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The Beck Cognitive Insight Scale: Psychometric properties in a Canadian

community sample

Article  in  Schizophrenia Research · March 2012

DOI: 10.1016/j.schres.2012.02.020 · Source: PubMed

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 Schizophrenia Research 137 (2012) 254–255

Contents lists available at SciVerse ScienceDirect

Schizophrenia Research
journal homepage: www.elsevier.com/locate/schres

Letter to the Editor

The Beck Cognitive Insight Scale: Psychometric properties in a As shown in Table 1, Self-Reflectiveness was represented in the first
Canadian community sample component, and the second component reflected Self-Certainty.
Chronbach's α was used to determine the following internal
consistencies: Self-Reflectiveness, α = 0.68, Self-Certainty, α = 0.65,
and Composite Index, α = 0.51.
Dear Editors,
BCIS ratings revealed: Self-Reflectiveness, M = 12.3, SD = 3.8,
The Beck Cognitive Insight Scale (BCIS) (Beck et al., 2004) was range = 4–25, Self-Certainty, M = 8.1, SD = 3.2, range = 1–15, and
developed to evaluate how individuals with psychosis understand Composite Index, M = 4.2, SD = 5.4, range = −8–17. Pearson's
their own reasoning processes, beliefs and judgments. In the original correlations determined that age significantly correlated with Self-
BCIS study, Beck et al. (2004) established a two factor structure for the Reflectiveness, r = −0.18, p = 0.04, Self-Certainty, r = 0.27, p b 0.01,
measure. The first factor was interpreted as an expression of one's and Composite Index scores, r = −0.28, p b 0.01. Education significantly
willingness to acknowledge fallibility, corrigibility and recognition of correlated with Self-Reflectiveness, r = −0.19, p = 0.05, but not Self-
dysfunctional reasoning, and was labelled Self-Reflectiveness. The Certainty or the Composite Index, r = −0.17, p = 0.08 and r = −0.05,
second factor focused on one's overconfidence and was considered p = 0.62, respectively. Gender did not significantly correlate to Self-
to represent Self-Certainty. The main clinical finding was that patients Reflectiveness, χ2(1) = 21.3, p = 0.32, Self-Certainty, χ2(1) = 14.7,
with psychosis could be reliably distinguished from psychiatric p = 0.40, or Composite Index scores, χ2(1) = 26.2, p = 0.40.
controls with major depression on the basis of their BCIS scores: Several summary points can be drawn from these data. First,
those with psychosis endorsed relatively less Self-Reflectiveness and consistent with Beck et al.'s (2004) original validation of the BCIS,
greater Self-Certainty. The authors concluded that the BCIS may be a principle component analysis revealed a 9-item Self-Reflectiveness
sensitive measure of cognitive insight impairments in psychosis. factor and a 6-item Self-Certainty factor. This indicates that in members
In the current BCIS literature, interest has shifted toward establishing of the general population, the factor structure of the BCIS is the same as
normative or prevalent levels of cognitive insight in non-psychiatric that for people with psychoses. Second, the internal consistency for the
control participants. These investigations have typically reported that two BCIS subscales were similar to those reported by Beck et al. (2004)
relative to people with psychosis, healthy people endorse “better” and other independent studies (Pedrelli et al., 2004; Bora et al., 2007;
cognitive insight through higher Self-Reflectiveness (Kao and Liu, Engh et al., 2007). Third, the norms presented here provide a bench-
2010; Martin et al., 2010; Kao et al., 2011) and lower Self-Certainty mark for prevalent cognitive insight levels in the general population.
(Engh et al., 2007; Warman et al., 2007; Martin et al., 2010; Kao et al., Finally, age and education significantly correlated with BCIS scores.
2011). Although these findings support the theoretical model of the Future research may consider recruiting healthy participants who are
BCIS, the inferences that can be drawn are restricted as most participants similar to patients in age/education or controlling statistically for their
were young university students. Remarkably, the relationship of the effects.
BCIS to demographic characteristics (e.g., age, education) has not been A limitation is that participants were not screened out for psychiatric
systematically broached in healthy or psychosis samples. Examination diagnosis, and firm conclusions about healthy cognition cannot be
of the BCIS in a demographically diverse, general population sample drawn from this dataset. Rather, the results should be interpreted in
may improve our understanding of cognitive insight levels expected in
a community sample and its relation to participants' demographics.
We thus sought to investigate the factor structure, norms and Table 1
demographic correlates of the BCIS in a Canadian community sample Varimax rotated factor loadings for the 15 BCIS items.
of the general population. BCIS item I II
One-hundred forty-two people (69 females) were drawn from the
(4) Jumped to conclusions 0.69 0.69
general population via advertisement in newspapers and online (6) Ideas were false 0.69 –0.20
classifieds (e.g., Craigslist) and were not screened for psychiatric (5) Due to imagination 0.65 –0.24
diagnosis. Participants were aged 17–62 (M = 37.5), their mean (8) Could be wrong 0.55 0.00
education was 14.8 years (SD = 2.5) and 25% were university students. (1) Have misunderstood 0.52 –0.23
(12) Willing to consider 0.46 0.07
Participants were tested in subgroups of 7–15 and financially (14) Possible explanations 0.35 0.18
compensated. (15) Due to stress 0.32 –0.26
Self-Reflectiveness, Self-Certainty and Composite Index (Self-Re- (3) Others more objective 0.15 0.01
flectiveness–Self-Certainty) scores were computed using the BCIS (9) Know problems 0.00 0.74
(13) Trust own judgment –0.18 0.73
(Beck et al., 2004). Each question is rated on a 4-point scale from
(2) Definitely right –0.04 0.71
0 (do not agree at all) to 3 (agree completely). To reveal the factor (7) Feels right is right 0.01 0.68
structure of the 142 fifteen-item BCIS ratings, a principle component (10) People are wrong 0.24 0.38
analysis with varimax rotation was performed using SPSS 18.0. (11) Cannot trust opinion –0.10 0.38
A scree plot suggested that two components should be extracted, % Total variance explained 16.60 17.16

with all but one item loading saliently (≥0.30) on either component. Note. Significant loadings (>0.30) are in bold.

0920-9964/$ – see front matter © 2012 Elsevier B.V. All rights reserved.
doi:10.1016/j.schres.2012.02.020
 Letter to the Editor
the context of a true community sample of the general population.
Replication in independent general population samples, including
healthy samples, is needed to further establish typical levels of cognitive
insight. The findings also touch on a growing sentiment in the field:
adaptive cognitive insight levels in the general population are probably
not adaptive in psychosis. While high Self-Certainty and low Self-
Reflectiveness may impede distorted belief correction in patients, it
could reflect a realistic grasp of facts and events in general population
members. What is more, it is doubtful that one cutoff score on the BCIS
will discern normal and dysfunctional reasoning. All things considered,
the results suggest that the BCIS is a valid instrument to assess cognitive
insight in the general population.
The role of funding source
Funding for this study was provided by the Canadian Institute of Health Research
(CIHR) (operating grant 68961; studentship to L.B.).
Author contributions
The first author assisted in conceptualizing the study, analyzed the data and wrote
the manuscript. The second author assisted in conceiving and designing the study,
provided laboratory space, and collected the data. The third author funded the project
and contributed to the writing of the final version of the manuscript.
Conflict of interest
All authors declare no conflict of interest.
Acknowledgments
The authors are thankful to Douglas Brain Imaging Group members for collecting
the BCIS data: Emmanuelle Dionne-Dostie and Tina Montreuil. We are also very grateful
to all the people who participated in our study. Sackler Foundation (to M.L.), and Fonds
de la Recherche en Sante du Que'bec (FRSQ) (salary award to M.L.).
References
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View publication stats
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Lisa Buchy
Brain Imaging Group, Douglas Mental Health University Institute, Canada
Department of Neurology & Neurosurgery, Montreal Neurological Institute,
McGill University, Canada
Mathieu B. Brodeur
Brain Imaging Group, Douglas Mental Health University Institute, Canada
Martin Lepage
Brain Imaging Group, Douglas Mental Health University Institute, Canada
Department of Neurology & Neurosurgery, Montreal Neurological Institute,
McGill University, Canada
Corresponding author at: Douglas Mental Health University Institute,
6875 LaSalle Blvd., Verdun, Quebec, Canada, H4H 1R3.
Tel.: +1 514 761 6131x4393; fax: +1 514 888 4064.
E-mail address: martin.lepage@mcgill.ca (M. Lepage).
13 December 2011