Metacognition in psychosis

Abstract

This Special Issue of the Journal of Experimental Psychopathology is designed to provide an overview of metacognition in psychosis. While the term metacognition has been used extensively in the psychological literature since it was formally defined by Flavell in 1979, the application of the construct to psychotic disorders, specifically schizophrenia, has been much slower and has only recently gained significant interest (Figure 1). Reasons for the relatively slow shift of attention to metacognition are unclear; however, several developments likely support the increased, and now sustained, focus on this topic. First, the definition of metacognition, and how it may conceptually relate to schizophrenia, has recently been clarified. Instead of presenting metacognition as “thinking about thinking,” which could be assumed to be a singular construct that is either intact or impaired in schizophrenia, it is now acknowledged as an overarching term that includes a spectrum of processes spanning discrete to more integrated activities. At the discrete end of the continuum are activities consistent with self-assessment such as immediate awareness of the accuracy of one’s judgments (i.e., introspective accuracy (IA)). Knowledge of cognitive processes, and the biases that may be present within them, is also included along this continuum as well as the ability to regulate or improve these processes. And, as Lysaker and colleagues argue (this issue), metacognition also includes more complex and integrated processes that allow individuals to combine multiple pieces of information into an idea or representation about the self. For example, multiple episodes of forgetting important information may lead to the idea that one has a poor memory. Recent formulations of social processes, such as the Research Domain Criteria (RDoC) framework of the National Institute of Mental Health, have also helped to refine the conceptualization of metacognition and separate it from related constructs like mentalizing or Theory of Mind. Specifically, the RDoC matrix parses the perception and understanding of the self (e.g., self-knowledge) from perception and understanding of others (e.g., understanding mental states). Thus, metacognitive processes like IA or metacognitive regulation can be distinguished from related constructs in that they are primarily self-focused. Metacognition therefore represents a distinct domain, and as demonstrated by the articles included in this Special Issue, the spectrum view provides numerous avenues for metacognitive research to improve our understanding of psychosis and to help promote functional recovery. Second, multiple strategies and measures are now available to assess metacognition. To address the more discrete activities, such as IA, participant reports of ability can be compared to objective task performance (e.g., Koren, Seidman, Goldsmith, & Harvey, 2006; Pinkham, Klein, Hardaway, Kemp, & Harvey, 2018) or to reports of knowledgeable informants (Gould et al., 2015). Sophisticated methods that utilize the signal detection framework to control for bias are also now available (e.g., Davies et al., 2018), and advanced statistical techniques offer improved methods for assessing both accuracy and bias (Pinkham et al., this issue). The integrated aspects