University of Sussex
Wright, Abigail.pdf (6.3 MB)

Developing a dynamic model of metacognitive influences on anomalous experiences and functional outcome in young people with and without psychosis

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posted on 2023-06-09, 16:29 authored by Abigail Wright
Beck and Rector (2005) proposed a model of functional outcome in schizophrenia, suggesting the path between neurocognition and functioning is mediated by functional capacity and cognitive processes. These cognitive processes include defeatist performance beliefs, self-stigma and, most recently, metacognition, considered ‘thinking about thinking’. Metacognition has been proposed to work in a hierarchy between the object- and meta-level, outlined within Nelson and Narens (1990) model, including several metacognitive components: metacognitive ability, experience and efficiency, connected by metacognitive processes. Firstly, this thesis investigated how different metacognitive components may interact dynamically and predict both what people do in their everyday lives (functional outcome) and how people feel about their everyday lives (subjective recovery outcome) in First Episode Psychosis (N=62), compared to healthy controls (N=73). Following this, this thesis examined the role of metacognition in predicting functional outcome across a three-year period, in FEP (N=26). Finally, it was suggested that metacognition may be expanded to include the way one thinks about oneself through important memories, e.g. self-defining memories (SDMs). The role of SDMs as an additional mediator between neurocognition and functioning in psychosis (N=71) was investigated. Next, using only one of the metacognitive components: metacognitive efficiency, this thesis explored whether this component could be used to explain the presence of anomalous experiences. Anomalous experiences refer to a rich number of various psychic phenomena, including anomalous self-experiences and anomalous perceptual experiences, leading to anomalous delusional beliefs. Initially, this thesis developed and piloted two metacognitive tasks in healthy student sample (N=125). Next, these tasks were used to examine the relationship between anomalous experiences and metacognitive efficiency within the first two samples (N=135): FEP group (N=62) and healthy control (N=73). Current findings demonstrated a role for metacognitive ability in predicting both functional outcome and subjective outcome in FEP, cross-sectionally, and in predicting functional outcome across three years. Alongside this, holding specific self-defining memories was shown to predict functional outcome, independent of neurocognition and metacognition, in FEP. However, no significant association was demonstrated between anomalous experiences and metacognitive efficiency, instead anomalous self-experiences were associated with auditory perceptual biases. This thesis highlights the importance of enhancing metacognitive ability, alongside neurocognitive ability and SDMs, in order to improve functioning.


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University of Sussex

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