Confidence, accuracy judgments and feedback in schizophrenia and bipolar disorder: a time series network analysis

Psychol Med. 2023 Jul;53(9):4200-4209. doi: 10.1017/S0033291722000939. Epub 2022 Apr 28.


Background: Inaccurate self-assessment of performance is common among people with serious mental illness, and it is associated with poor functional outcomes independent from ability. However, the temporal interdependencies between judgments of performance, confidence in accuracy, and feedback about performance are not well understood.

Methods: We evaluated two tasks: the Wisconsin Card Sorting Test (WCST) and the Penn Emotion recognition task (ER40). These tasks were modified to include item-by-item confidence and accuracy judgments, along with feedback on accuracy. We evaluated these tasks as time series and applied network modeling to understand the temporal relationships between momentary confidence, accuracy judgments, and feedback. The sample constituted participants with schizophrenia (SZ; N = 144), bipolar disorder (BD; N = 140), and healthy controls (HC; N = 39).

Results: Network models for both WCST and ER40 revealed denser and lagged connections between confidence and accuracy judgments in SZ and, to a lesser extent in BD, that were not evidenced in HC. However, associations between feedback regarding accuracy with subsequent accuracy judgments and confidence were weaker in SZ and BD. In each of these comparisons, the BD group was intermediate between HC and SZ. In analyses of the WCST, wherein incorporating feedback is crucial for success, higher confidence predicted worse subsequent performance in SZ but not in HC or BD.

Conclusions: While network models are exploratory, the results suggest some potential mechanisms by which challenges in self-assessment may impede performance, perhaps through hyperfocus on self-generated judgments at the expense of incorporation of feedback.

Keywords: Bipolar disorder; causal time series analysis; cognition; metacognition; network analysis; schizophrenia.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Bipolar Disorder*
  • Feedback
  • Humans
  • Judgment
  • Schizophrenia*
  • Time Factors