Subjective versus objective cognition: Evidence for poor metacognitive monitoring in schizophrenia

Moritz, Steffen; Balzan, Ryan; Bohn, Francesca; Veckenstedt, Ruth; Kolbeck, Katharina; Bierbrodt, Julia; Dietrichkeit, Mona

doi:10.1016/j.schres.2016.08.021

Cited by 40 publications

(18 citation statements)

References 80 publications

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“…Even though this scientifically relevant starting point, multidisciplinary exchange during its origin, and case studies are encouraging (Lysaker et al, 2018b(Lysaker et al, , 2019b(Lysaker et al, , 2020, randomized-controlled pilot-studies could, until now, not verify the assumed predictive effects on functioning and work readiness as secondary outcomes (de Jong et al, 2019). More discrete metacognitive interventions (Moritz et al, 2014(Moritz et al, , 2016 as well as cognitive behavioral approaches to non-affective psychosis (Jauhar et al, 2014) primarily define their strength in modulating cognitive biases, thus focus on an improvement of metacognitive monitoring and a decrease of positive symptoms, whereas beneficial effects on social functioning are still debated (Laws et al, 2018). Unfortunately, there is a blatant lack of empirical evidence according to current scientific standards regarding the treatment effects of modern psychodynamic approaches to psychosis.…”

Section: Discussionmentioning

confidence: 99%

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

et al. 2020

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Synthetic metacognition is defined by integrative and contextualizing processes of discrete reflexive moments. These processes are supposed to be needed to meet intrapsychic as well as interpersonal challenges and to meaningfully include psychotic experience in a personal life narrative. A substantial body of evidence has linked this phenomenon to psychosocial functioning and treatment options were developed. The concept of synthetic metacognition, measured with the Metacognition Assessment Scale-Abbreviated (MAS-A), rises hope to bridge gaps between therapeutic orientations and shares valuable parallels to modern psychodynamic constructs, especially the 'levels of structural integration' of the Operationalized Psychodynamic Diagnosis (OPD-2). As theoretical distinctions remain, aim of this study was to compare the predictive value of both constructs with regard to psychosocial functioning of patients with non-affective psychoses, measured with the International Classification of Functioning, Disability and Health (MINI-ICF-APP). It was further explored if levels of structural integration (OPD-LSIA) would mediate the impact of metacognition (MAS-A) on function (MINI-ICF-APP). Expert ratings of synthetic metacognition (MAS-A), the OPD-2 'levels of structural integration' axis (OPD-LSIA), psychosocial functioning (MINI-ICF-APP) and assessments of general cognition and symptoms were applied to 100 individuals with non-affective psychoses. Whereas both, MAS-A and OPD-LSIA, significantly predicted MINI-ICF-APP beyond cognition and symptoms, OPD-LSIA explained a higher share of variance and mediated the impact of MAS-A on MINI-ICF-APP. Levels of structural integration, including the quality of internalized object representations and unconscious interpersonal schemas, might therefore be considered as valuable predictors of social functioning and as one therapeutic focus in patients with non-affective psychoses. Structural integration might go beyond and form the base of a person's actual reflexive and metacognitive capabilities. Psychotherapeutic procedures

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Section: Discussionmentioning

confidence: 99%

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

et al. 2020

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“…However, the correlation between neurocognition and IA has been shown to be small and evidence suggests mean scores on performance-based neurocognitive tests do not differ across levels of IA (Nair et al, 2013). Patients’ self-reported cognitive skills consistently do not correlate with their performance on cognitive tasks or with clinician reports of their cognitive capacity (Duran et al, 2015; Moritz et al, 2016). Between 28% and 52% of individuals with schizophrenia who show cognitive deficits fail to indicate that they have any problems (Medalia & Lim, 2004; Medalia & Thysen, 2008; Medalia, Thysen, & Freilich, 2008), and our own work has demonstrated that 25–50% of patients’ overestimate their abilities when compared to both clinician ratings and performance on neurocognitive tests (Bowie et al, 2007; Sabbag et al, 2011; Sabbag et al, 2012).…”

Section: Neurocognitive Iamentioning

confidence: 99%

Impaired introspective accuracy in schizophrenia: an independent predictor of functional outcomes

Silberstein

Harvey

2018

Cognitive Neuropsychiatry

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Introduction. Individuals with schizophrenia present across a spectrum of symptomatology. Disability remains a debilitating reality across varying disease presentations and remains pervasive despite psychiatric medications. Cognition (neuro/social cognition) and negative symptoms have emerged as the strongest predictors of real-world disability, but account for <50% of the variance in outcomes. Methods. Our attempts to determine what accounts for the remaining 50% of variance has shown that poor introspective accuracy (IA) may be the most potent predictor of functional outcomes 25% of individuals with schizophrenia. We define IA as the adequacy of self-assessments of ability, skills, performance, or decisions. We suggest that IA is a progression of metacognition and can extend beyond cognition to include misestimation of prior and likely future performance in social or other adaptively relevant situations. Results. Additionally, IA is bidirectional and self-orientated. Emerging research has found that IA of neurocognitive ability better predicts everyday functional deficits than scores on performance-based measures or neurocognitive skills and has found that IA of social cognition accounts unique variance in real-world disability above social cognitive performance. Discussion. We argue that impaired IA, affecting 25–50% of patients with schizophrenia, in the absence or minimal presence of other impairments might be the most powerful predictor of functional outcomes.

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“…3 Importantly, awareness of these biases is often poor in patients. 43 , 44 The metacognitive aspect that sets apart metacognitive training from the other approaches described in this review is the attenuation of overconfidence (ie, “sowing the seeds of doubt”) which according to the metacognitive model of Koriat 9 and others represents a central element of metacognition (see also ref 45).…”

Section: Metacognitive Training For Psychosismentioning

confidence: 99%

Metacognitive and cognitive-behavioral interventions for psychosis: new developments

Moritz

Klein

Lysaker

et al. 2019

Dialogues in Clinical Neuroscience

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This review describes four cognitive approaches for the treatment of schizophrenia: cognitive-behavioral therapy for psychosis (CBTp), metacognitive therapy, metacognitive training, and metacognitive reflection insight therapy (MERIT). A central reference point of our review is a seminal paper by James Flavell, who introduced the term metacognition (“cognition about cognition”). In a way, every psychotherapeutic approach adopts a metacognitive perspective when therapists reflect with clients about their thoughts. Yet, the four approaches map onto different components of metacognition. CBTp conveys some “metacognitive knowledge” (eg, thoughts are not facts) but is mainly concerned with individual beliefs. Metacognitive therapy focuses on unhelpful metacognitive beliefs about thinking styles (eg, thought suppression). Metacognitive training brings distorted cognitive biases to the awareness of patients; a central goal is the reduction of overconfidence. MERIT focuses on larger senses of identity and highlights metacognitive knowledge about oneself and other persons. For CBTp and metacognitive training, meta-analytic evidence supports their efficacy; single studies speak for the effectiveness of MERIT and metacognitive therapy.

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Subjective versus objective cognition: Evidence for poor metacognitive monitoring in schizophrenia

Cited by 40 publications

References 80 publications

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

Impaired introspective accuracy in schizophrenia: an independent predictor of functional outcomes

Metacognitive and cognitive-behavioral interventions for psychosis: new developments

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