Metacognition, self-reflection and recovery in schizophrenia

Metacognition reflects a spectrum of activities that includes discrete acts in which persons form ideas about specific thoughts and feelings, and synthetic acts in which persons integrate discrete thoughts and feelings into complex representations of themselves and others. This article reviews literature suggesting that persons with schizophrenia and related psychosis experience deficits across the spectrum of metacognitive activities and that these deficits play a key role in dysfunction, often mediating and moderating the impact of symptoms and social adversity on daily life. Treatment approaches including metacognitive training and adaptations of psychotherapy are still in their infancy. Future work is needed to study the etiology of deficits in discrete and synthetic metacognition, as well as their overlap with related constructs such as mentalization and social cognition.