IU Indianapolis ScholarWorks :: Browsing by Subject "Metacognition"

Browsing by Subject "Metacognition"

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A pilot randomized controlled trial comparing a novel compassion and metacognition approach for schizotypal personality disorder with a combination of cognitive therapy and psychopharmacological treatment
(BMC, 2023-02-20) Cheli, Simone; Cavalletti, Veronica; Lysaker, Paul H.; Dimaggio, Giancarlo; Petrocchi, Nicola; Chiarello, Francesca; Enzo, Consuelo; Velicogna, Francesco; Mancini, Francesco; Goldzweig, Gil; Psychiatry, School of Medicine
Background: Schizotypal personality disorder is characterized by a pervasive pattern of maladaptive behavior that has been associated with the liability for schizophrenia. Little is known about effective psychosocial interventions. This pilot non-inferiority randomized controlled trial aimed to compare a novel form of psychotherapy tailored for this disorder and a combination of cognitive therapy and psychopharmacological treatment. The former treatment - namely, Evolutionary Systems Therapy for Schizotypy-integrated evolutionary, metacognitively oriented, and compassion focused approaches. Methods: Thirty-three participants were assessed for eligibility, twenty-four randomized on a 1:1 ratio, nineteen included in the final analysis. The treatments lasted 6 months (24 sessions). The primary outcome was change across nine measurements in personality pathology, the secondary outcomes were remission from diagnosis and pre-post changes in general symptomatology and metacognition. Results: Primary outcome suggested a non-inferiority of the experimental treatment in respect to control condition. Secondary outcomes reported mixed results. There was no significant difference in terms of remission, but experimental treatment showed a larger reduction of general symptomatology (η2 = 0.558) and a larger increase in metacognition (η2 = 0.734). Conclusions: This pilot study reported promising results about the effectiveness of the proposed novel approach. A confirmatory trial on large sample size is needed to provide evidence about relative effectiveness of the two treatment conditions.
A Recovery-Oriented Approach: Application of Metacognitive Reflection and Insight Therapy (MERIT) for Youth with Clinical High Risk (CHR) for Psychosis
(MDPI, 2024-04-15) Leonhardt, Bethany L.; Visco, Andrew C.; Hamm, Jay A.; Vohs, Jenifer L.; Psychiatry, School of Medicine
Clinical High Risk for psychosis (CHR) refers to a phase of heightened risk for developing overt psychosis. CHR often emerges during adolescence or early adulthood. CHR has been identified as a group to target for intervention, with the hope that early intervention can both stave off prolonged suffering and intervene before mental health challenges become part of an individual’s identity. However, there are few treatment modalities that can address some of the specific needs of CHR. Metacognitive Reflection and Insight Therapy (MERIT) is an integrative psychotherapy that can be applied to the CHR population. MERIT offers unique advantages to working with the CHR population as it aims to improve self-direction and recovery through stimulation of metacognitive capacity, a phenomenon that has been associated with recovery. This paper explores unique aspects of the CHR population and how MERIT can address barriers to recovery for individuals experiencing psychosis-like symptoms. Several case examples and a clinical vignette using MERIT to support patients with CHR are offered to exemplify this approach. MERIT offers a way to assist persons with CHR to address barriers to their personal recovery and to develop nuanced understandings of ways to master challenges.
Acute kidney injury in Ugandan children with severe malaria is associated with long-term behavioral problems
(Public Library of Science, 2019-12-17) Hickson, Meredith R.; Conroy, Andrea L.; Bangirana, Paul; Opoka, Robert O.; Idro, Richard; Ssenkusu, John M.; John, Chandy C.; Pediatrics, School of Medicine
Background Acute kidney injury (AKI) is a risk factor for neurocognitive impairment in severe malaria (SM), but the impact of AKI on long-term behavioral outcomes following SM is unknown. Methods We conducted a prospective study on behavioral outcomes of Ugandan children 1.5 to 12 years of age with two forms of severe malaria, cerebral malaria (CM, n = 226) or severe malarial anemia (SMA, n = 214), and healthy community children (CC, n = 173). AKI was defined as a 50% increase in creatinine from estimated baseline. Behavior and executive function were assessed at baseline and 6, 12, and 24 months later using the Child Behavior Checklist and Behavior Rating Inventory of Executive Function, respectively. Age-adjusted z-scores were computed for each domain based on CC scores. The association between AKI and behavioral outcomes was evaluated across all time points using linear mixed effect models, adjusting for sociodemographic variables and disease severity. Results AKI was present in 33.2% of children with CM or SMA at baseline. Children ≥6 years of age with CM or SMA who had AKI on admission had worse scores in socio-emotional function in externalizing behaviors (Beta (95% CI), 0.52 (0.20, 0.85), p = 0.001), global executive function (0.48 (0.15, 0.82), p = 0.005) and behavioral regulation (0.66 (0.32, 1.01), p = 0.0002) than children without AKI. There were no behavioral differences associated with AKI in children <6 years of age. Conclusions AKI is associated with long-term behavioral problems in children ≥6 years of age with CM or SMA, irrespective of age at study enrollment.
Adapting Writing Center Pedagogy for Composition Classrooms: A Metacognitive Approach
(2012-05-04) Gellin, Laura M.; Fox, Stephen L.; Buchenot, Andre; Hogue, Teresa Molinder
While a writing center tutor may view her role as a coach, a commentator, and a counselor, the tutor actually serves as scaffolding, a temporary, supportive replacement of the processes more experienced writers can manage alone without a tutor, namely, the metacognitive processes of self-assessing, self-monitoring, and self-motivating. Metacognition then becomes the essential factor in adapting writing center practices into the composition classroom. By re-conceptualizing the three roles of a writing center tutor and re-visioning the classroom into a more “pure” learning space, tutor-teachers improve students’ writing skills, increase their engagement, and redirect students’ focus toward the writing process rather than the grade. To demonstrate the efficacy of this adapted writing center approach in the composition classroom, I created an authentic, challenging project in which the pre-project activities, task design, work process, and reflection assignment enact my proposed theory. By adopting this approach, tutor-teachers ultimately empower students and design compositional tasks that act as a catalyst for transforming the way students understand themselves as writers and as students.
Associations between Cortical Thickness and Metamemory in Alzheimer’s Disease
(Springer, 2022) Duran, Tugce; Woo, Ellen; Otero, Diana; Risacher, Shannon L.; Stage, Eddie; Sanjay, Apoorva B.; Nho, Kwangsik; West, John D.; Phillips, Meredith L.; Goukasian, Naira; Hwang, Kristy S.; Apostolova, Liana G.; Neurology, School of Medicine
Metacognitive deficits affect Alzheimer's disease (AD) patient safety and increase caregiver burden. The brain areas that support metacognition are not well understood. 112 participants from the Imaging and Genetic Biomarkers for AD (ImaGene) study underwent comprehensive cognitive testing and brain magnetic resonance imaging. A performance-prediction paradigm was used to evaluate metacognitive abilities for California Verbal Learning Test-II learning (CVLT-II 1-5) and delayed recall (CVLT-II DR); Visual Reproduction-I immediate recall (VR-I Copy) and Visual Reproduction-II delayed recall (VR-II DR); Rey-Osterrieth Complex Figure Copy (Rey-O Copy) and delayed recall (Rey-O DR). Vertex-wise multivariable regression of cortical thickness was performed using metacognitive scores as predictors while controlling for age, sex, education, and intracranial volume. Subjects who overestimated CVLT-II DR in prediction showed cortical atrophy, most pronounced in the bilateral temporal and left greater than right (L > R) frontal cortices. Overestimation of CVLT-II 1-5 prediction and DR performance in postdiction showed L > R associations with medial, inferior and lateral temporal and left posterior cingulate cortical atrophy. Overconfident prediction of VR-I Copy performance was associated with right greater than left medial, inferior and lateral temporal, lateral parietal, anterior and posterior cingulate and lateral frontal cortical atrophy. Underestimation of Rey-O Copy performance in prediction was associated with atrophy localizing to the temporal and cingulate areas, and in postdiction, with diffuse cortical atrophy. Impaired metacognition was associated to cortical atrophy. Our results indicate that poor insight into one's cognitive abilities is a pervasive neurodegenerative feature associated with AD across the cognitive spectrum.
Autobiographical memory in schizophrenia: The role of metacognition
(Elsevier, 2021) Mediavilla, Roberto; López-Arroyo, Manuel; Gómez-Arnau, Jorge; Wiesepape, Courtney; Lysaker, Paul H.; Lahera, Guillermo; Psychiatry, School of Medicine
Background: Autobiographical memory is an important component of declarative memory, which refers to the ability to recall personal events that happened in the past. This requires that the person senses or experiences himself/herself in the past (i.e., conscious recollection). For people with schizophrenia, conscious recollection can be particularly difficult, resulting in difficulty accessing detailed, specific autobiographical information. Our hypothesis is that the ability to monitor and think about one's cognitive processes (metacognition) is a requisite for conscious recollection, and that it mediates the association between having schizophrenia and recalling fewer specific, personal memories. Methods: Participants were 30 adults with schizophrenia and 30 matched healthy controls. The main assessment instruments were the Metacognition Assessment Scale-Abbreviated (MAS-A) and the Autobiographical Memory Test (AMT). Severity of symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Cognitive performance was measured with the Screen for Cognitive Impairment in Psychiatry (SCIP). Mediation analysis was conducted following Baron and Kenny's procedure. Results: People with schizophrenia had more semantic associations and fewer specific memories than controls in the AMT. Metacognition (MAS-A total score) partially mediated the association between having schizophrenia and recalling fewer specific past events, even after controlling for cognitive impairment as a potential confounding source. Conclusions: Metacognitive ability, which can be improved with available programs, intervenes in the process of accessing autobiographical memories in people with schizophrenia. Practical implications of this finding are discussed.
Co-occurring Deficits in Clinical and Cognitive Insight in Prolonged Schizophrenia- Spectrum Disorders: Relationship to Metacognitive Deficits
(Oxford University Press, 2021-07-20) Mervis, Joshua E.; Bonfils, Kelsey A.; Cooper, Samuel E.; Wiesepape, Courtney; Lysaker, Paul H.; Psychiatry, School of Medicine
People diagnosed with schizophrenia have been broadly observed to experience deficits in clinical and cognitive insight; however, less is understood about how these deficits are related. One possibility is that these deficits co-occur among people when other deficits in cognition are present, such as in executive function, social cognition, and metacognition, which may either promote the development of both forms of poor insight or allow one to negatively influence the other. To explore this possibility, we conducted a cluster analysis using assessments of clinical and cognitive insight among 95 adults with a schizophrenia spectrum disorder. As predicted, this analysis yielded a group with concurrently poor clinical and cognitive insight (n = 36). Additional groups were found with concurrently good clinical and cognitive insight (n = 28) and poor clinical insight and good cognitive insight (n = 31). Groups were then compared on assessments of executive function, social cognition, and metacognition. The group with concurrently lower levels of cognitive and clinical insight had significantly poorer metacognition relative to the other groups. In particular, they tended to form more fragmented and less integrated ideas about themselves and others. No differences were found for executive function or social cognition. The result may suggest that while clinical and cognitive insight is partially orthogonal phenomena, relatively lower levels of metacognition, or difficulties forming integrated ideas about oneself and others, maybe a condition leading to the confluence of lower clinical and cognitive insight. Interventions targeting metacognition may be of particular use for this group.
A cognitive model of diminished expression in schizophrenia: The interface of metacognition, cognitive symptoms and language disturbances
(Elsevier, 2020-12) García-Mieres, Helena; Lundin, Nancy B.; Minor, Kyle S.; Dimaggio, Giancarlo; Popolo, Raffaele; Cheli, Simone; Lysaker, Paul H.; Psychology, School of Science
The resistance of negative symptoms to pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. However, little is understood about the psychological processes that reinforce and sustain the negative symptoms domain of diminished expression. Prior research has shown that higher levels of diminished expression relate to deficits in metacognitive capacity. We propose a more complex model in which diminished expression occurs when impairments in metacognitive self-reflectivity, alterations in higher-order language structure, and cognitive symptoms interact and thus interfere with persons' ability to understand and express emotions in ways others can recognize. Individuals with schizophrenia-spectrum disorders (N = 201) provided personal narratives detailing their life story and reflections about their mental illness. Self-reflectivity was measured with the Metacognition Assessment Scale-Abbreviated, and situation models were extracted from participants' personal narratives via Coh-Metrix 3.0, an automated program that calculates language indices. Diminished expression and cognitive symptoms were measured with the Positive and Negative Syndrome Scale. Structural equation models (SEM) examined whether self-reflectivity mediated the impact of cognitive symptoms and situation models on diminished expression. Results of the SEM revealed that self-reflectivity partially mediated the impact of situation models on diminished expression (β = -.073, p = .008, ±95% CI [-0.126, -0.019]). and fully mediated the influence of cognitive symptoms in diminished expression (β = 0.099, p = .001, ±95% CI [0.038, 0.160]). In conclusion, results suggest that self-reflectivity, linguistic cohesion, and cognitive symptoms may be useful targets for intervention in efforts to treat diminished expression in psychosis.
Disorganized Speech and Metacognition in Schizophrenia: Differential Relations and a Comparison of Behavioral Speech Measures
(2021-08) Myers, Evan J.; Minor, Kyle S.; Salyers, Michelle P.; Lysaker, Paul H.
Disorganized speech is a core feature of schizophrenia. It is a key component of formal thought disorder (FTD). Recent work has tied disorganized speech to deficits in metacognition, or one’s ability to integrate experiences to form complex mental representations. In this study, we aimed to 1) explore the relationship between disorganized speech and metacognition and 2) compare trained rater and emerging automated analysis methods. Positive and Negative Syndrome Scale (PANSS) and Indiana Psychiatric Illness Interviews (IPII) were conducted; the IPII was coded for disorganized speech using the Communication Disturbances Index (CDI) and Coh-Metrix multidimensional indices. Metacognition was rated using the Metacognition Assessment Scale. We compared FTD (n = 16; PANSS conceptual disorganization ≥ 3) and non-FTD (n = 29; PANSS conceptual disorganization < 3) groups on metacognition and examined CDI and Coh-Metrix’s ability to account for variance in metacognition. We hypothesized that the FTD group would have lower metacognition and that both CDI and Coh-Metrix would account for significant variance in metacognition. Analyses indicated metacognition did not differ between groups and neither measure accounted for significant variance in metacognition. Results also showed that the CDI was able to distinguish the groups. Overall, results suggest little relationship between FTD and metacognition. Findings also indicate that trained rater measures of disorganized speech may have clinical utility in classifying FTD. Future research examining these constructs should address important limitations of this study by ensuring adequate levels of FTD in the study sample and by assessing neurocognition.
Exploiting the power of information in medical education
(Taylor & Francis, 2021) Cutrer, William B.; Spickard, W. Anderson, III; Triola, Marc M.; Allen, Bradley L.; Spell, Nathan, III; Herrine, Steven K.; Dalrymple, John L.; Gorman, Paul N.; Lomis, Kimberly D.; Medicine, School of Medicine
The explosion of medical information demands a thorough reconsideration of medical education, including what we teach and assess, how we educate, and whom we educate. Physicians of the future will need to be self-aware, self-directed, resource-effective team players who can synthesize and apply summarized information and communicate clearly. Training in metacognition, data science, informatics, and artificial intelligence is needed. Education programs must shift focus from content delivery to providing students explicit scaffolding for future learning, such as the Master Adaptive Learner model. Additionally, educators should leverage informatics to improve the process of education and foster individualized, precision education. Finally, attributes of the successful physician of the future should inform adjustments in recruitment and admissions processes. This paper explores how member schools of the American Medical Association Accelerating Change in Medical Education Consortium adjusted all aspects of educational programming in acknowledgment of the rapid expansion of information.

Browsing by Subject "Metacognition"

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