Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Centre for Innovation in Mental Health, School of Psychology, University of Southampton, UK.
Schizophr Res. 2024 Mar;265:74-82. doi: 10.1016/j.schres.2022.12.023. Epub 2023 Jan 7.
Hallucinations have been linked to failures in metacognitive reflection suggesting an association between hallucinations and overestimation of performance, although the cross-sectional findings are inconsistent. This inconsistency may relate to the fluctuating hallucinatory experiences that are not captured in cross-sectional studies. Ecological Momentary Assessment (EMA) captures in-the-moment experiences over time so can identify causal relationships between variables such as the associations between metacognition and hallucinatory experience in daily life and overcome problems in cross-sectional designs.
Participants (N = 41) experiencing daily hallucinations completed baseline questionnaires and smartphone surveys 7 times per day for 14 days. They were prompted to identify a task they would complete in the next 4 h and to make metacognitive predictions around the likelihood of completing the task, the difficulty of the task, and how well they would complete it (standard of completion).
76 % finished the 14-days of assessment with an average of 42.2 % survey completion. Less accurate metacognition was associated with more hallucinations, but less accurate likelihood and standard of completion was associated with fewer hallucinations. Using a cross-lagged analysis, metacognitive predictions around the likelihood of completion (p < .001) and standard of completion (p = .01) predicted hallucination intensity at the following timepoint, and metacognitive predictions regarding likelihood of completion (p = .02) predicted hallucination control at the following timepoint.
Interventions that aim to improve metacognitive ability in-the-moment may serve to reduce the intensity and increase the control of hallucinations.
幻觉与元认知反射失败有关，这表明幻觉与对表现的高估之间存在关联，尽管横断面研究的结果不一致。这种不一致可能与横断面研究无法捕捉到的幻觉体验的波动有关。生态瞬时评估（EMA）随时间捕捉即时体验，因此可以识别变量之间的因果关系，例如元认知和日常生活中的幻觉体验之间的关联，并克服横断面设计中的问题。
每天经历幻觉的参与者（N=41）完成基线问卷和智能手机调查，每天 7 次，持续 14 天。他们被提示确定他们将在接下来的 4 小时内完成的任务，并对完成任务、任务难度以及完成任务的程度（完成标准）的可能性进行元认知预测。
76%的参与者完成了 14 天的评估，平均完成率为 42.2%。元认知准确性较低与幻觉较多有关，而准确性较低的可能性和完成标准与幻觉较少有关。使用交叉滞后分析，完成可能性（p<0.001）和完成标准（p=0.01）的元认知预测在随后的时间点预测幻觉强度，完成可能性的元认知预测（p=0.02）预测随后时间点的幻觉控制。
旨在提高即时元认知能力的干预措施可能有助于降低幻觉的强度和增加幻觉的控制。
