Transcranial Direct Current Stimulation over the Orbitofrontal Cortex Enhances Self-Reported Confidence but Reduces Metacognitive Sensitivity in a Perceptual Decision-Making Task

<b>Background</b>: Metacognition refers to the ability to reflect on and regulate cognitive processes. Despite advances in neuroimaging and lesion studies, its neural correlates, as well as their interplay with other cognitive domains, remain poorly understood. The orbitofrontal cortex (OFC) is proposed as a potential substrate for metacognitive processing due to its contribution to evaluating and integrating reward-related information, decision-making, and self-monitoring. <b>Methods</b>: This study examined OFC involvement in metacognition using transcranial direct current stimulation (tDCS) while participants performed a two-alternative forced choice task with confidence ratings to assess their metacognitive sensitivity. Before stimulation, the subjects completed the Metacognitions Questionnaire-30 and a monetary intertemporal choice task for the quantification of delay discounting. <b>Results</b>: Linear mixed-effects models showed that anodal tDCS over the left OFC reduced participants' metacognitive sensitivity compared to sham stimulation, leaving perceptual decision-making accuracy unaffected. Moreover, real stimulation increased self-reported confidence ratings compared to the sham. Significant correlations were found between metacognitive sensitivity and negative beliefs about thinking. <b>Conclusions</b>: These results highlight the potential involvement of the OFC in the processing of retrospective second-order judgments about decision-making performance. Additionally, they support the notion that OFC overstimulation contributes to metacognitive dysfunctions detected in clinical conditions, such as difficulties in assessing the reliability of one's thoughts and decision outcomes.