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Integrating cognitive neuroscience and clinical perspectives on metacognitive mechanisms in psychopathology

Nature Reviews Psychology volume 5, pages 9–28 (2026)Cite this article

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Abstract

Metacognition (the fundamental ability to reflect on and evaluate one’s own thoughts and actions) can shape human decisions and behaviours. Alterations in metacognition, such as distortions in confidence, self-reflection and beliefs about mental processes, are frequent in patients with mental disorders and are the target of effective clinical interventions. However, inconsistent frameworks and conceptual barriers between cognitive neuroscience and clinical disciplines have hindered advances in understanding and treating metacognition in psychopathology. In this Review, we review the metacognition literature to highlight cross-disciplinary inconsistencies and overlaps in terminology, experimental approaches and study populations between cognitive neuroscience and clinical perspectives. We build on a hierarchical framework of metacognition to start the process of integrating these literatures, and discuss the challenges associated with categorical and dimensional approaches to mental disorders. Our recommendations for future directions highlight the need for collaborative work between cognitive and clinical experts and methodological approaches that capture the causal links between metacognition and psychopathology.

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Fig. 1: Neural substrates of metacognition.
Fig. 2: Initial metacognitive hierarchy.
Fig. 3: Metacognitive hierarchy integrating clinical and neurocognitive definitions.
Fig. 4: Examples of how disruptions in metacognition at any hierarchy point might lead to dysfunction.

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Acknowledgements

The authors thank A. Meinert for help in summarizing the evidence for metacognitive interventions in Table 2. T.X.F.S. is supported by a Sir Henry Wellcome Postdoctoral Fellowship (224051/Z/21/Z) of the Wellcome Trust. T.U.H. has received funding from the Wellcome Trust (316955/Z/24/Z) and the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No. 946055).

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Authors and Affiliations

  1. Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK

    Tricia X. F. Seow & Tobias U. Hauser

  2. Functional Imaging Laboratory, Department of Imaging Neuroscience, University College London, London, UK

    Tricia X. F. Seow & Tobias U. Hauser

  3. Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Lena Jelinek & Steffen Moritz

  4. Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Tübingen, Tübingen, Germany

    Tobias U. Hauser

  5. German Center for Mental Health (DZPG), Tübingen, Germany

    Tobias U. Hauser

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Contributions

T.X.F.S. and T.U.H. conceptualized the review. T.X.F.S., L.J. and S.M. wrote the original draft. All authors contributed substantially to discussion of the content, wrote, reviewed and/or edited the manuscript before submission.

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Correspondence to Tricia X. F. Seow or Tobias U. Hauser.

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Competing interests

S.M. and L.J. have been invited to present on metacognitive training, for which they have occasionally received honoraria. S.M. has also served as a consultant for Boehringer Ingelheim. T.U.H. consults for Limbic Ltd and holds shares in the company (this activity has had no influence on this paper).

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Seow, T.X.F., Jelinek, L., Moritz, S. et al. Integrating cognitive neuroscience and clinical perspectives on metacognitive mechanisms in psychopathology. Nat Rev Psychol 5, 9–28 (2026). https://doi.org/10.1038/s44159-025-00503-4

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