Metacognition and Social Functioning in Schizophrenia: Evidence, Mechanisms of Influence and Treatment Implications

Abstract

Objective: The term “schizophrenia” concerns heterogeneous psychopathological syndromes that are often associated with neurocognitive impairment and poor functional outcome. Research over the past 20 years or so has revealed that many symptoms associated with schizophrenia can be interpreted as a result of poor “metacognition”, first defined as the ability to think about ones mental operations, which in our understanding more specifically refers to the ability to reflect upon mental states of oneself and others, and to flexibly entertain this knowledge in social interaction and problemsolving (termed “mastery”). The latter aspect implies that metacognitive dysfunction is putatively critical to explain social impairment. Method: The present article reviews the evidence for a link between metacognitive deficits in schizophrenia and poor social functioning. Results: Metacognition including its subcomponents such as self-reflectivity, empathetic perspective-taking and mastery are profoundly linked with awareness of illness and social functioning in schizophrenia. The impact of metacognition on awareness of illness and social functioning seems to be partially independent of neurocognitive functioning. Conclusion: Research into metacognitive abilities in schizophrenia have revealed new insights into the understanding of individual symptoms and outcome measures, with potentially important implications for psychotherapy and (meta-) cognitive remediation in schizophrenia.