Previous studies have observed that impaired insight into one’s illness is common among individuals with first episode psychosis (FEP) and is associated with more severe symptoms, greater impairment in functioning, and worse course of illness. Despite the importance of insight as a predictor of outcomes, little research has examined the effects of early intervention services (EIS) on improving insight in individuals with psychosis.
Analyzing data from a randomized controlled trial, Nicole DeTore, PhD, Director of Research in the Resilience and Prevention Program and colleagues examined the impact of the NAVIGATE program compared to usual community care on insight in individuals participating in the Recovery After Initial Schizophrenia Episode-Early Treatment Program (.
The NAVIGATE program was developed specifically for the RAISE-ETP study, which compared NAVIGATE to usual community care in a cluster randomized design involving 34 sites and 404 patients. NAVIGATE is a team-based, multi-component treatment program designed to be implemented in community mental health treatment settings with the goal of guiding people with a first episode of psychosis (and their families) toward psychological and functional health. The program includes four interventions: Individualized Resiliency Training, Family Education Program, Supported Employment and Education, and Personalized Medication Management). The components are available in manualized form at www.raiseetp.org.
In the RAISE-ETP study, individuals with first episode, non-affective psychosis between the age of 15 and 40 years were recruited; 58.7% of participants enrolled following their first hospitalization (on average 2 months following the index hospitalization). Participants received either NAVIGATE or community care (randomization by site). In this study, assessments were conducted at baseline and every 6 months for 2 years. Insight was measured with the Lack of Judgement and Insight item on the PANSS, which evaluates the person’s unawareness of having a psychiatric condition and the need for treatment.
Improved Insight, Outcomes for Individuals in NAVIGATE Program
Over the course of the study, greater improvements in insight were observed in individuals participating in the NAVIGATE program compared to those receiving community care. At baseline, higher levels of insight were associated with less severe psychosis and negative symptoms and better psychosocial functioning. Although individuals with greater insight at baseline reported more severe depression and worse well-being at baseline, in individuals participating in the NAVIGATE program, better insight was no longer associated with either worse depression or lower well-being at the 6-month mark or at subsequent assessments. Improvements in insight from baseline to 6 months were more strongly correlated with improvements in social relationships in the NAVIGATE group compared to community care.
In this randomized controlled trial, DeTore and colleagues observed that the NAVIGATE program improved insight significantly more than usual community care. Although previous studies have indicated that greater awareness of illness was associated with higher depressive symptoms in individuals with schizophrenia, the findings of the current study suggest that early intervention programs like NAVIGATE can improve insight without worsening depression in FEP.
The authors speculate that the NAVIGATE program may foster insight into the illness without worsening depression or well-being because the program is specifically designed to support self-determination and to instill hope by helping individuals to identify and work toward specific goals, including completion of education, finding or maintaining work, and developing close relationships.
The findings also indicate that greater insight into one’s illness was associated with increased quality of social relationships in those participating in the NAVIGATE program. These results raise the possibility that insight and social relationships interacted synergistically over time in response to treatment, with positive changes in one domain contributing to positive changes in the other.
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NAVIGATE | Treatment for First Episode Psychosis
DeTore NR, Bain K, Wright A, Meyer-Kalos P, Gingerich S, Mueser KT. A Randomized Controlled Trial of the Effects of Early Intervention Services On Insight in First Episode Psychosis. Schizophr Bull. 2022 Nov 18; 48(6):1295-1305.
Mueser KT, Penn DL, Addington J, Brunette MF, Gingerich S, Glynn SM, Lynde DW, Gottlieb JD, Meyer-Kalos P, McGurk SR, Cather C, Saade S, Robinson DG, Schooler NR, Rosenheck RA, Kane JM. The NAVIGATE Program for First-Episode Psychosis: Rationale, Overview, and Description of Psychosocial Components. Psychiatr Serv. 2015 Jul;66(7):680-90.
Nicole DeTore, PhD is a clinical and research psychologist, Director of Research for the Resilience and Prevention Program (RAPP), and an Assistant Professor of Psychology at Harvard Medical School. Her research focuses on developing and studying interventions that can prevent the onset or reduce the severity of serious mental illnesses.
