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 found in schizophrenia. However, despite clear relevance few studies have investigated the link between these abilities in psychosis. 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. In sum, we observe that those diagnosed with bipolar and schizophrenia were less oriented to focus on influencing a social other, and more concerned with their own performance, whereas the opposite was true of controls. Symptom-based analysis provided preliminary evidence that advice confidence 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.