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An observational study of individuals suffering from anxiety and depression disorders reported an association between the improvement in anxiety or depression symptoms and an increase in confidence. The authors suggest that this correlation arises because the improvement in symptoms diminishes metacognitive biases, thereby enhancing confidence. The study was published in eLife.
The word metacognition refers to the cognitive processes that involve thinking about one’s own thinking. It allows individuals to monitor, control, and adjust their cognitive activities. Metacognition is a higher-order thinking skill that is crucial for effective learning, problem-solving, and decision-making. However, metacognition may sometimes produce errors and erroneous judgements. This is referred to as metacognitive bias.
Metacognitive biases are systematic errors or distortions in metacognitive processes that can impact decision-making and problem-solving. These biases can arise from various factors, including cognitive limitations, the need to draw conclusions without enough information, and social influences. For example, the confirmation bias is a common metacognitive bias where individuals show a tendency to favor information that confirms their pre-existing beliefs while disregarding contradictory evidence. The overconfidence bias is another common metacognitive bias where individuals tend to overestimate their own abilities or the accuracy of their judgments. Individuals can also underestimate their own abilities and this tendency is particularly important in the scope of various mental disorders.
Metacognitive abilities and biases vary among individuals. However, it was unclear whether these could change. To explore this, study author Celine Ann Fox and her colleagues investigated the metacognition in a large cohort both before and after undergoing internet-based cognitive behavioral therapy.
The study involved 836 individuals receiving internet-based cognitive behavioral therapy, 102 undergoing antidepressant therapy, and 113 participants serving as a control group with no therapy. Each treatment group completed a 4-week course. Approximately 20-22% of participants dropped out during the study, reducing the number of those who completed all assessments. The majority of the participants were female, primarily residing in the UK or Ireland.
At the beginning and end of the study, a span of four weeks, participants completed assessments for various mental health issues. These included functional impairment (Work and Social Adjustment Scale), depression (Zung Self-Rating Depression Scale), trait anxiety (State Trait Anxiety Inventory), schizotypy (Short Scales for Measuring Schizotypy), impulsivity (Barratt Impulsiveness Scale 11), obsessive-compulsive disorder (OCI-R), social anxiety (Liebowitz Social Anxiety Scale), eating disorders (Eating Attitudes Test), apathy (Apathy Evaluation Scale), and alcohol misuse (Alcohol Use Disorders Identification Test).
They also completed a metacognitive task. In the task, the testing system would display two sunflowers with varying numbers of seeds for 300 milliseconds. Participants’ task was to make a judgement on which of the two sunflower pictures contained more seeds and to rate their confidence level in that judgement. There was a total of 210 such trials divided into 5 blocks. The researchers controlled and adjusted the differences between the two pictures in order to keep the objective accuracy of participants’ answers at 70% of correct answers. In that way, all participants were objectively equally successful in the task. However, in spite of this, their confidence levels in their judgments differed.
Results showed that males had significantly higher confidence than women across all treatments. Participants whose education level was above undergraduate had significantly lower confidence compared to those with education up to the undergraduate level. Confidence levels were not associated with accuracy in the metacognitive task, with the time participants needed to give an answer, nor with their age.
Overall, all psychiatric symptoms showed improvement during the treatment period, except for impulsivity. The average confidence level among participants also rose. A notable correlation was observed between the changes in confidence and the alterations in anxiety and depression symptoms. Those who experienced the most significant reductions in these symptoms also exhibited the greatest increase in confidence from the beginning to the end of the study.
Group comparisons revealed that the levels of anxiety and depression symptoms remained unchanged in the control group. In contrast, average changes in these symptoms were observed only in the two treatment groups. The most significant increase in confidence from the start to the end of the study occurred in the antidepressant group, whereas it remained unchanged in the control group. Additionally, participants demonstrated enhanced performance in the metacognitive task at the study’s conclusion.
“Our findings replicated the cross-sectional evidence that higher levels of anxious-depression are associated with under-confidence,” the study authors concluded. “We demonstrate that metacognitive confidence increases following four weeks of internet-based cognitive behavioral therapy or antidepressant treatment. Overall, we observed that the greater the improvement in anxious-depression, the more confident participants became, which did not appear to be dependent on treatment type. This suggests that metacognitive biases in anxious-depression are state-dependent and might be normalized through clinical improvements.”
The study sheds light on the links between confidence and psychopathological symptoms. However, it also has limitations that need to be considered. Notably, the association between changes in symptoms and in confidence was very weak and the change in confidence between the start and the end of the study was very small. Additionally, confidence was measured solely using a single visual perception and judgement task. Results might not be the same if a different way of measuring confidence was used.
The paper, “An observational treatment study of metacognition in anxious-depression”, was authored by Celine Ann Fox, Chi Tak Lee, Anna Kathleen Hanlon, Tricia XF Seow, Kevin Lynch, Siobhán Harty, Derek Richards, Jorge Palacios, Veronica O’Keane, Klaas Enno Stephan, and Claire M Gillan.
