Mental time travel and insight in schizophrenia

Schizophrenia features pervasive insight deficits, with many failing to recognize symptoms or the need for treatment, predictors of poorer outcomes. Rather than unitary, insight comprises clinical (awareness of illness and need for care) and cognitive (self-reflectiveness and the ability to question one's beliefs). This review examines whether mental time travel (MTT) - vivid recollection of past events and construction of detailed future scenarios - may underlie insight deficits in schizophrenia. We synthesize evidence up to May 2025 from meta-analyses, experimental studies, and neuroimaging/neuroanatomical reports on MTT (autobiographical memory specificity, future simulation, temporal horizon) and their associations with clinical and cognitive insight. Individuals with schizophrenia show reduced autobiographical specificity, future simulation vividness, alongside a narrowed temporal horizon. These impairments are linked to diminished self-reflection, narrative coherence, and metacognitive abilities, all of which are essential for accurate illness recognition. Neuroimaging indicates that the networks supporting mental time travel, self-reflection, and insight - particularly the default-mode and ventromedial prefrontal circuits - substantially overlap and are disrupted in schizophrenia, with heterogeneity across illness stage and analytic approach. Moderators such as negative symptoms and trauma appear to intensify the MTT-insight links, while depressive mood may paradoxically enhance illness awareness. Although therapies targeting episodic specificity and metacognitive mastery show promise, longitudinal and interventional evidence remains limited. Associations between MTT impairments and insight are robust but largely correlational, so reverse or bidirectional causality cannot be excluded. We outline priorities for longitudinal, interventional, and trauma-stratified studies - attentive to illness stage and default-mode dynamics - to clarify mechanisms and guide targeted interventions.