The mind’s mirror A neurocognitive perspective on confidence and metacognition in psychiatry

This thesis investigates the feeling of confidence as a metacognitive construct, exploring its neurobiological foundations, biases, and its relationship with psychiatric symptoms and disorders. Through a series of studies encompassing clinical samples of patients with obsessive-compulsive disorder and/or gambling disorder, healthy controls and general population samples, it investigates the disruptions in metacognitive abilities across different contexts. By employing a range of methodologies such as functional MRI, eye-tracking, cognitive computer tasks, questionnaires and computational modelling, we gain a multifaceted understanding of confidence in psychiatry.
This work shows confidence abnormalities across various (sub)clinical psychiatric conditions, with specific directions for different symptom presentations. Moreover, it demonstrates that motivational processes can modulate metacognitive. Confidence is explored across multiple hierarchical levels to look at the interplay between confidence and self-beliefs and their relation to transdiagnostic psychopathology.
Additionally, it shows that OCD patients exhibit underconfidence across the confidence hierarchy compared to control subjects, but intact metacognitive sensitivity. In patients with GD our studies indicate overconfidence in gambling-related contexts.
This thesis also discusses the generalizability of neurocognitive findings from general population samples to clinical samples. It shows that clinical OCD patients have distinct metacognitive patterns (namely, underconfidence) compared to highly compulsive individuals from the general population (namely, overconfidence).
Overall, our findings indicate that disturbances in confidence, and in a broader sense, metacognition, are a central aspect of mental health and thereby a potential therapeutic target.