# The Assessment of Metacognition in Psychosis: Systematic Review and Future Lines of Research

## TL;DR

This paper reviews tools for assessing metacognition in psychosis and proposes a framework to categorize these tools for better clinical and research use.

## Contribution

The paper introduces a framework categorizing metacognition assessment tools into four domains to improve their selection and use.

## Key findings

- Over 30 instruments have been identified to assess metacognition in psychosis.
- A framework groups these tools into four domains: Metacognitive Awareness, Metacognitive Capacity, Neurometacognition, and Social Metacognition.
- Short self-report scales are practical for clinical settings, while interviews or performance-based tasks are better for research.

## Abstract

Impaired metacognition, the capacity to understand one's own and others' mental states, has gained increasing attention in psychosis research. Different conceptualizations, psychological treatments and assessment methods have emerged; however, there is a lack of consensus regarding the appropriate tools for clinical and research use. This systematic review had two aims: (1) to compile and organize available assessment tools and (2) to propose an index of metacognitive domains and processes. Instruments were categorized according to authorship, year of use in psychosis, outcomes assessed, language/version, administration time and type of Clinical Outcome Assessment (ClinRO, PRO or PerfO). We identified 42 studies that used 31 instruments. The tools were classified into four domains: Metacognitive Awareness, Metacognitive Capacity, Neurometacognition and Social Metacognition. Our findings highlight the diversity of the available measures and propose a framework for aligning instruments with specific reflective processes. This work represents a practical and theoretical first step toward building consensus and facilitating both the use of available tools according to practical needs and the development of an agreed‐upon definition and components of metacognition.

Metacognition is the capacity to reflect on one's own and others' psychological processes, including thoughts, emotions, behaviours and relationships.Deficits in metacognition are robustly associated with poorer functional outcomes in psychosis, even when controlling for symptom severity and neurocognition.More than 30 instruments have been detected to assess metacognition in psychosis, but the lack of consensus makes their clinical use and research comparisons difficult.We propose a framework grouping these tools into four main areas—Metacognitive Awareness, Metacognitive Capacity, Neurometacognition and Social Metacognition—making it easier to select instruments depending on the type of reflective processes of interest.In practice, short self‐report scales can be useful in busy clinical settings, while interviews or performance‐based tasks are more suitable for research or specialized care.

Metacognition is the capacity to reflect on one's own and others' psychological processes, including thoughts, emotions, behaviours and relationships.

Deficits in metacognition are robustly associated with poorer functional outcomes in psychosis, even when controlling for symptom severity and neurocognition.

More than 30 instruments have been detected to assess metacognition in psychosis, but the lack of consensus makes their clinical use and research comparisons difficult.

We propose a framework grouping these tools into four main areas—Metacognitive Awareness, Metacognitive Capacity, Neurometacognition and Social Metacognition—making it easier to select instruments depending on the type of reflective processes of interest.

In practice, short self‐report scales can be useful in busy clinical settings, while interviews or performance‐based tasks are more suitable for research or specialized care.