Insight and treatment outcome with cognitive-behavioral social skills training for older people with schizophrenia

Poor insight (awareness of having a mental illness that requires treatment) is common in schizophrenia and typically predicts poor outcome, yet greater insight has been linked to negative outcomes, including hopelessness. This study focused on two questions: (1) Does insight moderate the effects of cognitive-behavioral social skills training (CBSST) on functional outcomes in schizophrenia? (2) Does a specific type of insight (e.g., awareness of illness, need for treatment) predict benefit from CBSST? We examined insight as a predictor of everyday functioning in a randomized controlled trial of CBSST versus treatment as usual (TAU) for middle-aged and older people with schizophrenia (n = 62). We used linear regression models to examine moderators of the relationship between baseline insight and everyday functioning measured 12 months following completion of the 6-month intervention. Insight, especially insight into the need for treatment, moderated the relationship between treatment group and everyday functioning (Independent Living Skills Survey), such that CBSST offset the negative effect of insight on functioning observed with TAU (wherein greater insight was related to poorer everyday functioning). Post hoc analyses showed that reduction of insight-linked hopelessness may have accounted for the positive effect of CBSST on functioning relative to TAU.