Abstract
BackgroundInsight is impaired in a majority of people with schizophrenia. Impaired insight is associated with poorer outcomes of the disorder. Based on existing literature, we developed a model that explains which processes may possibly play a role in impaired insight. This model was the starting point of the development of REFLEX: a brief psychosocial intervention to improve insight in schizophrenia. REFLEX is a 12-sessions group training, consisting of three modules of four sessions each. Modules in this intervention are: "coping with stigma", "you and your personal narrative", and "you in the present".Methods/DesignREFLEX is currently evaluated in a multicenter randomized controlled trial. Eight mental health institutions in the Netherlands participate in this evaluation. Patients are randomly assigned to either REFLEX or an active control condition, existing of cognitive remediation exercises in a group. In a subgroup of patients, fMRI scans are made before and after training in order to assess potential haemodynamic changes associated with the effects of the training.DiscussionREFLEX is one of the few interventions aiming specifically to improving insight in schizophrenia and has potential value for improving insight. Targeting insight in schizophrenia is a complex task, that comes with several methodological issues. These issues are addressed in the discussion of this paper.Trial registrationCurrent Controlled Trials: ISRCTN50247539
Highlights
Insight is impaired in a majority of people with schizophrenia
Targeting insight in schizophrenia is a complex task, that comes with several methodological issues
REFLEX may have a potential for improving insight in patients with schizophrenia
Summary
REFLEX may have a potential for improving insight in patients with schizophrenia. Our design offers the opportunity to examine the results of REFLEX at a behavioral level, but takes underlying changes in brain activation into account as well. A methodological problem that is associated with insight is that most assessment instruments are based upon the traditional medical model: patients have to use the same terminology as their psychiatrists to be considered insightful This approach ignores the insight some patients demonstrate, when they are able to describe the problems they experience in daily life and to attribute these problems to a mental illness. If they do not use the term “psychosis” or “schizophrenia” to describe their mental health, their insight is rated as impaired by most of the current instruments. Through the unique focus in REFLEX on the improvement of self-reflectivity and perspective taking abilities and by that improving insight we expect to make a significant contribution to the well-being of people with schizophrenia
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