People with depression and posttraumatic stress disorder tend to underestimate their cognitive abilities—a pattern that may worsen their mental health. A new study published in Neuropsychology provides evidence that this negative self-perception, known as metacognitive bias, is both common and severe in individuals with high levels of depressive and PTSD symptoms. The researchers also found that targeted or game-based cognitive training can improve these biases and may contribute to a reduction in symptom severity.
Depression and PTSD are two of the most common mental health conditions, often marked by persistent negative thoughts and emotional distress. Depression is characterized by symptoms such as sadness, low energy, and loss of interest in daily activities, while PTSD can involve intrusive memories, avoidance of reminders, emotional numbness, and heightened arousal following exposure to traumatic events. Both conditions are known to distort how individuals perceive themselves and the world around them.
In recent years, researchers have become increasingly interested in how metacognition—the ability to reflect on and evaluate one’s own thoughts and abilities—may influence mental health. One important aspect of metacognition is “metacognitive bias,” or the tendency to systematically overestimate or underestimate one’s own abilities.
While people in the general population often show a slight tendency to overestimate themselves, this study focused on the opposite problem: large-scale underestimation among individuals with depression and PTSD. The researchers wanted to examine how strongly these negative self-perceptions were related to symptoms and whether cognitive training could help reduce them.
To explore these questions, researchers reanalyzed data from a randomized controlled trial known as the BRAVE study, which involved 84 participants, mostly military veterans, who had experienced mild traumatic brain injuries and reported cognitive difficulties. About three-quarters of the participants had either elevated depression, PTSD symptoms, or both.
The participants were randomly assigned to one of two 13-week training programs: a “targeted cognitive training” group that completed computerized exercises designed to improve attention, memory, and executive function, or an “entertainment training” group that played puzzle and board games like Tetris and Solitaire.
Before and after the training, participants completed a variety of assessments. Self-reported cognitive performance was measured using the Cognitive Failures Questionnaire, a validated 25-item scale that captures daily lapses in attention and memory. Objective cognitive performance was evaluated using a battery of tests measuring learning, memory, working memory, attention, and cognitive flexibility. By comparing self-perceived and actual performance, researchers calculated each participant’s metacognitive bias. Depression and PTSD symptoms were also measured using well-established clinical questionnaires.
At the start of the study, the researchers found that people with elevated depression or PTSD symptoms significantly underestimated their cognitive abilities compared to their actual test scores. On average, participants with both conditions scored nearly 2.3 standard deviations below the norm in their self-assessments, despite relatively mild objective impairments. This discrepancy—referred to as a negative global metacognitive bias—was strongly linked to the severity of depression and PTSD symptoms. The researchers found no evidence that these negative biases were linked to specific types of cognitive impairment, suggesting that they reflect a broader pattern of self-doubt rather than performance in a particular area.
Over the 13-week intervention period, participants in both the targeted and entertainment training groups showed notable improvements. Those who completed either program reported fewer cognitive problems, reduced depression symptoms, and improved metacognitive accuracy. Importantly, the size of the improvement in metacognitive bias was correlated with the reduction in both depression and PTSD symptoms. This relationship was especially strong in the entertainment training group, where participants who most improved their self-perception also experienced the greatest mental health benefits.
Interestingly, while both training programs improved self-reported cognition and metacognitive bias, only the targeted training group showed small, non-significant trends toward better objective cognitive performance. This suggests that the subjective feeling of improved cognitive ability—rather than actual test performance—may play a more important role in symptom improvement for people with depression and PTSD.
The researchers believe the performance feedback embedded in both training programs may be key to these improvements. In both training conditions, participants received feedback on their progress and were rewarded for correct performance, helping them to form more accurate beliefs about their cognitive abilities. This positive reinforcement may have helped counteract the negative thinking patterns common in depression and PTSD.
Three months after training ended, participants continued to report lower depression symptoms, and those in the entertainment group also maintained improvements in PTSD symptoms and metacognitive bias. These lasting effects suggest that cognitive training—especially when designed to be engaging and motivating—may have durable benefits for people struggling with self-doubt and negative thinking.
While the study offers promising evidence, the authors note several limitations. The sample consisted primarily of military veterans with a history of mild traumatic brain injury, which may limit the generalizability of the findings to other groups. Additionally, the study did not include a no-treatment control group, making it difficult to rule out the influence of nonspecific effects such as time, attention, or participant expectations.
Future studies with larger, more diverse samples and more rigorous control conditions will be needed to confirm whether improvements in metacognitive bias can directly lead to reductions in depression and PTSD symptoms.
The study, “Negative Global Metacognitive Biases Are Associated With Depressive and Posttraumatic Stress Disorder Symptoms and Improve With Targeted or Game-Based Cognitive Training,” was authored by Sam Agnoli, Henry Mahncke, Sarah-Jane Grant, Zachary T. Goodman, William P. Milberg, Michael Esterman, and Joseph DeGutis.