Investigating the relationship between negative symptoms and metacognitive functioning in psychosis: An individual participant data meta-analysis

Nicola McGuire, Andrew Gumley, Ilanit Hasson-Ohayon, Stephanie Allan, Warut Aunjitsakul, Orkun Aydin, Sune Bo, Kelsey A. Bonfils, Anna Lena Bröcker, Steven de Jong, Giancarlo Dimaggio, Felix Inchausti, Jens Einar Jansen, Tania Lecomte, Lauren Luther, Angus MacBeth, Christiane Montag, Marlene Buch Pedersen, Gerdina Henrika Maria Pijnenborg, Raffaele PopoloMatthias Schwannauer, Anne Marie Trauelsen, Rozanne van Donkersgoed, Weiming Wu, Kai Wang, Paul H. Lysaker, Hamish McLeod

Research output: Contribution to journalReview articlepeer-review


Purpose: Negative symptoms are a persistent, yet under-explored problem in psychosis. Disturbances in metacognition are a potential causal factor in negative symptom development and maintenance. This meta-analysis uses individual participant data (IPD) from existing research to assess the relationship between negative symptoms and metacognition treated as summed scores and domains. Methods: Data sets containing individuals with negative symptoms and metacognition data, aged 16+ with psychosis, were identified according to pre-specific parameters. IPD integrity and completeness were checked and data were synthesized in two-stage meta-analyses of each negative symptoms cluster compared with metacognition in seemingly unrelated regression using restricted maximum likelihood estimation. Planned and exploratory sensitivity analyses were also conducted. Results: Thirty-three eligible data sets were identified with 21 with sufficient similarity and availability to be included in meta-analyses, corresponding to 1301 participants. The strongest relationships observed were between summed scores of negative symptoms and metacognition. Metacognitive domains of self-reflectivity and understanding others' minds, and expressive negative symptoms emerged as significant in some meta-analyses. The uncertainty of several effect estimates increased significantly when controlling for covariates. Conclusions: This robust meta-analysis highlights the impact of using summed versus domain-specific scores of metacognition and negative symptoms, and relationships are not as clear-cut as once believed. Findings support arguments for further differentiation of negative symptom profiles and continued granular exploration of the relationship between metacognition and negative symptoms.

Original languageEnglish
Pages (from-to)918-933
Number of pages16
JournalPsychology and Psychotherapy: Theory, Research and Practice
Issue number4
Early online date2 Aug 2023
StatePublished - Dec 2023

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.


  • anhedonia
  • apathy
  • metacognition
  • psychosis
  • schizophrenia


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