Improving Insight in Schizophrenia Through Social Cognitive Group Treatment

people sitting in a circle at group therapy
people sitting in a circle at group therapy
Although the new psychosocial intervention REFLEX was composed to address specific aspects of insight, its effects were not superior to that of simplified cognitive remediation training.

The psychosocial structured intervention REFLEX did not prove superior to a simplified form of cognitive remediation group training, although improvements in insight were seen for both groups, according to a study published in Schizophrenia Research.

Impaired insight, which is linked to poorer outcomes, affects the majority of individuals with schizophrenia. Researchers in this randomized, multicenter, controlled trial evaluated the new psychosocial targeted intervention REFLEX, which aims to improve insight by targeting self-reflection, perspective taking, and stigma-sensitivity.

The primary outcomes were preconditions of insights: internalized stigma, self-reflection, mental flexibility, and perspective taking. Secondary outcomes were clinical and cognitive insight.

A total of 121 patients from 7 sites in Netherlands were randomly placed in either a REFLEX group or a cognitive remediation control group focused on simplified drill-and-practice cognitive training.

After the intervention, stigma sensitivity, self-reflection, perspective taking, and mental flexibility remained unchanged. However, both groups showed significant improvements in clinical insight both directly after treatment and at follow-up, as measured by the Positive and Negative Syndrome Scale (PANSS) and the Schedule for the Assessment of Insight-Expanded (SAI-E) Interview and Rater (PANSS G12, <.005; SAI-E Rater, P <.001; and PANSS G12, P <.0001; SAI-E Rater, <.01, SAI-E Interview, P <.001, respectively). Other outcomes like depression, self-esteem, and quality of life remained unchanged after the intervention.

Although clinical insight improvements were larger for REFLEX directly after treatment (SAI-E Rater, P <.05), control group participants did start with clinician-rated insight scores that were significantly lower at baseline. REFLEX did not increase cognitive insight.

Study investigators conclude that “although REFLEX was composed to address specific aspects of insight, its effects were not superior to that of simplified [cognitive remediation training]…Since insight is unlikely to improve spontaneously in chronic patients, further research on their underlying mechanisms is needed.”

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Pijnenborg GHM, de Vos AE, Timmerman ME, et al. Social cognitive group treatment for impaired insight in psychosis: A multicenter randomized controlled trial [published online November 12, 2018]. Schizophr Res. doi: 10.1016/j.schres.2018.10.018