CB Metacognition 2024 Lecture Notes PDF

University of the Year for Student Experience (The Times/Sunday Times Good University Guide 2020) Metacognition Dr Chris Benwell 2024 dundee.ac.uk...

University of the Year for Student Experience (The Times/Sunday Times Good University Guide 2020) Metacognition Dr Chris Benwell 2024 dundee.ac.uk Page 1 Metacognition - Lecture Series 1. Introduction to metacognition 2. Measuring metacognition 3. Metacognition and psychopathology 4. Metacognition and belief structures 5. Neural correlates of metacognition 6. Evolution and metacognition in other species 7. Presentations/discussions 8. Metacognition and consciousness 9. Improving metacognition 10. The limits of self-knowledge dundee.ac.uk Page 2 Metacognition – Assessment Level 4 Coursework: 1 x 2500 word assignment due on Wednesday November 13th. We will dedicate part of the session in week 6 (beginning 21/10)) to preparation for the assignment. Level 4 Exam: 2 hour, on-campus exam at end of semester. Worth 60% of module grade. Level 5 Coursework: 2 x 2500 word assignments, each worth 50% of the module grade: 1st assignment due: Friday 15th November (12 noon) 2nd assignment due: Friday 29th November (12 noon) dundee.ac.uk Page 3 What to study? (1) Lecture notes (2) I will upload relevant papers for each lecture to the module page on MyDundee. (3) Any questions/concerns: [email protected] dundee.ac.uk Page 4 Metacognition and Psychopathology In recent years there has been increasing understanding that metacognitive deficits play a key role in various psychiatric and neurological disorders. dundee.ac.uk Page 5 Metacognition and Psychopathology In recent years there has been increasing understanding that metacognitive deficits play a key role in various psychiatric and neurological disorders. The types of metacognitive deficits are multi-faceted, spanning multiple levels of abstraction: → Lack of general awareness that one has a disorder dundee.ac.uk Page 6 Metacognition and Psychopathology In recent years there has been increasing understanding that metacognitive deficits play a key role in various psychiatric and neurological disorders. The types of metacognitive deficits are multi-faceted, spanning multiple levels of abstraction: → Lack of general awareness that one has a disorder → More specific lack of awareness of specific symptoms/deficits dundee.ac.uk Page 7 Metacognition and Psychopathology In recent years there has been increasing understanding that metacognitive deficits play a key role in various psychiatric and neurological disorders. The types of metacognitive deficits are multi-faceted, spanning multiple levels of abstraction: → Lack of general awareness that one has a disorder → More specific lack of awareness of specific symptoms/deficits → Generally impaired self-evaluation, related to cognitive processes in general, not just those related to the disorder. dundee.ac.uk Page 8 Anosognosia and lack of insight In neuropsychiatry, the terms ‘anosognosia’ and ‘lack of awareness/insight’ are often used synonymously to describe a collection of attitudes and behaviours directed at one's illness. dundee.ac.uk Page 9 Anosognosia and lack of insight In neuropsychiatry, the terms ‘anosognosia’ and ‘lack of awareness/insight’ are often used synonymously to describe a collection of attitudes and behaviours directed at one's illness. → Stroke and other forms of traumatic brain injury (i.e., inability to recognise motor, speech or visual deficits) dundee.ac.uk Page 10 Anosognosia and lack of insight In neuropsychiatry, the terms ‘anosognosia’ and ‘lack of awareness/insight’ are often used synonymously to describe a collection of attitudes and behaviours directed at one's illness. → Stroke and other forms of traumatic brain injury (i.e., inability to recognise motor, speech or visual deficits) dundee.ac.uk Page 11 Anosognosia and lack of insight In neuropsychiatry, the terms ‘anosognosia’ and ‘lack of awareness/insight’ are often used synonymously to describe a collection of attitudes and behaviours directed at one's illness. → Stroke and other forms of traumatic brain injury (i.e., inability to recognise motor, speech or visual deficits) → Post-traumatic stress disorder dundee.ac.uk Page 12 Anosognosia and lack of insight In neuropsychiatry, the terms ‘anosognosia’ and ‘lack of awareness/insight’ are often used synonymously to describe a collection of attitudes and behaviours directed at one's illness. → Stroke and other forms of traumatic brain injury (i.e., inability to recognise motor, speech or visual deficits) → Post-traumatic stress disorder → Alzheimer’s disease (particularly recognition of memory deficits) dundee.ac.uk Page 13 Lack of insight in schizophrenia Metacognitive deficits are particularly salient in schizophrenia (see David et al., 2012 for a review) dundee.ac.uk Page 14 Lack of insight in schizophrenia Metacognitive deficits are particularly salient in schizophrenia (see David et al., 2012 for a review) → Inability to recognise illness dundee.ac.uk Page 15 Lack of insight in schizophrenia Metacognitive deficits are particularly salient in schizophrenia (see David et al., 2012 for a review) → Inability to recognise illness → Once seen as an essential symptom (but more nuanced view now) dundee.ac.uk Page 16 Lack of insight in schizophrenia Metacognitive deficits are particularly salient in schizophrenia (see David et al., 2012 for a review) → Inability to recognise illness → Once seen as an essential symptom (but more nuanced view now) → Compliance with treatment and effects of medication. dundee.ac.uk Page 17 Lack of insight in schizophrenia Metacognitive deficits are particularly salient in schizophrenia (see David et al., 2012 for a review) → Inability to recognise illness → Once seen as an essential symptom (but more nuanced view now) → Compliance with treatment and effects of medication. → Attribution of symptoms to illness dundee.ac.uk Page 18 Lack of insight in schizophrenia Metacognitive deficits are particularly salient in schizophrenia (see David et al., 2012 for a review) → Inability to recognise illness → Once seen as an essential symptom (but more nuanced view now) → Compliance with treatment and effects of medication. → Attribution of symptoms to illness → Dissociation of hallucinatory experiences and delusions from reality dundee.ac.uk Page 19 Lack of insight in schizophrenia Metacognitive deficits are particularly salient in schizophrenia (see David et al., 2012 for a review) → Insight can be preserved into some domains, whilst being impaired regarding others dundee.ac.uk Page 20 Lack of insight in schizophrenia Metacognitive deficits are particularly salient in schizophrenia (see David et al., 2012 for a review) → Insight can be preserved into some domains, whilst being impaired regarding others dundee.ac.uk Page 21 Lack of insight in other psychiatric disorders → Addiction → Individuals with low insight into addiction are known to overestimate their capacity to quit by themselves or control their use (Rinn et al., 2002) dundee.ac.uk Page 22 Lack of insight in other psychiatric disorders → Addiction → Individuals with low insight into addiction are known to overestimate their capacity to quit by themselves or control their use (Rinn et al., 2002) → Bipolar disorder (Crișan, 2018) → Often particularly poor insight during manic phases. → Negatively impacts treatment adherence. dundee.ac.uk Page 23 Lack of insight in other psychiatric disorders → Addiction → Individuals with low insight into addiction are known to overestimate their capacity to quit by themselves or control their use (Rinn et al., 2002) → Bipolar disorder (Crișan, 2018) → Often particularly poor insight during manic phases. → Negatively impacts treatment adherence. → Personality disorders dundee.ac.uk Page 24 Lack of insight in other psychiatric disorders → Addiction → Individuals with low insight into addiction are known to overestimate their capacity to quit by themselves or control their use (Rinn et al., 2002) → Bipolar disorder (Crișan, 2018) → Often particularly poor insight during manic phases. → Negatively impacts treatment adherence. → Personality disorders → Anorexia → Lack of insight related to distorted cognitions about body weight and shape and ambivalence about and variability in motivation to recover (Gorwood et al., 2019) dundee.ac.uk Page 25 Insight as a mixed blessing → Having more insight into disorders is sometimes positively correlated with low mood/depression (David et al., 2012) dundee.ac.uk Page 26 Insight as a mixed blessing → Having more insight into disorders is sometimes positively correlated with low mood/depression (David et al., 2012) → However, across many disorders, insight has been shown to improve treatment adherence and long-term outcomes (David et al., 2012). dundee.ac.uk Page 27 Depressive realism → Hypothesis that depressed individuals make more realistic inferences about themselves and the world than non-depressed individuals (Alloy and Abramson, 1988). dundee.ac.uk Page 28 Depressive realism → Hypothesis that depressed individuals make more realistic inferences about themselves and the world than non-depressed individuals (Alloy and Abramson, 1988). → In contrast to Aaron Beck’s negativity hypothesis (1967), which suggests that depressed individuals evaluate themselves in an overly negative way. dundee.ac.uk Page 29 Depressive realism → Hypothesis that depressed individuals make more realistic inferences about themselves and the world than non-depressed individuals (Alloy and Abramson, 1988). → In contrast to Aaron Beck’s negativity hypothesis (1967), which suggests that depressed individuals evaluate themselves in an overly negative way. → Evidence is mixed at best. Difficulty in establishing ground-truth for many real-life situations and characteristics. dundee.ac.uk Page 30 Depressive realism → Hypothesis that depressed individuals make more realistic inferences about themselves and the world than non-depressed individuals (Alloy and Abramson, 1988). → In contrast to Aaron Beck’s negativity hypothesis (1967), which suggests that depressed individuals evaluate themselves in an overly negative way. → Evidence is mixed at best. Difficulty in establishing ground-truth for many real-life situations and characteristics. → It may sometimes be beneficial for our well-being to see ourselves (and the world) as they are, other times it may not be. dundee.ac.uk Page 31  Any questions? dundee.ac.uk Page 32 dundee.ac.uk Abnormalities of confidence → Generally impaired self-evaluation, related to cognitive processes in general, not just those related to the disorder. dundee.ac.uk Page 34 Abnormalities of confidence → Generally impaired self-evaluation, related to cognitive processes in general, not just those related to the disorder. Hoven et al., (2019) reviewed literature of deficits in confidence (and relationships between confidence and objective performance) associated with psychiatric symptoms. dundee.ac.uk Page 35 Abnormalities of confidence → Generally impaired self-evaluation, related to cognitive processes in general, not just those related to the disorder. Hoven et al., (2019) reviewed literature of deficits in confidence (and relationships between confidence and objective performance) associated with psychiatric symptoms. The authors hypothesized that “a dysfunction of confidence may be at the root of psychiatric symptoms either expressed sub- clinically in the general population or clinically in the patient population”. dundee.ac.uk Page 36 Abnormalities of confidence dundee.ac.uk Page 37 Abnormalities of confidence Strongest evidence found for → ↓ overall confidence in OCD across multiple cognitive domains → ↓ metacognitive sensitivity in schizophrenia: driven particularly by inflated confidence in errors Suggestive evidence found for → ↑ overall confidence and ↓ metacognitive sensitivity in addiction → ↓ overall confidence in depression and anxiety dundee.ac.uk Page 38 Transdiagnostic abnormalities of confidence → Transdiagnostic psychiatry is an emerging scientific field which attempts to decipher the cognitive, affective and neurobiological processes underlying complex behaviour by relating them to symptom dimensions. dundee.ac.uk Page 39 Transdiagnostic abnormalities of confidence → Transdiagnostic psychiatry is an emerging scientific field which attempts to decipher the cognitive, affective and neurobiological processes underlying complex behaviour by relating them to symptom dimensions. → Since this approach transcends traditional diagnostic categories, it has the potential to refine the current nosology-based clinical classifications beyond the classical Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria. dundee.ac.uk Page 40 Transdiagnostic abnormalities of confidence → Transdiagnostic psychiatry is an emerging scientific field which attempts to decipher the cognitive, affective and neurobiological processes underlying complex behaviour by relating them to symptom dimensions. → Since this approach transcends traditional diagnostic categories, it has the potential to refine the current nosology-based clinical classifications beyond the classical Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria. → The underlying idea of this approach is that cognitive and brain-related functions (e.g., those relating to confidence processing) might map more closely onto symptomatology than DSM diagnoses. dundee.ac.uk Page 41 Transdiagnostic abnormalities of confidence Rouault et al., (2018) set out to investigate relationships between transdiagnostic symptom dimensions and both metacognitive bias and sensitivity. dundee.ac.uk Page 42 Transdiagnostic abnormalities of confidence Rouault et al., (2018) set out to investigate relationships between transdiagnostic symptom dimensions and both metacognitive bias and sensitivity. 2 online experiments (total N = 995) dundee.ac.uk Page 43 Transdiagnostic abnormalities of confidence Rouault et al., (2018) set out to investigate relationships between transdiagnostic symptom dimensions and both metacognitive bias and sensitivity. dundee.ac.uk Page 44 Transdiagnostic abnormalities of confidence Rouault et al., (2018) set out to investigate relationships between transdiagnostic symptom dimensions and both metacognitive bias and sensitivity. dundee.ac.uk Page 45  Metacognition and sub-clinical psychopathology → We attempted to replicate and extend findings of the Rouault et al., (2018) study. Benwell et al., (2022), Npj Mental Health Research dundee.ac.uk Page  Metacognition and sub-clinical psychopathology → We attempted to replicate and extend findings of the Rouault et al., (2018) study. → 2 online experiments (total N = 817) Benwell et al., (2022), Npj Mental Health Research dundee.ac.uk Page  Metacognition and sub-clinical psychopathology → We attempted to replicate and extend findings of the Rouault et al., (2018) study. → 2 online experiments (total N = 817) Low confidence High confidence Benwell et al., (2022), Npj Mental Health Research dundee.ac.uk Page  Metacognition and sub-clinical psychopathology → We attempted to replicate and extend findings of the Rouault et al., (2018) study. → 2 online experiments (total N = 817) Low confidence High confidence → Results extended to 2-AFC general knowledge task. Benwell et al., (2022), Npj Mental Health Research dundee.ac.uk Page  Metacognition and sub-clinical psychopathology → We attempted to replicate and extend findings of the Rouault et al., (2018) study. → 2 online experiments (total N = 817) Low confidence High confidence → Results extended to 2-AFC general knowledge task. → Bias effects replicated, efficiency effects did not. Benwell et al., (2022), Npj Mental Health Research dundee.ac.uk Page Transdiagnostic abnormalities of confidence dundee.ac.uk Page 51 Transdiagnostic abnormalities of confidence → Dissociable decision-making and confidence signatures relate to distinct symptom dimensions. Compulsivity and intrusive thoughts are associated with reduced objective accuracy but, paradoxically, increased absolute confidence, whereas a dimension characterized by anxiety and depression is associated with systematically low confidence in the absence of impairments in objective accuracy. dundee.ac.uk Page 52 Transdiagnostic abnormalities of confidence → Dissociable decision-making and confidence signatures relate to distinct symptom dimensions. Compulsivity and intrusive thoughts are associated with reduced objective accuracy but, paradoxically, increased absolute confidence, whereas a dimension characterized by anxiety and depression is associated with systematically low confidence in the absence of impairments in objective accuracy. → These relationships replicated across studies and distinct cognitive domains (perception and general knowledge), suggesting that they are reliable and domain general. dundee.ac.uk Page 53 Transdiagnostic abnormalities of confidence → Dissociable decision-making and confidence signatures relate to distinct symptom dimensions. Compulsivity and intrusive thoughts are associated with reduced objective accuracy but, paradoxically, increased absolute confidence, whereas a dimension characterized by anxiety and depression is associated with systematically low confidence in the absence of impairments in objective accuracy. → These relationships replicated across studies and distinct cognitive domains (perception and general knowledge), suggesting that they are reliable and domain general. → Whereas Big-5 personality traits also predicted objective task performance, only symptom dimensions related to subjective confidence. dundee.ac.uk Page 54 Transdiagnostic abnormalities of confidence → Dissociable decision-making and confidence signatures relate to distinct symptom dimensions. Compulsivity and intrusive thoughts are associated with reduced objective accuracy but, paradoxically, increased absolute confidence, whereas a dimension characterized by anxiety and depression is associated with systematically low confidence in the absence of impairments in objective accuracy. → These relationships replicated across studies and distinct cognitive domains (perception and general knowledge), suggesting that they are reliable and domain general. → Whereas Big-5 personality traits also predicted objective task performance, only symptom dimensions related to subjective confidence. → The results implicate confidence as a central component of mental health. dundee.ac.uk Page 55 A note on implications for depressive realism dundee.ac.uk Page 56  Next week Metacognition and belief structures dundee.ac.uk Page 57 dundee.ac.uk What to study? References Benwell, C. S., Mohr, G., Wallberg, J., Kouadio, A., & Ince, R. A. (2022). Psychiatrically relevant signatures of domain-general decision-making and metacognition in the general population. npj Mental Health Research, 1(1), 1-17. Crișan, C. A. (2018). Lack of insight in bipolar disorder: the impact on treatment adherence, adverse clinical outcomes and quality of life. Psychotic Disorders-An Update. David, A. S., Bedford, N., Wiffen, B., & Gilleen, J. (2012). Failures of metacognition and lack of insight in neuropsychiatric disorders. Philosophical Transactions of the Royal Society B: Biological Sciences, 367(1594), 1379-1390. Gorwood, P., Duriez, P., Lengvenyte, A., Guillaume, S., & Criquillion, S. (2019). Clinical insight in anorexia nervosa: Associated and predictive factors. Psychiatry Research, 281, 112561. Hoven, M., Lebreton, M., Engelmann, J. B., Denys, D., Luigjes, J., & van Holst, R. J. (2019). Abnormalities of confidence in psychiatry: an overview and future perspectives. Translational psychiatry, 9(1), 1-18. Rinn, W., Desai, N., Rosenblatt, H., & Gastfriend, D. R. (2002). Addiction denial and cognitive dysfunction: a preliminary investigation. The Journal of neuropsychiatry and clinical neurosciences, 14(1), 52-57. Rouault, M., Seow, T., Gillan, C. M., & Fleming, S. M. (2018). Psychiatric symptom dimensions are associated with dissociable shifts in metacognition but not task performance. Biological psychiatry, 84(6), 443-451. dundee.ac.uk Page 59