Theta-burst transcranial magnetic stimulation to the prefrontal cortex impairs metacognitive visual awareness
Abstract
We used a recently developed protocol of transcranial magnetic stimulation (TMS), theta-burst stimulation, to bilaterally depress activity in the dorsolateral prefrontal cortex as subjects performed a visual discrimination task. We found that TMS impaired subjects' ability to discriminate between correct and incorrect stimulus judgments. Specifically, after TMS subjects reported lower visibility levels for correctly identified stimuli, as if they were less fully aware of the quality of their visual information processing. A signal detection theory analysis confirmed that the results reflect a change in metacognitive sensitivity, not just response bias. The effect was specific to metacognition; TMS did not change stimulus discrimination performance, ruling out alternative explanations such as TMS impairing visual attention. Together these results suggest that activations in the prefrontal cortex in brain imaging experiments on visual awareness are not epiphenomena, but rather may reflect a critical metacognitive process.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
It is probable that there are transformations available within the brain wherein or is fixed but oi varies.
“That is, it is probable that there are transformations (as in Equation (9)) available within the brain wherein or is fixed but oi varies.”
From Falsification and consciousness (2021) · cites this paper as Rounis et al. 2010
Noninvasive transcranial brain stimulation and lesions of the lateral PFC impair perceptual abilities under controlled task conditions.
“Such work would be particularly valuable in evaluating iES effects in light of studies showing that both noninvasive transcranial brain stimulation (Rounis et al., 2010) and lesions (Marinkovic et al., 2000;Del Cul et al., 2009;Fleming et al., 2014;Colas et al., 2019) of the lateral PFC impair perceptual abilities under controlled task conditions.”
From Does the Prefrontal Cortex Play an Essential Role in Consciousness? Insights from Intracranial Electrical Stimulation of the Human Brain (2021) · cites this paper as Rounis et al., 2010
Cites
Detection Theory: A User's Guide
Macmillan, N. A., & Creelman, C. D. (1991) · Cited by 5,415 · see citing works
Theta Burst Stimulation of the Human Motor Cortex
Huang, Y.-Z., Edwards, M. J., Rounis, E., Bhatia, K. P., & Rothwell, J. C. (2005) · Neuron · doi:10.1016/j.neuron.2004.12.033 · Cited by 4,158 · see citing works
Self-citationDetection theory: A user's guide
Lories, G. (1993) · Behavioural Processes · doi:10.1016/0376-6357(93)90083-4 · Cited by 2,927 · see citing works
Responses to rapid-rate transcranial magnetic stimulation of the human motor cortex
Pascual‐Leone, Á., Valls‐Solé, J., Wassermann, E. M., & Hallett, M. (1994) · Brain · doi:10.1093/brain/117.4.847 · Cited by 1,457 · see citing works
Detection theory: A user's guide, 2nd ed.
Macmillan, N. A., & Creelman, C. D. (2005) · Cited by 1,117 · see citing works
Are we aware of neural activity in primary visual cortex?
Crick, F., & Koch, C. (1995) · Nature · doi:10.1038/375121a0 · Cited by 932 · see citing works
Dehaene, S., Sergent, C., & Changeux, J.-P. (2003) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1332574100 · Cited by 838 · see citing works
Neural correlates of consciousness in humans
Rees, G., Kreiman, G., & Koch, C. (2002) · Nature Reviews Neuroscience · doi:10.1038/nrn783 · Cited by 742 · see citing works
A theory of implicit and explicit knowledge
Dienes, Z., & Perner, J. (1999) · Behavioral and Brain Sciences · doi:10.1017/s0140525x99002186 · Cited by 672 · see citing works
Indices of discrimination or diagnostic accuracy: Their ROCs and implied models.
Swets, J. A. (1986) · Psychological Bulletin · doi:10.1037/0033-2909.99.1.100 · Cited by 580 · see citing works
Relative blindsight in normal observers and the neural correlate of visual consciousness
Lau, H. C., & Passingham, R. E. (2006) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0607716103 · Cited by 518 · cited 4× · see citing works
“One possibility is that TMS reduced visibility for correct trials, which would amount to a kind of relative blindsight (Lau & Passingham, 2006).”
BackgroundMethodInfluentialSelf-citationConcurrent TMS-fMRI and Psychophysics Reveal Frontal Influences on Human Retinotopic Visual Cortex
Ruff, C. C., Blankenburg, F., Bjoertomt, O., Bestmann, S., Freeman, E., Haynes, J.-D., Rees, G., Josephs, O., Deichmann, R., & Driver, J. (2006) · Current Biology · doi:10.1016/j.cub.2006.06.057 · Cited by 514 · see citing works
Post-decision wagering objectively measures awareness
Persaud, N., McLeod, P., & Cowey, A. (2007) · Nature Neuroscience · doi:10.1038/nn1840 · Cited by 454 · see citing works
Consciousness lost and found: a neuropsychological exploration
(1998) · Choice Reviews Online · doi:10.5860/choice.35-3011 · Cited by 432 · see citing works
Galvin, S. J., Podd, J. V., Drga, V., & Whitmore, J. (2003) · Psychonomic Bulletin & Review · doi:10.3758/bf03196546 · Cited by 405 · see citing works
Transfer of metacognitive skills and hint seeking in monkeys
Kornell, N., Son, L. K., & Terrace, H. S. (2007) · Psychological Science · doi:10.1111/j.1467-9280.2007.01850.x · Cited by 341 · cited 1× · see citing works
“The first method followed previous studies (eg, Kolb & Braun, 1995 ; Kornell, Son, & Terrace, 2007 ) in using the correlation between accuracy and subjective rating as a measure of metacognitive sensitivity.”
MethodCausal role of prefrontal cortex in the threshold for access to consciousness
Del Cul, A., Dehaene, S., Reyes, P., Bravo, E., & Slachevsky, A. (2009) · Brain · doi:10.1093/brain/awp111 · Cited by 337 · see citing works
Effect of Physiological Activity on an NMDA-Dependent Form of Cortical Plasticity in Human
Huang, Y., Rothwell, J. C., Edwards, M. J., & Chen, R. S. (2007) · Cerebral Cortex · doi:10.1093/cercor/bhm087 · Cited by 320 · see citing works
Self-citationThe Neural Fate of Consciously Perceived and Missed Events in the Attentional Blink
Marois, R., Yi, D.-J., & Chun, M. M. (2004) · Neuron · doi:10.1016/s0896-6273(04)00012-1 · Cited by 306 · see citing works
Pattern of neuronal activity associated with conscious and unconscious processing of visual signals
Sahraie, A., Weiskrantz, L., Barbur, J. L., Simmons, A., Williams, S., & Brammer, M. J. (1997) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.94.17.9406 · Cited by 270 · see citing works
Exploring Theta Burst Stimulation as an intervention to improve motor recovery in chronic stroke
Talelli, P., Greenwood, R., & Rothwell, J. C. (2006) · Clinical Neurophysiology · doi:10.1016/j.clinph.2006.10.014 · Cited by 264 · see citing works
Self-citationMünchau, A. M., Bloem, B. R., Irlbacher, K., Trimble, M., & Rothwell, J. C. (2002) · Journal of Neuroscience · doi:10.1523/jneurosci.22-02-00554.2002 · Cited by 257 · see citing works
Self-citationVisual field defects after frontal eye-field lesions in monkeys
Latto, R., & Cowey, A. (1971) · Brain Research · doi:10.1016/0006-8993(71)90002-3 · Cited by 208 · see citing works
Blindsight in normal observers
Kolb, F. C., & Braun, J. (1995) · Nature · doi:10.1038/377336a0 · Cited by 198 · see citing works
Preserved Adjustment but Impaired Awareness in a Sensory-Motor Conflict following Prefrontal Lesions
Slachevsky, A., Pillon, B., Fourneret, P., Pradat-Diehl, P., Jeannerod, M., & Dubois, B. (2001) · Journal of Cognitive Neuroscience · doi:10.1162/08989290151137386 · Cited by 170 · see citing works
Grossheinrich, N., Rau, A., Pogarell, O., Hennig-Fast, K., Reinl, M., Karch, S., Dieler, A., Leicht, G., Mulert, C., Sterr, A., et al. (2009) · Biological Psychiatry · doi:10.1016/j.biopsych.2008.10.029 · Cited by 168 · see citing works
Transcranial magnetic stimulation of the human frontal eye field facilitates visual awareness
Grosbras, M., & Paus, T. (2003) · European Journal of Neuroscience · doi:10.1111/j.1460-9568.2003.03055.x · Cited by 167 · see citing works
Segregation of Areas Related to Visual Working Memory in the Prefrontal Cortex Revealed by rTMS
Mottaghy, F. M. (2002) · Cerebral Cortex · doi:10.1093/cercor/12.4.369 · Cited by 154 · see citing works
Theta-burst stimulation: Remote physiological and local behavioral after-effects
Stefan, K., Gentner, R., Zeller, D., Dang, S., & Claßen, J. (2007) · NeuroImage · doi:10.1016/j.neuroimage.2007.11.037 · Cited by 94 · see citing works
Fear perception: Can objective and subjective awareness measures be dissociated?
Szczepanowski, R., & Pessoa, L. (2007) · Journal of Vision · doi:10.1167/7.4.10 · Cited by 92 · see citing works
The role of the right dorsolateral prefrontal cortex in visual change awareness
Turatto, M., Sandrini, M., & Miniussi, C. (2004) · Neuroreport · doi:10.1097/00001756-200411150-00024 · Cited by 71 · see citing works
Rounis, E., Stephan, K. E., Lee, L., Siebner, H. R., Pesenti, A., Friston, K. J., Rothwell, J. C., & Frackowiak, R. S. J. (2006) · Journal of Neuroscience · doi:10.1523/jneurosci.2657-06.2006 · Cited by 67 · see citing works
Self-citationThe prefrontal cortex and conscious monitoring of action
Slachevsky, A., Pillon, B., Fourneret, P., Renié, L., Lévy, R., Jeannerod, M., & Dubois, B. (2003) · Neuropsychologia · doi:10.1016/s0028-3932(02)00225-7 · Cited by 55 · see citing works
Cortical areas in visual awareness
Pollen, D. A. (1995) · Nature · doi:10.1038/377293b0 · Cited by 37 · see citing works
Binocular switch suppression: A new method for persistently rendering the visible ‘invisible’
Arnold, D. H., Law, P. C. F., & Wallis, T. S. A. (2008) · Vision Research · doi:10.1016/j.visres.2008.01.020 · Cited by 26 · see citing works
Arfeller, C., Vonthein, R., Plontke, S. K., et al. (2009) · Trials · doi:10.1186/1745-6215-10-74 · Cited by 12 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Experimental and theoretical approaches to conscious processing
Dehaene, S., & Changeux, J.-P. (2011) · Neuron · doi:10.1016/j.neuron.2011.03.018 · Cited by 2,573 · see citing works
Fleming, S. M., & Lau, H. C. (2014) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2014.00443 · Cited by 1,386 · see citing works
“A closely related measure is the difference between meta-d′ and d′, i.e., meta-d′ − d′ (Rounis et al., 2010).”
Self-citationEmpirical support for higher-order theories of conscious awareness
Lau, H., & Rosenthal, D. (2011) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2011.05.009 · Cited by 869 · see citing works
Self-citationRelating Introspective Accuracy to Individual Differences in Brain Structure
Fleming, S. M., Weil, R. S., Nagy, Z., Dolan, R. J., & Rees, G. (2010) · Science · doi:10.1126/science.1191883 · Cited by 809 · see citing works
What is consciousness, and could machines have it?
Dehaene, S., Lau, H., & Kouider, S. (2017) · Science · doi:10.1126/science.aan8871 · Cited by 855 · see citing works
Self-citationThe neural basis of metacognitive ability
Fleming, S. M., & Dolan, R. J. (2012) · Philosophical Transactions of the Royal Society B: Biological Sciences · doi:10.1098/rstb.2011.0417 · Cited by 747 · see citing works
“role in representing confidence rather than monitoring for response errors [19].”
BackgroundMethodInfluentialDistilling the neural correlates of consciousness
Aru, J., Bachmann, T., Singer, W., & Melloni, L. (2012) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2011.12.003 · Cited by 589 · see citing works
Understanding the Higher-Order Approach to Consciousness
Brown, R., Lau, H., & LeDoux, J. E. (2019) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2019.06.009 · Cited by 573 · see citing works
Self-citationBoly, M., Massimini, M., Tsuchiya, N., Postle, B. R., Koch, C., & Tononi, G. (2017) · The Journal of Neuroscience · doi:10.1523/jneurosci.3218-16.2017 · Cited by 557 · see citing works
Prefrontal Contributions to Metacognition in Perceptual Decision Making
Fleming, S. M., Huijgen, J., & Dolan, R. J. (2012) · The Journal of Neuroscience · doi:10.1523/jneurosci.6489-11.2012 · Cited by 391 · see citing works
Toward a computational theory of conscious processing
Dehaene, S., Charles, L., King, J.-R., & Marti, S. (2014) · Current Opinion in Neurobiology · doi:10.1016/j.conb.2013.12.005 · Cited by 404 · see citing works
The role of metacognition in human social interactions
Frith, C. D. (2012) · Philosophical Transactions of the Royal Society B: Biological Sciences · doi:10.1098/rstb.2012.0123 · Cited by 407 · see citing works
The attentional requirements of consciousness
Cohen, M. A., Cavanagh, P., Chun, M. M., & Nakayama, K. (2012) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2012.06.013 · Cited by 370 · see citing works
The Border Between Seeing and Thinking
Block, N. (2023) · doi:10.1093/oso/9780197622223.001.0001 · Cited by 367 · see citing works
Baird, B., Smallwood, J., Gorgolewski, K. J., & Margulies, D. S. (2013) · The Journal of Neuroscience · doi:10.1523/jneurosci.0786-13.2013 · Cited by 315 · see citing works
Should a Few Null Findings Falsify Prefrontal Theories of Conscious Perception?
Odegaard, B., Knight, R. T., & Lau, H. (2017) · The Journal of Neuroscience · doi:10.1523/jneurosci.3217-16.2017 · Cited by 316 · see citing works
Self-citationBrain correlates of hypnosis: A systematic review and meta-analytic exploration
Landry, M., Lifshitz, M., & Raz, A. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.02.020 · Cited by 295 · see citing works
Distinct brain mechanisms for conscious versus subliminal error detection
Charles, L., Van Opstal, F., Marti, S., & Dehaene, S. (2013) · NeuroImage · doi:10.1016/j.neuroimage.2013.01.054 · Cited by 208 · see citing works
Causal evidence for frontal cortex organization for perceptual decision making
Rahnev, D., Nee, D. E., Riddle, J., Larson, A. S., & D’Esposito, M. (2016) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1522551113 · Cited by 200 · see citing works
Effects of cortical microstimulation on confidence in a perceptual decision
Fetsch, C. R., Kiani, R., Newsome, W. T., & Shadlen, M. N. (2014) · Neuron · doi:10.1016/j.neuron.2014.07.011 · Cited by 185 · see citing works
Human Metacognition Across Domains: Insights from Individual Differences and Neuroimaging
Rouault, M., McWilliams, A., Allen, M. G., & Fleming, S. M. (2018) · Personality Neuroscience · doi:10.1017/pen.2018.16 · Cited by 176 · see citing works
The signal processing architecture underlying subjective reports of sensory awareness
Maniscalco, B., & Lau, H. (2016) · Neuroscience of Consciousness · doi:10.1093/nc/niw002 · Cited by 133 · see citing works
Self-citationRelating inter-individual differences in metacognitive performance on different perceptual tasks
Song, C., Kanai, R., Fleming, S. M., Weil, R. S., Schwarzkopf, D. S., & Rees, G. (2011) · Consciousness and Cognition · doi:10.1016/j.concog.2010.12.011 · Cited by 158 · see citing works
Multivoxel neurofeedback selectively modulates confidence without changing perceptual performance
Cortese, A., Amano, K., Koizumi, A., Kawato, M., & Lau, H. (2016) · Nature Communications · doi:10.1038/ncomms13669 · Cited by 157 · see citing works
Self-citationMeasures of metacognition on signal-detection theoretic models
Barrett, A. B., Dienes, Z., & Seth, A. K. (2013) · Psychological Methods · doi:10.1037/a0033268 · Cited by 155 · see citing works
Integrating information in the brain's EM field: the cemi field theory of consciousness
McFadden, J. (2020) · Neuroscience of Consciousness · doi:10.1093/nc/niaa016 · Cited by 148 · see citing works
Bor, D., & Seth, A. K. (2012) · Frontiers in Psychology · doi:10.3389/fpsyg.2012.00063 · Cited by 143 · see citing works
Comparing Bayesian and non-Bayesian accounts of human confidence reports
Adler, W. T., & Ma, W. J. (2018) · PLoS Computational Biology · doi:10.1371/journal.pcbi.1006572 · Cited by 118 · see citing works
Persaud, N., Davidson, M., Maniscalco, B., Mobbs, D., Passingham, R. E., Cowey, A., & Lau, H. (2011) · NeuroImage · doi:10.1016/j.neuroimage.2011.06.081 · Cited by 139 · see citing works
Self-citationThe neural system of metacognition accompanying decision-making in the prefrontal cortex
Qiu, L., Su, J., Ni, Y., Bai, Y., Zhang, X., Li, X., & Wan, X. (2018) · PLOS Biology · doi:10.1371/journal.pbio.2004037 · Cited by 125 · see citing works
Human VMPFC encodes early signatures of confidence in perceptual decisions
Gherman, S., & Philiastides, M. G. (2018) · eLife · doi:10.7554/elife.38293 · Cited by 107 · see citing works
Understanding hypnosis metacognitively: rTMS applied to left DLPFC increases hypnotic suggestibility
Dienes, Z., & Hutton, S. (2013) · Cortex · doi:10.1016/j.cortex.2012.07.009 · Cited by 106 · see citing works
Raccah, O., Block, N., & Fox, K. C. R. (2021) · The Journal of Neuroscience · doi:10.1523/jneurosci.1141-20.2020 · Cited by 96 · see citing works
Consensus Goals in the Field of Visual Metacognition
Rahnev, D., Balsdon, T., Charles, L., de Gardelle, V., Denison, R., Desender, K., Faivre, N., Filevich, E., Fleming, S. M., Jehee, J., et al. (2022) · Perspectives on Psychological Science · doi:10.1177/17456916221075615 · Cited by 63 · see citing works
Self-citationCalibration in consciousness science
Michel, M. (2023) · Erkenntnis · doi:10.1007/s10670-021-00383-z · Cited by 62 · see citing works
Action information contributes to metacognitive decision-making
Wokke, M. E., Achoui, D., & Cleeremans, A. (2020) · Scientific Reports · doi:10.1038/s41598-020-60382-y · Cited by 56 · see citing works
Falsification and consciousness
Kleiner, J., & Hoel, E. (2021) · Neuroscience of Consciousness · doi:10.1093/nc/niab001 · Cited by 46 · see citing works
“This is particularly true once one allows for interventions on the human brain by experimenters, such as perturbations like transcranial magnetic stimulation, which is already used in consciousness research (Rounis et al. 2010; Napolitani et al. 2014).”
BackgroundFalsification and consciousness
Kleiner, J., & Hoel, E. (2020) · arXiv · doi:10.48550/arxiv.2004.03541 · Cited by 46
Concepts in the Brain: The View From Cross-linguistic Diversity
Kemmerer, D. (2019) · doi:10.1093/oso/9780190682620.001.0001 · Cited by 42 · see citing works
Barttfeld, P., Wicker, B., McAleer, P., Belin, P., Cojan, Y., Graziano, M., Leiguarda, R., & Sigman, M. (2013) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1301353110 · Cited by 41 · see citing works
Whyte, C. J. (2019) · Consciousness and Cognition · doi:10.1016/j.concog.2019.102763 · Cited by 35 · see citing works
Conscious Perception and the Prefrontal Cortex A Review
Michel, M. (2022) · Journal of Consciousness Studies · doi:10.53765/20512201.29.7.115 · Cited by 33 · see citing works
Natural statistics support a rational account of confidence biases
Webb, T. W., Miyoshi, K., So, T. Y., Rajananda, S., & Lau, H. (2023) · Nature Communications · doi:10.1038/s41467-023-39737-2 · Cited by 31 · see citing works
Self-citationYeon, J., Shekhar, M., & Rahnev, D. (2020) · Scientific Reports · doi:10.1038/s41598-020-77820-6 · Cited by 30 · see citing works
Kwok, S. C., Cai, Y., & Buckley, M. J. (2019) · The Journal of Neuroscience · doi:10.1523/jneurosci.0330-19.2019 · Cited by 28 · see citing works
Winter, C. J., & Peters, M. A. K. (2022) · Attention, Perception, & Psychophysics · doi:10.3758/s13414-021-02358-2 · Cited by 17 · see citing works
The higher-order view does not require consciously self-directed introspection: response to Malach
Lau, H., & Rosenthal, D. (2011) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2011.09.005 · Cited by 14 · see citing works
Self-citationKinds of Access: Different Methods for Report Reveal Different Kinds of Metacognitive Access
Overgaard, M., & Sandberg, K. (2014) · The Cognitive Neuroscience of Metacognition · doi:10.1007/978-3-642-45190-4_4 · Cited by 9 · see citing works
An embarrassment of richnesses: the PFC isn’t the content NCC
Kozuch, B. (2024) · Neuroscience of Consciousness · doi:10.1093/nc/niae017 · Cited by 9 · see citing works
- Authors
- Rounis, E., Maniscalco, B., Rothwell, J. C., Passingham, R. E., & Lau, H.
- Affiliations
- University College London (GB)
- Columbia University (US)
- University of Oxford (GB)
- Corresponding author
- Maniscalco, Brian
- Venue
- Cognitive Neuroscience
- Publisher
- Informa UK Limited
- Published
- 2010-08-18
- Volume
- 1
- Issue
- 3
- Pages
- 165-175
- ISSN
- 1758-8928 (ISSN-L)
- 1758-8936
- OpenAlex
- W2092722949
- Cited by
- 407
- References
- 36
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 17 · 2023: 60 · 2022: 22 · 2021: 27 · 2020: 30 · 2019: 32 · 2018: 30 · 2017: 30 · 2016: 30 · 2015: 27 · 2014: 28 · 2013: 15 · 2012: 21
- FWCI
- 9.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Cognitive Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Visual perception and processing mechanisms
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- theta-burst transcranial magnetic stimulation, dorsolateral prefrontal cortex, metacognition, visual awareness, metacognitive sensitivity, signal detection theory, visual discrimination, response bias
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
