predict negative symptoms in first episode psychosis (Austin et al, 2019) and in more chronic samples, even after controlling for defeatist beliefs, affect recognition and neurocognitive functioning (Lysaker et al, 2015). Metacognitive deficits are also associated with concurrent and future negative symptoms when controlling for verbal memory and education (Faith et al, 2020;.…”

“…There is evidence that suggests a link between metacognition and negative symptoms as limitations in complex metacognitive processes predict negative symptoms in first episode psychosis (Austin et al, 2019) and in more chronic samples, even after controlling for defeatist beliefs, affect recognition and neurocognitive functioning (Lysaker et al, 2015). Metacognitive deficits are also associated with concurrent and future negative symptoms when controlling for verbal memory and education (Faith et al, 2020; Lysaker, et al, 2020). Interestingly, self‐reflection in itself has been found to mediate the relationship between neurocognition and negative symptoms (especially for deficits in capacity to communicate about internal states, so called diminished expression) while interpersonal cognitive differentiation (i.e., the ability to construe one's experiences as either similar or different from others' experiences) has been found to mediate the pathway between self‐reflectivity and negative symptoms (García‐Mieres et al, 2019, 2020).…”

Disturbances in dialogue and metacognition: A renewed way to understand and respond to alterations in self-experience in psychosis

“…These issues also raise even larger questions about the character and impact of metacognitive growth and stagnation in human development. For example, some theories of adult development (e.g., Erikson & Erikson, 1998) might be taken to suggest that some metacognitive capacities such as decentration and awareness of others may mature later in life. The study of metacognition may enrich our understanding of subjectivity, human development, and health.…”