Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older Consumers With Schizophrenia: Defeatist Performance Attitudes and Functional Outcome

Abstract

Objectives To determine whether cognitive behavioral social skills training (CBSST) is an effective psychosocial intervention to improve functioning in older consumers with schizophrenia, and whether defeatist performance attitudes are associated with change in functioning in CBSST. Design An 18-month, single-blind, randomized controlled trial. Setting Outpatient clinic at a university-affiliated Veterans Affairs hospital. Participants Veteran and non-veteran consumers with schizophrenia or schizoaffective disorder (N=79) age 45–78. Interventions CBSST was a 36-session, weekly group therapy that combined cognitive behavior therapy with social skills training and problem solving training to improve functioning. The comparison intervention, goal-focused supportive contact (GFSC), was supportive group therapy focused on achieving functioning goals. Measurements Blind raters assessed functioning (primary outcome: Independent Living Skills Survey) CBSST skill mastery, positive and negative symptoms, depression, anxiety, defeatist attitudes, self-esteem, and life satisfaction. Results Functioning trajectories over time were significantly more positive in CBSST than in GFSC, especially for participants with more severe defeatist performance attitudes. Greater improvement in defeatist attitudes was also associated with better functioning in CBSST, but not GFSC. Both treatments showed comparable significant improvements in amotivation, depression, anxiety, positive self-esteem and life satisfaction. Conclusions CBSST is an effective treatment to improve functioning in older consumers with schizophrenia, and both CBSST and other supportive goal-focused interventions can reduce symptom distress, increase motivation and self esteem, and improve life satisfaction. Participants with more severe defeatist performance attitudes may benefit most from cognitive behavioral interventions that target functioning.

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

“…Specifically, given that the interventions used in this study did not directly target negative beliefs about success, those with low levels of expectancies of success may benefit from techniques or interventions that focus on modifying beliefs to reduce negative symptoms (e.g. Grant et al, 2012;Granholm et al, 2013). Alternatively, given the identified links between low metacognitive capacity and both reduced intrinsic motivation (Vohs and Lysaker, 2014) and concurrent and prospective negative symptoms (Tas et al, 2012;McLeod et al, 2014) it may be that those with lower baseline expectancies of success would benefit from an integrated psychotherapy that aims to develop the degree to which persons form complex and integrated ideas about themselves, their future, and their goals (Lysaker et al, 2010).…”

“…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.…”

Additional support for the cognitive model of schizophrenia: evidence of elevated defeatist beliefs in schizotypy

“…Defeatist performance beliefs have been assessed in inpatients and outpatients with schizophrenia [13,16], older adults with schizophrenia [19], individuals with deficit syndrome schizophrenia [20], those with recent on-set schizophrenia [15], and veterans with schizophrenia [14]. Despite considerable research in schizophrenia samples, there is a dearth of research investigating defeatist performance beliefs in individuals with schizotypy.…”

Subjective Experiences of the Benefits and Key Elements of a Cognitive Behavioral Intervention Focused on Community Work Outcomes in Persons With Mental Illness

“…In response, CBT interventions have begun to arise that emphasize correcting unhelpful cognitions and tailor behavioral strategies directly pertinent to deficits in functioning. For example, interventions for persons with severe mental illness combining CBT with social skills training that include content adapted for interpersonal settings have demonstrated positive benefits over time with regard to independent living skills and social skills acquisition (Granholm et al, 2013).…”