Relationship between self-reflectivity, Theory of Mind, neurocognition, and global functioning: An investigation of schizophrenic disorder Laura Giusti, Monica Mazza, Rocco Pollice, Massimo Casacchia and Rita Roncone Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy Key words cognition, schizophrenia, Theory Mind. Correspondence Rita Roncone, Department of Life, Health and Environmental Sciences, Unit of Psychiatry, University of L’Aquila, Via Vetoio – Coppito, L’Aquila, AQ 67100, Italy. Email: rita.roncone@cc.univaq.it Received 18 October 2012; accepted 19 February 2013. doi:10.1111/cp.12006 Abstract Background: People with schizophrenia show impairments in metacognitive function, including awareness and monitoring of one’s mental processes (Self- Reflectivity (SR)), recognition of the fallibility of one’s thoughts, and the ability to infer others’ emotions and intentions (Theory of Mind (ToM)). The aim of the present study was to explore whether SR and ToM play a key role in influencing the global functioning of persons affected by schizophrenia. Methods: Twenty persons with schizophrenia were recruited before hospital discharge and compared with 17 controls. Clinical, neurocognitive, and global functioning assessments were performed. The Beck Cognitive Insight Scale was used to assess: (1) Self-Reflectiveness, which allows subjects with psycho- sis to objectively observe their cognitive distortions, and (2) Self-Certainty, which reflects rigid confidence in their own beliefs (over-confidence). ToM assessment included verbal and non-verbal measures. Results: Our study confirms the semi-independent nature of the metacogni- tive functions of ToM abilities and the cognitive insight domain. In fact, by multiple regression model analyses, only the Self-Reflectiveness deficit was found to be the best predictor of low global functioning in schizophrenia and represents a target for rehabilitation interventions to remediate the processes that cause fallible interpretations of daily events. Conclusions: Our results encourage a new trend in the cognitive-behaviour therapy of schizophrenia to be complemented with metacognitive approaches. Key Points 1 Deluded persons affected by schizophrenia were pro- posed to have limited “cognitive insight”, i.e., limited capacity for evaluation of their erroneous inferences and seem relatively resistant to corrective feedback. 2 Deficits of “cognitive insight,” as a metacognition component, in persons with schizophrenia seem to represent the main factor affecting global function- ing and potential target of psychosocial rehabilita- tion interventions. 3 It may be useful to include metacognition measures into the clinical assessment when developing integrated treatment programmes for people with schizophrenia. Introduction Several schizophrenia studies have focused on low global functioning predictors, such as psychopathology and neurocognition (Johnstone, Macmillan, Frith, Benn, & Crow, 1990; Lysaker, Bell, Zito, & Bioty, 1995; Mohamed et al., 2008). The significant, but poorly pre- dictive, association found in people with schizophrenia between symptoms (“positive” and “negative”) and functional outcome (Norman et al., 1999) has generated an increased interest in the potential relationship between neurocognition (e.g., executive functioning, attention, memory, flexibility in reasoning and judg- ments, and capacity of abstraction) and the social/ vocational functioning of persons with schizophrenia. Neurocognitive deficits are not sufficient to explain the poor function in daily life (Green, 1996; Norman et al., 1999). Conflict of interest: All authors declare that they have no conflicts of interest. Clinical Psychologist •• (2013) ••–•• © 2013 The Australian Psychological Society 1