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The association between metacognitive abilities and outcome measures among people with schizophrenia: A meta-analysis

Published online by Cambridge University Press:  23 March 2020

N. Arnon-Ribenfeld ,
I. Hasson-Ohayon ,
M. Lavidor ,
D. Atzil-Slonim  and
P.H. Lysaker
N. Arnon-Ribenfeld
Affiliation:
Department of Psychology, Bar-Ilan University, Max and Anna Webb St., Ramat-Gan, Israel
I. Hasson-Ohayon*
Affiliation:
Department of Psychology, Bar-Ilan University, Max and Anna Webb St., Ramat-Gan, Israel
M. Lavidor
Affiliation:
Department of Psychology, Bar-Ilan University, Max and Anna Webb St., Ramat-Gan, Israel
D. Atzil-Slonim
Affiliation:
Department of Psychology, Bar-Ilan University, Max and Anna Webb St., Ramat-Gan, Israel
P.H. Lysaker
Affiliation:
Roudebush VA Medical Center, Indianapolis, IN, United States
*
* Corresponding author. E-mail address:[email protected] (I. Hasson-Ohayon).
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Abstract

Background:

Deficits in metacognition are one of the major causes of the difficulties experienced by individuals with schizophrenia. Studies have linked these deficits to symptom exacerbation and deterioration in psychosocial functioning. The aim of the present meta-analysis was to examine the extensive existing literature regarding metacognitive deficits among persons with schizophrenia; a further aim was to assess the extent to which metacognitive abilities are linked to outcome measures of symptoms and psychosocial functioning.

Method:

We conducted a systematic literature search of studies examining the relationship between metacognitive abilities and outcome measures among people with schizophrenia. We then analyzed the data using a random-effects meta-analytic model with Cohen's d standardized mean effect size.

Results:

Heterogeneity analyses (k = 32, Cohen's d = −.12, 95% CI.−1.92 to 1.7) produced a significant Q-statistic (Q = 456.89) and a high amount of heterogeneity, as indicated by the I2 statistic (93.04%), suggesting that moderator analyses were appropriate. As hypothesized, measure type moderated the metacognitive deficit with homogenous effect for psychosocial functioning measures (Q = 9.81, I2 = 19.47%, d = .94. 95% CI .58 to 1.2) and symptoms (Q = 19.87, I2 = 0%, d = −1.07, 95% CI −1.18 to −.75). Further analysis found homogenous effects for MAS-A subscales as well as PANSS factors of symptoms.

Conclusion:

Our meta-analysis results illustrated a significant association between metacognitive deficits and both symptomatic and psychosocial functioning measures. These links suggest that the associations between metacognitive abilities and symptomatic outcomes are different from those between metacognitive abilities and psychosocial functioning measures. Intriguing hypotheses are raised regarding the role that metacognitive abilities play in both symptoms and psychosocial functioning measures of people diagnosed with schizophrenia spectrum disorders.

Keywords

Meta-analysisMetacognitionSchizophrenia
Type
Review
Information
European Psychiatry , Volume 46 , October 2017 , pp. 33 - 41
Copyright
Copyright © European Psychiatric Association 2017

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References

Lysaker, PHDimaggio, GMetacognitive capacities for reflection in schizophrenia: implications for developing treatments. Schizophr Bull 2014;40(3): 487–491.CrossRefGoogle ScholarPubMed
Lysaker, PHVohs, JLBallard, R, et al.Metacognition, self-reflection and recovery in schizophrenia: review of the literature. Future Neurol 2013;8(1): 103–115.CrossRefGoogle Scholar
Lysaker, PHHasson-Ohayon, IMetacognition in schizophrenia: introduction to the special issue. Isr J Psychiatry Relat Sci 2014;51(1): 4–7.Google Scholar
Pinkham, AEPenn, DLGreen, MF, et al.The social cognition psychometric evaluation study: results of the expert survey and rand panel. Schizophr Bull 2014;40:813–823.CrossRefGoogle ScholarPubMed
Green, MFLeitman, DISocial cognition in schizophrenia. Schizophr Bull 2008;34(4): 670–672.CrossRefGoogle ScholarPubMed
Hasson-Ohayon, IAvidan-Msika, MMashiach-Eizenberg, M, et al.Metacognitive and social cognition approaches to understanding the impact of schizophrenia on social quality of life. Schizophr Res 2015;161(2): 386–391.CrossRefGoogle ScholarPubMed
Vohs, JLLysaker, PHFrancis, MM, et al.Metacognition, social cognition and symptoms in patients with first episode and prolonged psychoses. Schizophr Res 2014;153(1): 54–59.CrossRefGoogle ScholarPubMed
Lysaker, PHLeonhardt, BLPijnenborg, M, et al.Metacognition in schizophrenia spectrum disorders: methods of assessment and associations with neurocognition, symptoms, cognitive style and function. Isr J Psychiatry Relat Sci 2014;51(1): 54–62.Google ScholarPubMed
Semerari, ACarcione, ADimaggio, G, et al.How to evaluate metacognitive function in psychotherapy? The Metacognition Assessment Scale and its applications. Clin Psychol Psychotherapy 2003;10(4): 238–261.CrossRefGoogle Scholar
Lysaker, PHClements, CAPlascak-Hallberg, CDInsight and personal narratives of illness in schizophrenia. Psychiatry Interpers Biol Processes 2002;65(3): 197–206.CrossRefGoogle Scholar
Lysaker, PHBuck, KDLeonhardt, BLBuck, BHamm, JHasson-Ohayon, I, et al.Metacognitively focused psychotherapy for people with schizophrenia: eight core elements that define practice. In: Lysaker, PHDimaggio, GBrune, M editors. Social cognition and metacognition in schizophrenia. Eastbourne, UK: Academic Press; 2014. p. 195–213.CrossRefGoogle Scholar
Corcoran, RMercer, GFrith, CDSchizophrenia, symptomatology and social influence: investigating ‘theory of mind’ in people with schizophrenia. Schizophr Res 1995;17:5–13.CrossRefGoogle Scholar
Frith, CDSchizophrenia and theory of mind. Psychol Med 2004;34(03): 385–389.CrossRefGoogle ScholarPubMed
Penn, DLCorrigan, PWBentall, RPRacenstein, JMNewman, LSocial cognition in schizophrenia. Psychol Bull 1997;121:114–132.CrossRefGoogle ScholarPubMed
Dimaggio, GProcacci, MNicolo, G, et al.Poor metacognition in narcissistic and avoidant personality disorders: four psychotherapy patients analyzed using the metacognition assessment scale. Clin Psychol Psychother 2007;14(5): 386–401.CrossRefGoogle Scholar
Lysaker, PHDimaggio, GBuck, KDCarcione, ANicolò, GMetacognition within narratives of schizophrenia: associations with multiple domains of neurocognition. Schizophr Res 2007;93(1): 278–287.CrossRefGoogle ScholarPubMed
Buck, KDWarman, DMHuddy, VLysaker, PHThe relationship of metacognition with jumping to conclusions among persons with schizophrenia spectrum disorders. Psychopathology 2012;45(5): 271–275.CrossRefGoogle ScholarPubMed
Kay, SRFlszbein, AOpfer, LAThe Positive And Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987;13(2): 261CrossRefGoogle Scholar
MacBeth, AGumley, ASchwannauer, M, et al.Metacognition, symptoms and premorbid functioning in a first episode psychosis sample. Compr Psychiatry 2014;55(2): 268–273.CrossRefGoogle Scholar
Rabin, SJHasson-Ohayon, IAvidan, MRozencwaig, SShalev, HKravetz, SMetacognition in schizophrenia and schizotypy: relation to symptoms of schizophrenia, traits of schizotypy and Social Quality of Life. Isr J Psychiatry Relat Sci 2014;51:44–53.Google ScholarPubMed
Lysaker, PHCarcione, ADimaggio, G, et al.Metacognition amidst narratives of self and illness in schizophrenia: associations with insight, neurocognition, symptom and function. Acta Psychiatr Scand 2005;112:64–71.CrossRefGoogle Scholar
Fridberg, DJBrenner, ALysaker, PHVerbal memory intrusions in schizophrenia: associations with self-reflectivity, symptomatology and neurocognition. Psychiatry Res 2010;179(1): 6–11.CrossRefGoogle ScholarPubMed
Nicolo, GDimaggio, GPopolo, R, et al.Associations of metacognition with symptoms, insight and neurocognition in clinically stable outpatients with schizophrenia. J Nerv Ment Dis 2012;200(7): 644–647.CrossRefGoogle ScholarPubMed
McLeod, HJGumley, AIMacBeth, ASchwannauer, MLysaker, PHMetacognitive functioning predicts positive and negative symptoms over 12 months in first episode psychosis. J Psychiatr Res 2014;54:109–115.CrossRefGoogle ScholarPubMed
Lysaker, PHRoe, DYanos, PTToward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope and self-esteem among people with schizophrenia spectrum disorders. Schizophr Bull 2006;33(1): 192–199.CrossRefGoogle ScholarPubMed
Roberts, DLPenn, DLSocial cognition in schizophrenia: from evidence to treatment. Oxford University Press; 2013.CrossRefGoogle Scholar
Lysaker, PHBell, MMilstein, R, et al.Insight and psychosocial treatment compliance in schizophrenia. Psychiatry 1994;57(4): 307–315.CrossRefGoogle Scholar
Brüne, MSchaub, DJuckel, G, et al.Social skills and behavioral problems in schizophrenia: the role of mental state attribution, neurocognition and clinical symptomatology. Psychiatry Res 2011;190(1): 9–17.CrossRefGoogle ScholarPubMed
Luedtke, BLKukla, MRenard, SDimaggio, GBuck, KDLysaker, PHMetacognitive functioning and social cognition as predictors of accuracy of self-appraisals of vocational function in schizophrenia. Schizophr Res 2012;37(1): 260–261.CrossRefGoogle Scholar
Lysaker, PHDimaggio, GCarcione, A, et al.Metacognition and schizophrenia: the capacity for self-reflectivity as a predictor for prospective assessments of work performance over six months. Schizophr Res 2010;122(1): 124–130.CrossRefGoogle ScholarPubMed
Lysaker, PHDimaggio, GDaroyanni, P, et al.Assessing metacognition in schizophrenia with the Metacognition Assessment Scale: associations with the Social Cognition and Object Relations Scale. Psychol Psychotherapy Theory Res Pract 2010;83(3): 303–315.CrossRefGoogle ScholarPubMed
Lysaker, PHShea, AMBuck, KDMetacognition as a mediator of the effects of impairments in neurocognition on social function in schizophrenia spectrum disorders. Acta Psychiatr Scand 2010;122(5): 405–413.CrossRefGoogle ScholarPubMed
Roe, DDavidson, LSelf and narrative in schizophrenia: time to author a new story. Med Humanit 2005;31(2): 89–94.CrossRefGoogle Scholar
Jansen, JELysaker, PHHarder, S, et al.Positive and negative caregiver experiences in first-episode psychosis: emotional over-involvement, wellbeing and metacognition. Psychol Psychother Theory Res Pract 2014;87(3): 298–310.CrossRefGoogle Scholar
Ladegaard, NLysaker, PHLarsen, ERVidebech, PA comparison of capacities for social cognition and metacognition in first episode and prolonged depression. Psychiatry Res 2014;220(3): 883–889.CrossRefGoogle ScholarPubMed
Tas, CBrown, ECEsen-Danaci, ALysaker, PHBrüne, MIntrinsic motivation and metacognition as predictors of learning potential in patients with remitted schizophrenia. J Psychiatr Res 2012;46(8): 1086–1092.CrossRefGoogle ScholarPubMed
Harrington, LLangdon, RSiegert, RJMcClure, JTheory of mind in schizophrenia: acritical review. Cognit Neuropsychiatry 2005;10:249–286.CrossRefGoogle Scholar
Langdon, RColtheart, MWard, PBCatts, SVDisturbed communication in schizophrenia: the role of poor pragmatics and poor mind-reading. Psychol Med 2002;32:1273–1284.CrossRefGoogle ScholarPubMed
Moher, DLiberati, ATetzlaff, JAltman, DGGrp, PPreferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med 2009;6(7):e1000097.CrossRefGoogle ScholarPubMed
Bell, MDLysaker, PHBeam-Goulet, JL, et al.Five-component model of schizophrenia: assessing the factorial invariance of the Positive and Negative Syndrome Scale. Psychiatry Res 1994;52(3): 295–303.CrossRefGoogle ScholarPubMed
Lysaker, PHErickson, MARinger, J, et al.Metacognition in schizophrenia: the relationship of mastery to coping, insight, self-esteem, social anxiety and various facets of neurocognition. Br J Clin Psychol 2011;50(4): 412–424.CrossRefGoogle ScholarPubMed
Lysaker, PHMcCormick, BPSnethen, G, et al.Metacognition and social function in schizophrenia: associations of mastery with functional skills competence. Schizophr Res 2011;131(1–3): 214–218.CrossRefGoogle ScholarPubMed
Luther, LFirmin, RLMinor, KS, et al.Metacognition deficits as a risk factor for prospective motivation deficits in schizophrenia spectrum disorders. Psychiatry Res 2016;245:172–178.CrossRefGoogle ScholarPubMed
Bo, SAbu-Akel, AKongerslev, MHaahr, UHBateman, AMentalizing mediates the relationship between psychopathy and type of aggression in schizophrenia. J Nerv Ment Dis 2014;202(1): 55–63.CrossRefGoogle Scholar
Abu-Akel, AHeinke, DGillespie, SMMitchell, IJBo, SMetacognitive impairments in schizophrenia are arrested at extreme levels of psychopathy: the cut-off effect. J Abnorm Psychol 2015;124(4): 1102–1109.CrossRefGoogle ScholarPubMed
Davis, LWEicher, ACLysaker, PHMetacognition as a predictor of therapeutic alliance over 26 weeks of psychotherapy in schizophrenia. Schizophr Res 2011;129(1): 85–90.CrossRefGoogle Scholar
Lipsey, MWWilson, DBPractical meta-analysis Thousand Oaks, California: SAGE Publications, Inc; 2001Google Scholar
Card, NAApplied meta-analysis for social science research New York, NY: Guilford Press; 2012Google Scholar
Hunter, JESchmidt, FLFixed effects vs. random effects meta-analysis models: implications for cumulative research knowledge. Int J Sel Assess 2000;8(4): 275–292.CrossRefGoogle Scholar
Borenstein, MHedges, LVHiggins, JPTRothstein, HRIntroduction to meta-analysis Wiltshire, UK: John Wiley & Sons, Ltd; 2009CrossRefGoogle Scholar
Higgins, JPThompson, SGDeeks, JJAltman, DGMeasuring inconsistency in meta-analyses. BMJ 2003;327:557–560.CrossRefGoogle ScholarPubMed
Huedo-Medina, TBSánchez-Meca, JMarín-Martínez, FBotella, JAssessing heterogeneity in meta-analysis: Q statistic or I 2 index?. Psychol Methods 2006;11:193–206.CrossRefGoogle ScholarPubMed
Minor, KSLysaker, PHNecessary, but not sufficient: links between neurocognition, social cognition and metacognition in schizophrenia are moderated by disorganized symptoms. Schizophr Res 2014;159:198–204.CrossRefGoogle Scholar
Suddendorf, TWhiten, AMental evolution and development: evidence for secondary representation in children, great apes and other animals. Psychol Bull 2001;127:629–650.CrossRefGoogle ScholarPubMed
Brüne, MTheory of mind and social competence in schizophrenia. Clin Neuropsychiatry 2006;3:132–138.Google Scholar
Salvatore, GDimaggio, GPopolo, RLysaker, PHDeficits in mind reading in stressful contexts and their relationships to social withdrawal symptoms in schizophrenia. Bull Menninger Clin 2008;72:189–207.CrossRefGoogle Scholar
James, AVHasson-Ohayon, IVohs, J, et al.Metacognition moderates the relationship between dysfunctional self-appraisal and social functioning in prolonged schizophrenia independent of psychopathology. Compr Psychiatry 2016;69:62–70.CrossRefGoogle ScholarPubMed
Vohs, JLLysaker, PHLiffick, E, et al.Metacognitive capacity as a predictor of insight in first-episode psychosis. J Nerv Ment Dis 2015;203:372–378.CrossRefGoogle ScholarPubMed
Hillis, JDLeonhardt, BLVohs, JL, et al.Metacognitive reflective and insight therapy for people in early phase of a schizophrenia spectrum disorder. J Clin Psychol 2015;71(2): 125–135.CrossRefGoogle ScholarPubMed
Arnon-Ribenfeld, NBloom, RAtzil-Slonim, DPeri, Tde Jong, SHasson-Ohayon, I Metacognitive Reflection and Insight Therapy (MERIT) among people with schizophrenia: lessons from two case studies. Am J Psychother 2017 [In press].CrossRefGoogle Scholar
Hasson-Ohayon, IKravetz, SLysaker, PHThe special challenges of psychotherapy with persons with psychosis: intersubjective metacognitive model of agreement and shared meaning. Clin Psychol Psychother 2017;24(2): 428–440.CrossRefGoogle ScholarPubMed
Buck, KDLysaker, PHAddressing metacognitive capacity in the psychotherapy for schizophrenia: a case study. Clin Case Stud 2009;8(6): 463–472.CrossRefGoogle Scholar
Hamm, JARenard, SBFogley, RL, et al.Metacognition and social cognition in schizophrenia: stability and relationship to concurrent and prospective symptom assessments. J Clin Psychol 2012;68(12): 1303–1312.CrossRefGoogle ScholarPubMed
Lysaker, PHErickson, MABuck, B, et al.Metacognition and social function in schizophrenia: associations over a period of five months. Cognit Neuropsychiatry 2011;16(3): 241–255.CrossRefGoogle Scholar
Snethen, GMcCormick, BPLysaker, PHPhysical activity and psychiatric symptoms in adults with schizophrenia spectrum disorders. J Nerv Ment Dis 2014;202(12): 845–852.CrossRefGoogle ScholarPubMed
Leonhardt, BLHamm, JABelanger, EALysaker, PHChildhood sexual abuse moderates the relationship of self-reflectivity with increased emotional distress in schizophrenia. Psychosis 2015;7(3): 195–205.CrossRefGoogle Scholar
Lysaker, PHKukla, MDubreucq, J, et al.Metacognitive deficits predict future levels of negative symptoms in schizophrenia controlling for neurocognition, affect recognition and self-expectation of goal attainment. Schizophr Res 2015;168(1–2):267–272.CrossRefGoogle ScholarPubMed
Luther, LFirmin, RLVohs, JLBuck, KDRand, KLLysaker, PHIntrinsic motivation as mediator between metacognitive deficits and impaired functioning in schizophrenia. Br J Clin Psychol 2016;55:332–347.CrossRefGoogle Scholar
Bo, SKongerslev, MDimaggio, GLysaker, PHAbu-Akel, AMetacognition and general functioning in patients with schizophrenia and a history of criminal behavior. Psychiatry Res 2015;225(3): 247–253.CrossRefGoogle Scholar
Trauelsen, AMGumley, AJansen, JEMetacognition in first-episode psychosis and its association with positive and negative symptom profiles. Psychiatry Res 2016;238:14–23.CrossRefGoogle ScholarPubMed
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