Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

Research using the integrated model of metacognition has suggested that the construct of metacognition could quantify the spectrum of activities that, if impaired, might cause many of the subjective disturbances found in psychosis. Research on social cognition and mentalizing in psychosis, however, has also pointed to underlying deficits in how persons make sense of their experience of themselves and others. To explore the question of whether metacognitive research in psychosis offers unique insight in the midst of these other two emerging fields, we have offered a review of the constructs and research from each field. Following that summary, we discuss ways in which research on metacognition may be distinguished from research on social cognition and mentalizing in three broad categories: (1) experimental procedures, (2) theoretical advances, and (3) clinical applications or indicated interventions. In terms of its research methods, we will describe how metacognition makes a unique contribution to understanding disturbances in how persons make sense of and interpret their own experiences within the flow of life. We will next discuss how metacognitive research in psychosis uniquely describes an architecture which when compromised - as often occurs in psychosis - results in the loss of persons' sense of purpose, possibilities, place in the world and cohesiveness of self. Turning to clinical issues, we explore how metacognitive research offers an operational model of the architecture which if repaired or restored should promote the recovery of a coherent sense of self and others in psychosis. Finally, we discuss the concrete implications of this for recovery-oriented treatment for psychosis as well as the need for further research on the commonalities of these approaches.

Metacognition, social cognition, and symptoms in patients with first episode and prolonged psychoses.

While it has been documented that persons with prolonged schizophrenia have deficits in metacognition and social cognition, it is less clear whether these difficulties are already present during a first episode. To explore this issue we assessed and compared metacognition using the Metacognition Assessment Scale-Abbreviated (MAS-A) and social cognition using the Eyes, Hinting and Bell-Lysaker Emotional Recognition Tests (BLERT) in participants with first episode psychosis (FEP; n=26), participants with a prolonged psychosis (n=72), and a psychiatric control group consisting of persons with a substance use disorder and no history of psychosis (n=14). Analyses revealed that both psychosis cohorts scored lower than controls on the MAS-A total and all subscales except metacognitive mastery. Compared to the FEP group, the persons with prolonged psychosis demonstrated greater metacognitive capacities only in those MAS-A domains reflective of the ability to understand the mental state of others and to see that others may have motivations and desires separate from their own. Other domains of metacognition did not differ between psychosis groups. The Eyes, Hinting and BLERT scores of the two psychosis groups did not differ but were poorer than those produced by the control group. Exploratory correlations in the FEP group showed a pattern similar to that previously observed in prolonged psychosis. Taken together, these findings suggest that while certain domains of metacognition could improve with prolonged psychosis, difficulties with global metacognition and social cognition may be stable features of the disorder and perhaps unique to psychosis.

Social cognition and metacognition in schizophrenia: evidence of their independence and linkage with outcomes.

OBJECTIVE: Research suggests that many with schizophrenia experience deficits in the ability to make discrete judgments about the thoughts and feelings of others as well as to form larger integrated representations of themselves and others. Little is known about whether these difficulties may be distinguished from one another and whether they are linked with different outcomes. METHOD: We administered three assessments of social cognition which tapped the ability to identify emotions and intentions and two metacognitive tasks which called for the formation of more integrated and flexible representations of the self and others. We additionally assessed symptoms, social functioning and neurocognition. Participants were 95 individuals with a schizophrenia spectrum disorder. RESULTS: A principle components analysis followed by a varimax rotation revealed two factors which accounted for 62% of the variance. The first factor was comprised of the three social cognition tests and the second of two tasks that tapped the ability to create representations of oneself and others which integrate more discreet information. The first factor was uniquely correlated with negative symptoms, and the second was uniquely correlated with social function. CONCLUSION: Results suggest that deficits in social cognition and metacognition represent different forms of dysfunction in schizophrenia.

Metacognition as a mediator of the effects of impairments in neurocognition on social function in schizophrenia spectrum disorders.

OBJECTIVE: This study explored whether Mastery, a domain of metacognition that reflects the ability to use knowledge about mental states to respond to psychological challenges, mediated the effects of neurocognition on the frequency of social contact and persons' capacity for social relatedness. METHOD: Participants were 102 adults with schizophrenia or schizoaffective disorder. Neurocognition was represented by a single factor score produced by a principal components analysis of a neurocognitive test battery. Mastery was assessed using the metacognitive assessment scale and social functioning by the quality of life scale. RESULTS: Using structural equation modeling, specifically measured-variable path analysis, a mediational model consisting of neurocognitive capacity linked to mastery and capacity for social relationships and mastery linked with frequency of social contact and capacity for social relatedness showed acceptable fit to the observed data. This persisted after controlling for negative and cognitive symptoms. CONCLUSION: Results suggest that certain forms of metacognition mediate the influence of neurocognition upon function in schizophrenia.

Metacognition amidst narratives of self and illness in schizophrenia: associations with neurocognition, symptoms, insight and quality of life.

OBJECTIVE: Impairments in laboratory tasks of metacognition appear to be associated with symptoms, functioning, and neurocognition in schizophrenia. We sought to replicate these results in a study of metacognition within personal narratives of self and illness. METHOD: Narratives of 61 men with schizophrenia were rated using the Metacognition Assessment Scale and correlated with concurrent assessment of symptoms, quality of life, neurocognition and insight. RESULTS: Controlling for age and education, understanding of one's own mind was linked with better neurocognition across multiple domains, and lesser emotional withdrawal. Greater understanding of other's mind was linked with better verbal memory and less emotional withdrawal. Greater metacognition in the context of purposeful problem solving was associated with better verbal memory, insight and social function, and less emotional withdrawal and paranoia. CONCLUSION: Deficits in metacognition within the narratives of persons with schizophrenia are linked with symptoms, quality of life, neurocognition and poorer awareness of illness.

Research utilization among clinical nurse specialists.

The purpose of this descriptive study was to explore utilization behavior of clinical nurse specialists (CNSs) relative to research-based information as distinguished from nonresearch-based information. A nontraditional conceptualization of knowledge utilization as encompassing both cognitive and instrumental application was employed. Twenty-four CNSs were interviewed in a field survey. Results indicated that subjects most frequently use findings conceptually; while on occasion, as illustrated in case examples, they reported using research both conceptually and instrumentally. Only half of the subjects, however, could list explicit criteria for evaluation of the applicability of findings to practice. What is most striking in this study's findings is its congruence with results from other research conducted on various, nonnursing populations.