The Beck Cognitive Insight Scale (BCIS): translation and validation of the Taiwanese version

Abstract

BackgroundOver the last few decades, research concerning the insight of patients with schizophrenia and its relationships with other clinical variables has been given much attention in the clinical setting. Since that time, a series of instruments assessing insight have been developed. The purpose of this study was to examine the reliability and validity of the Taiwanese version of the Beck Cognitive Insight Scale (BCIS). The BCIS is a self-administered instrument designed to evaluate cognitive processes that involves reevaluating patients' anomalous experiences and specific misinterpretations.MethodsThe English language version of the BCIS was translated into Taiwanese for use in this study. A total of 180 subjects with and without psychosis completed the Taiwanese version of the BCIS and additional evaluations to assess researcher-rated insight scales and psychopathology. Psychometric properties (factor structures and various types of reliability and validity) were assessed for this translated questionnaire.ResultsOverall, the Taiwanese version of the BCIS showed good reliability and stability over time. This translated scale comprised a two-factor solution corresponding to reflective attitude and certain attitude subscales. Following the validation of the internal structure of the scale, we obtained an R-C (reflective attitude minus certain attitude) index of the translated BCIS, representing the measurement of cognitive insight by subtracting the score of the certain attitude subscale from that of the reflective attitude subscale. As predicted, the differences in mean reflective attitude, certain attitude and R-C index between subjects with and without psychosis were significant. Our data also demonstrated that psychotic patients were significantly less reflective, more confident in their beliefs, and had less cognitive insight compared with nonpsychotic control groups.ConclusionsIn light of these findings, we believe that the Taiwanese version of BCIS is a valid and reliable instrument for the assessment of cognitive insight in psychotic patients.

Assessment of Cognitive Insight: A Qualitative Review

“…12,[14][15][16][17][18][19] While the original article established a 2-factor solution for inpatients, the new studies have replicated this finding 14 and shown that the same solution fits outpatient, 12,16 first-episode, 17 and healthy control 15,18 samples, both in English [16][17][18] and nonEnglish 12,14,15,19 speakers. These studies have, additionally, employed differing analytic strategies: principle components factor analysis, 14,15 confirmatory factor analysis, 12,16,18 exploratory factor analysis, 19 and correlational analysis. 17 …”

The neuropsychological correlates of cognitive insight in healthy participants

“…Furthermore, when directly compared to healthy controls, psychiatric patients showed definitely lower levels of SR and global cognitive insight, but higher levels of SC (Warman et al, 2007;Kao & Liu, 2010;Martin et al, 2010), except for one study where no difference for any of the three BCIS indexes emerged (Engh et al, 2007).…”

Measuring cognitive insight in people with problematic substance use: An exploration of the factor validity of the Beck Cognitive Insight Scale

“…A third study of an older population with a psychotic disorder achieved 0.08 loading for item 14, however removing it reportedly did not improve model fit and reasons why this item was poorly aligned were not discussed. In another study , items 12 and 14 aligned more strongly with self‐certainty. It may be the case that there is something within these items that does not strongly reflect the concept of self‐reflection, and this is more pronounced in a SUD population, particularly in treatment.…”