Dysfunctional Metacognition Research Articles

Dysfunctional metacognition across psychopathologies: A meta-analytic review

BackgroundDysfunctions in metacognition have been reported in individuals with anxiety disorders. Although recent studies have examined metacognition in other disorders, how dysfunctional metacognition compares across disorders is not clear. This review aimed to ascertain the importance of dysfunctional metacognition in various psychopathologies, and to identify similarities and differences in metacognitive profiles across disorders. MethodsForty-seven studies were selected from 586 articles published between 1990 and August 2015, including a total sample of 3772 patients and 3376 healthy individuals. Studies that measured metacognition using the Meta-Cognitions Questionnaire (MCQ) and its variants were included. We conducted five meta-analyses including 49 to 55 effect sizes, comparing psychiatric patients to healthy individuals on respective metacognitive dimensions of the MCQ. ResultsWe found elevated metacognitive dysfunctions in patients, as a group, on all MCQ dimensions. Group effects were large and robust for the two negative beliefs (i.e., beliefs about the uncontrollability and danger of thoughts, and beliefs about the need to control thoughts), and moderate and unstable for the positive beliefs. Patients showed decreased cognitive confidence and heightened cognitive self-consciousness on moderate to large levels. Moderator analyses revealed that negative beliefs about uncontrollability and danger of thoughts were most prevalent in generalized anxiety disorder, whereas heightened cognitive self-consciousness was more characteristic in obsessive-compulsive disorder. Generalized anxiety disorder, obsessive-compulsive disorder and eating disorders manifested more similar metacognitive profiles than other disorders. ConclusionsOur findings supported dysfunctional metacognition as common processes across psychopathologies, with certain dimensions being more prevalent in particular disorders.

Reduced sympathetic activity and dysfunctional metacognition in patients with anorexia nervosa: A preliminary study

Reduced sympathetic activity and dysfunctional metacognition in patients with anorexia nervosa: A preliminary study

Association of medial prefrontal resting state functional connectivity and metacognitive capacity in early phase psychosis

Metacognition refers to a range of cognitive processes that allow one to form complex ideas of self and others and to use this information to navigate psychosocial challenges. Several studies in both early-phase and prolonged schizophrenia have demonstrated not only that significant deficits in metacognitive ability are present, but importantly that they are associated with significant functional impairment and decreased quality of life. In spite of the importance of metacognitive impairment in schizophrenia, relatively little is known about the biological substrates that may contribute to this dysfunction. In this study, we examined the relationship between resting state functional connectivity of the medial prefrontal cortex (mPFC), a structure shown in prior voxel-based morphometry studies to be associated with metacognition, with metacognitive function in an early-phase psychosis cohort (n=18). Analyses revealed a positive association of resting state functional connectivity between the mPFC and precuneus and posterior cingulate structures and metacognitive ability. These results provide evidence of disrupted resting state connectivity in structures relevant to metacognitive dysfunction in early-phase psychosis, which may have implications for pathophysiological models of complex cognitive deficits in this illness.

An Analysis into Metacognition and Family History of Diabetes Mellitus among First Year Medical Students.

Medical course requires immense effort by the students to deal with vast curriculum and hence, the need to adopt metacognitive skill to cope up. Diabetes mellitus has an impact on cognition. Metacognition, being a component of cognition, is likely to be affected by diabetes. Children of diabetic parents have demonstrated insulin resistance which may contribute to metacognitive dysfunction. Hence, it is important to focus into the link between family history of diabetes and metacognition. To evaluate the impact of family history (parents and grandparents) of diabetes mellitus on metacognition in medical students. The present study was a questionnaire based cross-sectional study. Hundred first year medical students were recruited and they filled the Metacognitive Awareness (MA) questionnaire along with the details of the family history of diabetes. The metacognitive awareness questionnaire evaluated MA, its components (metacognitive knowledge and regulation) and their subcomponents. Positive history of diabetes in parents and grandparents were taken into account. The participants were then divided into two groups: with family history of diabetes (n=73) and without family history of diabetes (n=27). The metacognitive awareness and its subcomponents between the two groups were analysed using Student t-test between the groups (with and without family history). Pearson correlation was done to analyse the association between metacognition and family history of diabetes. Metacognitive knowledge (global score) was significantly lower in group with family history of diabetes (10.25±3.01 vs 12.04±3.2, p-value<0.05) as was metacognitive regulation global score (7.08±1.83 vs 7.99±1.36, p-value<0.05). Declarative knowledge and information management showed significant difference. Metacognitive knowledge showed a significant negative correlation with family history of diabetes (correlation coefficient = -0.263, p-value<0.01). Students with family history of diabetes had reduced metacognitive awareness. The awareness that metacognitive dysfunction can occur in early age in individuals with family history of diabetes would help us to identify them and device strategies to delay or prevent metacognitive dysfunction.

S.07.02 - The serotonergic hallucinogen 5-MeO-DMT disrupts cortical activity in rodents

Metacognition refers to a range of cognitive processes that allow one to form complex ideas of self and others and to use this information to navigate psychosocial challenges. Several studies in both early-phase and prolonged schizophrenia have demonstrated not only that significant deficits in metacognitive ability are present, but importantly that they are associated with significant functional impairment and decreased quality of life. In spite of the importance of metacognitive impairment in schizophrenia, relatively little is known about the biological substrates that may contribute to this dysfunction. In this study, we examined the relationship between resting state functional connectivity of the medial prefrontal cortex (mPFC), a structure shown in prior voxel-based morphometry studies to be associated with metacognition, with metacognitive function in an early-phase psychosis cohort (n=18). Analyses revealed a positive association of resting state functional connectivity between the mPFC and precuneus and posterior cingulate structures and metacognitive ability. These results provide evidence of disrupted resting state connectivity in structures relevant to metacognitive dysfunction in early-phase psychosis, which may have implications for pathophysiological models of complex cognitive deficits in this illness.

ID 41 – High Reward Sensitivity as a biomarker of online gambling. A multi-method study on gambling behaviour

Objective The present research explored the main risky factors that can influence subjects’ choices during the decisional process in an online game context. We supposed that reward bias, metacognitive deficit and personality trait make subjects’ strategies more disadvantageous and “gambling”. Methods Twenty-one subjects were tested using the IGT and GO/noGo task while the EEG was registered and alpha-band modulation were considered. Secondly, the Behavioral Activation System (BAS)/Behavioral Inhibition System (BIS) scale was use for testing the effect of reward sensitivity and metacognitive questionary was applied. Results It was found that high-BAS subjects increased their tendency to opt in favour of the immediate reward rather than the long-term option, they tend to have difficulties to inhibit the automatic response, and they show a dysfunctional metacognition abilities. Finally, high-BAS subjects showed an increased left-hemisphere activation in response to immediate reward choices if compared to low-BAS subjects. Conclusions A reward bias effect was supposed to explain both the bad strategy and the unbalanced hemispheric activation for high-BAS and more risk-taking subjects. Key message These findings could have important repercussions in the social context for the prevention of dysfunctional behaviours that affect compulsive disorders like addiction.

Dysfunctional metacognition and drive for thinness in typical and atypical anorexia nervosa.

BackgroundAnorexia nervosa is complex and difficult to treat. In cognitive therapies the focus has been on cognitive content rather than process. Process-oriented therapies may modify the higher level cognitive processes of metacognition, reported as dysfunctional in adult anorexia nervosa. Their association with clinical features of anorexia nervosa, however, is unclear. With reclassification of anorexia nervosa by DSM-5 into typical and atypical groups, comparability of metacognition and drive for thinness across groups and relationships within groups is also unclear. Main objectives were to determine whether metacognitive factors differ across typical and atypical anorexia nervosa and a non-clinical community sample, and to explore a process model by determining whether drive for thinness is concurrently predicted by metacognitive factors.MethodsWomen receiving treatment for anorexia nervosa (n = 119) and non-clinical community participants (n = 100), aged between 18 and 46 years, completed the Eating Disorders Inventory (3rd Edition) and Metacognitions Questionnaire (Brief Version). Body Mass Index (BMI) of 18.5 kg/m2 differentiated between typical (n = 75) and atypical (n = 44) anorexia nervosa. Multivariate analyses of variance and regression analyses were conducted.ResultsMetacognitive profiles were similar in both typical and atypical anorexia nervosa and confirmed as more dysfunctional than in the non-clinical group. Drive for thinness was concurrently predicted in the typical patients by the metacognitive factors, positive beliefs about worry, and need to control thoughts; in the atypical patients by negative beliefs about worry and, inversely, by cognitive self-consciousness, and in the non-clinical group by cognitive self-consciousness.ConclusionsDespite having a healthier weight, the atypical group was as severely affected by dysfunctional metacognitions and drive for thinness as the typical group. Because metacognition concurrently predicted drive for thinness in both groups, a role for process-oriented therapy in adults is suggested. Implications are discussed.

Reward Sensitivity (Behavioral Activation System), Cognitive, and Metacognitive Control in Gambling Behavior: Evidences From Behavioral, Feedback-Related Negativity, and P300 Effect.

The present research explored the main factors able to influence the subjects' choices in the case of decisions and distinguish between high- and low-risk decisions. Behavioral responses (Iowa Gambling Task [IGT]), meta-cognitive strategy, and event-related potential (feedback-related negativity [FRN] and P300) effects were used as predictive markers of gambling behavior. Behavioral activation system (BAS)-reward measure was applied to distinguish between high-BAS and low-BAS. It was found that higher-BAS opted in favor of the immediate reward, with a concomitant dysfunctional metacognition of their strategy. Finally, a consistent "reward bias" affected the high-BAS performance reducing the P300 and FRN in response to unexpected (loss) events. The cortical localization (sLORETA) of ERPs showed the contribution by distinct anterior and posterior areas.

Unique Contributions of Metacognition and Cognition to Depressive Symptoms

ABSTRACTThis study attempts to examine the unique contributions of “cognitions” or “metacognitions” to depressive symptoms while controlling for their intercorrelations and comorbid anxiety. Two-hundred-and-fifty-one university students participated in the study. Two complementary hierarchical multiple regression analyses were performed, in which symptoms of depression were regressed on the dysfunctional attitudes (DAS-24 subscales) and metacognition scales (Negative Beliefs about Rumination Scale [NBRS] and Positive Beliefs about Rumination Scale [PBRS]). Results showed that both NBRS and PBRS individually explained a significant amount of variance in depressive symptoms above and beyond dysfunctional schemata while controlling for anxiety. Although dysfunctional attitudes as a set significantly predicted depressive symptoms after anxiety and metacognitions were controlled for, they were weaker than metacognitive variables and none of the DAS-24 subscales contributed individually. Metacognitive beliefs about ruminations appeared to contribute more to depressive symptoms than dysfunctional beliefs in the “cognitive” domain.

The three factors of the psychoticism scale of SCL-90-R.

Former studies have repeatedly found the psychoticism (PSY) scale of Symptom Checklist-90-Revised to be a heterogeneous construct. The aim of this study was to confirm and further explore the nature of this heterogeneity within a large sample of patients with mainly personality disorders. Within a total sample of 3 794 patients, one-half was randomly selected for explorative factor analysis in order to assess the internal structure of the PSY scale and the other half to cross-validate the findings by a confirmatory factor analysis. The total sample was then used to assess associations between the components from the factor analyses and several clinical measures and diagnoses. A one-factor solution of the PSY scale yielded poor fit to the data, but a proposed structure of three latent constructs was confirmed by good model fit. The three subsets of the PSY scale, labelled metacognitive dysfunction, self-accusation and detachment, shared variance with different personality disorders and different aspects of psychopathology, e.g. previous psychotic episodes. The heterogeneous PSY scale of SCL-90-R can be divided into three meaningful clinical concepts, reflecting different aspects of psychosis-near experiences. The factors warrant confirmation in other populations. Copyright © 2014 John Wiley & Sons, Ltd.

Metacognition in eating disorders: Comparison of women with eating disorders, self-reported history of eating disorders or psychiatric problems, and healthy controls

ObjectiveThe aim of the study was to compare a clinical sample with eating disorders to different control samples on self-report measures of metacognition and eating disorder symptoms, in order to investigate the role of metacognition in eating disorders. MethodThe clinical group consisted of 53 female patients with eating disorders who completed the Metacognitions Questionnaire-30 and the Eating Disorder Examination Questionnaire 6.0. One-hundred and fifty women who served as a control group completed the questionnaires as an Internet survey. This control group was divided into three groups based on self-reported history of eating and psychiatric problems (N=47), other psychiatric problems (N=37), or no such problems (healthy controls: N=66). ResultsThe clinical group scored significantly higher on dysfunctional metacognition than healthy controls, especially on “negative beliefs about uncontrollability and danger”, “need to control thoughts”, and total MCQ-30 score. Eating disorder symptomatology was positively correlated with metacognition. Metacognition explained 51% of the variance in eating disorder symptoms after controlling for age and BMI, with “need to control thoughts” as the most important factor. ConclusionMetacognitive beliefs may be central in understanding eating disorders, and metacognitive treatment strategies could be a promising approach in developing new psychological treatments for eating disorders.

Reward sensitivity, decisional bias, and metacognitive deficits in cocaine drug addiction.

The present research explored the effect of reward sensitivity bias and metacognitive deficits on substance use disorder (SUD) in the decision-making process. The behavioral activation system (BAS) was used as a predictive marker of dysfunctional behavior during the Iowa gambling task (IGT). We also tried to relate this motivational system bias to self-reported metacognitive measures (self-knowledge, strategic planning, flexibility, and efficacy) in the decision processes. Thirty-four SUD participants (cocaine dependent) and 39 participants in the control group underwent the IGT. The SUD group was associated with a poorer performance on the IGT and a dysfunctional metacognition ability (unrealistic representation). An increase in the reward sensitivity (higher BAS, BAS reward responsiveness, and BAS reward) was observed in the SUD group compared with the control group and explained (through a regression analysis) the main behavioral deficits. More generally, an increase in the BAS reward responsiveness may be considered a predictive measure of risk-taking and dysfunctional behavior, not only in pathological (SUD) individuals, but also in subclinical individuals (controls). We discuss the likely cognitive, brain, and neurotransmitter contributions to this phenomenon.

A manual-based individual therapy to improve metacognition in schizophrenia: protocol of a multi-center RCT

BackgroundMetacognitive dysfunction has been widely recognized as a feature of schizophrenia. As it is linked with deficits in several aspects of daily life functioning, improvement of metacognition may lead to improvement in functioning. Individual psychotherapy might be a useful form of treatment to improve metacognition in patients with schizophrenia; multiple case reports and a pilot study show promising results. The present study aims to measure the effectiveness of an individual, manual-based therapy (Metacognitive Reflection and Insight Therapy, MERIT) in improving metacognition in patients with schizophrenia. We also want to examine if improvement in metacognitive abilities is correlated with improvements in aspects of daily life functioning namely social functioning, experience of symptoms, quality of life, depression, work readiness, insight and experience of stigma.Methods/DesignMERIT is currently evaluated in a multicenter randomized controlled trial. Thirteen therapists in six mental health institutions in the Netherlands participate in this study. Patients are randomly assigned to either MERIT or the control condition: treatment as usual (TAU).DiscussionIf proven effective, MERIT can be a useful addition to the care for schizophrenia patients. The design brings along some methodological difficulties, these issues are addressed in the discussion of this paper.Trial registrationCurrent Controlled Trials: ISRCTN16659871.

Mediating Effect of Ambivalence in Emotional Expression on the Association between Dysfunctional Metacognition, Depression among Military Soldiers

Mediating Effect of Ambivalence in Emotional Expression on the Association between Dysfunctional Metacognition, Depression among Military Soldiers

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

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.

From social neurons to social cognition: implications for schizophrenia research / Sosyal nöronlardan sosyal kognisyona: Şizofreni araştırmalarına etkileri

From social neurons to social cognition: implications for schizophrenia research The term schizophrenia embraces a group of disorders that are characterised by a heterogeneous set of symptoms. Poor social cognition, including metacognitive dysfunction is present across all schizophrenia phenotypes, accounting for a large proportion of patients’ social impairment. Metacognitive functioning is subserved by a distinct neural network of widely distributed regions of the brain, foremost areas of the prefrontal cortex, as well as, areas in the temporal and parietal lobes. While dysfunction of the metacognition neural network in schizophrenia has been well documented, the underlying neuronal correlates are only partially understood. This review focuses on two distinct cell populations that evolved during primate evolution: The mirror neurons, and the von Economo neurons. Empirical evidence suggests that these cell types have a special role in social cognition and metacognitive functioning. However, only recent studies have addressed their potential role in schizophrenia. In spite of current paucity of research on mirror neuron function in schizophrenia, it seems plausible to suggest that their functional properties are compromised, and contribute to aberrant imitation behaviour in schizophrenia. The potential impact of von Economo neurons in the pathophysiology of schizophrenia is even less clear, but future research may help to better understand the nature of this devastating group of

Dysfunctional metacognitions in anorexia nervosa

The aim was to compare women with anorexia nervosa (AN) and without AN in terms of dysfunctional metacognitions. 167 Australian women with AN (N=74; mean age 24.3 yrs) and without AN (N=93; mean age 27.3 yrs) completed the Metacognitions Questionnaire-30. Multivariate analyses revealed that relative to controls, AN patients had higher scores on metacognitive dysfunction: they exhibited low confidence in their cognitive competence, reported obsessively monitoring and striving to control their thoughts, and held negative beliefs about the danger of worrying. Furthermore, this was not due to starvation effects. However, patients did not exhibit significantly more positive beliefs about worry than controls once body mass index had been controlled. Metacognitive dysfunction may play a key role in the maintenance of AN; therefore, metacognitive therapy may be usefully applied to its treatment.

Dissociative and metacognitive factors in hallucination-proneness when controlling for comorbid symptoms

Introduction. Recent studies have linked hallucination-proneness to dysfunctional metacognitive beliefs, dissociation, and disrupted capacity to discriminate between internal and external cognitive events (reality discrimination). This study addressed a number of methodological limitations of previous research by investigating the relationship between hallucination-proneness and the aforementioned variables while controlling for comorbid symptoms. Method. A large sample of nonclinical participants was screened on measures of hallucination-proneness, cognitive intrusions, paranoid ideation, metacognitive beliefs, and dispositional mindfulness (including measures of dissociation-like experiences). In addition, a signal detection task was used to investigate reality discrimination in four subgroups of participants selected on the basis of their scores on hallucination-proneness and intrusions. Results. Regression analyses for the self-report data were conducted to investigate the predictors of hallucination-proneness and paranoia when controlling for comorbid symptoms. Also, between-group differences on the behavioural data were tested to determine whether perturbed reality discrimination is specifically associated with hallucination-proneness rather than cognitive intrusions. Results revealed that metacognitive beliefs are more strongly associated with intrusions and paranoia than hallucination-proneness, whereas hallucination-proneness is related to perturbed reality discrimination and dissociation. Conclusions. These results clarify previous research on metacognitive dysfunction in hallucination-proneness, and highlight the importance of controlling for the covariation among symptoms when investigating the cognitive processes underlying psychotic experiences.

Cognitive Therapy for Delusions in Schizophrenia: Models, Benefits, and New Approaches

The main purpose of the review is to demonstrate how cognitive models of psychosis translate into cognitive-behavioral approaches for intervening with psychotic symptoms in schizophrenia. Several cognitive-behavioral factors which play a role in the maintenance and possibly formation of delusional beliefs are discussed, including attentional bias to threat, “data gathering” deficits, dysfunctional metacognition, and safety behaviors. Strategies for engagement, problem formulation, and psychoeducation with deluded patients are described. Cognitive-behavioral interventions are presented, specifically, cognitive restructuring, behavioral experiments, and coping skills training. Challenges to conducting cognitive-behavioral therapy (CBT) with delusions in schizophrenia are reviewed. Novel cognitive therapies, which address these challenges, are presented.

Metacognition and maladaptive coping as components of test anxiety

Text anxiety refers both to states of distress and worry during examinations, and to traits which predispose the person to state anxiety. Wells and Matthews (1994) have proposed a general model of emotional disorder which describes a variety of cognitive processes which may contribute to trait and state test anxiety. These processes include excessive metacognition, maladaptive coping and worry. A study was run to investigate relationships between cognitive processes and test anxiety. Eighty-four undergraduate students completed questionnaires relating to cognition and trait text anxiety prior to an examination. Their stress states and coping during the examination itself were also assessed. Results showed that trait test anxiety relates to two distinct cognitive factors, relating to (i) metacognition and worry, and (ii) maladaptive coping. Cognitive measures also predicted some aspects of state response to the examination setting. Relationships between cognition and test anxiety were generally consistent with the model of Wells and Matthews (1994). Results also suggested that treatment for pathological test anxiety should reflect its cognitive basis. For example, test anxiety based on metacognitive dysfunction may require use of cognitive–behavioural techniques used to treat more general anxiety conditions. Conversely, test anxiety derived from maladaptive coping may respond best to training in coping skills. Attention training techniques may contribute to therapy for both metacognition and coping-based disorder. Copyright © 1999 John Wiley & Sons, Ltd.