The Communication of Metacognition for Social Strategy in Psychosis: An Exploratory Study

Sharing privately held information, for example, one’s confidence in the likelihood of future events, can greatly help others make better decisions as well as promoting one’s reputation and social influence. Differences in metacognition on the one hand, and difficulties in social functioning and social cognition on the other, have been reported in people diagnosed with schizophrenia and bipolar disorder. However, despite clear relevance few studies have investigated the link between these abilities and psychosis. In this exploratory study, we compared individuals diagnosed with schizophrenia, bipolar disorder, and a group of unselected general population controls, in an online competitive advice-giving task. Participants gave advice to a client by making a probabilistic perceptual judgment. They could strategically adapt the advice confidence to gain influence over the client. Crucially, participants competed with a rival adviser to attract the client’s endorsement. We observe that participants diagnosed with schizophrenia displayed an overall overconfidence in their advice compared with other, bipolar, and unselected control groups, but did not differ in metacognitive efficiency from controls. Symptom-based analysis revealed that the social-influence effect was associated with the presence of delusions but not hallucinations or mood symptoms. These results suggest that the social communication of uncertainty should be further investigated in psychosis.