Differences in metacognitive functioning between obsessive-compulsive disorder patients and highly compulsive individuals from the general population.

BACKGROUND: Our confidence, a form of metacognition, guides our behavior. Confidence abnormalities have been found in obsessive-compulsive disorder (OCD). A first notion based on clinical case-control studies suggests lower confidence in OCD patients compared to healthy controls. Contrarily, studies in highly compulsive individuals from general population samples showed that obsessive-compulsive symptoms related positively or not at all to confidence. A second notion suggests that an impairment in confidence estimation and usage is related to compulsive behavior, which is more often supported by studies in general population samples. These opposite findings call into question whether findings from highly compulsive individuals from the general population are generalizable to OCD patient populations. METHODS: To test this, we investigated confidence at three hierarchical levels: local confidence in single decisions, global confidence in task performance and higher-order self-beliefs in 40 OCD patients (medication-free, no comorbid diagnoses), 40 controls, and 40 matched highly compulsive individuals from the general population (HComp). RESULTS: In line with the first notion we found that OCD patients exhibited relative underconfidence at all three hierarchical levels. In contrast, HComp individuals showed local and global overconfidence and worsened metacognitive sensitivity compared with OCD patients, in line with the second notion. CONCLUSIONS: Metacognitive functioning observed in a general highly compulsive population, often used as an analog for OCD, is distinct from that in a clinical OCD population, suggesting that OC symptoms in these two groups relate differently to (meta)cognitive processes. These findings call for caution in generalizing (meta)cognitive findings from general population to clinical samples.

Interoceptive and metacognitive facets of fatigue in multiple sclerosis.

Numerous disorders are characterised by fatigue as a highly disabling symptom. Fatigue plays a particularly important clinical role in multiple sclerosis (MS) where it exerts a profound impact on quality of life. Recent concepts of fatigue grounded in computational theories of brain-body interactions emphasise the role of interoception and metacognition in the pathogenesis of fatigue. So far, however, for MS, empirical data on interoception and metacognition are scarce. This study examined interoception and (exteroceptive) metacognition in a sample of 71 persons with a diagnosis of MS. Interoception was assessed by prespecified subscales of a standard questionnaire (Multidimensional Assessment of Interoceptive Awareness [MAIA]), while metacognition was investigated with computational models of choice and confidence data from a visual discrimination paradigm. Additionally, autonomic function was examined by several physiological measurements. Several hypotheses were tested based on a preregistered analysis plan. In brief, we found the predicted association of interoceptive awareness with fatigue (but not with exteroceptive metacognition) and an association of autonomic function with exteroceptive metacognition (but not with fatigue). Furthermore, machine learning (elastic net regression) showed that individual fatigue scores could be predicted out-of-sample from our measurements, with questionnaire-based measures of interoceptive awareness and sleep quality as key predictors. Our results support theoretical concepts of interoception as an important factor for fatigue and demonstrate the general feasibility of predicting individual levels of fatigue from simple questionnaire-based measures of interoception and sleep.

Illusion of knowledge in statistics among clinicians: evaluating the alignment between objective accuracy and subjective confidence, an online survey.

Healthcare professionals' statistical illiteracy can impair medical decision quality and compromise patient safety. Previous studies have documented clinicians' insufficient proficiency in statistics and a tendency in overconfidence. However, an underexplored aspect is clinicians' awareness of their lack of statistical knowledge that precludes any corrective intervention attempt. Here, we investigated physicians', residents' and medical students' alignment between subjective confidence judgments and objective accuracy in basic medical statistics. We also examined how gender, profile of experience and practice of research activity affect this alignment, and the influence of problem framing (conditional probabilities, CP vs. natural frequencies, NF). Eight hundred ninety-eight clinicians completed an online survey assessing skill and confidence on three topics: vaccine efficacy, p value and diagnostic test results interpretation. Results evidenced an overall consistent poor proficiency in statistics often combined with high confidence, even in incorrect answers. We also demonstrate that despite overconfidence bias, clinicians show a degree of metacognitive sensitivity, as their confidence judgments discriminate between their correct and incorrect answers. Finally, we confirm the positive impact of the more intuitive NF framing on accuracy. Together, our results pave the way for the development of teaching recommendations and pedagogical interventions such as promoting metacognition on basic knowledge and statistical reasoning as well as the use of NF to tackle statistical illiteracy in the medical context.

Adaptive tuning of human learning and choice variability to unexpected uncertainty.

Human value-based decisions are notably variable under uncertainty. This variability is known to arise from two distinct sources: variable choices aimed at exploring available options and imprecise learning of option values due to limited cognitive resources. However, whether these two sources of decision variability are tuned to their specific costs and benefits remains unclear. To address this question, we compared the effects of expected and unexpected uncertainty on decision-making in the same reinforcement learning task. Across two large behavioral datasets, we found that humans choose more variably between options but simultaneously learn less imprecisely their values in response to unexpected uncertainty. Using simulations of learning agents, we demonstrate that these opposite adjustments reflect adaptive tuning of exploration and learning precision to the structure of uncertainty. Together, these findings indicate that humans regulate not only how much they explore uncertain options but also how precisely they learn the values of these options.

A shared brain system forming confidence judgment across cognitive domains.

Confidence is typically defined as a subjective judgment about whether a decision is right. Decisions are based on sources of information that come from various cognitive domains and are processed in different brain systems. An unsettled question is whether the brain computes confidence in a similar manner whatever the domain or in a manner that would be idiosyncratic to each domain. To address this issue, human participants performed two tasks probing confidence in decisions made about the same material (history and geography statements), but based on different cognitive processes: semantic memory for deciding whether the statement was true or false, and duration perception for deciding whether the statement display was long or short. At the behavioral level, we found that the same factors (difficulty, accuracy, response time, and confidence in the preceding decision) predicted confidence judgments in both tasks. At the neural level, we observed using functional magnetic resonance imaging that confidence judgments in both tasks were associated to activity in the same brain regions: positively in the ventromedial prefrontal cortex and negatively in a prefronto-parietal network. Together, these findings suggest the existence of a shared brain system that generates confidence judgments in a similar manner across cognitive domains.

Controllability boosts neural and cognitive signatures of changes-of-mind in uncertain environments.

In uncertain environments, seeking information about alternative choice options is essential for adaptive learning and decision-making. However, information seeking is usually confounded with changes-of-mind about the reliability of the preferred option. Here, we exploited the fact that information seeking requires control over which option to sample to isolate its behavioral and neurophysiological signatures. We found that changes-of-mind occurring with control require more evidence against the current option, are associated with reduced confidence, but are nevertheless more likely to be confirmed on the next decision. Multimodal neurophysiological recordings showed that these changes-of-mind are preceded by stronger activation of the dorsal attention network in magnetoencephalography, and followed by increased pupil-linked arousal during the presentation of decision outcomes. Together, these findings indicate that information seeking increases the saliency of evidence perceived as the direct consequence of one's own actions.

Consensus Goals in the Field of Visual Metacognition.

Despite the tangible progress in psychological and cognitive sciences over the last several years, these disciplines still trail other more mature sciences in identifying the most important questions that need to be solved. Reaching such consensus could lead to greater synergy across different laboratories, faster progress, and increased focus on solving important problems rather than pursuing isolated, niche efforts. Here, 26 researchers from the field of visual metacognition reached consensus on four long-term and two medium-term common goals. We describe the process that we followed, the goals themselves, and our plans for accomplishing these goals. If this effort proves successful within the next few years, such consensus building around common goals could be adopted more widely in psychological science.

Low self-esteem and the formation of global self-performance estimates in emerging adulthood.

High self-esteem, an overall positive evaluation of self-worth, is a cornerstone of mental health. Previously we showed that people with low self-esteem differentially construct beliefs about momentary self-worth derived from social feedback. However, it remains unknown whether these anomalies extend to constructing beliefs about self-performance in a non-social context, in the absence of external feedback. Here, we examined this question using a novel behavioral paradigm probing subjects' self-performance estimates with or without external feedback. We analyzed data from young adults (N = 57) who were selected from a larger community sample (N = 2402) on the basis of occupying the bottom or top 10% of a reported self-esteem distribution. Participants performed a series of short blocks involving two perceptual decision-making tasks with varying degrees of difficulty, with or without feedback. At the end of each block, they had to decide on which task they thought they performed best, and gave subjective task ratings, providing two measures of self-performance estimates. We found no robust evidence of differences in objective performance between high and low self-esteem participants. Nevertheless, low self-esteem participants consistently underestimated their performance as expressed in lower subjective task ratings relative to high self-esteem participants. These results provide an initial window onto how cognitive processes underpinning the construction of self-performance estimates across different contexts map on to global dispositions relevant to mental health such as self-esteem.

How Local and Global Metacognition Shape Mental Health.

Metacognition is the ability to reflect on our own cognition and mental states. It is a critical aspect of human subjective experience and operates across many hierarchical levels of abstraction-encompassing local confidence in isolated decisions and global self-beliefs about our abilities and skills. Alterations in metacognition are considered foundational to neurologic and psychiatric disorders, but research has mostly focused on local metacognitive computations, missing out on the role of global aspects of metacognition. Here, we first review current behavioral and neural metrics of local metacognition that lay the foundation for this research. We then address the neurocognitive underpinnings of global metacognition uncovered by recent studies. Finally, we outline a theoretical framework in which higher hierarchical levels of metacognition may help identify the role of maladaptive metacognitive evaluation in mental health conditions, particularly when combined with transdiagnostic methods.

Formation of global self-beliefs in the human brain.

Humans create metacognitive beliefs about their performance across many levels of abstraction-from local confidence in individual decisions to global estimates of our skills and abilities. Despite a rich literature on the neural basis of local confidence judgements, how global self-performance estimates (SPEs) are constructed remains unknown. Using functional magnetic resonance imaging, we scanned human subjects while they performed several short blocks of tasks and reported on which task they think they performed best, providing a behavioral proxy for global SPEs. In a frontoparietal network sensitive to fluctuations in local confidence, we found that activity within ventromedial prefrontal cortex and precuneus was additionally modulated by global SPEs. In contrast, activity in ventral striatum was associated with subjects' global SPEs irrespective of fluctuations in local confidence, and predicted the extent to which global SPEs tracked objective task difficulty across individuals. Our findings reveal neural representations of global SPEs that go beyond the tracking of local confidence, and lay the groundwork for understanding how a formation of global self-beliefs may go awry in conditions characterized by distorted self-evaluation.

Forming global estimates of self-performance from local confidence.

Metacognition, the ability to internally evaluate our own cognitive performance, is particularly useful since many real-life decisions lack immediate feedback. While most previous studies have focused on the construction of confidence at the level of single decisions, little is known about the formation of "global" self-performance estimates (SPEs) aggregated from multiple decisions. Here, we compare the formation of SPEs in the presence and absence of feedback, testing a hypothesis that local decision confidence supports the formation of SPEs when feedback is unavailable. We reveal that humans pervasively underestimate their performance in the absence of feedback, compared to a condition with full feedback, despite objective performance being unaffected. We find that fluctuations in confidence contribute to global SPEs over and above objective accuracy and reaction times. Our findings create a bridge between a computation of local confidence and global SPEs, and support a functional role for confidence in higher-order behavioral control.

Prefrontal mechanisms combining rewards and beliefs in human decision-making.

In uncertain and changing environments, optimal decision-making requires integrating reward expectations with probabilistic beliefs about reward contingencies. Little is known, however, about how the prefrontal cortex (PFC), which subserves decision-making, combines these quantities. Here, using computational modelling and neuroimaging, we show that the ventromedial PFC encodes both reward expectations and proper beliefs about reward contingencies, while the dorsomedial PFC combines these quantities and guides choices that are at variance with those predicted by optimal decision theory: instead of integrating reward expectations with beliefs, the dorsomedial PFC built context-dependent reward expectations commensurable to beliefs and used these quantities as two concurrent appetitive components, driving choices. This neural mechanism accounts for well-known risk aversion effects in human decision-making. The results reveal that the irrationality of human choices commonly theorized as deriving from optimal computations over false beliefs, actually stems from suboptimal neural heuristics over rational beliefs about reward contingencies.

Human metacognition across domains: insights from individual differences and neuroimaging.

Metacognition is the capacity to evaluate and control one's own cognitive processes. Metacognition operates over a range of cognitive domains, such as perception and memory, but the neurocognitive architecture supporting this ability remains controversial. Is metacognition enabled by a common, domain-general resource that is recruited to evaluate performance on a variety of tasks? Or is metacognition reliant on domain-specific modules? This article reviews recent literature on the domain-generality of human metacognition, drawing on evidence from individual differences and neuroimaging. A meta-analysis of behavioral studies found that perceptual metacognitive ability was correlated across different sensory modalities, but found no correlation between metacognition of perception and memory. However, evidence for domain-generality from behavioral data may suffer from a lack of power to identify correlations across model parameters indexing metacognitive efficiency. Neuroimaging data provide a complementary perspective on the domain-generality of metacognition, revealing co-existence of neural signatures that are common and distinct across tasks. We suggest that such an architecture may be appropriate for "tagging" generic feelings of confidence with domain-specific information, in turn forming the basis for priors about self-ability and modulation of higher-order behavioral control.

Psychiatric Symptom Dimensions Are Associated With Dissociable Shifts in Metacognition but Not Task Performance.

BACKGROUND: Distortions in metacognition-the ability to reflect on and control other cognitive processes-are thought to be characteristic of poor mental health. However, it remains unknown whether such shifts in self-evaluation are due to specific alterations in metacognition and/or a downstream consequence of changes in decision-making processes. METHODS: Using perceptual decision making as a model system, we employed a computational psychiatry approach to relate parameters governing both decision formation and metacognitive evaluation to self-reported transdiagnostic symptom dimensions in a large general population sample (N = 995). RESULTS: Variability in psychopathology was unrelated to either speed or accuracy of decision formation. In contrast, leveraging a dimensional approach, we revealed independent relationships between psychopathology and metacognition: a symptom dimension related to anxiety and depression was associated with lower confidence and heightened metacognitive efficiency, whereas a dimension characterizing compulsive behavior and intrusive thoughts was associated with higher confidence and lower metacognitive efficiency. Furthermore, we obtained a robust double dissociation-whereas psychiatric symptoms predicted changes in metacognition but not decision performance, age predicted changes in decision performance but not metacognition. CONCLUSIONS: Our findings indicate a specific and pervasive link between metacognition and mental health. Our study bridges a gap between an emerging neuroscience of decision making and an understanding of metacognitive alterations in psychopathology.