Developing a dynamic model of metacognitive influences on anomalous experiences and functional outcome in young people with and without psychosis

Wright, Abigail (2019) Developing a dynamic model of metacognitive influences on anomalous experiences and functional outcome in young people with and without psychosis. Doctoral thesis (PhD), University of Sussex.

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Beck and Rector (2005) proposed a model of functional outcome in schizophrenia,
suggesting the path between neurocognition and functioning is mediated by functional
capacity and cognitive processes. These cognitive processes include defeatist
performance beliefs, self-stigma and, most recently, metacognition, considered ‘thinking
about thinking’. Metacognition has been proposed to work in a hierarchy between the
object- and meta-level, outlined within Nelson and Narens (1990) model, including
several metacognitive components: metacognitive ability, experience and efficiency,
connected by metacognitive processes. Firstly, this thesis investigated how different
metacognitive components may interact dynamically and predict both what people do in
their everyday lives (functional outcome) and how people feel about their everyday lives
(subjective recovery outcome) in First Episode Psychosis (N=62), compared to healthy
controls (N=73). Following this, this thesis examined the role of metacognition in
predicting functional outcome across a three-year period, in FEP (N=26). Finally, it was
suggested that metacognition may be expanded to include the way one thinks about
oneself through important memories, e.g. self-defining memories (SDMs). The role of
SDMs as an additional mediator between neurocognition and functioning in psychosis
(N=71) was investigated.

Next, using only one of the metacognitive components: metacognitive efficiency, this
thesis explored whether this component could be used to explain the presence of
anomalous experiences. Anomalous experiences refer to a rich number of various psychic
phenomena, including anomalous self-experiences and anomalous perceptual
experiences, leading to anomalous delusional beliefs. Initially, this thesis developed and
piloted two metacognitive tasks in healthy student sample (N=125). Next, these tasks
were used to examine the relationship between anomalous experiences and metacognitive
efficiency within the first two samples (N=135): FEP group (N=62) and healthy control

Current findings demonstrated a role for metacognitive ability in predicting both
functional outcome and subjective outcome in FEP, cross-sectionally, and in predicting
functional outcome across three years. Alongside this, holding specific self-defining
memories was shown to predict functional outcome, independent of neurocognition and
metacognition, in FEP. However, no significant association was demonstrated between
anomalous experiences and metacognitive efficiency, instead anomalous self-experiences
were associated with auditory perceptual biases. This thesis highlights the importance of
enhancing metacognitive ability, alongside neurocognitive ability and SDMs, in order to
improve functioning.

Item Type: Thesis (Doctoral)
Schools and Departments: School of Psychology > Psychology
Subjects: B Philosophy. Psychology. Religion > BF Psychology > BF0712 Developmental psychology Including infant psychology, child psychology, adolescence, adulthood
Depositing User: Library Cataloguing
Date Deposited: 18 Jan 2019 12:47
Last Modified: 18 Jan 2019 12:47

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