**2. Metacognitive therapy and role of consciousness**

**1. Introduction**

106 Prefrontal Cortex

cal operations in human social life [8].

The questions about the nature of how we know other people's minds (mindreading, "theory of mind" [1]) and how we know our own mind (metacognition [2, 3]) are intensely debated in a variety of research fields such as cognitive sciences, psychology, or psychiatry [4, 5]. The term "metacognition" describes cognitive processes that are involved in "thinking about own thinking" by which people can reflect upon (monitor) their own internal mental states and use their knowledge to evaluate and regulate (control) their own mental states [6, 7]. On the other hand, the notion of mindreading is related to our own cognitive processes that can be applied to other people ("thinking about the thinking of others") in terms of recognizing others' intentions, mental states, emotions, as well as predicting possible behavior of other people [1, 4, 8]. In fact, Bateman and Fonagy [9] point out that both mental capacities (metacognition and mindreading) can be a form of mentalization engaging cognitive processes that are aimed at implicit and explicit interpretation of our own actions and actions of other people as meaningful. In fact, both components influence one another and involve complex and criti-

Crucially, clinical research interest focuses also on attempts to explain various mental disorders in relation to deficits in mindreading [10], dysfunctional metacognition, [11] as well as an abnormal relationship between both cognitive facilities [11]. Typically, clinical researchers define mindreading deficits as limitations or complete loss of capacity to recognize and attribute mental states in order to understand other people, including their intentions, beliefs, emotions, and possible behaviors [4, 11]. For instance, such persistent mindreading deficits are commonly observed in a group of patients with schizophrenia [11]. In turn, impairments in metacognition are thought to be involved in formation of abnormal recognition and understanding one's own mental states and deficits in proper control and monitoring of one's own internal states [12]. Apparently, deficits in metacognition are demonstrable in a variety of mental disorders. Some clinical studies demonstrate influence of dysfunctional metacognitive beliefs on the development of and formation of psychotic symptoms, including hallucinations and symptoms of anxiety accompanying mental disorders [13]. For instance, a core positive symptom of schizophrenia, which is a lack of insight, clearly represents a failure of metacognition. Over the last decade, the empirical research emphasizes the role of dysfunctional metacognitive beliefs (declarative knowledge) or metacognitive thought control strategies (procedural knowledge) as predictive to development of psychosis in normal and clinical populations [14–16] and maintenance of neurotic symptoms [17]. A vast body of research gives also indication that patients with psychosis have also dysfunctional meta-beliefs. For instance, in a nonclinical sample, García-Montes and colleagues [18] based on Metacognitions Questionnaire construct (MCQ construct; [19]) in their correlation study showed that both metacognitive factors such as thought control strategies about worry as well as loss of confi-

dence were indicative to hallucination proneness when trait anxiety was controlled.

Nonetheless, the present article considers a more complex cognitive architecture of social cognition that may possibly underline the dysfunctional interaction between mindreading and metacognitive capacities. For example, recent clinical studies on various causes of mental Before going ahead with our theoretical discussion, it is first instructive to start with discussing a case from clinical intervention that shows cognitive complexity and real challenges behind the relation between social cognition and consciousness. Recently, there has been a substantial progress in the field of cognitive-behavioral interventions for treatment of psychiatric disorders (for instance, see [26]). Empirical studies on new therapeutic approaches based on metacognitive training provide solid evidence that corrective experiences are efficient in handling cognitive biases in psychiatric populations [27]. Positive clinical results are achieved through a variety of metacognitive technique exercises including the "theory of mind" skills (https:// clinical-neuropsychology.de/metacognitive\_training/). Research studies clearly show that psychiatric patients who underwent intervention of metacognitive training for psychosis can substantially reduce their cognitive biases [26]. For instance, patients undergoing a therapeutic intervention based on the "theory of mind" module for psychosis by engaging conscious evaluation may diminish overconfidence in errors, frequency of jumping to conclusions, etc.

Let us imagine an omnipotent patient that attempts to identify the actor as a leader who speaks to the crowd and may be overconfident in his/her wrong response. The example shown in **Figure 1** can help us to capture the phenomenology of social cognition and conscious evaluation. It is most likely that abnormal information processing in this patient would lead to biased responses (distortion in social cognition) and overconfidence (abnormal metacognition) in his/her attempts to recognize social information. We can see that in these circumstances the patient can fail to construct accurate knowledge. Although after therapeutic intervention and engaging mechanisms of conscious access to his/her interpretation, it comes to a symptom's reduction, and the patient gains accurate knowledge about their surrounding others. This particular situation illustrates how faulty interpretation can be potentially corrected by conscious evaluation. How then the patient eventually gains accurate knowledge and forms the proper interpretation? Here, we will attempt to answer these research questions from a cognitive perspective by demonstrating that conscious access is an important mechanism for correcting our theories and judgments intended to interpret and predict behavior of other people.


only one mindreading mechanism that underlie our social cognition. This view claims that metacognition is only grounded on mindreading and therefore attribution processes of mental states to oneself and other people are results of prior unconscious interpretation. Adoption of such a one-system architecture indicates that knowledge about our own state results only from mindreading mechanisms that accesses a variety of information sources (percepts): incoming perceptual states or quasi-perceptual states [4]. This account clearly implicates that introspec-

Consciousness and Social Cognition from an Interactionist Perspective: A New Approach…

http://dx.doi.org/10.5772/intechopen.79584

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Indeed, the idea of one-system architecture ignores conscious access to the information that is, in fact, in contradiction with commonsense observations of the role of consciousness in regulating our behavior. In fact, although our cognitive system in various situations is dominated by unconscious events and shows some limitations, we can consciously correct our theories and judgments to interpret and effectively predict behavior of other people (see, for instance, [29]). In fact, it is important to emphasize that the one-system architecture by Carruthers [4] excludes clear activation of conscious access through the interaction between modules, because the architecture implicates a homogeneous mechanism that processes the content of various kinds from different functionally levels and the inputs. The same conclusions may come also from consideration of another architecture which postulates that mindreading and metacognition are parts of the one metacognitive mechanism [30–32]. In this account, it is believed that the attribution of mental states to other people depends on our direct access to these mental states (introspection) via subsequent processes of simulation and inference. Thus, human capacity for mindreading is based on the introspective data, which are initially accessed to imagine other's state, and then is used to make the attribution of this state to

Interestingly, the latest accounts of the relationship between mindreading and metacognition clearly favor arguments for interactionism in the formation of social knowledge. In particular, Arango-Muñoz [6] presents a two-level architecture (two different levels of complexity) enabling a mutual interaction within a complex metacognitive system that is evolutionary structured into higher- and lower-level metacognition with different functions and tasks. Both metacognitive systems "start to interact and influence each other" by forming a complex social cognition [6]. In particular, mindreading is the higher level structure that engages rational knowledge, which is a psychological concept or naive psychological theory, to interpret and rationalize others' behavior. The main function of this level is therefore to interpret others' behavior, although self-interpretation from this level is possible but is not a priority. Within lower level structures operate unconscious processes of control and evaluation that serve to adjust epistemic states (e.g., subject's feelings) to the individual's current behavior. The dual-process account makes predictions of cognitive regulation based on the bidirectional interactions: (i) a "from-low-to-high-level" direction that predicts possible evaluation and monitoring and then the attribution of a psychological content and (ii) a reverse interaction in a "from-high-to-low-level" direction that activates rational knowledge and control

tion of propositional states is replaced by interpretation without conscious access [4].

interpret or rationalize other's behavior (simulation).

**4. Interactionist approach in social cognition**

processes to regulate current social responses to others people.


**Figure 1.** An example of cognitive intervention from the metacognitive training course aimed at cognitive enhancement of social cognition (https://clinical-neuropsychology.de/metacognitive\_training/). The exercise activates formation of social understanding by asking a client to infer emotional states of the actor on the picture. During this exercise a patient attempts to recognize an emotional state of the actor presented on the picture by choosing one of four options and then expresses confidence in his/her responses. The therapist analyzes the client's answers and helps the client to reach a correct answer (option no. 4).
