Anna-Lena Bröcker1, Samuel Bayer2, Frauke Stuke1, Patrick Giemsa1,3, Andreas Heinz1, Felix Bermpohl1, Paul H Lysaker4,5, Christiane Montag1. 1. Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany. 2. International Psychoanalytic University Berlin (IPU), Berlin, Germany. 3. Department Psychology, Medical School Brandenburg Theodor Fontane, Am Alten Gymnasium 1-3, 16186, Neuruppin, Germany. 4. Roudebush VA Medical Center, Indianapolis, Indiana, USA. 5. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Abstract
OBJECTIVES: Metacognition, the capacity 'to think about thinking' and thus to reflect and to master interpersonal problems on a mentalistic basis, is often impaired among patients with schizophrenia spectrum disorders and has been suggested as a potential treatment target. However, little is known about the reliability of its measurement and links with related phenomena. The aim of this study was to validate a German translation of the Metacognition Assessment Scale (MAS-A) as a measure to assess metacognition from free narratives of patients' personally relevant episodes and relationships. DESIGN AND METHODS: MAS-A was applied to narratives of 22 individuals with schizophrenia spectrum disorders together with self-ratings and behavioural tests of metacognitive and related functions such as mentalizing and emotional awareness. Multi-level modelling allowed to calculate inter-rater reliability (IRR) and inter-rater agreement (IRA) and to include test results as level-2 predictors of the aggregated scorings on the MAS-A subscales in order to explore convergent validity. After considering neurocognition and symptom scores as further predictors, aggregated scorings were correlated with psychosocial functioning. RESULTS: There were high IRRs and IRAs all over the ratings. None of the related measures accounted for variance in MAS-A scorings, indicating the existence of separable, non-overlapping constructs. Verbal memory and positive symptoms were significant predictors for MAS-A subscales. MAS-A, but no other measure, displayed significant associations with psychosocial functioning. CONCLUSIONS: MAS-A is a reliable expert rating to assess metacognition from patients' free narratives. Considering the link to psychosocial functioning, MAS-A appears to be a promising tool for the evaluation of metacognition. PRACTITIONER POINTS: MAS-A is a reliable tool to evaluate metacognitive function from narratives about emotionally relevant topics and meaningful relationships. Metacognition appears separate from neighbouring constructs such as mentalizing, ToM, or emotional awareness. MAS-A scales are significantly predicted by verbal memory and positive symptoms. Only MAS-A scales display significant associations with psychosocial functioning, and it thus is a promising tool to evaluate metacognition in psychotherapy research.
OBJECTIVES: Metacognition, the capacity 'to think about thinking' and thus to reflect and to master interpersonal problems on a mentalistic basis, is often impaired among patients with schizophrenia spectrum disorders and has been suggested as a potential treatment target. However, little is known about the reliability of its measurement and links with related phenomena. The aim of this study was to validate a German translation of the Metacognition Assessment Scale (MAS-A) as a measure to assess metacognition from free narratives of patients' personally relevant episodes and relationships. DESIGN AND METHODS: MAS-A was applied to narratives of 22 individuals with schizophrenia spectrum disorders together with self-ratings and behavioural tests of metacognitive and related functions such as mentalizing and emotional awareness. Multi-level modelling allowed to calculate inter-rater reliability (IRR) and inter-rater agreement (IRA) and to include test results as level-2 predictors of the aggregated scorings on the MAS-A subscales in order to explore convergent validity. After considering neurocognition and symptom scores as further predictors, aggregated scorings were correlated with psychosocial functioning. RESULTS: There were high IRRs and IRAs all over the ratings. None of the related measures accounted for variance in MAS-A scorings, indicating the existence of separable, non-overlapping constructs. Verbal memory and positive symptoms were significant predictors for MAS-A subscales. MAS-A, but no other measure, displayed significant associations with psychosocial functioning. CONCLUSIONS: MAS-A is a reliable expert rating to assess metacognition from patients' free narratives. Considering the link to psychosocial functioning, MAS-A appears to be a promising tool for the evaluation of metacognition. PRACTITIONER POINTS: MAS-A is a reliable tool to evaluate metacognitive function from narratives about emotionally relevant topics and meaningful relationships. Metacognition appears separate from neighbouring constructs such as mentalizing, ToM, or emotional awareness. MAS-A scales are significantly predicted by verbal memory and positive symptoms. Only MAS-A scales display significant associations with psychosocial functioning, and it thus is a promising tool to evaluate metacognition in psychotherapy research.
Keywords:
Metacognition Assessment Scale-abbreviated; mentalizing; metacognition; perspective-taking; psychosis; psychotherapy; schizophrenia; social cognition; theory of mind