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

Abstract

BackgroundDistortions 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.MethodsUsing 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).ResultsVariability 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.ConclusionsOur 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.

Transdiagnostic Phenotyping Reveals a Host of Metacognitive Deficits Implicated in Compulsivity

“…Confidence was not just unresponsive to various factors underlying learning, it was also inflated in compulsive individuals. This finding replicates prior work that examined confidence in the context of perceptual decision making 14 , showing it extends to reinforcement learning -which is of course highly relevant for the behavioural aspects of compulsivity. Future work will be needed to dissect the specific mechanism through which confidence becomes inflated in compulsivity.…”

“…The finding of intact confidence in OCD is consistent with prior work in perceptual decisionmaking where individuals high versus low in OCD symptoms had no differences in their confidence 13 -results echoed by two large internet-based samples (N > 490) with the same task that also found no relationship to OCD symptoms 14 . A problem with this type of study design, however, is that it fails to capture the potentially competing influence of co-occurring disorders/symptoms in psychiatric populations.…”

“…In comparison to work with diagnosed patients, the benefits of the transdiagnostic approach are the same. Prior work using this task found no difference in OCD patients' mean confidence ratings compared to healthy controls 12 , while we found a strong a reproducible association between CIT and inflated confidence and AD and diminished confidence 14 . Given that OCD is frequently comorbid with anxiety disorders (over 75% 25 ), which has an opposing relationship to confidence, it is no surprise that differences between OCD patients and controls are obscured when transdiagnostic dimensions are not considered.…”

“…Previous research utilizing the predictive-inference task were constrained to small sample psychiatric populations 12 . As such, we referred to earlier work that investigated confidence abnormalities in large general population cohorts with transdiagnostic symptom dimensions to determine an appropriate sample size 14 . The prior study reported an association of the 'anxious-depression' factor with lowered confidence level (β = −0.20, p < 0.001), an effect size suggesting that N = 295 participants were required to achieve 90% power at 0.001 significance level.…”

Perceptual metacognition of human faces is causally supported by function of the lateral prefrontal cortex

“…The ability to introspect on one's own mental content is termed metacognition, a process that gives rise to representations considered important for conscious experiences (2). Metacognitive insight is thought to guide decision making-for instance, lower levels of metacognitive awareness have been observed in individuals espousing radical beliefs (3) and in various forms of psychopathology (4,5). Yet there continues to be vigorous debate regarding the neural architecture that gives rise to metacognitive ability.…”