Academic journal article The Israel Journal of Psychiatry and Related Sciences

Metacognition in Schizophrenia Spectrum Disorders: Methods of Assessment and Associations with Neurocognition, Symptoms, Cognitive Style and Function

Academic journal article The Israel Journal of Psychiatry and Related Sciences

Metacognition in Schizophrenia Spectrum Disorders: Methods of Assessment and Associations with Neurocognition, Symptoms, Cognitive Style and Function

Article excerpt

ABSTRACT

Deficits in metacognitive capacity in schizophrenia can be conceptualized as existing along a spectrum from more discrete to more synthetic activities. While each represents an equally importantfocus of study, synthetic metacognitive activities may be more difficult to measure given they are more a matter of assessing complexity of thought rather than concrete accuracy; and therefore have received less attention. This review summarizes research on synthetic metacognition using a paradigm in which metacognitive capacity is rated within personal narratives. Results across the work reviewed here provides evidence that these deficits are detectable in patients with schizophrenia and that deficits are related to, but not reducible to, symptom severity and poorer neurocognitive function. I ndependent of symptoms and neurocognition, deficits in synthetic metacognition are related to a range of mental activities including reasoning style, learning potential and insight. These deficits may also play a role in longterm outcome via their impact on the ability to function in work settings and to think about and sustain social connections.

Schizophrenia is among the most complex and devastating forms of mental illness. Most models have stressed that the dysfunction found in this condition results from an array of symptoms, neurocognitive deficits, and associated social factors such as trauma, poverty and stigma (e.g., 1-5). More recent work, however, has stressed that deficits in core psychological processes also play a role in outcome. In particular, one set of processes which may mediate or moderate the impact of social and biological factors upon daily life in schizophrenia is metacognition. Though originally used within the educational literature to refer to the ability to think about ones own thinking when learning (6), metacognition has come to take on a range of meanings including broader processes in which information is integrated in more or less effective ways into complex and evolving representations of the self and others (e.g., 7). As noted earlier in this issue (8), metacognition may reflect a spectrum of activities which includes discrete acts, such as noticing errors, memories or specific beliefs about other beliefs and more synthetic kinds of activities involved in integrating and bringing together any number of perceptions into complex ideas about the self and others as unique agents in the world. These discrete and synthetic acts are thought to bi-directionally inform one another as persons evolve ideas of themselves and others in the flow of daily life (9, 10). For example, noticing that one is having a specific emotion or making an error in a specific situation may affect ones larger sense of oneself just as ones larger sense of oneself may affect how one notices errors and emotions in that moment.

In this paper we will focus on research concerned with the more synthetic elements of metacognition, namely the complexities of self representations within the personal narrative of schizophrenia. This form of metacognition may have unique links with function as it is part of the basis for an evolving, nuanced personal understanding of immediate and long standing challenges of schizophrenia and trials of regular life outside of psychosis. Our goals are first to discuss one set of methods for quantitatively assessing synthetic aspects of metacognition within personal narratives in schizophrenia. We will then summarize research using this method to study the links between metacognition in schizophrenia with (i) deficits in neurocognitive ability and symptoms, (ii) cognitive styles and related elements and iii) functional outcomes such as vocational and social proficiency. A nuanced understanding of these issues could have important implications not merely for models of function, but also for addressing underlying barriers to recovery. A summary of the results of all studies presented along with participant characteristics is presented in Table 1. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.