توسعه مصاحبه ارزیابی فراشناخت: شرح ابزار، ساختار عاملی و قابلیت اطمینان در یک نمونه غیر بالینی

Background Metacognition is a multi-facet psychological construct; deficits in metacognitive abilities are associated to low social functioning, low quality of life, psychopathology, and symptoms. The aim of this study was to describe and develop a valid and reliable interview for assessing metacognition. Methods The semi-structured interview, based on the author's theory model of the metacognition construct, is described. The Metacognition Assessment Interview (MAI) is an adaptation of the Metacognition Assessment Scale (MAS) and evaluates how the subject is interviewed used metacognition during his own real life experiences elicited by the interviewer. A user manual was developed to assist the interview and scoring procedure. Results Exploratory factor analysis and confirmatory factor analysis revealed preliminary evidence of a two factor-hierarchical structure, with two lower-order scales, representing the two main theoretical domains of the metacognitive function, “the Self” and “the Other”, and one single higher-order scale that we labelled metacognition. Contrary to the authors' prediction the existence of the four distinct dimensions under the two domains was not confirmed. The MAI and its two domains demonstrated acceptable levels of inter-rater reliability and internal consistency.

Research investigating the metacognitive construct has advanced rapidly over the past decade. Metacognition, as formulated by Semerari (Semerari et al., 2003 and Carcione et al., 2008), refers to a broad set of cognitive and affective skills which allow people to identify mental states, reasoning about them, and ascribing them to themselves and others. These skills allow us to recognize the reason why a person reacts psychologically according to some regularities and constructs personal meaning over their lifespan. Several authors refer to the same concept with different meanings. Wells (2000), for example, views metacognition as a set of beliefs about one's own mental content that helps people to regulate their attentive processes and that, in some cases, could induce the maintenance of dysfunctional attentive processes such as worry. There is a terminological confusion over metacognition and this is also due to the fact that mind-reading abilities have been traditionally investigated by researchers belonging to different theoretical backgrounds and research fields, each of them with their own lexicon ( Flavell, 1976, Fonagy, 1991, Baron-Cohen, 1995, Frith and Happé, 1999 and Frith and Frith, 2006). Metacognition, as considered by Semerari et al. (2003), partially overlaps with similar constructs such as theory of mind (ToM) (Baron-Cohen et al., 1985) and mentalization (Bateman and Fonagy, 2004 and Allen et al., 2008), but with some differences. Compared to ToM, as described below, metacognition usually includes more complex mental functions. Additionally, metacognition also refers to emotional understanding, while ToM mainly focuses on cognitive attribution. Compared to the general definition of mentalization given by Bateman and Fonagy (2004), Semerari's concept differs since it considers mind-reading to be a general ability created by different subfunctions that interact with each other and that can be selectively impaired. Dysfunctions in metacognition are associated with low social functioning, low quality of life, psychopathology and symptoms of several psychiatric and personality disorders, and seem to predict worst treatment response (Semerari et al., 2007, Lysaker et al., 2010a, Lysaker et al., 2010b, Carcione et al., 2011, Lysaker et al., 2011a and Ogrodniczuk et al., 2011). However, the lack of a reliable and valid instrument for measuring metacognition has limited progress in this field, especially for developing clinical applications. Assessments of psychological constructs such as social cognition mostly rely on self-report instruments, laboratory tasks and structured interviews, and each has its own pros and cons. Interviews have unique advantages such as avoiding bias in self-ratings, especially if one is called upon to use a skill such as self-reflection, which in itself is supposed to be compromised; they also ask the person to reason about mental states in the context of personally relevant matters, i.e. the ones in which it is most important to be able to fully and swiftly understand the mental states of oneself and others. Therefore it is likely that metacognition as measured from interviews provides more clinician-friendly information that can directly affect treatment protocols (Lysaker et al., 2010a and Lysaker et al., 2011b). The aim of the present study was to investigate the reliability, internal consistency and structure of a semi-structured interview for assessing metacognition: the Metacognition Assessment Interview (MAI). The MAI is an adaptation of the Metacognitive Assessment Scale (MAS) (Semerari et al., 2003, Carcione et al., 2008 and Carcione et al.,), a rating scale assessing the construct as manifest in individual verbalization in psychotherapy transcripts. The common theoretical framework which underlines both the MAS and the MAI is that metacognition is made of specific and relatively independent subfunctions, each of them likely to be selectively damaged in clinical populations. The MAS is therefore divided into three scales: understanding one's own mind, understanding others' minds and mastery. Each scale is further composed of different subfunctions. The subfunction scales of understanding one's own mind and understanding others' minds are included in the MAI and they will be described in detail in Section 2. Work on an interview to investigate the third scale, mastery, is still in progress. The MAS and its subscales demonstrated acceptable levels of factorial validity, inter-rater agreement, internal validity and test–retest stability (Semerari et al., 2003, Semerari et al., 2005, Lysaker et al., 2005, Carcione et al., 2008, Dimaggio et al., 2009, Lysaker et al., 2010b, Lysaker et al., 2011a and Lysaker et al., 2011b) and were related to executive functions and treatment outcomes (Lysaker et al., 2005, Semerari et al., 2005, Carcione et al., 2008 and Lysaker et al., 2008). Studies on patients with personality disorders showed different profiles of metacognitive impairments in patients with different diagnoses (Semerari et al., 2003, Semerari et al., 2005, Semerari et al., 2007 and Dimaggio et al., 2009). Furthermore, specific function impairment correlated with different symptoms in patients with schizophrenia (Lysaker et al., 2005). However, the MAS does not allow metacognitive functions to be directly stimulated through specific questions. Therefore, when the therapist does not directly investigate one specific subfunction, perhaps during a psychotherapy session, it is impossible to define whether the lack of use of this subfunction is due to impairment of it or simply to a lack of use of it in that specific circumstance. However, the direct investigation of a specific subfunction through specific questions, along with the weak answers that patients might give, highlights more clearly specific impairments in the metacognitive domains. For this reason, we aimed to develop a new tool that is capable of directly measuring metacognition and is less time-consuming than the MAS: the MAI (Semerari et al., 2008). Our hypotheses were (a) that metacognition could be elicited by such an interview and reliably scored; (b) that metacognition has a two-factor structure, with two separate domains, one for understanding the mental states of the self and one for understanding the mental states of others.