Dr Emma Palmer-Cooper

2023

Background

Hallucinations (unshared experiences) have been linked to less ability to reflect on our own thoughts and behaviours (also known as ‘metacognition’). This suggests that there might be a link between unshared experiences and people being overconfident in their abilities on daily tasks. Studies tend to measure people’s recollection of hallucination experiences over a period of time using a questionnaire that may ask about experiences in the last week or month. However we know that hallucinations can vary in how often they are experienced and their content. Because of this, we decide to use Ecological Momentary Assessment (EMA). This asks questions about what a person is doing in-the-moment, over a certain period time, so we can identify relationships between thoughts and experiences. It is also really easy for participants to use, because apps can be built for smartphones to ask questions throughout the day.

Methods

41 participants experiencing daily hallucinations completed baseline questionnaires and smartphone surveys 7 times per day for 14 days. They were asked to identify a task they would complete in the next 4 hours and to make ‘metacognitive’ predictions around the likelihood of completing the task, the difficulty of the task, and how well they would complete it (standard of completion).

Results

76% of our participants finished the 14-days of assessment with about 42% of surveys completed. Less accurate metacognitive self-reflection was associated with more hallucinations. Less accurate likelihood and standard of completion was associated with fewer hallucinations. Using a cross-lagged analysis, predictions around the likelihood of completion (p < .001) and standard of completion (p = .01) predicted hallucination intensity at the following timepoint, and metacognitive predictions regarding likelihood of completion (p = .02) predicted hallucination control at the following timepoint.

Discussion

We found that people who are able to reflect well on how well they will complete future tasks had less frequent hallucinations. Interventions that aim to improve metacognitive reflection in-the-moment may help to reduce the intensity and increase the control of hallucinations.

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