A new instrument for measuring insight: the Beck Cognitive Insight Scale

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Abstract

The clinical measurements of insight have focused primarily on patients' unawareness of their having a mental disorder and of their need for treatment ([Acta Psychiatr. Scand. 89 (1994) 62; Am. J. Psychiatry 150 (1993) 873]; etc.). A complementary approach focuses on some of the cognitive processes involved in patients' re-evaluation of their anomalous experiences and of their specific misinterpretations: distancing, objectivity, perspective, and self-correction. The Beck Cognitive Insight Scale (BCIS) was developed to evaluate patients' self-reflectiveness and their overconfidence in their interpretations of their experiences. A 15-item self-report questionnaire was subjected to a principle components analysis, yielding a 9-item self-reflectiveness subscale and a 6-item self-certainty subscale.

A composite index of the BCIS reflecting cognitive insight was calculated by subtracting the score for the self-certainty scale from that of the self-reflectiveness scale. The scale demonstrated good convergent, discriminant, and construct validity: (a) the BCIS composite index showed a significant correlation with being aware of having a mental disorder on the Scale to Assess Unawareness of Mental Disorder (SUMD; Arch. Gen. Psychiatry 51 (1994) 826) and the self-reflectiveness subscale was significantly correlated with being aware of delusions on the SUMD, (b) the composite index score of the BCIS differentiated inpatients with psychotic diagnoses from inpatients without psychotic diagnoses, and (c) in a separate study, change scores on the BCIS were significantly correlated with change scores on positive and negative symptoms. The results provided tentative support for the validity of the BCIS. Suggestions were made for further investigation of the cognitive processes involved in identifying and correcting erroneous beliefs and misinterpretations.

Section snippets

Sample

The sample was composed of 150 adult (18 years old and above) inpatients who were consecutively admitted to the adult psychiatric unit of a general hospital located in Cherry Hill, NJ, who were diagnosed with schizophrenia, schizoaffective disorder, major depressive disorder without psychosis, or major depression with psychotic features (who will be referred to as psychotic depressives for the remainder of this paper). All of the patients were required to have a Global Assessment of Functioning

Factor analysis

A variety of principal factor analyses with both orthogonal (varimax) and nonorthogonal (promax) rotations were first conducted with the 15 BCIS ratings for not only the total sample of 150 inpatients together, but also separately for the 75 (50%) patients diagnosed with schizophrenia or schizoaffective disorder and the 75 (50%) patients diagnosed with an MDD. Although these analyses indicated that one or two items might shift from loading on one dimension to another, all of the factor analyses

Discussion

The Beck Cognitive Insight Scale (BCIS) was developed in order to increase the understanding of patients' perspectives about their anomalous experiences, their attributions, and their aberrant interpretations of specific life events. The BCIS showed adequate convergent validity and discriminant validity. The moderate correlations with the Scale to Assess Unawareness of Mental Disorder (Amador et al., 1994) suggest that the BCIS has relevance to the patients' objectivity regarding their

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