Decision-making and Metacognition

This workstream is spearheaded by Prof Anthony David at the UCL Institute of Mental Health, with key involvement from the Metalab, led by Dr Stephen Fleming at the UCL Wellcome Centre for Human Neuroimaging and Department of Experimental Psychology. Through theoretical and experimental work, we combine techniques from cognitive neuroscience with experiential research grounded in professional practice. Integral to our work is the input of the McPin Foundation Service User Advisory Group, which has informed us on questions of design and test-driven our experimental paradigms.

Our work on metacognition is closely allied to that of workstream 4 on insight. Insight may be viewed as a particular kind of metacognition which concerns itself with reflecting upon whether one’s thinking, and resulting beliefs and perceptions, is yielding accurate and useful conclusions. Some clinical psychiatrists would say that decision making capacity is undermined when someone fails to recognize that their thinking is altered. Others disagree, pointing out that the psychiatrist’s determination on insight is subjective and has potential to be abused in legal contexts. We use systematic reviews and empirical studies to scrutinise how insight is used and whether it relates to objective measures of metacognition. Tony David’s ‘King’s Lecture’ on Insight is available here.

Steve Fleming has pioneered measurement of metacognition in the lab. Participants are asked to make a decision and give a self-rating of their confidence that they have decided correctly. We are able to quantify the extent to which that confidence was justified at a given level of performance accuracy, generating a parameter (“meta-d’ ”) with specific neural correlates. Our adapted paradigms enable comparison between healthy and clinical groups, and across the lifecourse, and a gamified metacognitive measure has facilitated measurement of metacognition for people with Parkinson’s Disease and Alzheimer’s and quantification of how specific disorder-related deficits interact with metacognition and insight.

The effects of social influences on an individual’s decision-making form another focus of our work. We undertake theoretical and experimental studies to explore how people use advice and when they may be subject to undue influence from others. We have compared advice-taking behaviours across cultures, in an empirical study with Peking University, China, and we propose that studying advice-taking itself may be useful as a model for the using-and-weighing of options in capacitous decision-making. Collaborating with Prof Francesca Happe’s group, we measuring metacognition in people with autistic spectrum disorder and the neurotypical population to investigate whether people who better understand other people’s minds are also have better metacognition. Finally, we have undertaken a case review with workstream 6, to explore how social pressures may affect decision making capacity in Court of Protection cases.

Real-world assessment practice is another strand of study for the workstream, using survey and interview methods with health and social care professionals and observational studies of the Court of Protection. This has allowed us to examine the ethical and practical issues of introducing neuroscientific measurement techniques and to make recommendations for improving assessment practices in a variety of settings.

As part of the Dear World Project, Elisa van der Plas and Andrew McWilliams were paired with artists to explore themes of mental illness, decision-making, capacity and vulnerability. Members of the workstream mentor for In2Science and In2Research, helping students from disadvantaged backgrounds to discover and achieve careers in science after school or university.