Psychiatric Symptom Dimensions Are Associated With Dissociable Shifts in Metacognition but Not Task Performance

Abstract

Background

Distortions in metacognition—the ability to reflect on and control other cognitive processes—are thought to be characteristic of poor mental health. However, it remains unknown whether such shifts in self-evaluation are due to specific alterations in metacognition and/or a downstream consequence of changes in decision-making processes.

Methods

Using perceptual decision making as a model system, we employed a computational psychiatry approach to relate parameters governing both decision formation and metacognitive evaluation to self-reported transdiagnostic symptom dimensions in a large general population sample ( N = 995).

Results

Variability in psychopathology was unrelated to either speed or accuracy of decision formation. In contrast, leveraging a dimensional approach, we revealed independent relationships between psychopathology and metacognition: a symptom dimension related to anxiety and depression was associated with lower confidence and heightened metacognitive efficiency, whereas a dimension characterizing compulsive behavior and intrusive thoughts was associated with higher confidence and lower metacognitive efficiency. Furthermore, we obtained a robust double dissociation—whereas psychiatric symptoms predicted changes in metacognition but not decision performance, age predicted changes in decision performance but not metacognition.

Conclusions

Our findings indicate a specific and pervasive link between metacognition and mental health. Our study bridges a gap between an emerging neuroscience of decision making and an understanding of metacognitive alterations in psychopathology.