Kelly D. Buck

Metacognition and schizophrenia: The capacity for self-reflectivity as a predictor for prospective assessments of work performance over six months

Research has indicated that many with schizophrenia experience deficits in metacognitive capacity, defined as impairments in the ability to think about thinking. These difficulties are related to, but not reducible to symptoms and have been hypothesized to function as an independent impediment to psychosocial function. To explore the possibility that deficits in one domain of metacognition, self-reflectivity, are a barrier to effective work function, 56 participants with schizophrenia were categorized into three groups according to their capacity for self reflection based on an interview conducted prior to accepting a job placement. Blind ratings of work performance of these three groups over the next six months were then compared. Results of repeated measures ANOVA revealed that the group rated as having the highest level of metacognition, that is, able to see that their conclusions are subjective and fallible, had higher ratings of work performance over time than groups with medium and low levels of self reflectivity. These findings were found to persist even when impairment on a test of executive function was controlled for statistically. Results are interpreted as consistent with emerging models that deficits in metacognition may be key features of severe mental illness which affect function. Clinical and theoretic implications are discussed.

Metacognition as a mediator of the effects of impairments in neurocognition on social function in schizophrenia spectrum disorders

Lysaker PH, Shea AM, Buck KD, Dimaggio G, Nicolò G, Procacci M, Salvatore G, Rand KL. Metacognition as a mediator of the effects of impairments in neurocognition on social function in schizophrenia spectrum disorders.

Metacognition within narratives of schizophrenia: Associations with multiple domains of neurocognition

Research has suggested many with schizophrenia experience impairments in metacognition, or difficulties apprehending their own thoughts and the thoughts of others, and that those deficits are not reducible to a single symptom or cognitive impairment. While links between metacognition and more severe levels of symptoms have emerged, less clear is whether there are consistent associations between metacognition and other neurocognitive capacities. Accordingly the current study sought to examine whether different patterns of metacognition deficits have different neurocognitive correlates. Narratives were gathered from 69 adults with schizophrenia spectrum disorder using the Indiana Psychiatric Illness Interview along with a symptom interview and neurocognitive battery including subtests of the Wechsler Adult Intelligence Scale III, Wechsler Memory Scale III and the Wisconsin Card Sorting Test. Metacognitive capacity within the narrative interview was assessed using the Metacognition Assessment Scale and participants were divided based on those scores into three groups: minimal self-reflectivity/not decentered (n=25); basic self-reflectivity/not decentered (n=33); and basic self-reflectivity/decentered (n=11). Basic self-reflectivity refers to the ability to distinguish ones own thoughts and feelings while decentered refers to the ability to see others as having independent perspectives and relationships with one another. MANOVA and ANOVA comparing groups revealed that the participants lacking basic self-reflectivity had significantly poorer working memory and more symptoms of disorganization, while participants able to see others as having independent perspectives and relationships demonstrated better visual memory. Results suggest different deficits in metacognition may be linked to different neurocognitive capacities.

Poor insight in schizophrenia: links between different forms of metacognition with awareness of symptoms, treatment need, and consequences of illness

OBJECTIVE Many persons with schizophrenia experience poor insight or reflexive unawareness of the symptoms and consequences of their illness and, as a result, are at risk for treatment nonadherence and a range of negative outcomes. One recent theory regarding the origins of poor insight in schizophrenia has suggested that it may result, in part, from deficits in metacognitive capacity, or the ability to think about thinking, both ones own and the thinking of others. METHODS Participants were 65 adults with a schizophrenia spectrum disorder in a postacute phase of illness living in the community. For all participants, we obtained measures of three domains of metacognition, including self-reflectivity, mastery, and perspective taking, using the Metacognitive Assessment Scale and the hinting test and three domains of insight, which were awareness of symptoms, treatment need, and consequences of illness, using the Scale to Assess Unawareness of Mental Disorder. Measures of neurocognition were also collected for potential use as covariates. RESULTS Univariate correlations followed by stepwise multiple regressions, which controlled for neurocognition, indicated that self-reflectivity was significantly linked with awareness of symptoms, mastery with treatment need, and mastery and perspective taking were linked with awareness of consequences of illness. CONCLUSIONS Results suggest that metacognition may be linked to insight in persons with schizophrenia independent of concurrent impairments in neurocognition.

The recovery of metacognitive capacity in schizophrenia across 32 months of individual psychotherapy: A case study

Abstract It has been asserted that psychotherapy might help persons with schizophrenia to improve their capacity for metacognition, that is, their ability to think about their own thinking and the thinking of others. To explore this issue, metacognitive capacity, delusions, and insight were assessed using the psychotherapy transcripts of an adult with schizophrenia and severe delusions for a period of time spanning 32 months. Correlations revealed that metacognitive capacity increased as symptoms and lack of insight decreased. Results suggest that metacognitive capacities increased before symptoms changed and that awareness of ones own thoughts emerged before awareness of others’ thoughts. Progress appeared to be initially volatile, with early gains sustained only after approximately 1½ years.

Social cognition and metacognition in schizophrenia: evidence of their independence and linkage with outcomes

Lysaker PH, Gumley A, Luedtke B, Buck KD, Ringer JM, Olesek K, Kukla M, Leonhardt BL, Popolo R, Dimaggio G. Social cognition and metacognition in schizophrenia: evidence of their independence and linkage with outcomes.

Metacognition and social cognition in schizophrenia: stability and relationship to concurrent and prospective symptom assessments.

OBJECTIVE Schizophrenia has been linked with deficits in the ability to form complex representations about oneself and others. Less clear is whether these deficits are stable over time, and whether they are related to symptoms. METHOD We assessed metacognition capacity, affect recognition, executive function, and symptoms at baseline and 6 months later for 49 adults with schizophrenia. RESULTS Paired t tests revealed assessments of metacognition and affect recognition were stable across measurements points. Metacognition was related to concurrent assessments of positive, negative and disorganized symptoms. Multiple regressions revealed metacognition was related to prospective assessments of negative symptoms after controlling for baseline negative symptoms and executive function. CONCLUSIONS Metacognitive deficits are a stable feature of schizophrenia related with negative symptoms.

Metacognition, social cognition, and symptoms in patients with first episode and prolonged psychoses.

While it has been documented that persons with prolonged schizophrenia have deficits in metacognition and social cognition, it is less clear whether these difficulties are already present during a first episode. To explore this issue we assessed and compared metacognition using the Metacognition Assessment Scale-Abbreviated (MAS-A) and social cognition using the Eyes, Hinting and Bell-Lysaker Emotional Recognition Tests (BLERT) in participants with first episode psychosis (FEP; n=26), participants with a prolonged psychosis (n=72), and a psychiatric control group consisting of persons with a substance use disorder and no history of psychosis (n=14). Analyses revealed that both psychosis cohorts scored lower than controls on the MAS-A total and all subscales except metacognitive mastery. Compared to the FEP group, the persons with prolonged psychosis demonstrated greater metacognitive capacities only in those MAS-A domains reflective of the ability to understand the mental state of others and to see that others may have motivations and desires separate from their own. Other domains of metacognition did not differ between psychosis groups. The Eyes, Hinting and BLERT scores of the two psychosis groups did not differ but were poorer than those produced by the control group. Exploratory correlations in the FEP group showed a pattern similar to that previously observed in prolonged psychosis. Taken together, these findings suggest that while certain domains of metacognition could improve with prolonged psychosis, difficulties with global metacognition and social cognition may be stable features of the disorder and perhaps unique to psychosis.

Assessing metacognition in schizophrenia with the Metacognition Assessment Scale: Associations with the Social Cognition and Object Relations Scale

OBJECTIVES Impairments in metacognition are believed to be closely linked with functional impairments among persons with schizophrenia. Recently, we proposed a method for assessing multiple domains of metacognition by rating a narrative generated by a semi-structured interview with an abbreviated form of the Metacognition Assessment Scale (MAS). Less is known about how this measure is linked to social cognition. DESIGN The current study sought to compare, in a cross-sectional design, assessments of metacognition using the MAS and social cognition measured using the Social Cognition and Object Relations Scale (SCORS). METHODS Participants were 37 adults with schizophrenia spectrum disorders who completed an assessment battery that included the Hopkins Verbal Learning Test, Wisconsin Card Sorting Test, the Positive and Negative Syndrome Scale, and the procedures needed to derive the MAS and SCORS indices. RESULTS Univariate correlations and multiple regressions revealed that mastery, a domain of metacognition measuring thinking about oneself and coping with psychological challenges, was linked to SCORS indices which assess awareness of interpersonal relationships as the result of complex psychological forces and the recognition that relationships involve people with independent needs. This relationship persisted when the effects of symptoms and neurocognitive deficits were statistically controlled. CONCLUSIONS Mastery, one domain of metacognition, is linked to social cognition independent of neurocognitive function and symptoms.

Metacognitive and social cognition deficits in patients with significant psychiatric and medical adversity: a comparison between participants with schizophrenia and a sample of participants who are HIV-positive.

Abstract Theory of mind (ToM) is an aspect of social cognition that refers to the ability to make inferences about the thoughts, feelings, and intentions of other people. It is believed to be related to social functioning. Previous investigations of ToM in schizotypy have yielded mixed results. Using a correlational approach, the present study explored the relationship between schizotypal traits, ToM, neurocognition, depressed mood, and social functioning in a sample of 50 undergraduate students. Schizotypy was related to poor social functioning. Contrary to predictions, schizotypal traits were not associated with impaired ToM. In fact, schizotypal traits were associated with enhanced performance on a ToM task that involved detection of ironic statements. However, strong relationships emerged among schizotypy, depressed mood, and social functioning, highlighting the need to also examine depression when assessing the relations between elevated schizotypy and poor social functioning.Research exploring metacognition and social cognition in schizophrenia has tended to use control groups experiencing relatively little adversity. Therefore, it remains unclear whether the deficits found among persons with schizophrenia are merely the result of greater life adversity. To explore this issue, we assessed metacognition and social cognition among 40 participants with schizophrenia and 25 adults with HIV. We chose to explore this phenomenon in people with HIV given the literature suggesting that this group experiences significant adversity. Measures of metacognition and social cognition included the Metacognition Assessment Scale (MAS), the Hinting test, and the Bell-Lysaker Emotion Recognition Test (BLERT). After controlling for education, years since diagnosis, and memory, the schizophrenia group performed more poorly on the MAS and the Hinting test. No differences were found on the BLERT. The results are consistent with the possibility that schizophrenia is linked to decrements in metacognition and some forms of social cognition.