Psychiatrically relevant signatures of domain-general decision-making and metacognition in the general population

Distorted learning from local metacognition supports transdiagnostic underconfidence

Individuals experiencing symptoms of anxiety and depression have been shown to exhibit persistent underconfidence. The origin of such metacognitive biases presents a puzzle, given that individuals should be able to learn appropriate levels of confidence from observing their own performance. In two large general population samples (N = 230 and N = 278), we measure both 'local' confidence in individual task instances and 'global' confidence as longer-run self-performance estimates while manipulating external feedback. Global confidence is sensitive to both local confidence and feedback valence-more frequent positive (negative) feedback increases (respectively decreases) global confidence, with asymmetries in feedback also leading to shifts in affective self-beliefs. Notably, however, global confidence exhibits reduced sensitivity to instances of higher local confidence in individuals with greater subclinical anxious-depression symptomatology, despite sensitivity to feedback valence remaining intact. Our finding of blunted sensitivity to increases in local confidence offers a mechanistic basis for how persistent underconfidence is maintained in the face of intact performance.

Domain-specific updating of metacognitive self-beliefs

Metacognitive self-monitoring is thought to be largely domain-general, with numerous prior studies providing evidence of a metacognitive g-factor. The observation of shared inter-individual variance across different measures of metacognition does not however preclude the possibility that some aspects may nevertheless be domain-specific. In particular, it is unknown the degree to which explicit metacognitive beliefs regarding one's own abilities may exhibit domain generality. Similarly, little is known about how such prior self-beliefs are maintained and updated in the face of new metacognitive experiences. In this study of 330 healthy individuals, we explored metacognitive belief updating across memory, visual, and general knowledge domains spanning nutritional and socioeconomic facts. We find that across all domains, participants strongly reduced their self-belief (i.e., expressed less confidence in their abilities) after completing a multi-domain metacognition test battery. Using psychological network and cross-correlation analyses, we further found that while metacognitive confidence exhibited strong domain generality, metacognitive belief updating was highly domain-specific, such that participants shifted their confidence specifically according to their performance on each domain. Overall, our findings suggest that metacognitive experiences prompt a shift in self-priors from a more general to a more specific focus.

Information search under uncertainty across transdiagnostic psychopathology and healthy ageing

When making decisions in everyday life, we often rely on an internally generated sense of confidence to help us revise and direct future behaviours. For instance, confidence directly informs whether further information should be sought prior to commitment to a final decision. Many studies have shown that aging and both clinical and sub-clinical symptoms of psychopathology are associated with systematic alterations in confidence. However, it remains unknown whether these confidence distortions influence information-seeking behaviour. We investigated this question in a large general population sample (N = 908). Participants completed a battery of psychiatric symptom questionnaires and performed a perceptual decision-making task with confidence ratings in which they were offered the option to seek helpful information (at a cost) before committing to a final decision. Replicating previous findings, an 'anxious-depression' (AD) symptom dimension was associated with systematically low confidence, despite no detriment in objective task accuracy. Conversely, a 'compulsive behaviour and intrusive thoughts' (CIT) dimension was associated with impaired task accuracy but paradoxical over-confidence. However, neither symptom dimension was significantly associated with an increased or decreased tendency to seek information. Hence, participants scoring highly for AD or CIT did not use the option to information seek any more than average to either increase their confidence (AD) or improve the accuracy of their decisions (CIT). In contrast, older age was associated with impaired accuracy and decreased confidence initially, but increased information seeking behaviour mediated increases in both accuracy and confidence for final decisions. Hence, older adults used the information seeking option to overcome initial deficits in objective performance and to increase their confidence accordingly. The results show an appropriate use of information seeking to overcome perceptual deficits and low confidence in healthy aging which was not present in transdiagnostic psychopathology.

Reliable, rapid, and remote measurement of metacognitive bias

Metacognitive biases have been repeatedly associated with transdiagnostic psychiatric dimensions of 'anxious-depression' and 'compulsivity and intrusive thought', cross-sectionally. To progress our understanding of the underlying neurocognitive mechanisms, new methods are required to measure metacognition remotely, within individuals over time. We developed a gamified smartphone task designed to measure visuo-perceptual metacognitive (confidence) bias and investigated its psychometric properties across two studies (N = 3410 unpaid citizen scientists, N = 52 paid participants). We assessed convergent validity, split-half and test-retest reliability, and identified the minimum number of trials required to capture its clinical correlates. Convergent validity of metacognitive bias was moderate (r(50) = 0.64, p < 0.001) and it demonstrated excellent split-half reliability (r(50) = 0.91, p < 0.001). Anxious-depression was associated with decreased confidence (β =  - 0.23, SE = 0.02, p < 0.001), while compulsivity and intrusive thought was associated with greater confidence (β = 0.07, SE = 0.02, p < 0.001). The associations between metacognitive biases and transdiagnostic psychiatry dimensions are evident in as few as 40 trials. Metacognitive biases in decision-making are stable within and across sessions, exhibiting very high test-retest reliability for the 100-trial (ICC = 0.86, N = 110) and 40-trial (ICC = 0.86, N = 120) versions of Meta Mind. Hybrid 'self-report cognition' tasks may be one way to bridge the recently discussed reliability gap in computational psychiatry.

Confidence biases in problem gambling

Background and aims

Subjective confidence plays an important role in guiding behaviour, especially when objective feedback is unavailable. Systematic misjudgements in confidence can foster maladaptive behaviours and have been linked to various psychiatric disorders. In this study, we adopted a transdiagnostic approach to examine confidence biases in problem gamblers across three levels: local decision confidence, global task performance confidence, and overall self-esteem. The importance of taking a transdiagnostic perspective is increasingly recognised, as it captures the dimensional nature of psychiatric symptoms that often cut across diagnostic boundaries. Accordingly, we investigated if any observed confidence biases could be explained by transdiagnostic symptom dimensions of Anxiety-Depression and Compulsive Behaviour and Intrusive Thought. This approach allows us to gain a more comprehensive understanding of the role of metacognitive processes in problem gambling, beyond the constraints of traditional diagnostic categories.

Methods

Thirty-eight problem gamblers and 38 demographically matched control participants engaged in a gamified metacognition task and completed self-report questionnaires assessing transdiagnostic symptom dimensions.

Results

Compared to controls, problem gamblers displayed significantly elevated confidence at the local decision and global task levels, independent of their actual task performance. This elevated confidence was observed even after controlling for the heightened symptom levels of Anxiety-Depression and Compulsive Behaviour and Intrusive Thought among the problem gamblers.

Discussion

The results reveal a notable disparity in confidence levels between problem gamblers and control participants, not fully accounted for by the symptom dimensions Anxiety-Depression and Compulsive Behaviour and Intrusive Thought. This suggests the contribution of other factors, perhaps linked to gambling-specific cognitive distortions, to the observed confidence biases.

Conclusion

The findings highlight the intricate link between metacognitive confidence and psychiatric symptoms in the context of problem gambling. It underscores the need for further research into metacognitive biases, which could enhance therapeutic approaches for individuals with psychiatric conditions.

Association of temporal discounting with transdiagnostic symptom dimensions

Temporal discounting (TD), the tendency to devalue future rewards as a function of delay until receipt, is aberrant in many mental disorders. Identifying symptom patterns and transdiagnostic dimensions associated with TD could elucidate mechanisms responsible for clinically impaired decision-making and facilitate identifying intervention targets. Here, we tested in a general population sample (N = 731) the extent to which TD was related to different symptom patterns and whether effects of time framing (dates/delay units) and monetary magnitude (large/small) had particularly strong effects in people scoring higher on specific symptom patterns. Analyses revealed that TD was related to symptom patterns loading on anxious-depression and inattention-impulsivity-overactivity dimensions. Moreover, TD was lower in the date than the delay version and with higher magnitudes, especially in people scoring higher on the inattention-impulsivity-overactivity dimension. Overall, this study provides evidence for TD as a transdiagnostic process across affective and impulsivity-related dimensions. Future studies should test framing interventions in clinical populations characterized by impulsivity.Preregistration: This research was preregistered at https://osf.io/fg9sc .

Differences in metacognitive functioning between obsessive-compulsive disorder patients and highly compulsive individuals from the general population

BACKGROUND

Our confidence, a form of metacognition, guides our behavior. Confidence abnormalities have been found in obsessive-compulsive disorder (OCD). A first notion based on clinical case-control studies suggests lower confidence in OCD patients compared to healthy controls. Contrarily, studies in highly compulsive individuals from general population samples showed that obsessive-compulsive symptoms related positively or not at all to confidence. A second notion suggests that an impairment in confidence estimation and usage is related to compulsive behavior, which is more often supported by studies in general population samples. These opposite findings call into question whether findings from highly compulsive individuals from the general population are generalizable to OCD patient populations.

METHODS

To test this, we investigated confidence at three hierarchical levels: local confidence in single decisions, global confidence in task performance and higher-order self-beliefs in 40 OCD patients (medication-free, no comorbid diagnoses), 40 controls, and 40 matched highly compulsive individuals from the general population (HComp).

RESULTS

In line with the first notion we found that OCD patients exhibited relative underconfidence at all three hierarchical levels. In contrast, HComp individuals showed local and global overconfidence and worsened metacognitive sensitivity compared with OCD patients, in line with the second notion.

CONCLUSIONS

Metacognitive functioning observed in a general highly compulsive population, often used as an analog for OCD, is distinct from that in a clinical OCD population, suggesting that OC symptoms in these two groups relate differently to (meta)cognitive processes. These findings call for caution in generalizing (meta)cognitive findings from general population to clinical samples.

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

BACKGROUND AND OBJECTIVES

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.

METHODS

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.

RESULTS

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.

LIMITATIONS

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.

CONCLUSIONS

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.

An observational treatment study of metacognition in anxious-depression

Prior studies have found metacognitive biases are linked to a transdiagnostic dimension of anxious-depression, manifesting as reduced confidence in performance. However, previous work has been cross-sectional and so it is unclear if under-confidence is a trait-like marker of anxious-depression vulnerability, or if it resolves when anxious-depression improves. Data were collected as part of a large-scale transdiagnostic, four-week observational study of individuals initiating internet-based cognitive behavioural therapy (iCBT) or antidepressant medication. Self-reported clinical questionnaires and perceptual task performance were gathered to assess anxious-depression and metacognitive bias at baseline and 4-week follow-up. Primary analyses were conducted for individuals who received iCBT (n=649), with comparisons between smaller samples that received antidepressant medication (n=82) and a control group receiving no intervention (n=88). Prior to receiving treatment, anxious-depression severity was associated with under-confidence in performance in the iCBT arm, replicating previous work. From baseline to follow-up, levels of anxious-depression were significantly reduced, and this was accompanied by a significant increase in metacognitive confidence in the iCBT arm (β=0.17, SE=0.02, p<0.001). These changes were correlated (r(647)=-0.12, p=0.002); those with the greatest reductions in anxious-depression levels had the largest increase in confidence. While the three-way interaction effect of group and time on confidence was not significant (F(2, 1632)=0.60, p=0.550), confidence increased in the antidepressant group (β=0.31, SE = 0.08, p<0.001), but not among controls (β=0.11, SE = 0.07, p=0.103). Metacognitive biases in anxious-depression are state-dependent; when symptoms improve with treatment, so does confidence in performance. Our results suggest this is not specific to the type of intervention.

History biases reveal novel dissociations between perceptual and metacognitive decision-making

Human decision-making and self-reflection often depend on context and internal biases. For instance, decisions are often influenced by preceding choices, regardless of their relevance. It remains unclear how choice history influences different levels of the decision-making hierarchy. We used analyses grounded in information and detection theories to estimate the relative strength of perceptual and metacognitive history biases and to investigate whether they emerge from common/unique mechanisms. Although both perception and metacognition tended to be biased toward previous responses, we observed novel dissociations that challenge normative theories of confidence. Different evidence levels often informed perceptual and metacognitive decisions within observers, and response history distinctly influenced first- (perceptual) and second- (metacognitive) order decision-parameters, with the metacognitive bias likely to be strongest and most prevalent in the general population. We propose that recent choices and subjective confidence represent heuristics, which inform first- and second-order decisions in the absence of more relevant evidence.

Depressive Symptoms are Associated with More Negative Global Metacognitive Biases in Combat Veterans, and Biases Covary with Symptom Changes over Time

Metacognitive awareness, insight into one's abilities, is thought to be disrupted in depression and posttraumatic stress disorder (PTSD), with more negative metacognitive biases and reduced awareness, respectively. However, studies have rarely examined global aspects of metacognitive awareness in depression and PTSD, instead using task-specific measures. In 467 trauma-exposed post-9/11 veterans, we administered assessments of PTSD and depression, self-report and objective measures of cognitive functioning (neuropsychological battery of memory, attention, and executive function measures), and self-report and objective measures of general health (index of five cardiometabolic factors). We used self-report/objective correlations to measure metacognitive sensitivity and 'self-report minus objective' scores to measure bias. We also examined associations between changes in metacognitive awareness and changes in PTSD and depression over time. Metacognitive sensitivity was comparable between individuals with and without PTSD and depression. However, metacognitive bias was significantly more negative in those with greater depressive symptoms (i.e., underconfidence) across cognition and health, independent of PTSD symptoms. Notably, metacognitive bias changes covaried with depressive and PTSD symptom changes two years later. This shows that, in trauma-exposed veterans, negative metacognitive biases are specifically related to depressive symptoms and these biases may be relatively domain general. Further, our longitudinal results suggest that, rather than being a stable trait, metacognitive biases change with PTSD/depressive symptoms over time.