Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

A review compares three research fields—metacognition, social cognition, and mentalizing—to determine whether metacognitive research offers unique insight into psychosis. The authors argue that metacognition, as defined by the integrated model, can quantify activities whose impairment may cause subjective disturbances in psychosis. They distinguish metacognition from the other fields in experimental procedures, theoretical advances, and clinical applications. Metacognitive research uniquely describes an architecture that, when compromised in psychosis, leads to loss of purpose, possibilities, place in the world, and self-coherence. Repairing this architecture may promote recovery of a coherent sense of self and others, with implications for recovery-oriented treatment.

Study at a glance

Abstract

Research using the integrated model of metacognition has suggested that the construct of metacognition could quantify the spectrum of activities that, if impaired, might cause many of the subjective disturbances found in psychosis. Research on social cognition and mentalizing in psychosis, however, has also pointed to underlying deficits in how persons make sense of their experience of themselves and others. To explore the question of whether metacognitive research in psychosis offers unique insight in the midst of these other two emerging fields, we have offered a review of the constructs and research from each field. Following that summary, we discuss ways in which research on metacognition may be distinguished from research on social cognition and mentalizing in three broad categories: (1) experimental procedures, (2) theoretical advances, and (3) clinical applications or indicated interventions. In terms of its research methods, we will describe how metacognition makes a unique contribution to understanding disturbances in how persons make sense of and interpret their own experiences within the flow of life. We will next discuss how metacognitive research in psychosis uniquely describes an architecture which when compromised – as often occurs in psychosis – results in the loss of persons’ sense of purpose, possibilities, place in the world and cohesiveness of self. Turning to clinical issues, we explore how metacognitive research offers an operational model of the architecture which if repaired or restored should promote the recovery of a coherent sense of self and others in psychosis. Finally, we discuss the concrete implications of this for recovery-oriented treatment for psychosis as well as the need for further research on the commonalities of these approaches.