Abstract
BackgroundContemporary psychiatric research focuses its attention on the patient’s dysfunction of metacognition in relation to the basic cognitive processes of mental activity. The current study investigated dysfunctional metacognition in relation to self-monitoring of memory in patients diagnosed with schizophrenia. Dysfunctions in metacognition were examined by focusing on two types of metacognitive measures: post-decision wagering (PDW) scale and confidence ratings (CR) scale (CR).ObjectivesThe research employed an action-memory task that required patients with schizophrenia (N = 39) and healthy controls (N = 50) to evaluate their metacognition by categorizing self-monitoring actions (imagined vs. performed actions) either with PDW or CR. It was hypothesized that metacognition in self-monitoring activity in patients diagnosed with schizophrenia is improved by imaginary monetary incentives.Material and MethodsTo test this hypothesis, participants were asked to memorize actions either performed or imagined during the first phase of the experiment. The second phase was to identify previous actions as performed, imagined or new, and then to express confidence using two measures of metacognition (CR or PDW scales) that were randomly allocated to participants.ResultsOur study showed reduced performance in the action memory task for patients with schizophrenia, although there were no group differences in confidence measures when assessing self-monitoring actions. In particular, irrespective of the diagnosis, no differences in confidence measures for correct responses were found in the case of the PDW and CR scales. We also observed that metacognitive judgements were more accurate for incorrect responses when both groups used monetary incentives to reveal their metacognition.ConclusionsOur findings suggest that monetary incentives improve accuracy of metacognition among both patients and healthy controls. This accuracy-enhancing effect of monetary incentives on metacognition was possibly a result of motivational processes, including aversion to loss. The paper discusses the potential application of PDW in therapeutic metacognitive training for patients with schizophrenia.
Highlights
Recent clinical research has adopted a metacognitive approach to treating schizophrenia spectrum disorders [1, 2]
The participants’ responses were collected, and in the step we examined the influence of the diagnosis and the type of metacognitive scale (CR vs. post-decision wagering (PDW)) on performance in the action memory task
The participants were assigned to four categories: 1) healthy controls using the confidence ratings (CR) scale; 2) healthy controls using the PDW scale; 3) patients using the CR scale; 4) patients using the PDW scale
Summary
Recent clinical research has adopted a metacognitive approach to treating schizophrenia spectrum disorders [1, 2]. The notion of “metacognition” per se describes cognitive processes that are linked with activation of “thinking about one’s own thinking”, by which individuals can reflect upon (monitor) their own internal mental states and apply their knowledge to evaluate and regulate (control) their own mental states [3] This theoretical approach claims that abnormality of higher-order processes and knowledge is responsible for dysfunctional regulation of the primary cognitive processes (i.e., memory and other cognitive functions) [3] and may lead to severe mental disorders. For the sake of brevity, abnormality of metacognition relates to impairments in control and monitoring and higher-order knowledge structures (e.g., beliefs) that together regulate storage and acquisition of information from different modalities Given this theoretical view, clinicians may identify cognitive causes that lead to the formation and persistence of psychopathological symptoms in a variety of mental disorders, including psychotic disorders, schizophrenia, or anxiety disorders [1,2,3,4,5,6]. Dysfunctions in metacognition were examined by focusing on two types of metacognitive measures: post-decision wagering (PDW) scale and confidence ratings (CR) scale (CR)
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