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Biomedicines
Volume 13
Issue 7
10.3390/biomedicines13071522
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Article

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

by
Daniele Saccenti
1,
Andrea Stefano Moro
1,2,
Gianmarco Salvetti
1,
Sandra Sassaroli
1,3,
Antonio Malgaroli
2,4,5,
Jacopo Lamanna
2,5,*,† and
Mattia Ferro
1,2,*,†
1
Department of Psychology, Sigmund Freud University, 20143 Milan, Italy
2
Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
3
Studi Cognitivi, Cognitive Psychotherapy School and Research Center, 20143 Milan, Italy
4
Clinical Center Tourette Syndrome, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
5
Faculty of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Biomedicines 2025, 13(7), 1522; https://doi.org/10.3390/biomedicines13071522 (registering DOI)
Submission received: 29 May 2025 / Revised: 16 June 2025 / Accepted: 20 June 2025 / Published: 21 June 2025
(This article belongs to the Special Issue Non-Invasive Brain Stimulation Techniques and Their Application in the Study of Cognitive Function Physiology and Neuro-Psychiatric Rehabilitation)
Versions Notes

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Keywords: accuracy; confidence; metacognitive sensitivity; decision-making; orbitofrontal cortex; OFC; transcranial direct current stimulation; tDCS accuracy; confidence; metacognitive sensitivity; decision-making; orbitofrontal cortex; OFC; transcranial direct current stimulation; tDCS

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MDPI and ACS Style

Saccenti, D.; Moro, A.S.; Salvetti, G.; Sassaroli, S.; Malgaroli, A.; Lamanna, J.; Ferro, M. Transcranial Direct Current Stimulation over the Orbitofrontal Cortex Enhances Self-Reported Confidence but Reduces Metacognitive Sensitivity in a Perceptual Decision-Making Task. Biomedicines 2025, 13, 1522. https://doi.org/10.3390/biomedicines13071522

AMA Style

Saccenti D, Moro AS, Salvetti G, Sassaroli S, Malgaroli A, Lamanna J, Ferro M. Transcranial Direct Current Stimulation over the Orbitofrontal Cortex Enhances Self-Reported Confidence but Reduces Metacognitive Sensitivity in a Perceptual Decision-Making Task. Biomedicines. 2025; 13(7):1522. https://doi.org/10.3390/biomedicines13071522

Chicago/Turabian Style

Saccenti, Daniele, Andrea Stefano Moro, Gianmarco Salvetti, Sandra Sassaroli, Antonio Malgaroli, Jacopo Lamanna, and Mattia Ferro. 2025. "Transcranial Direct Current Stimulation over the Orbitofrontal Cortex Enhances Self-Reported Confidence but Reduces Metacognitive Sensitivity in a Perceptual Decision-Making Task" Biomedicines 13, no. 7: 1522. https://doi.org/10.3390/biomedicines13071522

APA Style

Saccenti, D., Moro, A. S., Salvetti, G., Sassaroli, S., Malgaroli, A., Lamanna, J., & Ferro, M. (2025). Transcranial Direct Current Stimulation over the Orbitofrontal Cortex Enhances Self-Reported Confidence but Reduces Metacognitive Sensitivity in a Perceptual Decision-Making Task. Biomedicines, 13(7), 1522. https://doi.org/10.3390/biomedicines13071522

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