Associations between self-esteem, anxiety and depression and metacognitive awareness or metacognitive knowledge

Contributions of age and clinical depression to metacognitive performance

One aspect of metacognition is the ability to judge the accuracy of our own performance, even in the absence of external feedback, which is often measured using confidence ratings. Past research suggests that confidence is lower in Major Depressive Disorder (MDD). Less is known about the ability of MDD patients to discriminate correct from incorrect performance (metacognitive efficiency). The metacognitive performance of aged MDD patients (62-89y) was compared to an age-matched control group. A younger control group (21-28y) was included to also explore the relationshipbetweenageandmetacognitive performance. We found no difference in confidence bias nor metacognitive efficiency between MDD patients and age-matched controls.We found age-related differences in metacognition:normal aging was associated with higher confidencebut lower metacognitive efficiency. The overconfidence was specifically driven by overconfidence in incorrect trials. Our results point to the importance ofage while investigating the relation between MDD and metacognitive performance.

Metacognitive Ability and the Precision of Confidence

In prior research, signal detection theory (SDT) has been widely utilized to assess metacognitive ability. However, the SDT metacognitive model requires the use of a two-alternative forced-choice task, while confidence must also be measured discretely. In our model, participants' cognitive ability and their confidence in the cognitive task were used to estimate their metacognitive abilities. Therefore, in this study, a metacognitive model that can be applied to various cognitive tasks was developed. This model implements the item response theory (IRT) and Q-learning models to estimate cognitive ability; participants' metacognitive ability is defined as the discrepancy between their confidence in their cognitive ability and their actual cognitive ability. The entire procedure was divided into two experiments. In experiment 1, two different cognitive tasks were used to estimate metacognitive ability and to examine overall discriminative and convergent validity. Notably, the parameters representing metacognitive ability did not correlate with cognitive ability but were positively correlated between the two tasks. In experiment 2, we performed a similar analysis using a different task to test the replicability of experiment 1. The results for experiment 2 were replicated for discriminative and convergent validity, albeit with weak results. Our metacognitive model exhibited high interpretability and versatility.

Metacognitive knowledge and experience across multiple cognitive domains in euthymic bipolar disorder

Background

Metacognitive knowledge (MK; general awareness of cognitive functioning) and metacognitive experience (ME; awareness of cognitive performance on a specific cognitive task) represent two facets of metacognition that are critical for daily functioning, but are understudied in bipolar disorder. This study was conducted to evaluate MK and ME across multiple cognitive domains in individuals diagnosed with bipolar disorder and unaffected volunteers, and to investigate the association between metacognition and quality of life (QoL).

Methods

Fifty-seven euthymic participants with bipolar disorder and 55 demographically similar unaffected volunteers provided prediction and postdiction ratings of cognitive task performance across multiple cognitive domains. Self-ratings were compared to objective task performance, and indices of MK and ME accuracy were generated and compared between groups. Participants rated QoL on the Quality of Life in Bipolar Disorder Scale (QoL.BD).

Results

Metacognitive inaccuracies in both MK and ME were observed in participants with bipolar disorder, but only in select cognitive domains. Furthermore, most metacognitive inaccuracies involved underestimation of cognitive ability. Metacognitive indices were minimally associated with medication variables and mood symptoms, but several indices were related to QoL.

Conclusions

Individuals with bipolar disorder demonstrate inaccuracies in rating their cognitive functioning and in rating their online cognitive task performance, but only on select cognitive functions. The tendency to underestimate performance may reflect a negative information processing bias characteristic of mood disorders. Metacognitive variables were also predictive of QoL, indicating that further understanding of cognitive self-appraisals in persons with bipolar disorder has significant clinical relevance.

How internalised stigma reduces self-esteem in schizophrenia: the crucial role of off-line metacognition

Introduction: Stigma is widely recognised as a major barrier to recovery. In schizophrenia, internalised stigma (IS) strongly impacts self-esteem, but the mechanisms underlying this phenomenon remain poorly understood. In this study, we suggest that IS alters self-esteem by leading people to perceive their cognitive functioning as inefficient. We investigated whether off-line metacognitive complaints mediate the effect of IS on self-esteem in schizophrenia.Methods: We included 78 participants diagnosed with schizophrenia or schizoaffective disorder. IS was measured with the Internalised Stigma of Mental Illness scale, self-esteem by the Rosenberg Self-Esteem scale, and off-line metacognitive complaints with the Subjective Scale to Investigate Cognition in Schizophrenia.Results: Mediation analysis revealed that the effect of IS on self-esteem was mediated by off-line metacognitive complaints.Conclusion: Results suggest that IS reduces self-esteem by negatively impacting metacognition, such as perception of cognitive difficulties. We suggest that taking metacognition into account in the form of metacognitive complaints may be relevant in interventions aiming at reducing IS in psychosis.

Abnormalities of confidence in psychiatry: an overview and future perspectives

Our behavior is constantly accompanied by a sense of confidence and its' precision is critical for adequate adaptation and survival. Importantly, abnormal confidence judgments that do not reflect reality may play a crucial role in pathological decision-making typically seen in psychiatric disorders. In this review, we propose abnormalities of confidence as a new model of interpreting psychiatric symptoms. We hypothesize a dysfunction of confidence at the root of psychiatric symptoms either expressed subclinically in the general population or clinically in the patient population. Our review reveals a robust association between confidence abnormalities and psychiatric symptomatology. Confidence abnormalities are present in subclinical/prodromal phases of psychiatric disorders, show a positive relationship with symptom severity, and appear to normalize after recovery. In the reviewed literature, the strongest evidence was found for a decline in confidence in (sub)clinical OCD, and for a decrease in confidence discrimination in (sub)clinical schizophrenia. We found suggestive evidence for increased/decreased confidence in addiction and depression/anxiety, respectively. Confidence abnormalities may help to understand underlying psychopathological substrates across disorders, and should thus be considered transdiagnostically. This review provides clear evidence for confidence abnormalities in different psychiatric disorders, identifies current knowledge gaps and supplies suggestions for future avenues. As such, it may guide future translational research into the underlying processes governing these abnormalities, as well as future interventions to restore them.

Postdecision Evidence Integration and Depressive Symptoms

Background: Metacognition, or the ability to reflect on one's own thoughts, may be important in the development of depressive symptoms. Recent work has reported that depressive symptoms were associated with lower metacognitive bias (overall confidence) during perceptual decision making and a trend toward a positive association with metacognitive sensitivity (the ability to discriminate correct and incorrect decisions). Here, we extended this work, investigating whether confidence judgments are more malleable in individuals experiencing depressive symptoms. We hypothesized that depressive symptoms would be associated with greater adjustment of confidence in light of new evidence presented after a perceptual decision had been made. Methods: Participants (N = 416) were recruited via Amazon Mechanical Turk. Metacognitive confidence was assessed through two perceptual decision-making tasks. In both tasks, participants made a decision about which of two squares contained more dots. In the first task, participants rated their confidence immediately following the decision, whereas in the second task, participants observed new evidence (always in the same direction as initial evidence) before rating their confidence. Participants also completed questionnaires measuring depressive symptoms and self-esteem. Analysis: Metacognitive bias was calculated as overall mean confidence, whereas metacognitive sensitivity was calculated using meta-d' (a response-bias free measure of how closely confidence tracks task performance) in the first task. Postdecision evidence integration (PDEI) was defined as the change in confidence following postdecision evidence on the second task. Results: Participants with more depressive symptoms made greater confidence adjustments (i.e., greater PDEI) in light of new evidence (β = 0.119, p = 0.045), confirming our main hypothesis. We also observed that lower overall confidence was associated with greater depressive symptoms, although this narrowly missed statistical significance (β = -0.099, p = 0.056), and we did not find an association between metacognitive sensitivity (meta-d') and depressive symptoms. Notably, self-esteem was robustly associated with overall confidence (β = 0.203, p < 0.001), which remained significant when controlling for depressive symptoms. Conclusions: We found that individuals with depressive symptoms were more influenced by postdecisional evidence, adjusting their confidence more in light of new evidence. Individuals with low self-esteem were less confident about their initial decisions. This study should be replicated in a clinically depressed sample.

Development and testing of a self-regulation model for recurrent depression

Self-regulation is a strategy for self-management of depression. Study aims were to (1) describe development of an intervention based on metacognition and self-regulation, (2) test intervention feasibility and utility, and (3) determine its effectiveness in reducing depressive symptoms. The Self-Regulated Illness Management of Depression intervention was developed and taught to 22 participants with recurrent depression. There was no attrition 6 months post intervention. At 6 months, there was a significant decrease in depressive symptoms (M = 10.21, standard deviation = 8.0), t(18) = 5.60, p < .001, and 73 percent of participants used Self-Regulated Illness Management of Depression frequently. Results indicated that Self-Regulated Illness Management of Depression was feasible and useful.