Metacognition: A Transdiagnostic Mechanism of Psychopathology

Abstract

Cognitive dysfunction is a pervasive, pathological feature of mental illness. Yet, precise cognitive mechanisms underlying psychiatric disorders remain elusive. Despite decades of research from thousands of independent studies, no disorder-specific cognitive markers have been identified with adequate specificity, sensitivity, or predictive validity, to have sufficient diagnostic or therapeutic utility. This slow progress partly reflects an overreliance on antiquated research practices, including a strong allegiance to small sampled and case-controlled studies, which narrowly focus on cross-sectional evidence obtained from cognitive tasks without established reliability. By tackling shortcomings associated with the traditional research model, this thesis aims to uncover precise cognitive mechanisms underlying psychopathology. This thesis focuses specifically on metacognition, a central facet of cognitive functioning that has been implicated across a broad range of psychiatric disorders. By employing online and smartphone-based research methods to rapidly acquire data within and across individuals, this thesis evaluates metacognition through time and through treatment. An enhanced understanding of metacognitive disturbances in mental illness is then leveraged to reshape how we define psychopathology entirely. Specifically, the results of this thesis demonstrate that unsupervised factor analysis of psychiatric symptoms represents a powerful framework for determining precise cognitive mechanisms of mental illness.