title: Metacognitive deficits predict future levels of negative symptoms in schizophrenia controlling for neurocognition, affect recognition, and self-expectation of goal attainment.
abstract: The recalcitrance of negative symptoms in the face of pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. Accordingly, this study investigated whether deficits in metacognition, or the ability to form integrated ideas about oneself, others, and the world, prospectively predicted levels of negative symptoms independent of deficits in neurocognition, affect recognition and defeatist beliefs. Participants were 53 adults with a schizophrenia spectrum disorder. Prior to entry into a rehabilitation program, all participants completed concurrent assessments of metacognition with the Metacognitive Assessment Scale-Abbreviated, negative symptoms with the Positive and Negative Syndrome Scale, neurocognition with the MATRICS battery, affect recognition with the Bell Lysaker Emotion Recognition Task, and one form of defeatist beliefs with the Recovery Assessment Scale. Negative symptoms were then reassessed one week, 9weeks, and 17weeks after entry into the program. A mixed effects regression model revealed that after controlling for baseline negative symptoms, a general index of neurocognition, defeatist beliefs and capacity for affect recognition, lower levels of metacognition predicted higher levels of negative symptoms across all subsequent time points. Poorer metacognition was able to predict later levels of elevated negative symptoms even after controlling for initial levels of negative symptoms. Results may suggest that metacognitive deficits are a risk factor for elevated levels of negative symptoms in the future. Clinical implications are also discussed.
authors.affiliation: Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA; Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA. Electronic address: plysaker@iupui.edu.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Lysaker
authors.affiliation: Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA; Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA. Electronic address: mkukla@iupui.edu.
authors.forename: Marina
authors.initials: M
authors.lastname: Kukla
authors.affiliation: Center of Reference for Psychosocial Rehabilitation, CH Alpes Isère, Grenoble, France; Réseau Handicap Psychique (RéHPsy), Grenoble, France. Electronic address: jdubreucq@ch-alpes-isere.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Dubreucq
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Gumley
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors.forename: Hamish
authors.initials: H
authors.lastname: McLeod
authors.affiliation: Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA; Prevention and Recovery Center for Early Psychosis, Midtown Community Mental Health Centers, Wishard Hospital, Indianapolis, IN, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA. Electronic address: jvohs@iupui.edu.
authors.forename: Jenifer L
authors.initials: JL
authors.lastname: Vohs
authors.affiliation: Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA. Electronic address: kelly.buck@va.gov.
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Buck
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA. Electronic address: ksminor@iupui.edu.
authors.forename: Kyle S
authors.initials: KS
authors.lastname: Minor
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA. Electronic address: lutherl@iupui.edu.
authors.forename: Lauren
authors.initials: L
authors.lastname: Luther
authors.affiliation: Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA. Electronic address: bethany.leonhardt@va.gov.
authors.forename: Bethany L
authors.initials: BL
authors.lastname: Leonhardt
authors.affiliation: School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, GH 109, Indianapolis, IN 46227, USA. Electronic address: belangere@uindy.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Belanger
authors.affiliation: Center for Metacognitive Interpersonal Therapy, via Ravenna 9/c, 00161, Rome, Italy. Electronic address: popoloraffaele@gmail.com.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Popolo
authors.affiliation: Center for Metacognitive Interpersonal Therapy, via Ravenna 9/c, 00161, Rome, Italy. Electronic address: gdimaje@libero.it.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Dimaggio
mesh_terms: D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D015928:Cognitive Behavioral Therapy; D004644:Emotions; D005260:Female; D006040:Goals; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D000067489:Metacognition; D008875:Middle Aged; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology* / Q000534:rehabilitation / Q000628:therapy; D021641:Recognition, Psychology; D012044:Regression Analysis; D012559:Schizophrenia / Q000175:diagnosis* / Q000534:rehabilitation / Q000628:therapy; D012565:Schizophrenic Psychology; D012649:Self Concept
keywords: Metacognition; Negative symptoms; Neurocognition; Recovery; Schizophrenia; Social cognition