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.
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We found associations of metacognitive deficits with negative symptoms and impaired processes discussed above.
“We also found associations of metacognitive deficits with negative symptoms and impaired processes discussed above (91).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [91]
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“We also found associations of metacognitive deficits with negative symptoms and impaired processes discussed above (91).”
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Frileux, S., Faivre, N., Urbach, M., Vidal, N., Bottemanne, H., Berna, F. S., Belmonte, C., Boyer, L., Capdevielle, D., Clauss, J. M. E., et al. (2025) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2025.152622 · Cited by 1 · see citing works
Self-citationMetacognitive and Related Approaches in the Treatment of Schizophrenia-Spectrum Disorders
Fiszdon, J. M., Martin, A. M. S., & Kurtz, M. M. (2025) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-061724-085601 · Cited by 2 · see citing works
Granato, G., Mattera, A., Cartoni, E., & Baldassarre, G. (2026) · Scientific Reports · doi:10.1038/s41598-026-37612-w · Cited by 2 · see citing works
Blindness of intentions and metacognitive deficits during moral judgements in schizophrenia
Cyrkot, T., Ramsey, D. J., Wójta-Kempa, M., Misiak, B., & Szczepanowski, R. (2024) · Advances in Clinical and Experimental Medicine · doi:10.17219/acem/175918 · Cited by 1 · see citing works
Déstigmatiser grâce à la remédiation cognitive
Dubreucq, J., Gabayet, F., & Lucas, T. (2016) · Elsevier eBooks · doi:10.1016/b978-2-294-74526-3.00010-3
Self-citationRéduire l'autostigmatisation et les symptômes négatifs par la remédiation cognitive
Dubreucq, J., Gabayet, F., Lucas, T., Mélis, F., & Faraldo, M. (2018) · Elsevier eBooks · doi:10.1016/b978-2-294-75915-4.00084-0
Self-citationDavis, B. J. (2020) · Purdue e-Pubs (Purdue University System) · doi:10.25394/pgs.12689606
Recovering from Substance Misuse: The Role of Mastery and Unity Revealed through the‘Life as a Film’
Rowlands, D. J. (2019) · University of Huddersfield Repository (University of Huddersfield)
Lysaker, P. H., & Wiesepape, C. N. (2023) · Springer eBooks · doi:10.1007/978-3-031-41788-7_8
Self-citationShen, L., Yan, J., Xiao, W., Sun, L., Du, M., & He, Y. (2025) · Psychology Research and Behavior Management · doi:10.2147/prbm.s548616
Swanson, L., Rask, B., Persson, J., Graner, P., Bengtsson, J., Bodén, R., Cernvall, M., Sällström, U., Tyrberg, M. J., Möritz, S., et al. (2026) · Trials · doi:10.1186/s13063-026-09879-x
- Authors
- Lysaker, P. H., Kukla, M., Dubreucq, J., Gumley, A., McLeod, H., Vohs, J. L., Buck, K. D., Minor, K. S., Luther, L., Leonhardt, B. L., Belanger, E. A., Popolo, R., & Dimaggio, G.
- Affiliations
- Richard L. Roudebush VA Medical Center (US)
- University of Glasgow (GB)
- Indiana University Hospital (US)
- Indiana University – Purdue University Indianapolis (US)
- Indiana University School of Medicine (US)
- University of Indianapolis (US)
- Centro di Terapia Metacognitiva Interpersonale (IT)
- Corresponding author
- Lysaker, Paul H.
- ORCID
- Venue
- Schizophrenia Research
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 168
- Issue
- 1-2
- Pages
- 267-272
- ISSN
- 0920-9964 (ISSN-L)
- OpenAlex
- W1958323847
- Cited by
- 47
- References
- 59
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 5 · 2019: 6 · 2018: 6 · 2017: 6 · 2016: 4
- FWCI
- 4.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Schizophrenia Research (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Funders
- Veterans Administration Rehabilitation Research and Development Service (D 6629R)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- metacognition, negative symptoms
- MeSH terms
- Metacognition, Cognition Disorders, Emotions, Female, Goals, Humans, Interview, Psychological, Male, Middle Aged, Prognosis, Psychiatric Status Rating Scales, Psychological Tests, Psychotic Disorders, Regression Analysis, Schizophrenia, Schizophrenic Psychology, Self Concept, Cognitive Behavioral Therapy, Recognition, Psychology
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