What if metacognition is not enough? Its association with delusion may be moderated by self-criticism

Metacognition among those reporting psychotic symptoms is associated with a distortion in the way they understand their own and others’ mental states. Recent advances suggest that distortion in the form of self-criticism may activate a threat response and fuel symptom expression. At high level of self-criticism metacognition may reduce its protective role towards psychosis. Here, we explored whether the associations between impaired self-reflectivity and delusional ideation would decrease in the presence of self-criticism. A moderated regression model confirmed our hypothesis in a large sample of healthy young adults (N = 2065) even when controlled for sex, education, and family income. Our findings suggest how interventions aimed at reducing symptoms and promoting metacognition should always be interconnected with those targeting self-criticism