Experiencing hallucinations in daily life: the role of metacognition

Wright, A. C., Palmer-Cooper, E., Cella, M., McGuire, N., Montagnese, M., Dlugunovych, V., Liu, C.-W. J., Wykes, T. and Cather, C. (2023) Experiencing hallucinations in daily life: the role of metacognition. Schizophrenia Research, (doi: 10.1016/j.schres.2022.12.023) (PMID:36623979) (In Press)

Abstract

Background Hallucinations have been linked to failures in metacognitive reflection suggesting an association between hallucinations and overestimation of performance, although the cross-sectional findings are inconsistent. This inconsistency may relate to the fluctuating hallucinatory experiences that are not captured in cross-sectional studies. Ecological Momentary Assessment (EMA) captures in-the-moment experiences over time so can identify causal relationships between variables such as the associations between metacognition and hallucinatory experience in daily life and overcome problems in cross-sectional designs. Methods Participants (N = 41) experiencing daily hallucinations completed baseline questionnaires and smartphone surveys 7 times per day for 14 days. They were prompted to identify a task they would complete in the next 4 h and to make metacognitive predictions around the likelihood of completing the task, the difficulty of the task, and how well they would complete it (standard of completion). Results 76 % finished the 14-days of assessment with an average of 42.2 % survey completion. Less accurate metacognition was associated with more hallucinations, but less accurate likelihood and standard of completion was associated with fewer hallucinations. Using a cross-lagged analysis, metacognitive predictions around the likelihood of completion (p < .001) and standard of completion (p = .01) predicted hallucination intensity at the following timepoint, and metacognitive predictions regarding likelihood of completion (p = .02) predicted hallucination control at the following timepoint. Discussion Interventions that aim to improve metacognitive ability in-the-moment may serve to reduce the intensity and increase the control of hallucinations.

• Item Type: Articles
• Additional Information: This research project was supported by an internal fund from Massachusetts Department of Mental Health to the Center of Excellence for Psychosocial and Systemic Research at Massachusetts General Hospital.
• Keywords: Mobile health, psychosis, hallucinations, ESM, EMA, metacognition, cognitive-affective processing.
• Status: In Press
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McGuire, Nicola
• Authors: Wright, A. C., Palmer-Cooper, E., Cella, M., McGuire, N., Montagnese, M., Dlugunovych, V., Liu, C.-W. J., Wykes, T., and Cather, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
• Journal Name: Schizophrenia Research
• Publisher: Elsevier
• ISSN: 0920-9964
• ISSN (Online): 1573-2509
• Published Online: 07 January 2023
• Copyright Holders: Copyright © 2023 Elsevier B.V.
• First Published: First published in Schizophrenia Research 2023
• Publisher Policy: Reproduced in accordance with the publisher copyright policy