The Communication of Metacognition for Social Strategy in Psychosis: An Exploratory Study

Abstract

Sharing privately held information, for example, one’s confidence in the likelihood of future events, can greatly help others make better decisions as well as promoting one’s reputation and social influence. Differences in metacognition on the one hand, and difficulties in social functioning and social cognition on the other, have been reported in people diagnosed with schizophrenia and bipolar disorder. However, despite clear relevance few studies have investigated the link between these abilities and psychosis. In this exploratory study, we compared individuals diagnosed with schizophrenia, bipolar disorder, and a group of unselected general population controls, in an online competitive advice-giving task. Participants gave advice to a client by making a probabilistic perceptual judgment. They could strategically adapt the advice confidence to gain influence over the client. Crucially, participants competed with a rival adviser to attract the client’s endorsement. We observe that participants diagnosed with schizophrenia displayed an overall overconfidence in their advice compared with other, bipolar and unselected control groups, but did not differ in metacognitive efficiency from controls. Symptom-based analysis revealed that the social-influence effect was associated with the presence of delusions but not hallucinations or mood symptoms. These results suggest that the social communication of uncertainty should be further investigated in psychosis.

A normative account of self-deception, overconfidence, and paranoia

“…This addresses detractors of predictive coding models of delusions 19 and provides empirical support for the proposed solutions to the challenge of biased beliefs 20 . More broadly, our work joins the growing literature wherein normative Bayesian models can explain apparently irrational phenomena -like political polarization 29 . Much like perceptual illusions can be cast in Bayesian terms , decision-making phenomena that appear to depart from normative Bayesian principles, and demand heuristic explanations -evoking the plesitocene evolutionary environment 31 -may likewise yield to Bayesian explanation, albeit one that incorporates the utility of self-esteem and implements illusory self-regard .…”

“…Differing self-deception when confidence is communicated between partners would be consistent with a role for self-deception in deceiving others as well as self 1 . In an advice-giving task, patients with schizophrenia were overconfident in their own advice, particularly those with delusions 29 . Our data suggest this effect might be driven by self-deception secondary to an experience of one's own perceptual unreliability.…”

“…Given the debate about self-deception and delusions 42 , it will be important to establish whether the same effects are present in people with confirmed delusional beliefs. Recent work on advice giving by people with schizophrenia suggests that patients with delusions are over confident in their advice 29 . We suggest that our data are consistent with the possibility that delusion (albeit on the extreme end of a continuum of paranoia) might entail self-deception.…”