Metacognition in Individuals With Psychosis

Metacognition has only received significant attention within the field of psychosis during the last 2 decades. With this burgeoning interest, independent researchers have investigated metacognitive abilities in individuals with psychosis without a consensus regarding how to define metacognition or where its boundaries lie. This has resulted in 3 separate frameworks for understanding metacognition, namely as a) an awareness of one's own abilities and cognitive biases, b) beliefs about one's own thought processes, and c) a process by which one incorporates multiple pieces of evidence into understanding the self and others. In using each of these frameworks, researchers have discovered significant associations between metacognition and functional outcomes, and each framework has produced metacognitive intervention strategies that have demonstrated promise in improving the lives of those with psychosis. However, the variety of definitions makes interpreting findings across the literature challenging and results in a lack of clarity regarding how to best move forward. Efforts are currently underway to reach agreement on a consensus definition and to develop a clear pathway for future research. What is the significance of this article for the general public? This commentary provides a primer on the many ways that the term metacognition has been defined within the field of psychosis, identifying three major branches of research, each with its own unique treatment. We highlight that these independent definitions of metacognition create challenges within the field, specifically in regard to how metacognition is measured and how it may relate to psychotic symptoms. We emphasize the need for basic studies that clarify the boundaries of the metacognitive construct and offer potential pathways for unifying the field.