شناخت فراشناختی و اجتماعی نزدیک برای فهم تاثیر اسکیزوفرنی بر کیفیت زندگی اجتماعی

While some studies view metacognition and social cognition as representing the same phenomenon, others suggest that they represent distinctive sets of abilities that are related to different outcomes. The current study used a cross-sectional design that includes samples of persons with schizophrenia (N = 39) and healthy individuals (N = 60) to further explore the distinction between social cognition and metacognition and their associations with social quality of life. The Face Emotion Identification Task (FEIT), Faux-Pas Task, Indiana Psychiatric Illness Interview (IPII), Metacognition Assessment Scale — Abbreviated (MAS-A), and Social Quality of Life Scale were administrated to all participants. Correlations, t-tests and regressions were conducted. Results showed that persons with schizophrenia performed more poorly on all measures than healthy controls. Social cognition and metacognition measures were related for the combined total sample, but only a few associations were found among both sub-samples. A diagnosis of schizophrenia and metacognitive capacity, but not social cognition, predicted social quality of life. Self-reflectivity had a negative relationship to social quality of life while understanding of others' minds had a positive relation to social quality of life. The current study provides evidence that many with schizophrenia experience deficits in both social cognition and metacognition and that those deficits may be distinct and have different kinds of relationships with social quality of life. Clinical implications include the need to emphasize narrative aspects of psychotherapy in order to promote metacognition.

Recent conceptualizations of schizophrenia suggest that one of the greatest barriers to psychosocial functioning is deficits in metacognition, which limits a person's abilities to make sense of the social, psychological, and biological challenges presented by their condition (Semerari et al., 2003, Lysaker and Hasson-Ohayon, 2014 and Lysaker et al., 2014b). Metacognition is a psychological function that includes a spectrum of mental activities. These activities involve thinking about thinking and range from more discrete acts, in which people recognize specific thoughts and feelings, to more synthetic acts in which an array of intentions, thoughts, feelings, and connections between events are integrated into larger complex representations. Metacognition allows persons to capture what others think and feel, and ultimately supplies the mentalistic knowledge that allows decisions to be made about how to more effectively respond to social and psychological challenges (Semerari et al., 2003, Lysaker et al., 2013a, Lysaker et al., 2013b, Lysaker and Dimaggio, 2014 and Lysaker and Hasson-Ohayon, 2014). Impairments in metacognition have been found in both early and later phases of schizophrenia (Brune et al., 2011, Lysaker et al., 2014b, MacBeth et al., 2014 and Vohs et al., 2014) and are linked with both objective and subjective indicators of wellness, independent of symptom severity (Lysaker et al., 2010, Lysaker et al., 2011b, Kukla et al., 2013, Lysaker et al., 2013a, Lysaker et al., 2013b and Rabin et al., 2014). While a variety of definitions of metacognition have been used in connection with schizophrenia (cf. Brüne, 2014), recent research and theoretical discussions provide the basis for using the term metacognition to capture the organization of increasingly complex and coherent representations of the self and others. It has been also suggested that metacognitive functions may be distinguished upon the basis of their focus and include self-reflectivity, understanding of others' minds, decentration (the ability to see the world as understandable from a number of different perspectives), and mastery (the ability to use knowledge of mental states to solve psychological problems) (cf. Lysaker et al., 2014a). As the literature on metacognition has grown, one issue that remains unclear is the extent and manner in which metacognition is related to social cognition. Whereas some of the literature treats metacognition as a form of social cognition (Pinkham et al., 2014), other literature regards these constructs as distinct in several ways (Lysaker et al., 2013a, Lysaker and Dimaggio, 2014 and Vohs et al., 2014). Viewing metacognition and social cognition as representing a similar set of abilities, Brüne (2014) has suggested that metacognition and social cognition both refer to reflections about social processes (Green and Leitman, 2008 and Brune et al., 2011). He notes that one difference between these terms concerns the persons who use them; while metacognition is generally employed by clinicians, social cognition is more often used by neuroscientists and assessed in laboratory tasks. Indeed, both share a concern with regard to how persons form ideas about social exchanges. Concerning how the terms differ conceptually, social cognition has been used to refer to a range of different cognitive, affective, automatic and voluntary processes (Green & Leitman, 2008). It is generally used to refer to specific representations that are assessed by the accuracy or flexibility of judgments regarding these representations (Brüne, 2014 and Lysaker and Hasson-Ohayon, 2014). By contrast, metacognition has been used to describe the complex ongoing processes of constructing holistic and integrative representations of self and other (Lysaker & Dimaggio, 2014). As such, the term metacognition is used to refer to interrelated sets of representations of events and situations often assessed within discourse. Theoretically, investigations of metacognition may also diverge from investigations of social cognition in that metacognition includes the complex ability to shift back and forth from one's own perspective to the valid and differing perspectives of others, rather than accurately detecting a particular fact (Lysaker and Dimaggio, 2014 and Lysaker et al., 2014a). Of note, some aspects of metacognition do seem more similar to social cognition than others, such as understanding the minds of others. To date, little work has tested empirically whether these constructs can be distinguished from one another. One study (Lysaker et al., 2013b) has subjected scores related to metacognition and social cognition to a factor analysis and uncovered two orthogonal factors: a metacognitive factor related to the complexity of mental states, and a social cognitive factor related to the discrete abilities of emotion identification and theory of mind tasks. Importantly, each factor appeared to have different pattern of correlates: the social cognition factor was uniquely related to negative symptoms, while the metacognition factor was uniquely related to social function (Lysaker et al., 2013b). Recent studies have shown, however, that the links of both social cognition and metacognition with neurocognition are moderated by disorganized symptoms (Minor & Lysaker, 2014), and that both social cognition and metacognition can contribute to the predication of anhedonia in the absence of depression (Buck et al, 2014). Thus, further research is needed in order to trace similarities and differences between the two constructs. Accordingly, the current study has explored whether assessments of metacognition and social cognition possessed different kinds of association with social outcome. The current study also used a control group of healthy individuals in order to first determine whether the associations of metacognition and social cognition are specific to individuals with schizophrenia or merely a general phenomenon. Additionally, we were interested in whether a different relationship between social cognition and metacognition exists among persons with schizophrenia versus healthy individuals. A similar phenomenon to metacognition, emotional intelligence, has been found in one study to have a different factorial structure among persons with schizophrenia (two factors) when compared to healthy individuals (four factors; Eack et al, 2009). We made three hypotheses: 1) persons with schizophrenia would perform more poorly on tests of metacognition and social cognition than persons from the healthy control group 2) metacognition and social cognition would be moderately related with each other in both groups, but stronger associations would be found among the group of persons with schizophrenia; 3) metacognition would be more closely related than social cognition with social quality of life. This third prediction is consistent with the finding of Lysaker et al. (2013b) that metacognition was more closely related to social functioning than to social cognition.