Randomized clinical trial of cognitive behavioral social skills training for schizophrenia: Improvement in functioning and experiential negative symptoms.

Abstract

Objective Identifying treatments to improve functioning and reduce negative symptoms in consumers with schizophrenia is of high public health significance. Method In this randomized clinical trial, participants with schizophrenia or schizoaffective disorder (N=149) were randomly assigned to cognitive behavioral social skills training (CBSST) or an active goal-focused supportive contact (GFSC) control condition. CBSST combined cognitive behavior therapy with social skills training and problem solving training to improve functioning and negative symptoms. GFSC was weekly supportive group therapy focused on setting and achieving functioning goals. Blind raters assessed functioning (primary outcome: Independent Living Skills Survey (ILSS)), CBSST skill knowledge, positive and negative symptoms, depression, and defeatist performance attitudes. Results In mixed-effects regression models in intent-to-treat analyses, CBSST skill knowledge, functioning, amotivation/asociality negative symptoms and defeatist performance attitudes improved significantly more in CBSST relative to GFSC. In both treatment groups, comparable improvements were also found for positive symptoms and a performance-based measure of social competence. Conclusions The results suggest CBSST is an effective treatment to improve functioning and experiential negative symptoms in consumers with schizophrenia, and both CBSST and supportive group therapy that is actively focused on setting and achieving functioning goals can improve social competence and reduce positive symptoms.

Ist Negativsymptomatik bei Schizophrenie überhaupt behandelbar? Ein systematisches Literaturreview zur Wirksamkeit psychotherapeutischer Interventionen für Negativsymptomatik

“…149) untersuchten Granholm et al [2013Granholm et al [ , 2014 eine Erweiterung des SST um Elemente der kognitiven Therapie und fanden jeweils einen signifikanten Rückgang der motivationalen, nicht jedoch der expressiven Negativsymptomatik. In der größeren der beiden Studien [Granholm et al, 2014] waren diese Symptomverbesserungen auch im Vergleich zur aktiven Kontrollbedingung (supportive Gruppentherapie) signifikant (ES = -0,72), wobei die Unterschiede erst zum Katamnesezeitpunkt 12 Monate nach Therapieende deutlich wurden. Eine Kombination von SST und KR zeigte ebenfalls keinen Effekt auf die expressive Negativsymptomatik [Galderisi et al, 2010], wobei die Ergebnisse zur motivationalen Negativsymptomatik nicht berichtet wurden.…”

Expectancies of success as a predictor of negative symptoms reduction over 18 months in individuals with schizophrenia

“…Longitudinal investigations of defeatist performance beliefs in individuals with schizophrenia have largely been conducted in the context of cognitive therapy clinical trials, which have found some support for an association between a reduction in defeatist performance beliefs and improved negative symptoms and functioning over time (Granholm et al, 2013;Granholm et al, 2014). However, the longitudinal relationship between negative symptoms and other types of dysfunctional beliefs remains unclear.…”

“…Although recent psychosocial treatments have shown efficacy in improving a subset of negative symptoms (Grant et al, 2012;Granholm et al, 2014;Grant et al, 2014), negative symptoms can often persist despite psychosocial treatments and antipsychotic medication (Tandon et al, 2010). …”

Entrenamiento en habilidades sociales orientado a la Metacognición (MOSST): Marco teórico, metodología de trabajo y descripción del tratamiento para pacientes con Esquizofrenia

“…Debido al escaso impacto de estos programas, diversos autores han propuesto algunas mejoras para incrementar su eficacia. Por ejemplo, Granholm et al (2014;2007) han obtenido resultados prometedores combinando el EHS con la terapia cognitivo-conductual (TCC) en adultos con esquizofrenia.…”