REFLEX, a social-cognitive group treatment to improve insight in schizophrenia: study protocol of a multi-center RCT

doi:10.1186/1471-244X-11-161

BMC Psychiatry. 2011; 11: 161.

Published online 2011 October 5. doi: 10.1186/1471-244X-11-161

PMCID: PMC3222612

REFLEX, a social-cognitive group treatment to improve insight in schizophrenia: study protocol of a multi-center RCT

GHM Pijnenborg,^1,^2,⁴ Mark Van der Gaag,^5,⁶ Claudi LH Bockting,² Lisette Van der Meer,^3,⁴ and André Aleman^2,⁴

¹Dept. of Psychotic Disorders, GGZ-Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands

²Dept. of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands

³Lentis, Center for Mental Healthcare, Department of Longterm Rehabilitation, Zuidlaren, the Netherlands

⁴Neuroimaging Center, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, Groningen, the Netherlands

⁵VU University and EMGO+ Institute of Health and Care Research, Dept. of Clinical Psychology, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands

⁶Parnassia Psychiatric Institute, Prinsegracht 63, 2512 EX The Hague, the Netherlands

Corresponding author.

GHM Pijnenborg: g.h.m.pijnenborg/at/rug.nl; Mark Van der Gaag: m.vander.gaag/at/vu.nl; Claudi LH Bockting: c.l.h.bockting/at/rug.nl; Lisette Van der Meer: l.van.der.meer/at/med.umcg.nl; André Aleman: a.aleman/at/med.umcg.nl

Received June 30, 2011; Accepted October 5, 2011.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Insight 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/Design

REFLEX 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.

Discussion

REFLEX 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 registration

Current Controlled Trials: ISRCTN50247539

Keywords: schizophrenia, insight, treatment, self-reflection, self-stigma, perspective-taking

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