Task-based metacognition and insight in schizophrenia spectrum disorders: A systematic review and meta-analysis.
Asala Halaj, Tricia X F Seow, Anthony S David
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In 30 seconds
This systematic review and meta-analysis examined whether performance on behavioral metacognitive tasks is associated with insight in adults with schizophrenia spectrum or other psychosis spectrum disorders. Seventeen studies met the review criteria, and 12 contributed data to the pooled analysis. The overall association was small but significant (r = 0.18, 95% CI [0.05, 0.31]; I 2 = 60.2%). Associations differed by task: self-reflection paradigms and Meta-Wisconsin Card Sorting Test variants showed moderate associations, while several lower-level task types showed none.
Key findings
- Only 6 of 17 included studies (35.3%) reported significant associations between behavioral metacognitive task performance and insight.
- Across 12 pooled studies, the overall correlation was r = 0.18, 95% CI [0.05, 0.31]; I 2 = 60.2%.
- Self-reflection paradigms (r = 0.46) and Meta-Wisconsin Card Sorting Test variants (r = 0.33) showed moderate associations with insight.
- Task type accounted for approximately 89% of between-study heterogeneity; perceptual, probabilistic, metamemory, and social tasks showed no association.
Why it matters
The findings suggest that the relationship between metacognition and insight depends on how metacognition is assessed. Common domain-specific behavioral tasks may not capture the self-reflective processes most relevant to insight. This distinction matters when interpreting research on insight impairment and when selecting measures for studies intended to clarify its mechanisms.
What to keep in mind
Only 12 of the 17 included studies contributed to the pooled analysis, and between-study heterogeneity was substantial (I 2 = 60.2%).