REFLEX: A metacognitive group treatment to improve insight in psychosis

Abstract

Background: Many people with schizophrenia (50-80%) demonstrate impaired insight. A number of interventions aiming to improve insight have been proposed and evaluated, for example cognitive behavioral therapy and psycho-education. Results of these interventions leave room for improvement. Therefore, we propose a new intervention to improve insight in people with schizophrenia (REFLEX). REFLEX focuses on insight in one's functioning in everyday life and changes in general functioning after psychosis by improving metacognitive acts necessary for insight (selfreflectiveness, idiosyncratic self-certainty) and reducing stigma-sensitivity. Methods: The primary objective is to improve insight. By improving insight, we hope to improve functional outcome and symptoms. Results: 120 patients diagnosed with schizophrenia with poor insight and sensitive are included in a randomized controlled trial): REFLEX was compared to an active control condition consisting of group wise drill and practice cognitive remediation training. Preliminary analysis show that while clinical insight measures with the SAI-E remains unchanged, while cognitive insight measured with the BCIS improves in the REFLEX condition (F 1,85 4,9, p