Metacognitive monitoring in schizotypy: Systematic literature review and new empirical data

• Published in: Journal of behavior therapy and experimental psychiatry Vol. 81; p. 101891
• Main Authors: Lehmann, Mirko, Ettinger, Ulrich
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.12.2023
• Subjects: Confidence; Metacognition; Psychopathology; Psychosis; Schizophrenia; Self-monitoring; Psychosis; Schizophrenia; Self-monitoring; Psychopathology; Confidence; Metacognition
• ISSN: 0005-7916; 1873-7943
• DOI: 10.1016/j.jbtep.2023.101891

Deficits in metacognition, the ability to monitor one's own mental states, are key elements of the functional pathology of schizophrenia spectrum disorders. Little is known, however, about the integrity of metacognitive processes in subclinical schizotypy. The purpose of the present investigation was two-fold: First, we conducted a preregistered, systematic literature review to synthesize previous research efforts on the role of metacognition in schizotypy. Second, we investigated the relationship between self-reported dimensions of schizotypy and psychometric as well as behavioral measures of metacognition in a preregistered online study. A large sample (N = 330) completed a questionnaire battery and an episodic memory experiment; task-based metacognition was tapped via trial-by-trial confidence ratings. In keeping with findings from our literature review, higher schizotypy was associated with diminished introspective insight and an overly self-referential and maladaptive metacognitive style in metacognition questionnaires. Importantly, low task-based metacognitive efficiency was predictive of high levels of cognitive disorganization, whereas task-related overconfidence (i.e., increased metacognitive bias) was linked with positive schizotypy. Due to the comparatively small number of k = 20 studies meeting our inclusion criteria, the systematic literature review provides only preliminary indications for potential conclusions. Furthermore, control over potential disturbing influences in the experimental study was limited due to its online format. Overall, we provide evidence for specific metacognitive deficits in schizotypy and discuss a potential continuity of preserved and impaired aspects of metacognitive monitoring along the psychosis continuum. •We investigated the role of metacognitive processes in subclinical schizotypy.•We combined a systematic literature review with an experimental study.•Schizotypy was associated with less clarity of insight and a self-referential style.•Behaviorally assessed metacognitive efficiency predicted cognitive disorganization.