Metacognitive factors and alterations of attention related to predisposition to hallucinations

Empirical Evidence of the Metacognitive Model of Rumination and Depression in Clinical and Nonclinical Samples: A Systematic Review and Meta-Analysis

Rumination is considered a cognitive vulnerability factor in the development and maintenance of depression. The metacognitive model of rumination and depression suggests that the development of rumination and its association with depression partly depends on metacognitive beliefs. Two metacognitive beliefs about rumination have been identified: positive beliefs about its utility and negative beliefs about the uncontrollability and its negative social consequences. We conducted a systematic review and meta-analysis aimed: (1) to analyze the associations between metacognitive beliefs and rumination and depression; (2) to test the metacognitive model, using a Two-Stage Structural Equation Modeling approach (TSSEM). Literature search retrieved 41 studies. These 41 studies (N = 10,607) were included in the narrative synthesis and meta-analysis, and 16 studies (N = 4477) were comprised for the TSSEM. Results indicated metacognitive beliefs are associated with rumination and depression. Measures on metacognitive beliefs about rumination indicated that positive beliefs showed moderate associations with rumination (r = 0.50), and low with depression (r = 0.27); whereas negative beliefs showed moderate associations with both rumination (r = 0.46) and depression (r = 0.49). These results were consistent across studies using different instruments to measure metacognitive beliefs, and in both clinical and nonclinical samples. Moreover, results of the TSSEM analyses showed that the metacognitive model had a good fit. In sum, our results are in line with the metacognitive model of rumination and depression, highlighting that metacognitive beliefs are relevant factors to understand why people ruminate and get depressed. Future directions and clinical implications are discussed.

Emotion recognition in depression: An investigation of performance and response confidence in adult female patients with depression

Abnormalities in emotion recognition are frequently reported in depression. However, emotion recognition is not compromised in some studies, and confidence judgments, which are essential for social interaction, have not been considered to date. Due to the high prevalence rate of depression in women, and sex differences in emotion recognition, the aim of the present study was to investigate emotion recognition and confidence judgments in women with depression. A sample of female patients with depressive disorders (n=45) was compared with female healthy controls (n=30) in their ability to correctly identify facial emotion expressions along with confidence judgments. Groups performed similarly on emotional face recognition and showed no difference regarding confidence ratings. A negative correlation between self-assessed depression and response confidence was found. While some limitations of the study must be taken in consideration (e.g., small number of items per emotion category, low severity of depression), abnormalities in emotion recognition do not seem to be a major feature of depression. As self-assessed depression is accompanied by low response confidence for emotional faces, it is crucial to further examine the role of confidence judgments in emotion recognition, as underconfidence may foster interpersonal insecurity in depression.

Dysfunctional meta-cognitive beliefs mediate the relation between temperament traits and hallucination-proneness in non-clinical population

We investigated whether dysfunctional metacognitive beliefs (negative beliefs about uncontrollability and danger of thoughts) mediate the relationship between temperamental characteristics of behavior and hallucinatory-like experiences in healthy subjects (n=137). Our analyses showed that four temperamental traits (emotional reactivity, perseveration, endurance and briskness) were mediated by negative beliefs about uncontrollability and danger of thoughts in relation to hallucination proneness. Our research tentatively suggests that temperament affects hallucination proneness via metacognition.

Anxiety and depression in psychosis: a systematic review of associations with positive psychotic symptoms

OBJECTIVE

This review explores the influence of anxiety and depression on the experience of positive psychotic symptoms, and investigates the possibility of a causal role for anxiety and depression in the emergence and persistence of psychosis.

METHOD

A systematic literature search was undertaken, producing a number of papers which comment on the links between anxiety and depression, and the experience of delusions and hallucinations. In addition, evidence which could contribute to our understanding of the causal role of anxiety and depression was highlighted.

RESULTS

The findings show that both anxiety and depression are associated in meaningful ways with the severity of delusions and hallucinations, the distress they elicit and their content. However, the cross-sectional nature of the majority of studies and the focus on certain symptom subtypes tempers the validity of the findings. Data from non-clinical samples, studies which track the longitudinal course of psychosis and those which examine the impact of anxiety and depression on the prognosis for people experiencing psychosis, offer some support for the possibility of an influential role for anxiety and depression.

CONCLUSION

We conclude that anxiety and depression are related to psychotic symptom severity, distress and content and are also linked with sub-clinical experiences, symptom development, prognosis and relapse. These links may imply that anxiety and depression could be targets for therapeutic intervention. The article concludes with suggestions for further research, highlighting avenues which may circumvent the limitations of the body of work as it stands.

A metacognitive model of the sense of agency over thoughts

INTRODUCTION

The sense of agency over thoughts is the experience of oneself qua agent of mental action. Those suffering certain psychotic symptoms are thought to have a deficient sense of agency. Here I seek to explain this sense of agency in terms of metacognition.

METHOD

I start with the proposal that the sense of agency is elicited by metacognitive monitoring representations that are used in the intentional inhibition of thoughts. I apply this model to verbal hallucinations and the like and examine the plausibility of this model explaining deficits associated with these symptoms.

RESULTS

By tying the sense of agency to metacognitive inhibition I propose that the loss of a sense of agency in certain psychotic symptoms is accompanied by a particular deficit in the patient's ability to control their own thinking. This is consistent with the experiences of those at high risk of developing hallucinations, who report more intrusive thoughts than controls. The model I present is able to explain why those at risk of developing verbal hallucinations and those suffering from verbal hallucinations have deficits in the intentional inhibition of thought. I defend this account from a possible objection by distinguishing the form of the intentional inhibition deficit displayed by those suffering verbal hallucination from that displayed by those suffering from orbital-frontal cortex lesions and posttraumatic stress disorder.

CONCLUSION

A plausible hypothesis is that the sense of agency over thoughts is elicited by the metacognitive monitoring representation used to intentionally inhibit thoughts. The deficit in the sense of agency over thoughts associated with certain psychotic symptoms could be explained by a failure to properly metacognitively monitor certain thought processes.

Quality of hallucinatory experiences: differences between a clinical and a non-clinical sample

In this study, we asked people from two samples (a clinical one, consisting of patients with schizophrenia, and a non-clinical one, including university students) to complete the Revised Hallucination Scale (RHS) as a self-questionnaire. When the participants responded positively to an item, they were encouraged to provide further detailed descriptions (i.e., examples of their own experiences) concerning that item. We found that the kinds of descriptions provided by the two groups were very different. We suggest that it is not advisable to explore the presence of hallucinations in non-clinical samples using research protocols based exclusively on yes-or-no answers to questionnaires like the RHS. Hallucinatory or hallucinatory-like experiences cannot be reliably and validly assessed without a precise characterization of the phenomenal quality of the experience.

Hallucinations and related perceptual disturbance in a non-clinical Spanish population

BACKGROUND

Several studies have suggested the continuity of psychotic symptoms between the general population and clinical samples, and have shown that, in fact, the predisposition to hallucinations is a multi-dimensional construct. However, there is no agreement concerning the number of factors comprising it or the significance of psychotic-like experiences. An examination of the beliefs associated with these experiences could increase knowledge of the continuity of hallucinations.

AIMS

The purpose of this work was to analyze the structure of the Revized Hallucination Scale (RHS), applied to a sample of Spanish university students to find out the meaning for the participants and their associated beliefs on each item.

METHODS

The RHS was administered to a total of 265 participants. Along with the frequency of each experience, participants were asked to provide an example of each situation described and to what they attributed it.

RESULTS

The results emphasized the presence of four factors that are variously made up of six types of beliefs: personal difficulties; psychological explanations; dreamlike experiences; vivid thoughts; perceptive distortions; and personal desires.

CONCLUSIONS

The relevance of these results with regard to the differences that might exist in hallucinations in clinical and normal populations is discussed.

The metacognitive beliefs account of hallucinatory experiences: a literature review and meta-analysis

An influential model of hallucinations proposed by Morrison et al. (1995. Behavioural and Cognitive Psychotherapy, 23(3), 265-280) assumes that dysfunctional metacognitive beliefs lead to the misattribution of intrusive thoughts to external sources, therefore generating hallucinatory experiences. Following a comprehensive review of the literature, a series of meta-analyses was carried out to summarize the empirical findings on the association between hallucination-proneness and different metacognitive beliefs. The results of this research synthesis found little support for the existence of specific associations between hallucinations and dysfunctional metacognitive beliefs. While metacognitive beliefs are robustly associated with hallucination-proneness in non-clinical studies, they were only moderately associated with hallucinations in clinical samples. Additional analyses revealed that, after controlling for the effect of comorbid symptoms, hallucination-proneness was only weakly associated with metacognitive beliefs, suggesting that the large associations observed in previous research might stem from the failure to consider the covariation between different symptoms. These findings have important implications in relation to the role of metacognitive factors in psychopathological symptoms, as well as for the implementation of metacognitive-focused cognitive behavioural techniques for the treatment of psychosis.