Hot metacognition: poorer metacognitive efficiency following acute but not traumatic stress

Abstract:

Aberrations to metacognition— the ability to reflect on and evaluate self-performance— are a feature of poor mental health. Theoretical models suggest that following a stressful event, maladaptive metacognitive evaluations and appraisals of the event drive development of post-traumatic stress symptoms. Yet it is unclear whether disruptions to metacognition causes or contributes to symptom development, or are simply a consequence of ongoing psychopathology. In two studies, using hierarchical Bayesian modelling of metacognition combined with a memory encoding task, we assessed whether distortions to metacognition occur at a state-level after an acute stress induction, or at a trait-level in a sample of individuals experiencing intrusive memories following traumatic stress. Study 1 indicated that heightened perceived stress was associated with impairments in metacognitive efficiency on a memory test after a stress induction (N = 27). Study 2 demonstrated that a transdiagnostic sample of individuals experiencing intrusive memories following a traumatic stressor (N = 39) showed no significant differences in metacognitive efficiency compared to matched controls on the same memory test (N = 45). Our results show that alterations to metacognition do not occur in patients experiencing intrusive memories following traumatic stress, but instead are associated with temporary, heighted levels of acute stress. This suggests that differential sensitivity to acute stress, rather than ongoing psychopathology, induces metacognitive impairments, which could predispose individuals to future mental health problems via downstream changes to other cognitive processes.