The double-strand bond between metacognition and schizophrenia: actual impact and future directions

Abstract

Controlling, monitoring, and modulating cognitive processes is what is known as metacognition: it guides behavior through several types of mental activities that range in complexity from discrete activities, such as recognizing others' judgment, to more integrated ones, such as recognizing oneself and others' cognitive processes. There is an increasing body of research examining the impact of schizophrenia on metacognition, underlining their double-strand link, especially on a wide range of mental processes, including reasoning, autobiographical memory, cognitive beliefs, and clinical insight. Metacognition is intimately linked to the severity of symptoms as well as specific symptomatic sub-domains, such as positive symptoms, negative symptoms, or disorganization. Recently, cognitive-derived psychotherapies have been developed to treat metacognitive deficits in schizophrenia. While all these treatments share a metacognitive component, each one targets different aspects. In metacognitive therapy, false or unhelpful beliefs are treated; in metacognitive training, cognitive biases are the main focus; in cognitive-behavioral therapy for psychoses, the core is represented by schematic dysfunctional beliefs; in metacognitive reflection insight therapy, metacognitive knowledge and self-identity are addressed; and in metacognitive interpersonal therapy for psychosis, interpersonal ideas or events may trigger delusional thinking. Future directions should address the need for more refined knowledge of metacognition processes and the need for growing mental health professionals’ expertise in the field. Moreover, the evaluation of metacognition-based intervention effectiveness in real-world populations and in high-risk psychosis and their enforceability in mental health facilities should become a critical issue.