Metacognition & social cognition differentially influence experiential & expressive negative symptoms in schizophrenia

Negative symptoms are common and often enduring in schizophrenia spectrum disorders (Hovington et al., 2012). Recent work aims to gain a more nuanced understanding of the structure of negative symptoms. Several factor analytic studies using different negative symptom scales have found that negative symptoms are not a unitary construct. One alternative for how we can better represent negative symptoms is through a two-factor model, including experiential and expressive negative symptoms (Marder and Galderisi, 2017). Experiential symptoms reflect reduced experience of motivation and pleasure, including amotivation, anhedonia, and asociality. Expressive symptoms reflect diminished emotional expression, including blunted affect and reduced speech. While initial work has identified the differential impact these negative symptom domains have on functional outcomes (Llerena et al., 2018), few studies have examined differential mechanisms associated with each domain. One possible mechanism is metacognition. Metacognition refers to the process by which persons notice and reflect upon their experiences and form an integrated sense of oneself and others (Moritz and Lysaker, 2018). While it has been linked to overall negative symptoms (Lysaker et al., 2005), less is knows about its associations with specific domains of negative symptom. One hypothesis is that since metacognition is a cognitive phenomenon related primarily to one's awareness and integration of internal states (Lysaker et al., 2019; Semerari et al., 2003), it is likely linked to experiential symptoms, as this domain primarily involves internal experiences. One prior study revealed that metacognition was significantly associated with both experiential and expressive symptoms, but at 3-year follow-up, metacognition was only linked to expressive symptoms (Austin et al., 2019). Similarly, Garcia-Mieres et al. (2020) found metacognition mediated the relationship of linguistic disturbances with expressive but not experiential symptoms. Given these unexpected results, additional work is needed in this area. This study examined metacognition as a correlate of experiential and expressive symptoms in schizophrenia-spectrum disorders. Given the importance of internal states for metacognition, we hypothesized that metacognition would be associated with experiential, not expressive, symptoms. Social cognition-a related but distinct construct-has also been linked to overall negative symptoms, but differential prediction of negative symptom domains by metacognition and social cognition has not been examined. We explored the links between metacognition, social cognition, and negative symptom domains as well as differential prediction.

Automated summary

Negative symptoms are common and enduring in schizophrenia spectrum disorders, and research has shown that they are not a unitary construct but can be better represented through a two-factor model, including experiential and expressive negative symptoms. Metacognition, the process of noticing and reflecting on experiences, has been linked to negative symptoms, but its associations with specific domains need further exploration. Metacognition may be more closely associated with experiential symptoms, which involve internal experiences, while social cognition is also important but has not been compared in predicting different negative symptom domains.