Social cognitive group treatment for impaired insight in psychosis: A multicenter randomized controlled trial

G. H.M. Pijnenborg; A. E. de Vos; M. E. Timmerman; M. Van der Gaag; B. E. Sportel; J. Arends; E. M. Koopmans; L. Van der Meer; A. Aleman

doi:10.1016/j.schres.2018.10.018

Social cognitive group treatment for impaired insight in psychosis: A multicenter randomized controlled trial

G. H.M. Pijnenborg^*
, A. E. de Vos
, M. E. Timmerman
, M. Van der Gaag
, B. E. Sportel
, J. Arends
, E. M. Koopmans
, L. Van der Meer
, A. Aleman

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

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Abstract

Purpose: The majority of people with schizophrenia has impaired insight, which is related to a poorer outcome. In this study, we evaluate a new psychosocial intervention ‘REFLEX’ aimed at improving insight in people with schizophrenia. REFLEX focuses on targeting stigma-sensitivity, perspective taking and self-reflection in people with schizophrenia and low insight. Primary objective is to improve insight and subsequently to improve functional outcome and symptoms. Method: A total of 121 people diagnosed with schizophrenia according to DSM IV criteria with impaired insight was included in 2012–2015 from seven sites in a multicenter randomized controlled trial. REFLEX was compared to an active control condition consisting of group-wise simplified cognitive remediation training. Primary outcome of the study were the preconditions of insight: internalized stigma, self-reflection, mental flexibility and perspective taking. Clinical insight and cognitive insight were secondary outcomes. Results: Although perspective taking, self-reflection, mental flexibility and stigma sensitivity remained unchanged after the intervention, results showed a significant improvement of clinical insight in both conditions directly after treatment (SAI-E Rater, p < .001, PANSS G12, p < .005) and at follow-up (SAI-E Rater, p < .01, SAI-E interview, p < .001, PANSS G12, p < .0001). Improvement of clinical insight directly after treatment was larger in the REFLEX condition (SAI-E Rater, p < .05). Other outcomes (self-esteem, quality of life and depression) remained unchanged. Conclusion: Though insight improved in both conditions, REFLEX was not superior to simplified drill-and-practice cognitive remediation training. Nevertheless, this study indicates that structured interventions can significantly improve insight. Further research on the underlying mechanisms of both conditions is needed, as insight is unlikely to improve spontaneously in chronic patients.

Original language	English
Pages (from-to)	362-369
Number of pages	8
Journal	Schizophrenia Research
Volume	206
Early online date	12 Nov 2018
DOIs	https://doi.org/10.1016/j.schres.2018.10.018
Publication status	Published - Apr 2019

Funding

The study was funded in part by a European Young Investigator (EURYI) Award from the European Science Foundation to AA (N.W.O. number 044035001). Other contributions (in terms of personnel involved) are from the mental health centers involved. The authors gratefully acknowledge Lentis, Groningen; University Medical Hospital Groningen (UMCG), Groningen; Department of Psychotic Disorders GGZ Drenthe, Assen; Department of Psychotic Disorders GGZ Friesland, Leeuwarden; Parnassia Psychiatric Institute, Portugaal; GGZ Centraal, Ermelo, and GGZ Noord Holland Noord, Schagen for their participation in the trial. We are indebted to all therapists (Lentis, Groningen: Ineke Koopman, MSc. Wouter Draaisma, MSc. Anneke Zijlstra. GGZ Drenthe, Assen: Ellen Horsselenberg, MSc. UCP Groningen: Han Bous, Maarten Vos, MSc. GGZ Friesland: Ronald Boonstra, MSc. Petra Schuurmans MSc. Welmoed Kostwinder MSc. Rozanne van Donkersgoed, MSc. Parnassia Den Haag: Andra Lansbergen, MSc. Esme Marques, MSc. Gitty de Haan, MSc. Bianca Raaijmakers, MSc. Sandra van der Drift, MSc. en Wies Titulaer, MSc. GGZ Noord Holland Noord: Krijn van Berkel, Marjolijn Hoekert, PhD) and to Alfred Burema (GGZ Drenthe), Leonie Bais (Neuroimaging Center UMCG, Groningen), Erna van't Hag (UCP, UMCG Groningen), Roeline Nieboer (GGZ Friesland, Leeuwarden), Wubbieke Everts, Nicky Heerings, Bertus Jeronimus, Renske Buit, Stefanie de Vries, Marthe Mekel, Charlotte Rem, Remzi Karadayi, Arjan Pijpker, Anne Kuipers, Ingrid Sibum, Maaike Tjooitink, Dianne Tijmes, Roos Temmink, Jose de Jager, Michel Gernaat, Elsa Fledderus, Milou Wiersum, Merel Prikken, Daouia Larabi, Kiki Koster and Steven de Jong (all master students of the clinical psychology track of the University of Groningen) for their help in setting up the trial and collecting the data. The study was funded in part by a European Young Investigator (EURYI) Award from the European Science Foundation to AA (N.W.O. number 044035001 ). Other contributions (in terms of personnel involved) are from the mental health centers involved.

Funders	Funder number
GGZ Noord Holland Noord
University Medical Hospital Groningen
European Science Foundation	044035001

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Awareness
Clinical trial
Perspective taking
Schizophrenia
Self-reflection
Self-stigma

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10.1016/j.schres.2018.10.018

Social cognitive group treatment for impaired insight in psychosisFinal published version, 657 KBLicence: Article 25fa Dutch Copyright Act

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Cite this

@article{288816984e354ee1bb96e81ed76b0af2,

title = "Social cognitive group treatment for impaired insight in psychosis: A multicenter randomized controlled trial",

abstract = "Purpose: The majority of people with schizophrenia has impaired insight, which is related to a poorer outcome. In this study, we evaluate a new psychosocial intervention {\textquoteleft}REFLEX{\textquoteright} aimed at improving insight in people with schizophrenia. REFLEX focuses on targeting stigma-sensitivity, perspective taking and self-reflection in people with schizophrenia and low insight. Primary objective is to improve insight and subsequently to improve functional outcome and symptoms. Method: A total of 121 people diagnosed with schizophrenia according to DSM IV criteria with impaired insight was included in 2012–2015 from seven sites in a multicenter randomized controlled trial. REFLEX was compared to an active control condition consisting of group-wise simplified cognitive remediation training. Primary outcome of the study were the preconditions of insight: internalized stigma, self-reflection, mental flexibility and perspective taking. Clinical insight and cognitive insight were secondary outcomes. Results: Although perspective taking, self-reflection, mental flexibility and stigma sensitivity remained unchanged after the intervention, results showed a significant improvement of clinical insight in both conditions directly after treatment (SAI-E Rater, p < .001, PANSS G12, p < .005) and at follow-up (SAI-E Rater, p < .01, SAI-E interview, p < .001, PANSS G12, p < .0001). Improvement of clinical insight directly after treatment was larger in the REFLEX condition (SAI-E Rater, p < .05). Other outcomes (self-esteem, quality of life and depression) remained unchanged. Conclusion: Though insight improved in both conditions, REFLEX was not superior to simplified drill-and-practice cognitive remediation training. Nevertheless, this study indicates that structured interventions can significantly improve insight. Further research on the underlying mechanisms of both conditions is needed, as insight is unlikely to improve spontaneously in chronic patients.",

keywords = "Awareness, Clinical trial, Perspective taking, Schizophrenia, Self-reflection, Self-stigma",

author = "Pijnenborg, \{G. H.M.\} and \{de Vos\}, \{A. E.\} and Timmerman, \{M. E.\} and \{Van der Gaag\}, M. and Sportel, \{B. E.\} and J. Arends and Koopmans, \{E. M.\} and \{Van der Meer\}, L. and A. Aleman",

year = "2019",

month = apr,

doi = "10.1016/j.schres.2018.10.018",

language = "English",

volume = "206",

pages = "362--369",

journal = "Schizophrenia Research",

issn = "0920-9964",

publisher = "Elsevier B.V.",

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TY - JOUR

T1 - Social cognitive group treatment for impaired insight in psychosis

T2 - A multicenter randomized controlled trial

AU - Pijnenborg, G. H.M.

AU - de Vos, A. E.

AU - Timmerman, M. E.

AU - Van der Gaag, M.

AU - Sportel, B. E.

AU - Arends, J.

AU - Koopmans, E. M.

AU - Van der Meer, L.

AU - Aleman, A.

PY - 2019/4

Y1 - 2019/4

N2 - Purpose: The majority of people with schizophrenia has impaired insight, which is related to a poorer outcome. In this study, we evaluate a new psychosocial intervention ‘REFLEX’ aimed at improving insight in people with schizophrenia. REFLEX focuses on targeting stigma-sensitivity, perspective taking and self-reflection in people with schizophrenia and low insight. Primary objective is to improve insight and subsequently to improve functional outcome and symptoms. Method: A total of 121 people diagnosed with schizophrenia according to DSM IV criteria with impaired insight was included in 2012–2015 from seven sites in a multicenter randomized controlled trial. REFLEX was compared to an active control condition consisting of group-wise simplified cognitive remediation training. Primary outcome of the study were the preconditions of insight: internalized stigma, self-reflection, mental flexibility and perspective taking. Clinical insight and cognitive insight were secondary outcomes. Results: Although perspective taking, self-reflection, mental flexibility and stigma sensitivity remained unchanged after the intervention, results showed a significant improvement of clinical insight in both conditions directly after treatment (SAI-E Rater, p < .001, PANSS G12, p < .005) and at follow-up (SAI-E Rater, p < .01, SAI-E interview, p < .001, PANSS G12, p < .0001). Improvement of clinical insight directly after treatment was larger in the REFLEX condition (SAI-E Rater, p < .05). Other outcomes (self-esteem, quality of life and depression) remained unchanged. Conclusion: Though insight improved in both conditions, REFLEX was not superior to simplified drill-and-practice cognitive remediation training. Nevertheless, this study indicates that structured interventions can significantly improve insight. Further research on the underlying mechanisms of both conditions is needed, as insight is unlikely to improve spontaneously in chronic patients.

AB - Purpose: The majority of people with schizophrenia has impaired insight, which is related to a poorer outcome. In this study, we evaluate a new psychosocial intervention ‘REFLEX’ aimed at improving insight in people with schizophrenia. REFLEX focuses on targeting stigma-sensitivity, perspective taking and self-reflection in people with schizophrenia and low insight. Primary objective is to improve insight and subsequently to improve functional outcome and symptoms. Method: A total of 121 people diagnosed with schizophrenia according to DSM IV criteria with impaired insight was included in 2012–2015 from seven sites in a multicenter randomized controlled trial. REFLEX was compared to an active control condition consisting of group-wise simplified cognitive remediation training. Primary outcome of the study were the preconditions of insight: internalized stigma, self-reflection, mental flexibility and perspective taking. Clinical insight and cognitive insight were secondary outcomes. Results: Although perspective taking, self-reflection, mental flexibility and stigma sensitivity remained unchanged after the intervention, results showed a significant improvement of clinical insight in both conditions directly after treatment (SAI-E Rater, p < .001, PANSS G12, p < .005) and at follow-up (SAI-E Rater, p < .01, SAI-E interview, p < .001, PANSS G12, p < .0001). Improvement of clinical insight directly after treatment was larger in the REFLEX condition (SAI-E Rater, p < .05). Other outcomes (self-esteem, quality of life and depression) remained unchanged. Conclusion: Though insight improved in both conditions, REFLEX was not superior to simplified drill-and-practice cognitive remediation training. Nevertheless, this study indicates that structured interventions can significantly improve insight. Further research on the underlying mechanisms of both conditions is needed, as insight is unlikely to improve spontaneously in chronic patients.

KW - Awareness

KW - Clinical trial

KW - Perspective taking

KW - Schizophrenia

KW - Self-reflection

KW - Self-stigma

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UR - https://www.scopus.com/pages/publications/85056262192#tab=citedBy

U2 - 10.1016/j.schres.2018.10.018

DO - 10.1016/j.schres.2018.10.018

M3 - Article

AN - SCOPUS:85056262192

SN - 0920-9964

VL - 206

SP - 362

EP - 369

JO - Schizophrenia Research

JF - Schizophrenia Research

ER -

Social cognitive group treatment for impaired insight in psychosis: A multicenter randomized controlled trial

Abstract

Funding

UN SDGs

Keywords

Access to Document

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