Metacognition is defined as “cognition about cognition” or “thinking about thinking”. Precisely, it refers to the mental processes used to plan, monitor, and assess one’s understanding and performance (e.g., awareness that you have difficulty in mathematics, or reminding yourself to remember a person’s name).
The importance of metacognitive processes is pertinent in the formation and prolongation of intrusive thoughts. For example, it has been found that being aware of one’s own thoughts and having negative appraisals about intrusive thoughts both predict obsessive thoughts. By contrast, efforts to control those intrusive thoughts predict worry, suggesting that in OCD attempting to suppress intrusive thoughts is counter-effective.
Similarly, insight is one such mental process of metacognitions that refers to to awareness of having a mental illness. It is postulated that insight in obsessive-compulsive disorder(OCD) lies on a continuum that ranges from good insight, in which patients clearly recognize the excessiveness and/or senselessness of their concerns, to delusional conviction (i.e., lack of insight), in which the obsessions are considered realistic and reasonable.
Unfortunately, there is no conclusion regarding the relationship between insight and clinical factors, such as OCD severity, comorbid conditions, symptom dimensions, or treatment outcome. Some researchers find a relationship between poor insight and OCD severity, while others report no such results. However, several studies emphasize the role of metacognitions in the etiology (i.e., cause of a disease) of OCD and suggest that metacognition precipitates and maintains the psychopathology of OCD.
Furthermore, scores in uncontrollability and danger, need to control thoughts, and in cognitive self-consciousness are higher in the OCD group than in the healthy group, but they are lower among the OCD group with poor insight, which suggests that the need to control thoughts is useless when there is poor insight. Hence, exposure to unwanted thoughts or mental images may not effectively challenge OCD beliefs (i.e., therapy) when there is poor insight. It has even been suggesting that OCD with poor insight is closer to psychosis.
Reference:
Önen S., Karakaş Uğurlu G., & Çayköylü A. (2013). The relationship between metacognitions and insight in obsessive–compulsive disorder. Comprehensive Psychiatry 54(5):541-8. doi: 10.1016/j.comppsych.2012.11.006