T193. THE ROLE OF METACOGNITION ON NEGATIVE SYMPTOMS: A PSYCHOLOGICAL MODEL FOR DIMINISHED EXPRESSION IN SCHIZOPHRENIA

Abstract

BackgroundThe resistance of negative symptoms to pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. However, little is understood about the psychological processes that reinforce and sustain the negative symptoms domain of diminished expression. Prior research has shown that higher levels of diminished expression relate to deficits in metacognitive capacity. We propose a more complex model in which diminished expression occurs when impairments in metacognitive self-reflectivity, alterations in higher-order language structure, and cognitive deficits interact and thus interfere with persons’ ability to understand and express emotions in ways others can recognize.MethodsIndividuals with schizophrenia-spectrum disorders (N=201) provided personal narratives including their life story and reflections regarding their mental illness and a clinician-rated interview of psychotic symptoms (i.e., Positive and Negative Syndrome Scale; PANSS). Self-reflectivity was measured with the Metacognition Assessment Scale-Abbreviated, and situation models were extracted from participants’ personal narratives via Coh-Metrix 3.0, an automated program that calculates basic and complex language indices. Diminished expression and cognitive symptoms were measured with the PANSS. Structural equation models (SEM) examined whether self-reflectivity mediated the impact of cognitive deficits and situation models on diminished expression.ResultsSEM revealed that self-reflectivity partially mediated the impact of situation models on diminished expression (β = -.083, p = .005, ±95% CI [-.141, -.026]) and fully mediated the influence of cognitive symptoms in diminished expression (β = .099, p = .001, ±95% CI [.038, .160]). Findings persisted after controlling for educational level.DiscussionThis study is the first of its kind to utilize a mediational model including higher-order linguistic structures, cognitive impairment and metacognition to explain diminished expression in psychosis. Results suggest that self-reflectivity, situation models and cognitive symptoms may be useful targets for intervention in efforts to decrease diminished expression.