# How do confidence and self-beliefs relate in psychopathology: a transdiagnostic approach

Monja Hoven, Damiaan Denys, Marion Rouault, Judy Luigjes, Ruth J van Holst

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Monja Hoven, Damiaan Denys, Marion Rouault, Judy Luigjes, Ruth J van Holst. How do confidence and self-beliefs relate in psychopathology: a transdiagnostic approach. Nature Mental Health, 2023, 1, pp.337-345. 10.31234/osf.io/d45gn. hal-04788129

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# How do confidence and self-beliefs relate in psychopathology: a transdiagnostic approach

Preprint · March 2022

DOI: 10.31234/osf.io/d45gn

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1 How do confidence and self-beliefs relate
2 in psychopathology: a transdiagnostic
3 approach

4

5 Authors:

6 Monja Hoven Msc.¹*, Judy Luigjes PhD¹, Damiaan Denys MD PhD¹,

7 Marion Rouault PhD2-3, Ruth J. van Holst PhD1,4

8 ¹Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, The

9 Netherlands

10 ² Institut du Cerveau et de la Moelle Épinière (ICM), Centre National de la Recherche Scientifique

11 (CNRS), Hôpital Pitié Salpêtrière, 75013 Paris, France

12 ³Département d'Études Cognitives, École Normale Supérieure, Université Paris Sciences et Lettres

13 (PSL University), Paris, France

14 ⁴Centre for Urban Mental Health, University of Amsterdam, The Netherlands

15 * Corresponding author : m.hoven@amsterdamumc.nl

16

17 Corresponding author:

18 Monja Hoven, Meibergdreef 5 1105AZ Amsterdam, the Netherlands

19

20 Running title: Hierarchy of confidence in psychiatric dimensions

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26 **Abstract**

27 Confidence is suggested to be a key component in psychiatry and manifests at various
28 hierarchical levels, from confidence in a decision (local confidence), to confidence about
29 performance (global confidence) to higher-order traits such as self-beliefs. Most research
30 focused on local confidence, but global levels may relate more closely to symptoms. Using a
31 transdiagnostic framework, we tested the relationships between self-reported
32 psychopathology, local and global confidence and higher-order self-beliefs in a general
33 population sample(N=489). Here we show contrasting relationships between confidence and
34 psychopathology dimensions. An anxious-depression (AD) dimension related to local and
35 global underconfidence. Contrarily, a compulsive-intrusive-thoughts (CIT) dimension related
36 to increased overconfidence at both levels, and showed a decoupling between (i) higher-
37 order self-beliefs and (ii) local and global task confidence. The strongest predictor of mental
38 health was a self-beliefs dimension. This study examines higher-order confidence in relation
39 to psychiatric symptoms fluctuating in the general population. Critically psychopathological
40 symptoms show distinct associations with confidence.
41

41
42 **Introduction**

43 Using confidence judgments, we are able to think about, reflect upon and evaluate our own
44 thoughts, decisions and actions, which is central to our behavior and crucial for adequate
45 adaptation<sup>1-3</sup>, behavioral control<sup>4</sup> and learning<sup>5-7</sup>. A plethora of studies have shown
46 impairments in confidence in various psychiatric populations<sup>8</sup>, ranging from over- to
47 underconfidence. The majority of these earlier studies have focused on 'local' confidence,
48 i.e., the level of confidence reported on individual trial-by-trial decisions. Local confidence is
49 usually quantified using distinctive, independent metrics: confidence bias and metacognitive
50 sensitivity. Confidence bias (or calibration) reflects one's overall confidence level relative to
51 one's actual performance, whereas metacognitive sensitivity reflects how well one's
52 confidence judgments distinguish between correct and incorrect choices. However, these
53 metrics are limited regarding their time scale and the scope of behaviors they control.

54 A new theoretical framework has emerged which posits that confidence manifests at various
55 hierarchical levels of abstraction, from 'local' confidence judgments on a specific trial to
56 more 'global' metacognitive constructs<sup>9</sup>. In this framework, local constructs are theorized to
57 pertain to isolated choices. In contrast, global constructs are proposed to reflect beliefs
58 formed over extended periods of time and integrate larger amounts of information. For
59 instance, one can develop global confidence about one's ability to perform a certain task.
60 These local and global constructs are likely related to even higher-order feelings of
61 confidence about the self: self-beliefs, such as self-esteem, self-efficacy, mastery and
62 autonomy, which are relatively more stable over time for a given individual. All these
63 constructs focus on the self from distinct angles. Self-esteem relates to one's self-worth<sup>10</sup>,
64 self-efficacy to beliefs in one's ability to influence their lives<sup>11</sup>, autonomy to one's ability to
65 live a meaningful life<sup>12</sup>, and mastery to one's beliefs to control their lives<sup>13,14</sup>.

66 How these various levels of confidence are mutually related, and how they relate to
67 psychopathology are important open questions. One could argue that individuals suffering
68 from depressive symptoms develop negative self-beliefs, which could give rise to lower
69 confidence levels. These relationships between confidence levels may differ for individuals
70 suffering from other symptomatology, whose symptoms might instead be related to
71 increased confidence. Thus, alterations in local confidence found across psychopathology
72 could go hand-in-hand with alterations in global confidence, and eventually with higher-
order levels of confidence, such as self-belief constructs in a specific manner, dependent on the psychiatric symptoms at hand. In particular, relative to local confidence, higher-order forms of confidence may be more directly related to clinically relevant subjective experiences and psychopathological behavior in daily life. These higher-order constructs could influence behavior over a wide range of contexts and over longer time scales, where local confidence instead would only influence small-scale decisions. For example, patients suffering from major depression could in general have lower self-esteem and lower global confidence about their abilities, resulting in avoidance behavior and negative schemas¹⁵⁻¹⁷.

Gaining a deeper understanding of the mechanisms of higher-order confidence is hypothesized to provide more insight into clinically relevant psychopathological behavior⁹.

By identifying which specific processes are most impacted, therapies can be tailored and refined to be more effective in treating symptoms.

A recent study operated the formation of global confidence in a behavioral task¹⁸.

Participants performed two mini-blocks of perceptual games; after each block, they selected the game in which they thought they performed best, and gave global confidence ratings about their perceived ability at the games; both proxies for global confidence. To decompose the relationships between these various levels of confidence and mental health symptoms, a recent case has been made to employ a transdiagnostic approach⁹. The central idea is that cognitive processes might relate more closely to transdiagnostic symptomatology than to DSM diagnoses, due to high levels of comorbidity and heterogeneity in symptoms within a disorder¹⁹. For example, many OCD patients suffer to a greater or lesser extent from compulsivity, as well as anxiety, which can disguise important findings when only considering classic DSM disorder boundaries. Here, we leveraged a previously validated transdiagnostic approach that allowed to establish three latent transdiagnostic symptom dimensions termed "Anxious-Depression" (AD), "Compulsive Behavior and Intrusive Thought" (CIT) and "Social Withdrawal" (SW)²⁰. With this approach, previous work has shown that higher scores on the AD dimension related to lower confidence, while higher scores on the CIT dimension related to higher confidence levels²¹,²². Some of these findings were only visible within the transdiagnostic framework. Likewise, it has been argued that opposing effects of certain symptoms on local confidence could be clarified by considering multiple hierarchical levels of confidence at the same time, each of which may map differently onto mental health
symptoms⁹. Local confidence ratings could, for example, be more strongly driven by a prior
of low self-beliefs in anxious-depression, whereas in compulsivity these priors may have less
impact. However, studies testing these hypotheses are currently lacking.

Here, we tested this proposition by systematically investigating the relations between and
within the various levels of the confidence hierarchy and psychiatric symptoms. As
preregistered (https://osf.io/6vbpr), we acquired questionnaire and task data from a large
general population sample online, using a previously validated "local and global confidence
task"¹⁸ with a transdiagnostic approach. We hypothesized that local confidence informs
global confidence, and negative (respectively positive) relationships between the AD
(respectively CIT) symptom dimension and both local and global confidence, corresponding
to a general under- and overconfidence, respectively. Moreover, based on the proposed
hierarchical structure of confidence, we expected positive relationships between local
confidence, global confidence and self-belief constructs. Finally, we tested whether there
would be dissociations in the relationships between the hierarchical levels of confidence
depending on symptom dimensions, and identified which of the hierarchical levels of
confidence best explained symptom dimensions.
120 **Results**

121 *Experimental Design*

122 In this cross-sectional study, conducted online, human subjects performed a local and global
123 confidence task¹⁸. During this perceptual decision-making task, participants performed short
124 blocks with two randomly interleaved ‘games’ indicated by two arbitrary color cues (Figure
125 1). In each trial of a game subjects had to indicate which of two black boxed contained a
126 higher number of white dots. The games involved different conditions: they could either be
127 easy of difficult (i.e. difficulty feature), and deliver either veridical feedback or no feedback
128 (i.e. feedback feature). These features resulted in six possible pairings of conditions within
129 each block, which were repeated twice in randomized order. On all trials without feedback
130 participants had to indicate their *local confidence* about their probability of being correct on
131 that specific trial from 50% - 100%. After each block participants had to choose on which
132 game they believed they performed best (global task choice) for which they were
133 incentivized, and they had to rate their confidence in their overall performance on each of
134 the two games (*global confidence*) on a scale from 50% to 100%. See Methods for more
135 details on the task.

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<figure><img src="image_6.png" /></figure>

<figure><img src="image_7.png" /></figure>

<figure><img src="image_8.png" /></figure>

<figure><img src="image_9.png" /><figcaption>**Figure 1: Experimental task design.** A Participants performed learning blocks with two randomly alternating trials from two tasks, indicated by a task cue. Each task was either easy or difficult and provided feedback or no feedback (C), resulting in six different possible task pairings. Each trial started with the presentation of a color cue, indicating which of the two tasks was presented, after which subjects had to choose which of two boxes contained a higher number of dots. Each judgment was either easy or difficult, dependent on the dot difference between the boxes. After their choice, subjects either received feedback (correct or incorrect) about their choice, or did not receive feedback and instead were asked to provide a *local confidence* rating about the probability of their perceptual judgment being correct. B At the end of each learning block participants were asked to choose which task should be used to calculate a bonus (based on their performance; *global task choice*. They also rated their overall ability; *global confidence*. Together, they are measures of global metacognition. D The hierarchical levels of metacognitive evaluations, which consist of local confidence at the trial level in isolated decisions, global confidence at the task level and Self-Beliefs, which operate at a level more directly relevant to daily life. All levels include reciprocal interactions with the other levels, in a way that local confidence contributes to global confidence, and eventually to Self-Beliefs, and in turn these levels can impose their influence on local confidence. From trial level information at local confidence levels, to the aggregation of multiple trials at global confidence levels, up to the integration of multiple sources of information encountered in real life situations in one's Self-Beliefs.</figcaption></figure>

After finishing the task, participants filled in self-report questionnaires assessing psychiatric symptoms and self-belief constructs (see Methods for details). To study the interplay between the various hierarchical levels of confidence (local, global and self-beliefs) and psychopathology, we assessed psychopathology across a large range of different symptoms, as well as various higher order self-belief constructs.
163 *Behavioral Variables*

164 In order to relate our confidence measures to our psychopathology measures, various
165 behavioral variables were calculated. First, we calculated *global calibration* (task level),
166 which is the difference between average global confidence and performance on all trials,
167 reflecting how well subjects' overall task confidence matches their overall actual
168 performance. For *local calibration* (trial level), we calculated the difference between average
169 local confidence and performance on no feedback games only. Moreover, the correlation
170 between local and global confidence levels was calculated for the non-feedback condition
171 only (see Methods for more details). Finally, metacognitive efficiency (i.e. meta-d'/d', or M-
172 Ratio) was calculated per subject, which is a confidence precision measure, indexing how
173 well subjects can discriminate between correct and incorrect choices using their local
174 confidence ratings, independently of performance or confidence biases<sup>23,24</sup>. After applying
175 rigorous exclusion criteria (see Methods), data of 489 participants were used for the
176 analyses.
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177

178 *Transdiagnostic Dimensions*

179 Within a specific psychiatric questionnaire, different items may map onto different latent
180 psychiatric factors, which would be obscured in traditional analyses. In order to obtain a
181 more parsimonious latent transdiagnostic structure that would explain this item-level
182 variation in scores on all psychiatry questionnaires, we performed a factor analysis and
183 tested the relationship between our task variables and these latent transdiagnostic
184 psychiatry dimensions (see Supplementary Methods, Figure S1 and Figure S9 for more
185 details on the factor analysis). Our factor analysis indicated that a three-factor structure
186 provided the best and most parsimonious fit of the variance across the questionnaire items,
187 showing very strong correlations with the item loadings from previous studies<sup>21</sup> (Figure S8),
188 indicating that the factor analysis robustly identifies the same latent constructs. For
189 consistency, these three factors were given the same labels as earlier studies, according to
190 the items that loaded the most strongly on each factor, even though these labels are to
191 some extent arbitrary (Figure S1B)<sup>20,21</sup>: 'Anxious-Depression (AD)', 'Compulsive Behavior and
192 Intrusive Thought (CIT)', and 'Social Withdrawal (SW)'.
193

194 *Relating Task Variables to Transdiagnostic Dimensions*

195 First, our aim was to test the specific relationships between each transdiagnostic symptom dimension (AD, CIT and SW) and task variables (performance, local confidence, global confidence, local calibration, global calibration, metacognitive efficiency and the correlation between local and global confidence), while controlling for the other transdiagnostic dimensions and demographics. In this way, we tested whether we could replicate previously found relationships between local confidence and transdiagnostic dimensions, and whether these relationships were also found for higher-order levels of confidence.

202 Results of our multiple regression analyses showed that the AD dimension was significantly positively related with performance, while a significant negative relationship existed for the CIT dimension (Figure 2A, Table S1). Mean local and global confidence were significantly negatively related with scores on the AD dimension. For both local and global calibration, we found a significant negative (i.e., underconfidence) associations with the AD dimension, but positive (i.e., overconfidence) relationships with the CIT dimension.

208 Because there were effects of symptom dimensions on performance, we performed a sensitivity analysis to examine whether our results were maintained when adding participant's average performance level as a predictor to our regression models when predicting local and global confidence (i.e., Local/Global Confidence ~ AD + CIT + SW + Mean Performance + Age + IQ + Gender). We again found a negative relationship between AD and both local and global confidence (local: $\beta$ = -0.247 +- 0.045, t = -5.526, $p_{cor}$ < 0.001; global: $\beta$ = -0.219 +- 0.040, t = -5.473, $p_{cor}$ < 0.001), and also again showed significant positive relationships between CIT and both local and global confidence (local: $\beta$ = 0.160 +- 0.046, t = 3.508, $p_{cor}$ < 0.01; global: $\beta$ = 0.125 +- 0.041, t = 3.049, $p_{cor}$ < 0.05), with a type I error rate of .05/7. For additional exploratory analyses on reaction times and inattentiveness see Supplementary Results.

219 Moreover, CIT was associated with a lower correlation between local and global confidence, indicating that high CIT scores related to a more distorted coupling between local and global confidence. No associations with metacognitive efficiency were found, and the SW dimension did not relate significantly to any of our task variables (Table S1).
We further asked whether the uncovered relationships between the confidence variables and transdiagnostic dimensions were significantly different from each other. Since the SW dimension did not significantly relate to any of our variables, we did not include it in post-hoc tests. For performance, the regression coefficient of the CIT dimension was significantly lower than that of the AD dimension (Table S1). For local confidence, local calibration and global calibration, the regression coefficients of CIT were significantly higher than those of AD, indicating that individuals scoring high on CIT show a higher (over)confidence than those scoring high on AD. Moreover, the correlation of local and global confidence was significantly higher for AD than CIT, suggesting that local and global confidence show a better coupling in individuals scoring high on AD versus those scoring high on CIT.

Note that AD and CIT dimensions show a significant positive correlation (r = 0.24, p<.001, Figure 2D). Therefore, our finding of opposing relationships cannot be attributed to a negative correlation between the factors.
<figure><img src="image_10.png" /><figcaption>C</figcaption></figure>

<figure><img src="image_11.png" /><figcaption>B</figcaption></figure>

<figure><img src="image_12.png" /><figcaption>D</figcaption></figure>

<figure><img src="image_13.png" /></figure>

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**Figure 2:** Behavioral results of transdiagnostic dimensions and self-beliefs. **A:** Regression coefficients of the two-sided multiple regression models of the three latent factors comprising 'Anxious-Depression' (AD), 'Compulsive behavior and Intrusive Thought' (CIT) and 'Social Withdrawal' (SW) and various dependent variables measuring performance and metacognition. All factor scores were entered as predictors for each regression model, together with age, gender and IQ. N = 489 independent subjects. Results are corrected for multiple testing. **B:** Regression coefficients of the two-sided multiple regression models of the latent 'Self-Beliefs' (SB) factor. The regression model containing SB factor scores, together with age, gender and IQ revealed positive associations between SB scores and both local and global confidence and calibration. N = 489 independent subjects. Results are corrected for multiple testing. **C:** Relating the three psychiatry factors to the SB factor using a two-sided regression analysis. All three psychiatric factors are strongly negatively related to SB factor scores, with strongest effects for the AD scores. N = 489 independent subjects. **D:** Pearson correlation matrix of the psychiatric and SB factor scores across subjects. Correlation tests were two-sided and Bonferroni corrected for multiple testing. Error bars represent SEM. * p < 0.05, ** p < 0.01, *** p < 0.001, corrected for multiple comparisons over the number of dependent variables tested, ° p < 0.05 uncorrected. Exact p-values are described in Tables S1 and S2. AD = 'Anxious-Depression', CIT = 'Compulsive behavior and Intrusive Thoughts', SW = 'Social Withdrawal', SB = 'Self-Beliefs', Corr Local Global = correlation between local confidence and global confidence.

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## Relating Task Variables to Self-Beliefs

Since all self-belief construct questionnaire scores correlated highly (Figure S1C, Figure S5), we aimed to acquire an all-encompassing single latent factor underlying these constructs. To do so, we performed a second factor analysis on the self-belief construct questionnaires using the same methods. All questionnaires showed an average loading of > 0.5 (autonomy M = 0.50 +- 0.16, mastery M = 0.55 +- 0.1, self-esteem (Rosenberg's) M = 0.70 +- 0.08, self-efficacy M = 0.56 +- 0.09, self-esteem (Short Form) M = 0.63 +- 0.09). We labeled this factor the 'Self-Beliefs' (SB) factor (Figure S1D), an even higher hierarchical level of confidence. We then tested the association between this factor (i.e., highest-order level of confidence), performance, local confidence and global confidence using multiple linear regressions (see Methods for details) (Figure 2B). There was a significant positive relationship between SB scores and both local and global confidence, as well as local and global calibration, indicating that subjects with higher scores on the SB factor were more overconfident (Figure 2B, Table S2).

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## Relating Transdiagnostic Dimensions to Self-Beliefs

After investigating the associations between the transdiagnostic dimensions and both local and global confidence, we examined the associations between the transdiagnostic dimensions and the highest-order level of Self-Beliefs using a linear regression. We found that all three transdiagnostic dimensions related negatively to SB scores, while correcting for demographics (AD: $\beta$ = -0.706 +- 0.022, p<.001; CIT: $\beta$ = -0.151 +- 0.023, p<.001; SW: $\beta$ = -0.259 +- 0.023, p<.001) (Figure 2C). Post-hoc comparisons showed that the regression coefficient of the AD factor was significantly more negative than the SW (t = 12.257, p<.001) and CIT coefficient (t = 16.134, p<.001), whereas the coefficient of SW was more negative compared to CIT (t = 2.949, p = 0.003).

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## Relationships Between the Various Levels of Confidence

Since we argued that local confidence, global confidence and SB scores each represent various levels of confidence, it is expected that they show positive associations. Indeed, we
found that local and global confidence were significantly positively correlated (r=0.82, p < 0.001). Moreover, local confidence and SB scores, as well as global confidence and SB scores were also significantly positively related (r=0.16, p<0.001; r=0.13, p = 0.004, respectively).
Although, as expected, the task variables of local and global confidence correlate more strongly together than they both do with the questionnaire-based SB scores, critically all three confidence levels studied here correlate positively.

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292 *Predicting Psychopathology with Levels of Confidence*

Even though the various levels of confidence were positively correlated, their influence on symptoms could be divergent. Thus, to assess the influence and relative importance of the hierarchical levels in predicting psychiatric symptoms, we entered all three confidence levels as predictors of psychiatric dimension scores in three separate regressions (one for each dimension, see Methods for details) (Figure 3, Table S3).

SB scores strongly negatively predicted AD and SW scores, whereas neither local confidence nor global confidence was a significant predictor of AD or SW. For CIT, both SB scores and global confidence significantly negatively explained CIT scores, but contrarily, local confidence was a significant positive predictor of CIT scores. For all three psychiatric symptom dimensions, post-hoc tests showed stronger effects of the SB factor compared to both local confidence and global confidence measures (Table S4). Also, a comparison of the standardized absolute regression coefficients of the SB and local confidence predicting CIT indicated that SB was the most important predictor. Since local confidence and global confidence are highly correlated, we also examined (i) regression models where we used the average of local and global confidence as a predictor alongside self-beliefs and (ii) regression models where we only used either local or global confidence as a predictor alongside self-beliefs. Both approaches resulted in similar results as described above, see Supplementary Results for more detail.

Taken together, these results show that Self-Beliefs is the strongest predictor for all psychiatry dimensions. For CIT, a dissociation was found in the predictions of local confidence on the one hand, and global confidence and Self-Beliefs on the other hand. This
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further supports the finding of a decoupling between local and global confidence in high CIT
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**Figure 3: Relationships between hierarchical levels of metacognition and transdiagnostic symptom dimensions.** Regression coefficients of the two-sided regression models predicting AD scores, CIT scores or SW scores with the three levels of metacognitive hierarchy: local confidence, global confidence and ‘Self-Beliefs’ (SB) score. All three levels of the hierarchy were entered as predictors for each model, together with age, gender and IQ. Error bars represent SEM. \* p < 0.05, \*\* p < 0.01, \*\*\* p < 0.001. Post-hoc test results comparing the strength of the regression coefficients were corrected for multiple comparisons. Exact p-values are described in Tables S3 and S4. AD = ‘Anxious-Depression’, CIT = ‘Compulsive behavior and Intrusive Thoughts’, SW = ‘Social Withdrawal’.

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Discussion

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Measures of local confidence, global confidence, and self-beliefs, all concern judgments of the self and one's personal competence, albeit at various levels of abstraction formed over different timescales. Together, they are proposed to form a hierarchical structure of confidence, of which all levels impact our behavior⁹,¹⁸. Even though higher-order levels of confidence are an evident determinant of mental health¹⁰,²⁵, mostly local confidence has been empirically studied using behavioral tasks. Here, we assessed three key hierarchical levels of confidence across a large spectrum of psychopathology. We found opposite relationships between subclinical psychiatric symptoms and the hierarchical levels of confidence. Interestingly, the levels of confidence differently explained symptom dimensions, depending on the type of psychopathology.

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First, our transdiagnostic approach revealed that the “Anxious-Depression” (AD) symptom dimension was associated with local and global underconfidence. Contrarily, the “Compulsive Behavior and Intrusive Thoughts” (CIT) symptom dimension was related to local and global overconfidence, presumably driven by lower performance levels. The current study thus replicates and extends earlier results on local confidence²¹,²², by showing that alterations in local confidence generalize to global confidence. Interestingly, the “Social Withdrawal” (SW) symptom dimension did not significantly relate to either local or global confidence, but had a strong negative relationship with self-beliefs. This suggests that individuals with high SW symptom scores suffer from low self-beliefs, despite being able to properly evaluate their global and local confidence.

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Positive associations between local confidence, global confidence, and higher-order self-beliefs were found. This is in line with evidence for associations between confidence and metacognitive beliefs in educational settings²⁶,²⁷, positive associations between local confidence and self-esteem²⁸, and decreased global confidence in individuals with low versus high self-esteem²⁹. While previous reports had suggested that self-beliefs may function as a prior informing lower levels of confidence, the current study, for the first time empirically tested their relations. By doing so our study critically extends the literature by showing that higher-order self-beliefs are strongly positively related to confidence and overconfidence at both global and local levels in the same participants, while not being related to performance.
Self-beliefs were a general predictor of mental health, which manifested as strong negative relationships between all three symptom dimensions and SB scores, indicating that self-beliefs are affected across the entire spectrum of psychopathology. Self-beliefs were most strongly affected in the AD dimension, and least affected in the CIT dimension. This difference is reflected in the DSM, in which a feeling of worthlessness is a diagnostic criterion for depression³⁰. Indeed, self-beliefs such as self-esteem, autonomy and self-efficacy are usually strongly diminished in depression and anxiety disorders¹⁷,³¹⁻³⁵. In contrast, diminished self-beliefs are not an explicit diagnostic criterion of OCD and schizophrenia, disorders that contain symptoms relating to CIT. Instead, such symptoms might be more related to a lack of self-control and/or a loss of sense of reality, which could secondarily affect self-beliefs³⁶,³⁷. Our findings are in line with these observations and suggest that, to the extent that self-beliefs may act as priors, their influence was strongest in AD, resulting in decreased lower-level confidence. In contrast, for CIT and SW the prior was less strong, and possibly, therefore, did not lead to negative changes in local confidence. Despite these differences between dimensions, self-beliefs are deemed an important factor across many different disorders and symptoms²⁵.

Intriguingly, while for AD and SW symptoms there was no additional predictive influence of local and global confidence beyond self-beliefs, local and global confidence did significantly predict CIT symptoms, with a dissociation in the directionality of these effects. Higher CIT symptom scores were negatively related to self-beliefs and global confidence, but positively related to local confidence. It thus seems that higher local confidence in CIT did not generalize to increases in global confidence or self-beliefs, and vice versa that the influence of a negative self-beliefs prior did not lead to decreased local confidence levels. These findings of a disconnect between confidence levels are reinforced by our finding of a decreased correlation between local and global confidence with higher CIT symptoms.

The formation of local confidence is a coalescence of multiple influences: from higher-order confidence priors to local assessments of decision evidence. In CIT, it could be that higher-order confidence priors are not optimally used or simply underweighted to inform local confidence judgments. Alternatively, the assessment of local decision evidence might be erratic in CIT, and therefore less incorporated into higher-order beliefs about self-confidence. Indeed, it has been previously found that CIT is associated with lower sensitivity
387 to environmental evidence while informing confidence, leading to a decoupling between
388 action and confidence²². This sub-optimal transfer of information between different levels of
389 confidence could lead to maladaptive generalization across tasks and domains, resulting in
390 rigid self-beliefs that are not updated appropriately or not at all following decision
391 performance. This suggestion fits with recent theoretical models on the formation of
392 confidence³⁸ and self-esteem³⁹ that suggest reciprocal relationships between various levels
393 of self-beliefs, where higher levels can impact or constrain lower level components (i.e. local
394 confidence) and simultaneously these lower levels can exert bottom-up influence on higher-
395 order levels.

396 We hypothesized that confidence levels higher up the hierarchy would relate more strongly
397 to symptomatology. Indeed, self-beliefs significantly explained the transdiagnostic symptom
398 dimensions more strongly than local or global confidence, implying that they would be the
399 most important determinant of mental health. However, stronger relationships between
400 self-beliefs and symptoms could also arise since they both rely on questionnaires and
401 focused on phenomenological experiences, whereas local and global confidence are task-
402 based behavioral outcomes. However, the fact that we do find relationships between self-
403 beliefs and local and global confidence encourages the notion that behavioral confidence
404 measures can help characterize the cognitive processes that contribute to important
405 phenomenological experiences, such as self-beliefs and mental health.

406 Unlike previous findings showing a subthreshold decrease in metacognitive efficiency with
407 CIT²¹, we found no evidence for such a deviation other than a subthreshold increase of
408 metacognitive efficiency in CIT. This also is in contrast to our review evidencing a worsened
409 metacognitive efficiency in schizophrenia and addiction⁸, disorders with symptoms that are
410 thought to overlap with our CIT factor. However, a recent meta-analysis revealed that
411 alterations in metacognitive efficiency in schizophrenia likely have been overestimated,
412 which would better correspond to our present findings⁴⁰. Although metacognitive efficiency
413 takes into account task performance, here, by design, performance was not constant for all
414 subjects. This may have impacted the relationship between metacognitive efficiency and
415 symptoms. Moreover, it is worth noting that, due to the relatively low number of trials in the
416 current task, estimates of metacognitive efficiency may not be reliable enough for robustly
417 assessing these associations⁴¹. In the current subclinical sample, however neither symptoms
nor symptom dimensions significantly related to metacognitive efficiency, but instead, point
to specific disturbances of confidence level and bias.

Our study has limitations. By design, our task did not maintain a constant level of
performance across subjects, so we could not strictly isolate confidence changes from
performance changes. Using calibration measures, however, we could contrast confidence
with objective performance. In addition, controlling for performance differences between
subjects did not eradicate the positive relationship between CIT and both local and global
confidence. Since trials with excessive reaction times were excluded, inattentive trials could
not have influenced our findings of lower performance on the task. Moreover, a positive
relationship between CIT scores and reaction times did not survive correction for multiple
testing (see Supplementary Results). Overall, the relatively lower performance in individuals
with high CIT scores is likely not due to inattentiveness, and has also been reported recently
in a reinforcement learning paradigm⁴². This study is cross-sectional and only allowed us to
test for associations. Future longitudinal studies need to clarify how confidence develops
within each level over time, and how the levels reciprocally influence each other.

Longitudinal designs would also help to disentangle the directionality of the influence
between shifts in metacognition and shifts in mental health symptoms, at least in
establishing temporal precedence of one onto the other (e.g.⁴³,⁴⁴). Nevertheless, our findings
advance our understanding of the computational processes underlying the hierarchical
framework, which could in turn help to precisely target treatments to the cognitive steps
that are distorted and to a patient's specific symptom profile. Even though we are careful
not to extrapolate our findings pertaining to fluctuations in (sub)clinical symptoms in the
general population to formally diagnosed patients, previous studies have shown the same
behavioral effects in diagnosed clinical samples and general population samples using a
transdiagnostic approach²⁰,²²,⁴⁵⁻⁴⁷, but see⁴⁸. Using a general population sample allowed us
to study a broad set of symptoms and aspects of mental health rather than focusing on one
specific disorder or symptom set. Applying a transdiagnostic approach to large clinical
samples would be an important next step for this area of research. In addition, it remains to
be tested how our findings generalize to other cognitive domains⁴⁹, and to daily decisions.
Also, the influence of higher-order cognitive states, such as emotional distress or
motivational state on confidence should be taken into consideration, since they could play a
possible role as additional underlying factors for changes in metacognitive abilities. Here, we
have relied on metacognition as typically defined in the field of cognitive neuroscience,
quantifying the correspondence between subjective confidence judgments and objective
task performance⁵⁰. However, in other fields such as cognitive psychology models, the
definition of metacognitions encompasses other processes, including intersubjective
processes. A goal for future research is to combine insights from cognitive psychology
models, specifically the metacognitive model by Wells⁵¹, which centers around beliefs about
thinking (i.e. metacognitions), with findings from cognitive neuroscience studies that
examine feelings of confidence as a type of metacognition⁵⁰.

The current study provides empirical evidence that aberrancies in local confidence extend to
higher-order levels of confidence, that self-beliefs are related to local and global confidence,
that the associations between these confidence levels and psychiatric symptom dimensions
differ depending on the type of psychopathology and that confidence measures higher up
the hierarchy related more strongly to symptoms across psychiatry.

463
464 Methods

465 Ethics Approval and Consent

466 All participants gave informed consent in accordance with procedures approved by the

467 Ethics Committee of the University of Amsterdam (2020-CP-12416).

468

469 Participants

470 Data of 625 participants were collected online through the Prolific Academic platform

471 (prolific.co). Sample size was based on earlier similar transdiagnostic studies²¹. Subjects were

472 not screened for psychiatric diagnosis with official clinical interviews, but sampled from the

473 general population focusing on continuous variation across psychiatric symptoms that

474 naturally fluctuate in the general population. All participants were paid a base amount of

475 €7.5 per hour, plus a €1.5 bonus when passing check questions. The whole experiment

476 lasted 1.5 hours on average and was conducted in English. Using Prolific's available

477 demographic information, we only invited participants who reported being fluent in English,

478 regardless of their geographical location. We did not collect data on ethnic or cultural

479 background.

480

481 Study Design

482 The current study is a cross-sectional study. All data were collected between 13 October and

483 2 November 2020, and each participant was tested once.

484

485 Local and Global Confidence Task

486 The perceptual-decision making task was adapted from *Experiment 3* from Rouault et al.

487 (2019)¹⁸ and was coded in JavaScript, HTML and CSS using jsPsych version 4.3 and hosted on

488 Gorilla⁵². The code ensured that browsers were in full screen throughout the experiment.

489 During this experiment, participants performed short blocks with two randomly interleaved

490 'games' (6 trials each, pseudo-randomized) indicated by two arbitrary color cues (Figure 1).

491 All games involved perceptual discrimination judgments. In each trial of a game subjects
indicated which of two black boxes contained a higher number of white dots. The games involved different conditions: easy or difficult (i.e., difficulty feature), and deliver either veridical feedback or no feedback (i.e., feedback feature), resulting in six possible pairings of conditions within each block, which were repeated twice in randomized order. On all trials without feedback participants had to indicate their local confidence about their probability of being correct on that specific trial on a scale from ‘50% correct (chance level)’ to ‘100% correct (perfect)’. After each block participants had to choose between the two games, on which one they believed they performed best (global task choice), for which they were incentivized. Moreover, subjects were asked to rate their confidence in their overall performance on each of the two games (global confidence) on a scale from 50% to 100%. Subjects were not explicitly informed about the conditions of the games. For more information on the task structure, see Supplementary Methods.

504

### Self-report Psychiatric and Self-Belief Questionnaires

The symptoms assessed included alcoholism, apathy, impulsivity, eating disorders, social anxiety, obsessive-compulsive disorder, schizotypy, depression and generalized anxiety. The self-belief constructs assessed included autonomy, self-efficacy, mastery and self-esteem. Moreover, subjects were assessed with a rapid IQ evaluation⁵³. The order of questionnaires was fully randomized. See Supplementary Methods for detailed information on the specific questionnaires used and for distributions of total scores (Figure S6). Both the task and questionnaires were validated in previous research.

513

### Exclusion Criteria

To ensure good data quality, we employed a state-of-the-art approach⁵⁴, using a combination of multiple task-based and questionnaire-based checks, as preregistered here: https://osf.io/6vbpr. As described in the Supplementary Methods, we made sure that subjects who did not perform adequately on the task, failed comprehension tests or attention checks were excluded from analyses. After implementing our criteria, our final sample consisted of 489 subjects that were on average 27.2 years old (+- 8.5 years), of which 318 were male. For more details on exclusion criteria, see Supplementary Methods. An a

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posteriori power analysis using the G\*Power toolbox<sup>55</sup> was performed using the smallest
effect size from previous transdiagnostic research (f<sup>2</sup>=0.107)<sup>21</sup>, a power of 80% and an alpha
level of .05, which confirmed that a sample of 438 subjects would be well-powered. We took
into account an expected exclusion rate of 25% (common in online studies), and our final
sample consisted of 489 subjects.

527

528 *Behavioral Variables*

529 Analyses were performed using R-Studio version 4.0.3. We calculated *global calibration* and
530 *local calibration*. In addition, the relationship between local and global confidence in the
531 non-feedback condition was calculated, resulting in 12 games per subject. We extracted the
532 average local confidence per subject per game, and the corresponding global confidence. A
533 Spearman's correlation was performed between the local and global confidence values per
534 subject, which indicated the degree of correlation between the local and global confidence
535 levels.

536 Moreover, we computed *metacognitive efficiency* (meta-d'/d', or M-Ratio) per subject. Since
537 this computation relies on a signal detection theory framework and assumes that all trials
538 have a constant signal strength, we calculated metacognitive efficiency separately for easy
539 and hard trials in no-feedback trials (36 trials per difficulty level) and averaged the two
540 values per subject. We used the HMeta-d toolbox to perform individual participant fits to
541 compute metacognitive efficiency (using the fit_meta_d_mcmc function from the toolbox).
542 Due to a small number of trials per subject, some subjects' metacognitive efficiency values
543 were noisy, resulting in values that were negative or >3 standard deviations from the mean.
544 Those subjects were excluded (N=40) only for the regressions with metacognitive efficiency,
545 such that in those regressions we used data of 449 subjects. Finally, we performed several
546 control analyses to corroborate the effects of the task features (feedback and difficulty) on
547 performance, local- and global confidence<sup>18</sup>, described in Supplementary Results (Figure S2,
548 Figure S3).

549

550 *Relating Task Variables to Questionnaires*
As a first step, we studied the relationship between our task variables and scores on the (1) individual psychiatric symptom questionnaires and (2) individual self-belief construct questionnaires, using regressions, as is further detailed in the Supplementary Methods and Results (Figure S4, Figure S5).

555

556 *Relating Task Variables to Transdiagnostic Dimensions*

For more details on the factor analysis, see Supplementary Methods and Figure S1 and Figure S9. First, we tested the specific relationships between each psychiatric symptom factor and task variables, while controlling for the other factors and demographics. To do this, we used linear regressions, and controlled for demographics, as such:

Behavioral variable ~ AD + CIT + SW + Age + IQ + Gender

All regressors were z-scored before entering the models, such that we obtained standardized (i.e., comparable) regression coefficients. To correct for multiple testing a Bonferroni correction was applied that took the number of dependent variables into account, following Rouault et al (2018)²¹, which resulted in a type I error rate of .05/7. Post-hoc tests on regression coefficients were performed using the *esticon()* function from the *doBy* package in order to test whether the strength of the associations between the three factors and our various dependent variables differed. Post-hoc tests were also corrected using a Bonferroni correction with a type I error rate of .05/7. The distribution of data was assumed to be normal but this was not formally tested (Figure S7).

571

572 *Relating Task Variables to Self-Beliefs*

We tested the association between the SB factor (i.e., highest-order level of confidence) and the task variables using linear regressions:

Behavioral variable ~ SB + Age + IQ + Gender

Again, all regressors were z-scored and Bonferroni correction was applied (type I error rate of .05/7).

578
579 Relating Transdiagnostic Dimensions to Self-Beliefs

580 To directly relate our three psychiatry dimensions to the Self-Beliefs factor, a single linear

581 regression was performed, as such:

582 SB ~ AD + CIT + SW + Age + IQ + Gender

583 Regression coefficients were compared post-hoc, and were Bonferroni corrected for the

584 number of tests (type I error rate of .05/3).

585

586 Predicting Psychopathology with Levels of Confidence

587 Finally, we aimed to investigate how the three hierarchical levels of confidence studied (i.e.,

588 local confidence, global confidence and Self-Beliefs) may contribute to fluctuations in each

589 psychiatric factor. Importantly, after establishing the relationships between the task

590 variables and each symptom dimension, we aimed to investigate which hierarchical level

591 would best predict each of our psychiatric symptom dimensions. To achieve this, we set each

592 psychiatric factor as the dependent variable in three separate regressions. The hierarchical

593 levels of confidence were set to compete for variance that allowed us to compare their

594 predictive power in predicting symptom severity, and to identify possible dissociations

595 between the three confidence levels. To do so, we conducted Pearson's correlation tests,

596 and three linear regressions, where we separately regressed the three psychopathology

597 factors (i.e., AD, CIT and SW, z-scored) on local confidence, global confidence, and Self-

598 Beliefs scores, as such:

599 Psychiatry dimension (AD / CIT / SW) ~ local confidence + global confidence + SB + Age + IQ +

600 Gender.

601 Regression coefficients were compared post-hoc, and were Bonferroni corrected for the

602 number of tests (type I error rate of .05/3).

603

604 Data Availability

605 Fully anonymized task and questionnaire data are available on https://osf.io/ncg4s/.

606
607 *Code Availability*

608 The R analysis script is available on https://osf.io/ncg4s/.

609

610 **Author Contributions Statement**

611 JL and RJvH conceptualized the study. MR designed the task. MH performed data collection
612 and data analyses and wrote a first draft, and subsequent editing. JL, RJvH and MR
613 supervised data collection and analyses. JL, RJvH, MR and DD reviewed and edited the
614 manuscript.

615

616 **Competing Interests Statement**

617 None of the authors have any conflicts of interest to declare.

618

619 **Funding**

620 MR is the beneficiary of a postdoctoral fellowship from the AXA Research Fund, and is also
621 supported by the Fondation des Treilles, and by a department-wide grant from the Agence
622 Nationale de la Recherche (ANR-17-EURE-0017, EUR FrontCog) and receives support under
623 the program «Investissements d'Avenir» launched by the French Government and
624 implemented by ANR (ANR-10-IDEX-0001-02 PSL). JL and this work is supported by an NWO
625 VENI Fellowship grant (916-18-119). RjvH is supported by an NWO Aspasia Grant
626 (2019/SGW/00764779).

627

628

629

630

631

632
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