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8185 Interoception and metacognition anorexia nervosa
Patients with anorexia nervosa (AN) typically hold altered beliefs about their body that they struggle to update. These can vary from sensory, local beliefs about how full their stomach feels to global, prospective beliefs about how much they can trust their own body and its signals. Clinical questionnaire studies have provided ample evidence on the role of such beliefs in the onset, maintenance, and treatment of AN, yet the parameters that contribute to the formation and maintenance of such beliefs have not been identified. Here, I present a series of studies with independent samples of women at the acute AN (total N = 106) and post-acute AN state (N = 113), compared to matched healthy controls (N = 220) in which we aim to (1) assess interoceptive and exteroceptive perception and metacognitive beliefs using state-of-the-art methods and statistical approaches; (2) study how patients update these beliefs following feedback or contextual changes; (3) develop and validate a novel neurocomputational approach to determine the parameters that may influence belief formation and updating in these domains; (4) relate some of these parameters to clinical symptoms such as insight into illness and (5) translate these insights to the development and testing of the efficacy of a novel, interdisciplinary (psychophysiological) therapeutic module in a sub-clinical RCT study with 100 individuals with low interoception awareness, stratified for subclinical disordered eating.
Journal Article
Metacognitive Deficits Predict Impaired Insight in Schizophrenia Across Symptom Profiles: A Latent Class Analysis
Abstract
The integrated model of insight in schizophrenia suggests that poor insight is the result of multiple factors which compromise persons’ abilities to integrate streams of information into a personal awareness of psychiatric challenges, and make adaptive responses. This model hypothesizes that metacognitive deficits, or difficulties forming a complex and integrated understanding of the self and others, influence insight, regardless of other proximal causes including clinical profile. To explore this possibility, we performed a latent class analysis on 324 adults with schizophrenia or schizoaffective disorder. This analysis produced 4 groups on the basis of assessment of insight and Positive and Negative Syndrome Scale (PANSS) positive, negative, cognitive, and hostility symptoms. The resultant groups were characterized as: Good Insight/Low Symptoms (n = 71), Impaired Insight/High Negative Symptoms, (n = 43), Impaired Insight/High Positive Symptoms (n = 50) and Impaired Insight/Diffuse Symptoms (n = 160). When we compared metacognitive function as assessed with the Metacognition Assessment Scale - Abbreviated (MAS-A) across groups, we found that the good insight group had better overall metacognition as well as higher levels of self-reflectivity, awareness of the other and mastery as compared to all 3 groups with impaired insight. When controlling for total symptoms, all differences in metacognitive function between the good insight and the impaired insight groups remained significant. These results are consistent with the view that, independent of symptoms, impaired metacognition contributes to difficulties integrating information and hence impedes insight, or awareness of psychiatric challenges. Consistent with extant literature, results suggest that interventions focusing on metacognition as the target may lead to improved insight.
Journal Article
Metacognitive interpersonal therapy for personality disorders : a treatment manual
\"Patients with personality disorders need targeted treatments which are able to deal with the specific aspects of the core pathology and to tackle the challenges they present to the treatment clinicians. Such patients, however, are often difficult to engage, are prone to ruptures in the therapeutic alliance, and have difficulty adhering to a manualized treatment. Giancarlo Dimaggio, Antonella Montano, Raffaele Popolo and Giampaolo Salvatore aim to change this, and have developed a practical and systematic manual for the clinician, using Metacognitive Interpersonal Therapy (MIT), and including detailed procedures for dealing with a range of personality disorders. The book is divided into two parts, Pathology, and Treatment, and provides precise instructions on how to move from the basic steps of forming an alliance, drafting a therapy contract and promoting self-reflections, to the more advanced steps of promoting change and helping the patient move toward health and adaptation. With clinical examples, summaries of therapies, and excerpts of session transcripts, Metacognitive Interpersonal Therapy for Personality Disorders will be welcomed by psychotherapists, clinical psychologists and other mental health professionals involved in the treatment of personality disorders\"-- Provided by publisher.
Book
Revisiting the Metacognitive and Affective Model of Self-Regulated Learning: Origins, Development, and Future Directions
Efklides and colleagues developed the Metacognitive and Affective model of Self-Regulated Learning (MASRL) to provide a comprehensive theoretical framework of self-regulated learning (SRL). The distinguishing feature of MASRL is that it stresses metacognitive experiences and other subjective experiences (e.g., motivational, affective) as critical components of SRL. The insights underlying the model are that metacognitive experiences are related to affect, and that metacognition, motivation, and affect interact in SRL rather than function independently. Moreover, the MASRL proposes that SRL takes place at two levels, the Person and the Task X Person levels, with the latter being specific to the learning task and its demands. Although SRL can start with goal setting and planning in a top-down manner, monitoring and control processes at the Task X Person level provide input for bottom-up SRL. To highlight the theory-building process that led to the MASRL theory, we present questions that inspired its conception, its theoretical underpinnings, and current evidence supporting it. We also discuss the implications of the MASRL theory for understanding SRL in the classroom and for teacher–student interactions. Finally, we discuss open questions and issues that future research on MASRL would address in the context of educational psychology and SRL promotion.
Journal Article
Hydrocortisone decreases metacognitive efficiency independent of perceived stress
It is well established that acute stress produces negative effects on high level cognitive functions. However, these effects could be due to the physiological components of the stress response (among which cortisol secretion is prominent), to its psychological concomitants (the thoughts generated by the stressor) or to any combination of those. Our study shows for the first time that the typical cortisol response to stress is sufficient to impair metacognition, that is the ability to monitor one’s own performance in a task. In a pharmacological protocol, we administered either 20 mg hydrocortisone or placebo to 46 male participants, and measured their subjective perception of stress, their performance in a perceptual task, and their metacognitive ability. We found that hydrocortisone selectively impaired metacognitive ability, without affecting task performance or creating a subjective state of stress. In other words, the single physiological response of stress produces a net effect on metacognition. These results inform our basic understanding of the physiological bases of metacognition. They are also relevant for applied or clinical research about situations involving stress, anxiety, depression, or simply cortisol use.
Journal Article