Examining Auditory Hallucinations and Attention in Schizophrenia Patients According to the Metacognitive Model

We aimed to test predictions made by the metacognitive model of psychopathology, which assumes associations of metacognitive beliefs and consequent strategies (dubbed cognitive-attentional syndrome, CAS) with symptoms of schizophrenia and psychopathological symptoms in general.

Patients diagnosed with schizophrenia with current auditory hallucinations (n = 64) and without hallucinations (n = 70) and healthy controls (n = 69) were assessed in terms of symptoms, metacognitive factors, and attention functioning, and also experimental tasks measuring different facets of attention (auditory attention, attentional bias, and self-focused attention). Additionally, a network analysis with a mixed graphical model aimed at delineating relationships between these variables of interest was performed for the schizophrenia group. Such an analysis allows the study of intricate interrelations between variables while controlling the effects of other relevant variables.

Patients with hallucinations scored higher in measures of CAS and certain facets of metacognitive beliefs compared to those without hallucinations. In experimental tasks, we observed significant effects for auditory attention performance but not for attentional bias and self-focused attention. The network analysis results pointed to the prominent associations of metacognitive beliefs and CAS with hallucinations and psychopathology in general.

The obtained results offer insights into the role of metacognition and attention functioning in symptoms of schizophrenia, particularly hallucinations. The presented network model suggests that interventions addressing the change of these beliefs and maladaptive self-regulatory strategies may constitute valuable treatment targets.