1
|
Filip TF, Hellemann GS, Ventura J, Subotnik KL, Green MF, Nuechterlein KH, McCleery A. Defeatist performance beliefs in individuals with recent-onset schizophrenia: Relationships with cognition and negative symptoms. Schizophr Res 2024; 270:212-219. [PMID: 38924939 PMCID: PMC11323074 DOI: 10.1016/j.schres.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 06/01/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The cognitive model of negative symptoms of schizophrenia suggests that defeatist performance beliefs (DPB), or overgeneralized negative beliefs about one's performance, are an intermediary variable along the pathway from impaired neurocognitive performance to negative symptoms and functioning in daily life. Although reliable associations between these variables have been established in chronic schizophrenia, less is known about the nature of these relationships in recent-onset schizophrenia (ROSz). This current study tested the associations between DPB and variables in the cognitive model (neurocognitive performance, negative symptoms, functioning) as well as mediation by DPB of the association between neurocognitive performance and negative symptoms in ROSz. METHODS A total of 52 participants (32 adults with ROSz and 20 non-psychiatric healthy comparators; HC) completed in-lab measures of neurocognitive performance, self-reported defeatist performance beliefs, and clinician administered measures of negative symptoms and functional outcome. Bivariate relationships among these variables were tested with Pearson correlations. Bootstrapped regression analyses were conducted to test the strength of the indirect effect of neurocognitive performance on negative symptoms through DPB. RESULTS Defeatist performance beliefs were significantly elevated in ROSz, and were associated with neurocognitive performance, negative symptoms, and functional outcome as predicted by the cognitive model. There was a significant indirect effect of neurocognition on experiential negative symptoms through DPB, indicating DPB are a partial mediator of the relationship between neurocognitive performance and negative symptoms. CONCLUSION These findings are consistent with the cognitive model of negative symptoms and extend previous findings in both ROSz and established schizophrenia. Specifically, these data demonstrate that DPB are elevated among ROSz and the associations with neurocognition and clinical outcomes (e.g., negative symptoms and functioning) are of similar magnitude to those reported in chronic schizophrenia. DPB may therefore be a viable treatment target in the early course of illness.
Collapse
Affiliation(s)
- Tess F Filip
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, United States of America
| | - Gerhard S Hellemann
- Department of Public Health, The University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Amanda McCleery
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, United States of America; Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States of America.
| |
Collapse
|
2
|
Luther L, Raugh IM, Grant PM, Beck AT, Strauss GP. The Role of Defeatist Performance Beliefs in State Fluctuations of Negative Symptoms in Schizophrenia Measured in Daily Life via Ecological Momentary Assessment. Schizophr Bull 2024:sbae128. [PMID: 39066666 DOI: 10.1093/schbul/sbae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND HYPOTHESIS The Cognitive Model of Negative Symptoms is a prominent model that posits that defeatist performance beliefs (DPB) are a key psychological mechanism underlying negative symptoms in those with schizophrenia (SZ). However, the ecological validity of the model has not been established, and temporally specific evaluations of the model's hypotheses have not been conducted. This study tested the model's key hypotheses in real-world environments using ecological momentary assessment (EMA). STUDY DESIGN Fifty-two outpatients with SZ and 55 healthy controls (CN) completed 6 days of EMA. Multilevel models examined concurrent and time-lagged associations between DPB and negative symptoms in daily life. STUDY RESULTS SZ displayed greater DPB in daily life than CN. Furthermore, greater DPB were associated with greater concurrently assessed negative symptoms (anhedonia, avolition, and asociality) in daily life. Time-lagged analyses indicated that in both groups, greater DPB at time t led to elevations in negative symptoms (anhedonia, avolition, or asociality) at t + 1 above and beyond the effects of negative symptoms at time t. CONCLUSIONS Results support the ecological validity of the Cognitive Model of Negative Symptoms and identify a temporally specific association between DPB and subsequent negative symptoms that is consistent with the model's hypotheses and a putative mechanistic pathway in Cognitive Behavioral Therapy for negative symptoms. Findings suggest that DPB are a psychological factor contributing to negative symptoms in real-world environments. Implications for measuring DPB in daily life and providing just-in-time mobile health-based interventions to target this mechanism are discussed.
Collapse
Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA
| | - Paul M Grant
- Center for Recovery-Oriented Cognitive Therapy, Beck Institute, Philadelphia, PA
| | - Aaron T Beck
- Center for Recovery-Oriented Cognitive Therapy, Beck Institute, Philadelphia, PA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | | |
Collapse
|
3
|
Xu F, Zhang H. The application of cognitive behavioral therapy in patients with schizophrenia: A review. Medicine (Baltimore) 2023; 102:e34827. [PMID: 37565853 PMCID: PMC10419479 DOI: 10.1097/md.0000000000034827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
The aim of this review is to explore the clinical nursing application of cognitive behavioral therapy (CBT) in patients with schizophrenia. A literature search was conducted using the CINAHL and MEDLINE databases. The database search occurred during the month of December 2022. This article comprehensively summarizes the theoretical basis of CBT in improving schizophrenia in clinical nursing, its application in managing symptoms and improving social function, as well as research progress in this field. There are still inconsistencies in the research results on CBT, but overall, psychological intervention combined with drug treatment is more effective than conventional treatment alone. If social function training can be added at the same time, it is believed that it will have better effects on clinical treatment and can maintain long-lasting effectiveness. Only in this way can patients truly understand and recognize the disease, improve treatment compliance, and ultimately achieve the goal of improving prognosis and quality of life.
Collapse
Affiliation(s)
- Feifei Xu
- School of Psychology, Zhejiang Normal University, Jin Hua, China
| | - Hang Zhang
- School of Humanities and International Education Exchange, Anhui University of Chinese Medicine, HeFei, China
| |
Collapse
|
4
|
Abel DB, Rand KL, Salyers MP, Myers EJ, Mickens JL, Minor KS. Do People With Schizophrenia Enjoy Social Activities as Much as Everyone Else? A Meta-analysis of Consummatory Social Pleasure. Schizophr Bull 2023; 49:809-822. [PMID: 36820515 PMCID: PMC10154728 DOI: 10.1093/schbul/sbac199] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND The "emotion paradox" of schizophrenia suggests people with schizophrenia demonstrate deficits when reporting anticipated and retrospective pleasure; yet, in-the-moment, consummatory pleasure is largely intact. It is uncertain how these findings extend to social situations. This meta-analysis aimed to (1) determine the mean difference in consummatory social pleasure between people with schizophrenia and healthy controls, and (2) examine moderators of this effect, including study design and clinical characteristics of participants. DESIGN A literature search using PsycINFO, Web of Science, Pubmed, and EMBASE databases was conducted. Studies measuring consummatory social pleasure using experience sampling methods and laboratory social simulations were included. Random effects meta-analyses were conducted using Hedge's g. RESULTS Meta-analysis of 26 studies suggests people with schizophrenia exhibited a small, significant deficit in consummatory social pleasure (g = -0.38, 90% CI [-0.53, -0.22]). There was significant heterogeneity in effect sizes; magnitude was moderated by study design and type of measure used to assess social pleasure. CONCLUSIONS Overall, people with schizophrenia seem to exhibit less consummatory social pleasure than controls. However, this deficit is smaller than in studies of anticipated and retrospective pleasure. Thus, consummatory social pleasure may not be quite as impaired in people with schizophrenia as traditional anhedonia research suggests. Moreover, pleasure deficits observed in people with schizophrenia may result from differences in the quality of their daily social experiences rather than differences in their capacity for social pleasure. Results have important implications for clinical interventions that address barriers to social engagement, low-pleasure beliefs, and cognitive remediation to treat schizophrenia.
Collapse
Affiliation(s)
- Danielle B Abel
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Evan J Myers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Jessica L Mickens
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| |
Collapse
|
5
|
Schormann ALA, Pillny M, Haß K, Lincoln TM. "Goals in Focus"-a targeted CBT approach for motivational negative symptoms of psychosis: study protocol for a randomized-controlled feasibility trial. Pilot Feasibility Stud 2023; 9:72. [PMID: 37131247 PMCID: PMC10152726 DOI: 10.1186/s40814-023-01284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 03/28/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The reduction of goal-directed behavior is the main characteristic in motivational negative symptoms of psychosis as it accounts for the long-term decline in psychological well-being and psychosocial functioning. However, the available treatment options are largely unspecific and show only small effects on motivational negative symptoms. Interventions that directly target the relevant psychological mechanisms are likely to be more effective. For "Goals in Focus", we translated findings from basic clinical research on mechanisms underlying motivational negative symptoms into a tailored and comprehensive novel psychological outpatient treatment program. With this study, we will test the feasibility of the therapy manual and the trial procedures. We also aim to examine first estimates of the effect size that can be expected from "Goals in Focus" to inform the sample size calculation of a subsequent fully powered trial. METHODS Thirty participants diagnosed with a schizophrenia spectrum disorder and at least moderate motivational negative symptoms will be randomly assigned to either 24 sessions of "Goals in Focus" over the course of 6 months (n = 15) or to a 6-month wait-list control group (n = 15). Single-blind assessments will be conducted at baseline (t0) and 6 months after baseline completion (t1). Feasibility outcomes include patient recruitment, retention, and attendance rates. Acceptability will be rated by trial therapists and by participants at end of treatment. Primary outcome for effect size estimation is the motivational negative symptom subscale sum score of the Brief Negative Symptom Scale at t1 corrected for baseline values. Secondary outcomes include psychosocial functioning, psychological well-being, depressive symptoms, expressive negative symptoms, negative symptom factor scores, and goal pursuit in everyday life. DISCUSSION The feasibility and acceptability data will be used to improve trial procedures and the "Goals in Focus" intervention where necessary. The treatment effect on the primary outcome will provide the basis for the sample size calculation for a fully powered RCT. TRIAL REGISTRATION 1) ClinicalTrials.gov, NCT05252039 . Registered on 23 February 2022. 2) Deutsches Register Klinischer Studien, DRKS00018083 . Registered on 28 August 2019.
Collapse
Affiliation(s)
- Alisa L A Schormann
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany.
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - Katharina Haß
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
| |
Collapse
|
6
|
Van Eck RM, van Velden J, Vellinga A, van der Krieke L, Castelein S, de Haan L, Schirmbeck F, van Amelsvoort T, Bartels-Velthuis AA, Bruggeman R, Cahn W, Simons CJP, van Os J. Personal recovery suits us all: A study in patients with non-affective psychosis, unaffected siblings and healthy controls. Schizophr Res 2023; 255:24-32. [PMID: 36948073 DOI: 10.1016/j.schres.2023.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/25/2023] [Indexed: 03/24/2023]
Abstract
Personal recovery transcends illness and is a unifying human experience. Core elements in personal recovery are hope, meaning, and rebuilding oneself. Here we aim to investigate whether factors associated with personal recovery in patients with non-affective psychosis, unaffected siblings and healthy controls are similar. We investigated the association between personal recovery and resilience, social support, socio-demographic and illness-related variables in 580 patients, 630 siblings, and 351 healthy controls who participated in the Genetic Risk and Outcome of Psychosis (GROUP) study. Bi-variate associations between personal recovery and individual variables were assessed and multiple linear regression analyses were performed to estimate the proportion of variance in personal recovery that could be accounted for by the predictors and to investigate which predictors independently added to the model. Positive self was significantly and independently associated with personal recovery in all three groups. Pro-active action taking also seems to be important. Social functioning significantly contributed to explained variance in patients and siblings. Regarding illness-related factors, depressive symptoms had impact on personal recovery in both patients and siblings, whereas positive symptoms only did in siblings. The findings imply that not only personal recovery itself, but also some associated factors are universally human and suit us all. This means that patients and non-patients share supportive factors of personal recovery which may help to reach mutual understanding. Recovery-oriented practices and mental health services might be more effective when focusing also on improving self-image, functional coping styles and generating social interaction, next to the reduction of affective symptoms.
Collapse
Affiliation(s)
- Robin Michael Van Eck
- Mentrum, part of Arkin, the Netherlands; Arkin, Institute for Mental Health, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands.
| | - Judith van Velden
- Arkin, Institute for Mental Health, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
| | - Astrid Vellinga
- Mentrum, part of Arkin, the Netherlands; Arkin, Institute for Mental Health, Amsterdam, the Netherlands
| | - Lian van der Krieke
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research center, Groningen, the Netherlands
| | - Stynke Castelein
- Lentis Research, Lentis Psychiatric Institute, Groningen, the Netherlands; Faculty of Behavioural and Social Sciences, Department of Clinical Psychology, Groningen, the Netherlands
| | - Lieuwe de Haan
- Arkin, Institute for Mental Health, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
| | - Frederike Schirmbeck
- Arkin, Institute for Mental Health, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
| | - Therese van Amelsvoort
- Maastricht University, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research center, Groningen, the Netherlands
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research center, Groningen, the Netherlands; University of Groningen, Department of Clinical and Developmental Neuropsychology, Groningen, the Netherlands
| | - Wiepke Cahn
- University Medical Center Utrecht, Department of Psychiatry, Brain Centre Rudolf Magnus, Utrecht University, Utrecht, the Netherlands; Altrecht, General Mental Health Care, Utrecht, the Netherlands
| | - Claudia J P Simons
- Maastricht University, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, the Netherlands; GGzE Institute for Mental Health Care, Eindhoven, the Netherlands
| | - Jim van Os
- University Medical Center Utrecht, Department of Psychiatry, Brain Centre Rudolf Magnus, Utrecht University, Utrecht, the Netherlands; King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
| |
Collapse
|
7
|
Bennett ME, Brown CH, Fang LJ, Blanchard JJ. Increasing social and community participation in veterans living with schizophrenia: A treatment outcome study. Schizophr Res 2023; 252:262-270. [PMID: 36682317 DOI: 10.1016/j.schres.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
People living with schizophrenia often face challenges engaging in social and community activities. A critical barrier is negative symptoms that reflect diminished feelings and thoughts that support social interaction. Several years ago, we began a process of specifying an intervention for individuals with schizophrenia and clinically meaningful negative symptoms that could be delivered in an integrated fashion with mental health services offered in VA medical centers with the primary focus of improving social and community engagement. In the present study, we examined the impact of a multi-component intervention to improve social and community participation in a group of Veterans living with schizophrenia and negative symptoms. We compared an intervention called Engaging in Community Roles and Experiences (EnCoRE) - a 12-week program of individual and group meetings that support learning and implementing skills with the goal of helping participants increase engagement in personally-relevant social and community activities - to an active wellness education control condition. Participants in both conditions attended on average of at least half of the groups that were offered, indicating that many individuals living with negative symptoms are willing to participate in an intervention to improve social and community participation. Although there were no significant differences on the two primary outcomes, those in EnCoRE showed better social and general functioning at post treatment and improved social motivational negative symptoms and decreases in perceived limitations at a 3-month follow-up. EnCoRE may be especially beneficial for participants who endorsed more dysfunctional attitudes about their abilities.
Collapse
Affiliation(s)
- Melanie E Bennett
- VA Capital Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Maryland Health Care System (Baltimore Annex), 209 West Fayette Street, Baltimore, MD 20210, United States of America; Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, 5(th) Floor, Baltimore, MD 21201, United States of America.
| | - Clayton H Brown
- VA Capital Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Maryland Health Care System (Baltimore Annex), 209 West Fayette Street, Baltimore, MD 20210, United States of America; Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 W. Redwood Street, Baltimore, MD 21201, United States of America.
| | - Li Juan Fang
- Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, 5(th) Floor, Baltimore, MD 21201, United States of America.
| | - Jack J Blanchard
- Department of Psychology, University of Maryland, Biology/Psychology Building, 4094 Campus Dr., College Park, MD 20742, United States of America.
| |
Collapse
|
8
|
Low goal-directed behavior in negative symptoms is explained by goal setting - Results of a diary study. J Behav Ther Exp Psychiatry 2022; 76:101740. [PMID: 35738687 DOI: 10.1016/j.jbtep.2022.101740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/09/2021] [Accepted: 03/16/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Engaging in goal-directed activities is a core difficulty of people with negative symptoms in schizophrenia. A previously developed goal pursuit model of negative symptoms (Schlier et al. 2017) postulates that negative symptom severity correlates with a tendency to set more avoidance- than approach-oriented goals. This shift in goal orientation correlates with low levels of goal expectancy, goal importance, and goal commitment. We explored whether these alterations translate into reduced goal-directed behavior (i.e., reduced goal striving and goal attainment). METHODS We conducted a one-week diary-study in a population sample (N=91). Participants were assessed for subclinical negative symptoms at baseline. Next, they set a daily goal and completed an online survey measuring goal orientation, goal characteristics, goal pursuit, and goal attainment once per day for one week. RESULTS Multilevel regression analyses and structural equation models showed that negative symptoms correlated with a tendency to set less approach-oriented goals with reduced goal expectancy and goal commitment. Goal orientation, expectancy, and commitment mediated the association between negative symptoms and reduced goal pursuit and attainment. LIMITATIONS We used a community sample, thus our results need to be replicated in a clinical sample of people with motivational negative symptoms. CONCLUSIONS Our results support the hypothesis that dysfunctional goal pursuit processes explain why negative symptoms lead to reduced goal-directed behavior. Interventions focusing on goal setting and goal expectations could be promising in improving goal-directed behavior in people with negative symptoms.
Collapse
|
9
|
McLeod HJ. Splitting Things Apart to Put Them Back Together Again: A Targeted Review and Analysis of Psychological Therapy RCTs Addressing Recovery From Negative Symptoms. Front Psychiatry 2022; 13:826692. [PMID: 35633793 PMCID: PMC9133443 DOI: 10.3389/fpsyt.2022.826692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/28/2022] [Indexed: 11/20/2022] Open
Abstract
Negative symptoms have attracted growing attention as a psychological treatment target and the past 10 years has seen an expansion of mechanistic studies and clinical trials aimed at improving treatment options for this frequently neglected sub-group of people diagnosed with schizophrenia. The recent publication of several randomized controlled trials of psychological treatments that pre-specified negative symptoms as a primary outcome warrants a carefully targeted review and analysis, not least because these treatments have generally returned disappointing therapeutic benefits. This mini-review dissects these trials and offers an account of why we continue to have significant gaps in our understanding of how to support recovery in people troubled by persistent negative symptoms. Possible explanations for mixed trial results include a failure to separate the negative symptom phenotype into the clinically relevant sub-types that will respond to mechanistically targeted treatments. For example, the distinction between experiential and expressive deficits as separate components of the wider negative symptom construct points to potentially different treatment needs and techniques. The 10 negative symptom-focused RCTs chosen for analysis in this mini-review present over 16 different categories of treatment techniques spanning a range of cognitive, emotional, behavioral, interpersonal, and metacognitive domains of functioning. The argument is made that treatment development will advance more rapidly with the use of more precisely targeted psychological treatments that match interventions to a focused range of negative symptom maintenance processes.
Collapse
Affiliation(s)
- Hamish J. McLeod
- Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
10
|
Granholm E, Twamley EW, Mahmood Z, Keller AV, Lykins HC, Parrish EM, Thomas ML, Perivoliotis D, Holden JL. Integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training for Negative Symptoms of Psychosis: Effects in a Pilot Randomized Controlled Trial. Schizophr Bull 2022; 48:359-370. [PMID: 34665853 PMCID: PMC8886598 DOI: 10.1093/schbul/sbab126] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Negative symptoms and cognitive impairment in schizophrenia (SZ) remain unmet treatment needs as they are highly prevalent, associated with poor functional outcomes, and resistant to pharmacologic treatment. The current pilot randomized controlled trial examined the efficacy of an integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training (CBSST-CCT) intervention compared to Goal-focused Supportive Contact (SC) on negative symptoms and cognitive performance. METHODS Fifty-five adults with SZ or schizoaffective disorder with moderate-to-severe negative symptoms were randomized to receive 25 twice-weekly, 1-h manualized group sessions (12.5 weeks total duration) of either CBSST-CCT or SC delivered by master's level clinicians in five community settings. Assessments of negative symptom severity (primary outcomes) and neuropsychological performance, functional capacity, social skills performance, and self-reported functional ability/everyday functioning, psychiatric symptom severity, and motivation (secondary outcomes) were administered at baseline, mid-treatment, post-treatment, and 6-month follow-up. RESULTS Mixed-effects models using baseline, mid-treatment, and post-treatment data demonstrated significant CBSST-CCT-associated effects on negative symptom severity, as assessed by the Scale for the Assessment of Negative Symptoms (p = .049, r = 0.22), with improvements in diminished motivation driving this effect (p = .037, r = 0.24). The CBSST-CCT group also demonstrated improved verbal learning compared to SC participants (p = .026, r = 0.36). The effects of CBSST-CCT appeared to be durable at 6-month follow-up. CONCLUSIONS CBSST-CCT improved negative symptom severity and verbal learning in high-negative-symptom individuals relative to SC. CBSST-CCT warrants larger investigations to examine its efficacy in treating negative symptoms, along with other symptoms, cognition, and, ultimately, real-world functional outcomes. Clinical Trial registration number NCT02170051.
Collapse
Affiliation(s)
- Eric Granholm
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Research Service and Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Zanjbeel Mahmood
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Amber V Keller
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Hannah C Lykins
- Research Service and Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Emma M Parrish
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Michael L Thomas
- Psychology Department, Colorado State University, Fort Collins, CO, USA
| | - Dimitri Perivoliotis
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Jason L Holden
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
11
|
Swanson L, Schwannauer M, Bird T, Eliasson E, Millar A, Moritz S, Griffiths H. Metacognitive Training Modified for Negative Symptoms (MCT-N): A Feasibility study. Clin Psychol Psychother 2021; 29:1068-1079. [PMID: 34792834 DOI: 10.1002/cpp.2692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Although patients often prioritise the treatment of negative symptoms, few psychological interventions targeting negative symptoms exist. This study attempts to fill this gap by piloting a modified Metacognitive training programme, specifically targeted at negative symptoms (MCT-N), with a group of patients with prominent negative symptoms. METHOD We adopted a mixed methods case series design, providing detailed quantitative data on changes over time, to focus on potential mechanisms underlying the intervention, in combination with qualitative interviews. RESULTS The intervention showed good feasibility as demonstrated by the attendance rate, the positive feedback from participants and the multidisciplinary team, and the improvements on negative symptoms observed following the intervention. Multilevel modelling showed that depression, internalised stigma, and reflective functioning explained the variance in negative symptoms. DISCUSSION The pilot study indicated that the intervention has high feasibility and that improvements in negative symptoms can be partially explained by improvements on depression, stigma, and reflective functioning.
Collapse
Affiliation(s)
- Linda Swanson
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh.,NHS Lothian, UK, Psychology Department, Royal Edinburgh Hospital, Edinburgh.,Region Sörmland, Sweden, Centre for Clinical Research Sörmland, Eskilstuna
| | - Matthias Schwannauer
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
| | - Tim Bird
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
| | - Emma Eliasson
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
| | - Audrey Millar
- NHS Lothian, UK, Psychology Department, Royal Edinburgh Hospital, Edinburgh
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Germany, Department of Psychiatry and Psychotherapy, Hamburg
| | - Helen Griffiths
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
| |
Collapse
|
12
|
Devoe DJ, Cadenhead KS, Cornblatt B, Granholm E, Addington J. Negative symptoms: associations with defeatist beliefs, self-efficacy, and maladaptive schemas in youth and young adults at-risk for psychosis. Behav Cogn Psychother 2021; 50:1-14. [PMID: 34784991 DOI: 10.1017/s1352465821000461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Investigations into possible mechanisms that may contribute to the development, maintenance, and exacerbation of negative symptoms are needed. Defeatist beliefs, self-efficacy, and early maladaptive schemas have been shown to contribute to negative symptoms in schizophrenia. Likewise, negative symptoms occur in those at clinical high-risk (CHR) for psychosis. AIMS The aim of this study was to determine if negative symptoms were associated with defeatist beliefs, self-efficacy, and early maladaptive schemas in CHR participants of a group therapy intervention study. METHOD All CHR participants (n = 203; 99 males, 104 females) were recruited as part of a three-site randomized control trial: Recovery through Group Study (ReGroup). Negative symptoms, defeatist beliefs, self-efficacy and early maladaptive schemas were assessed by trained clinical raters. Mediation analyses were conducted to examine the relationship between defeatist beliefs, self-efficacy, functioning, and negative symptoms. RESULTS The majority of CHR youth (72.9%) had at least one negative symptom of moderate to above moderate severity at baseline. In multiple mediation analyses, both asocial beliefs and social self-efficacy mediated the effects of social functioning on negative symptoms. Finally, defeatist performance attitudes significantly mediated the effects of role functioning on negative symptoms. CONCLUSIONS These results highlight the importance of considering beliefs and attitudes in relation to functioning and severity of negative symptoms. Psychosocial interventions may wish to target beliefs and attitudes in effort to reduce negative symptoms and improve functioning in CHR youth.
Collapse
Affiliation(s)
- Daniel J Devoe
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - K S Cadenhead
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Barbara Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| |
Collapse
|
13
|
Lee KH, Yu CH. The moderating effect of mindfulness on self-defeatist beliefs and negative symptoms in a population of chronic schizophrenia patients in Taiwan. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
14
|
Clay KB, Raugh IM, Bartolomeo LA, Strauss GP. Defeatist performance beliefs in individuals at clinical high-risk for psychosis and outpatients with chronic schizophrenia. Early Interv Psychiatry 2021; 15:865-873. [PMID: 32743974 DOI: 10.1111/eip.13024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
Abstract
AIM Prior studies indicate that defeatist performance beliefs (DPBs) are elevated in those in the chronic phase of schizophrenia (SZ) and associated with negative symptoms, functional outcome and neurocognitive impairment. However, it is unclear whether these same patterns of results hold in participants at clinical high-risk (CHR) for psychosis. METHODS Two studies were conducted to determine whether prior results in SZ could be replicated and extended to CHR. Participants included 184 healthy controls (CN) and 186 outpatients with chronic SZ for Study 1, and 30 CN and 35 CHR in Study 2. In both studies, participants completed the DPB scale and measures of negative symptoms, psychosocial functioning and neurocognition. RESULTS Both chronic SZ and CHR participants had elevated DPBs compared to CN (p's < .01). In SZ, higher DPBs were associated with greater negative symptoms (r's = .31-.37, p's < .01), poorer social functioning and impaired social cognition (r = -.40, P < .001). In CHR, greater DPBs were associated with poorer social functioning (r = -.52, P < .05) and impairments in the neurocognitive domains of reasoning (r = -.48, P < .05) and processing speed (r = -.41, P < .05). Models testing whether DPBs mediated links between negative symptoms and functioning, negative symptoms and cognition and cognition and functioning were nonsignificant in SZ and CHR samples. CONCLUSIONS Findings generally provide support for the cognitive model of negative symptoms and functioning and suggest that DPBs are an important clinical target across phases of psychotic illness.
Collapse
Affiliation(s)
- Kendall B Clay
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Lisa A Bartolomeo
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| |
Collapse
|
15
|
Mei S, Hu Y, Sun M, Fei J, Li C, Liang L, Hu Y. Association between Bullying Victimization and Symptoms of Depression among Adolescents: A Moderated Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3316. [PMID: 33806969 PMCID: PMC8005068 DOI: 10.3390/ijerph18063316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/06/2021] [Accepted: 03/19/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Bullying victimization and its effect on symptoms of depression have received attention from researchers, but few studies have considered the potential mechanism. The aim of this study was to examine a moderated mediation model for the association between bullying victimization and depressive symptoms in terms of it being mediated by social anxiety, and investigated whether sleep duration would show moderating effects in this relationship. METHODS In this study, there were 2956 students, who completed three questionnaires, including a bullying victimization scale, as well as a social anxiety and epidemiologic studies depression scale. RESULTS Bullying victimization's effects on depressive symptoms were mediated by social anxiety. Furthermore, sleep duration moderated the relationship between bullying victimization and depressive symptoms. CONCLUSIONS The research contributes by clarifying the mechanisms underlying the relationship between bullying victimization and depressive symptoms.
Collapse
Affiliation(s)
- Songli Mei
- Department of Child and Adolescent Health, School of Public Health, Jilin University, NO. 1163 Xinmin Street, Changchun 130012, China;
| | - Yueyang Hu
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, NO. 1163 Xinmin Street, Changchun 130012, China; (Y.H.); (J.F.); (C.L.); (L.L.)
| | - Mengzi Sun
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, NO. 1163 Xinmin Street, Changchun 130012, China;
| | - Junsong Fei
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, NO. 1163 Xinmin Street, Changchun 130012, China; (Y.H.); (J.F.); (C.L.); (L.L.)
| | - Chuanen Li
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, NO. 1163 Xinmin Street, Changchun 130012, China; (Y.H.); (J.F.); (C.L.); (L.L.)
| | - Leilei Liang
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, NO. 1163 Xinmin Street, Changchun 130012, China; (Y.H.); (J.F.); (C.L.); (L.L.)
| | - Yuanchao Hu
- Department of Child and Adolescent Health, School of Public Health, Jilin University, NO. 1163 Xinmin Street, Changchun 130012, China;
| |
Collapse
|
16
|
Munin AO, Akulova AA, Belokrylov IV. Main methods of psychotherapy for negative schizophrenia symptoms. RUDN JOURNAL OF MEDICINE 2020. [DOI: 10.22363/2313-0245-2020-24-3-262-268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The review covers publications on the main methods of psychotherapy that can reduce negative symptoms of schizophrenia. Negative symptoms are difficult to treat, and generally persist despite standard antipsychotic treatment. Combined methods including medical and non-medical treatments can be more effective and fully meet the therapeutic needs of a patient. We examined the effects of cognitive-behavioral therapy, social skills training, and family interventions on negative symptoms. The negative symptoms of schizophrenia underlie poor functioning, impaired professional performance and patient disability, thereby being a key factor in the enormous financial cost to the healthcare. Effective treatment of negative symptoms will lead to clinical and functional recovery in patients with schizophrenic spectrum disorders.
Collapse
|
17
|
Granholm E, Holden J, Dwyer K, Mikhael T, Link P, Depp C. Mobile-Assisted Cognitive Behavioral Therapy for Negative Symptoms: Open Single-Arm Trial With Schizophrenia Patients. JMIR Ment Health 2020; 7:e24406. [PMID: 33258792 PMCID: PMC7738249 DOI: 10.2196/24406] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Negative symptoms are an important unmet treatment need for schizophrenia. This study is a preliminary, open, single-arm trial of a novel hybrid intervention called mobile-assisted cognitive behavioral therapy for negative symptoms (mCBTn). OBJECTIVE The primary aim was to test whether mCBTn was feasible and could reduce severity of the target mechanism, defeatist performance attitudes, which are associated with experiential negative symptoms and poor functioning in schizophrenia. METHODS Participants with schizophrenia or schizoaffective disorder (N=31) who met prospective criteria for persistent negative symptoms were enrolled. The blended intervention combines weekly in-person group therapy with a smartphone app called CBT2go. The app extended therapy group skills, including recovery goal setting, thought challenging, scheduling of pleasurable activities and social interactions, and pleasure-savoring interventions to modify defeatist attitudes and improve experiential negative symptoms. RESULTS Retention was excellent (87% at 18 weeks), and severity of defeatist attitudes and experiential negative symptoms declined significantly in the mCBTn intervention with large effect sizes. CONCLUSIONS The findings suggest that mCBTn is a feasible and potentially effective treatment for experiential negative symptoms, if confirmed in a larger randomized controlled trial. The findings also provide support for the defeatist attitude model of experiential negative symptoms and suggest that blended technology-supported interventions such as mCBTn can strengthen and shorten intensive psychosocial interventions for schizophrenia. TRIAL REGISTRATION ClinicalTrials.gov NCT03179696; https://clinicaltrials.gov/ct2/show/NCT03179696.
Collapse
Affiliation(s)
- Eric Granholm
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Jason Holden
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Kristen Dwyer
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Tanya Mikhael
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Peter Link
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Colin Depp
- VA San Diego Healthcare System, San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| |
Collapse
|
18
|
Edwards CJ, Garety PA, Hardy A. Remembering the past to live better in the future: A feasibility randomised controlled trial of memory specificity training for motivation in psychosis. J Behav Ther Exp Psychiatry 2020; 68:101564. [PMID: 32143065 DOI: 10.1016/j.jbtep.2020.101564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVES People with a diagnosis of psychosis often experience low motivation and reduced activity levels. Autobiographical memory deficits have been identified in people with psychosis and this may limit the role of memory retrieval in supporting motivation. This pilot study adapted a recently developed protocol, Memflex, which aims to enhance autobiographical memory and has shown promise in depression. Our brief intervention targets experiential negative symptoms of psychosis using supported autobiographical memory retrieval. METHOD A sample of 31 participants with psychosis were recruited from inpatient and community settings and randomised in a 2:1 ratio to either a basic recall control or an enhanced recall intervention group. Participants were asked to generate positive autobiographical memories linked to activities they wish to repeat in the future. The enhanced recall condition received additional prompts from the Memflex protocol, and the basic recall condition received no additional support. RESULTS The intervention delivered was acceptable (rated >80%) and feasible (94% adherence) to those who took part. Participants were able to generate positive autobiographical memories linked to their goals and experienced appropriate emotions linked to these. The controlled preliminary effect sizes (0.2-0.34) showed encouraging signals for self-efficacy, motivation and a reduction in negative mood. LIMITATIONS As this was a pilot study with a small sample size between-group tests of statistical significance were not conducted, and therefore findings should be interpreted with caution. CONCLUSIONS These findings suggest that guided autobiographical memory retrieval may be an effective way tool for targeting motivation in people with psychosis.
Collapse
Affiliation(s)
- C J Edwards
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - P A Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - A Hardy
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| |
Collapse
|
19
|
Bègue I, Kaiser S, Kirschner M. Pathophysiology of negative symptom dimensions of schizophrenia – Current developments and implications for treatment. Neurosci Biobehav Rev 2020; 116:74-88. [DOI: 10.1016/j.neubiorev.2020.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/13/2020] [Accepted: 06/02/2020] [Indexed: 02/06/2023]
|
20
|
Sitko K, Bewick BM, Owens D, Masterson C. Meta-analysis and Meta-regression of Cognitive Behavioral Therapy for Psychosis (CBTp) Across Time: The Effectiveness of CBTp has Improved for Delusions. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Abstract
Published research shows small-to-medium effects of Cognitive Behavioral Therapy for Psychosis (CBTp) on reducing psychotic symptoms. Given the on-going development of CBTp interventions, the aim of this systematic review is to examine whether the effectiveness of CBTp has changed across time. MEDLINE, EMBASE, PsycINFO, and CENTRAL were searched for randomized controlled trials examining CBTp interventions targeting positive and/or negative symptoms vs treatment as usual. Four meta-analyses were carried out to examine the effectiveness of CBTp for: positive symptoms; delusions; hallucinations; and negative symptoms. Four meta-regressions examined whether the effectiveness of CBTp changed across time for these groups of symptoms. A total of 28 studies (n = 2698) yielded a pooled g of −0.24 (95% confidence interval [CI] −0.32, −0.16, P < .001) favoring CBTp for positive symptoms, with nonsignificant heterogeneity (Q = 26.87, P = .47; I2 =0%); 13 studies (n = 890) yielded a pooled g of −0.36 (95% CI −0.59, −0.13, P = .002) for delusions, with substantial heterogeneity (Q = 31.99, P = .001; I2 =62%); 16 studies (n = 849) yielded a pooled g of −0.26 (95% CI −0.42, −0.11, P < .001) for hallucinations, with nonsignificant heterogeneity (Q = 18.10, P = .26; I2 =17%); 19 studies (n = 1761) yielded a pooled g of −0.22 (95% CI −0.33, −0.12, P < .001) for negative symptoms, with nonsignificant heterogeneity (Q = 20.32, P = .32, I2 =11%). Meta-regressions indicated a significant effect of year on the effectiveness of CBTp only for delusions (F[1, 11] = 5.99, P = .032; R2 = 0.594); methodological quality did not effect this finding. Findings indicate small-to-medium effects of CBTp for psychotic symptoms, with increasing effectiveness across time for delusions.
Collapse
Affiliation(s)
- Katarzyna Sitko
- Faculty of Medicine and Health, School of Medicine, University of Leeds, Leeds, UK
| | - Bridgette M Bewick
- Faculty of Medicine and Health, School of Medicine, University of Leeds, Leeds, UK
| | - David Owens
- Faculty of Medicine and Health, School of Medicine, University of Leeds, Leeds, UK
| | - Ciara Masterson
- Faculty of Medicine and Health, School of Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
21
|
Butcher I, Berry K, Haddock G. Understanding individuals' subjective experiences of negative symptoms of schizophrenia: A qualitative study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:319-334. [PMID: 32242945 DOI: 10.1111/bjc.12248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/10/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Individuals with a diagnosis of schizophrenia often experience both positive and negative symptoms. Negative symptoms can be disabling and have a serious impact on everyday functioning. Despite the range of clinician-rated measurement tools used to assess negative symptoms, very little is known about how individuals subjectively experience these symptoms. This study sought to examine, using qualitative methods, how people living with a diagnosis of schizophrenia subjectively experience negative symptoms. DESIGN Qualitative study. METHOD Semi-structured interviews were carried out with individuals with a diagnosis of schizophrenia who were experiencing negative symptoms. The sample was recruited from community and inpatient National Health Service mental health settings in the United Kingdom. Interviews were analysed using thematic analysis. RESULTS Twenty individuals took part. Individuals highlighted the persistent and enduring nature of their negative symptoms. Two central themes were identified: What it is like to experience negative symptoms and where have my negative symptoms come from? Within the first theme, four sub-themes emerged: loss of concentration, loss of motivation, withdrawal, and 'feeling but not feeling'. Within the second theme, four sub-themes emerged related to the causes of negative symptoms: impact of traumatic life events, positive psychotic symptoms, impact of social network, and recreational and prescribed drug use. CONCLUSION Individuals, who experience negative symptoms, were able to articulate the persistent and disabling nature of negative symptoms and clearly described factors which they believed contributed to the onset, exacerbation, and amelioration of the experiences. PRACTITIONER POINTS Negative symptoms for people diagnosed with schizophrenia are persistent and enduring and impact an individual's life. There has been little research conducted qualitatively on individuals' subjective experiences of negative symptoms. Individuals who experience negative symptoms attribute these to a number of factors, including adverse life events, recreational and prescribed drug use, an absence of social support, and positive psychotic symptoms. Understanding negative symptoms is important for services, clinicians, and family members, where misattributions made about negative symptoms can lead to such experiences being dismissed.
Collapse
Affiliation(s)
- Isabelle Butcher
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Manchester Academic Health Sciences Centre, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Manchester Academic Health Sciences Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Manchester Academic Health Sciences Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| |
Collapse
|
22
|
Wright A, Browne J, Mueser KT, Cather C. Evidence-Based Psychosocial Treatment for Individuals with Early Psychosis. Child Adolesc Psychiatr Clin N Am 2020; 29:211-223. [PMID: 31708048 DOI: 10.1016/j.chc.2019.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Coordinated specialty care (CSC) first-episode models are an evidence-based practice in the treatment of first-episode psychosis. Group, individual, and family therapies in CSC aim to help the client and family understand and cope with the experience of psychosis, promote symptomatic and functional recovery and improve quality of life, and support the pursuit of personally meaningful goals of the client. Common elements to these interventions include building a therapeutic alliance, recovery orientation, education, and skills training, which can be directed to a range of targets, including problem-solving, communication, social skills, and social cognition.
Collapse
Affiliation(s)
- Abigail Wright
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
| | - Julia Browne
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, USA
| | - Corinne Cather
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| |
Collapse
|
23
|
Gee B, Hodgekins J, Lavis A, Notley C, Birchwood M, Everard L, Freemantle N, Jones PB, Singh SP, Amos T, Marshall M, Sharma V, Smith J, Fowler D. Lived experiences of negative symptoms in first-episode psychosis: A qualitative secondary analysis. Early Interv Psychiatry 2019; 13:773-779. [PMID: 29573562 DOI: 10.1111/eip.12558] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 12/08/2017] [Accepted: 02/04/2018] [Indexed: 11/27/2022]
Abstract
AIM Exploring how negative symptoms are experienced and understood by individuals with lived experience of psychosis has the potential to offer insights into the complex psychosocial processes underlying negative symptom presentations. The aim of the current study was to investigate lived experiences of negative symptoms through secondary analysis of interviews conducted with individuals recovering from first-episode psychosis. METHOD Transcripts of in-depth interviews with participants (n = 24) recruited from Early Intervention in Psychosis services were analysed thematically with a focus on participants' experiences and personal understandings of features corresponding to the negative symptoms construct. RESULTS Descriptions of reductions in expression, motivation and sociability were common features of participants' accounts. Several participants described the experience of having difficulty interacting as like being a "zombie". Some participants experienced diminished capacity for emotion, thought or drive as underlying these experiences. However, participants typically attributed reductions in expression, motivation and sociability to medication side-effects, lack of confidence or active avoidance intended to protect them from rejection or ridicule, sometimes linked to internalized stigma. CONCLUSIONS Personal accounts of experiences of reduced expression, motivation and sociability during first-episode psychosis highlight the personal meaningfulness and role of agency in these features, challenging the framing of negative symptoms as passive manifestations of diminished capacity.
Collapse
Affiliation(s)
- Brioney Gee
- Norwich Medical School, University of East Anglia, Norwich, UK.,Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Anna Lavis
- University of Birmingham, Institute of Applied Health Research, Edgbastongh, Birmingham, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Max Birchwood
- University of Warwick, Warwick Medical School, Coventry, UK
| | - Linda Everard
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Nick Freemantle
- University College London, Department of Primary Care and Population Health, London, UK
| | - Peter B Jones
- University of Cambridge, Department of Psychiatry, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, UK
| | - Swaran P Singh
- University of Warwick, Warwick Medical School, Coventry, UK
| | - Tim Amos
- University of Bristol, Bristol Medical School, Bristol, UK
| | - Max Marshall
- University of Manchester, School of Health Sciences, Manchester, UK
| | - Vimal Sharma
- University of Chester, Faculty of Health and Social Care, Chester, UK.,Cheshire and Wirral Partnership NHS Foundation Trust, UK
| | - Jo Smith
- University of Worcester, Institute of Health and Society, Worcester, UK
| | - David Fowler
- University of Sussex, School of Psychology, Brighton, UK
| |
Collapse
|
24
|
Richardson T, Dasyam B, Courtney H, White L, Tedbury J, Butt J, Newman-Taylor K. Predictors of disengagement from cognitive behavioural therapy for psychosis in a National Health Service setting: A retrospective evaluation. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 58:440-451. [PMID: 31183886 DOI: 10.1111/bjc.12222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 04/04/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate whether demographic and clinical variables are related to disengagement rates in cognitive behavioural therapy (CBT) for psychosis in a clinical setting. METHODS The medical records and symptom severity data (from Health of the Nation Outcome Scales) were analysed retrospectively for 103 referrals for CBT for psychosis in a National Health Service secondary care and Early Intervention in Psychosis team. RESULTS Overall, 42.7% (n = 44) disengaged from CBT. There was no impact of gender or ethnicity, and no impact of clinical variables such as risk history and comorbid diagnosis. However, risk of disengagement was significantly higher for those who were younger, F = 6.89, partial η2 = .064, p = <.05; those with greater total HoNOS scores, F = 4.22, partial η2 = .04, p < .05; more severe symptoms on the HoNOS items of overactive, aggressive, disruptive, or agitated behaviour, χ2 = 6.13, p < .01; problem drinking or drug taking, χ2 = 7.65, p < .05; depressed mood, χ2 = 7.0, p < .01; and problems with occupation and activities: χ2 = 3.68, p < .05. There was a non-significant trend for shorter waiting times to be associated with greater levels of disengagement. CONCLUSIONS These results indicate that it may not be psychosis per se that disrupts engagement in CBT, but linked behavioural and emotional factors. A more assertive approach to these factors - overactive, aggressive, disruptive, or agitated behaviour, problem drinking or drug taking, depressed mood, and problems with occupation and activities, particularly in younger people - may be valuable prior to or early on in therapy as a means of increasing engagement in CBT for psychosis. PRACTITIONER POINTS Risk of disengagement from CBT for psychosis increases with overactive, aggressive, disruptive, or agitated behaviour (54.9% vs. 30.8%), problem drinking and drug taking (61.1% vs. 32.8%), depressed mood (56% vs. 30.2%), and problems with occupation and activities (53.3% vs. 34.5%), with a trend for younger age. An assertive and motivational approach to engagement and a focus on addressing low mood and problematic behaviours, prior to or early in therapy, may be warranted, particularly for younger people. This evaluation is limited by small sample size and being retrospective. These results speak to the question of whether psychosis itself renders people inappropriate for CBT for psychosis, or whether problems arise due to behavioural and emotional factors that might be addressed to increase access to CBT for psychosis.
Collapse
Affiliation(s)
- Thomas Richardson
- Mental Health Recovery and Early Intervention in Psychosis Teams, Solent NHS Trust, Portsmouth, UK
| | - Ben Dasyam
- Mental Health Recovery and Early Intervention in Psychosis Teams, Solent NHS Trust, Portsmouth, UK
| | - Helen Courtney
- Mental Health Recovery and Early Intervention in Psychosis Teams, Solent NHS Trust, Portsmouth, UK
| | - Lucy White
- Mental Health Recovery and Early Intervention in Psychosis Teams, Solent NHS Trust, Portsmouth, UK
| | - Jo Tedbury
- Mental Health Recovery and Early Intervention in Psychosis Teams, Solent NHS Trust, Portsmouth, UK
| | - Jane Butt
- Mental Health Recovery and Early Intervention in Psychosis Teams, Solent NHS Trust, Portsmouth, UK
| | - Katherine Newman-Taylor
- School of Psychology, University of Southampton, UK.,Southampton Psychology Service, Southern Health Foundation NHS Trust, Southampton, UK
| |
Collapse
|
25
|
Xiao Y, Zhang X, Luo D, Kuang Y, Zhu W, Chen X, Shen M. The efficacy of psychological interventions on psoriasis treatment: a systematic review and meta-analysis of randomized controlled trials. Psychol Res Behav Manag 2019; 12:97-106. [PMID: 30799963 PMCID: PMC6369842 DOI: 10.2147/prbm.s195181] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Previous observational studies have shown comorbidity between psoriasis and psychological disorders. However, the evidence of the efficacy of psychological interventions, including cognitive behavioral therapy (CBT) and other treatments, on psoriasis is still debated. Objectives The aim of this study was to systematically review the psychological interventions used in the treatment of psoriasis and to meta-analyze the efficacy of psychological interventions on psoriasis with respect to area and severity reduction. Materials and methods A systematic review and meta-analysis were conducted. PubMed, Web of Science, EMbase, and major Chinese academic journal databases were searched for articles published before January 2018. Studies of randomized controlled trials (RCTs) that applied psychological interventions in the treatment of psoriasis and used area and severity as the outcome measures were meta-analyzed. The pooled mean difference between groups was estimated using either fixed-effects models or random-effects models in the presence of heterogeneity. Subgroup analysis was performed by method of intervention and severity of psoriasis. Results Out of the 4,152 potentially relevant studies, 8 RCTs were included. The pooled mean difference was −1.36 (95% CI: −2.52 to −0.19; P=0.02). The pooled estimate was −1.80 (95% CI: −2.57 to −1.03; P<0.001) for CBT intervention and was −0.70 (95% CI: −2.39 to 0.99; P=0.42) for non-CBT intervention. The pooled estimates for mild and moderate-to-severe psoriasis were −1.95 (95% CI: −3.91 to 0.00; P=0.05) and −0.61 (95% CI: −1.61 to 0.38; P=0.23), respectively. Conclusion CBT is effective in the treatment of psoriasis in terms of area and severity reduction. Systemic treatment does not further enhance the efficacy of CBT. The effect of the psychological intervention is stronger in patients with moderate-to-severe psoriasis.
Collapse
Affiliation(s)
- Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China, ; .,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China, ; .,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China, ;
| | - Xingyu Zhang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Dan Luo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yehong Kuang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China, ; .,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China, ; .,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China, ;
| | - Wu Zhu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China, ; .,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China, ; .,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China, ;
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China, ; .,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China, ; .,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China, ;
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China, ; .,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China, ; .,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China, ;
| |
Collapse
|
26
|
Wijnen BFM, Pos K, Velthorst E, Schirmbeck F, Chan HY, de Haan L, van der Gaag M, Evers SMAA, Smit F. Economic evaluation of brief cognitive behavioural therapy for social activation in recent-onset psychosis. PLoS One 2018; 13:e0206236. [PMID: 30419038 PMCID: PMC6231612 DOI: 10.1371/journal.pone.0206236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/30/2018] [Indexed: 11/29/2022] Open
Abstract
Background In schizophrenia spectrum disorders, negative symptoms (e.g. social withdrawal) may persist after initial treatment with antipsychotics, much affecting the quality of life (QOL) of patients. This health-economic study evaluated if a dedicated form of cognitive behaviour therapy for social activation (CBTsa) would reduce negative symptoms and improve QOL in an economically sustainable way. Methods A health-economic evaluation was conducted alongside a single-blind randomised controlled trial in two parallel groups: guideline congruent treatment as usual (TAU; n = 50) versus TAU augmented with adjunct CBTsa (n = 49). Outcomes were PANSS negative symptom severity and EQ-5D quality adjusted life years (QALYs) gained. The health-economic evaluation was conducted both from the societal and the health sector perspective. Results Both conditions showed improvement in the respective outcomes over the follow-up period of six months, but QALY gains were significantly higher in the CBTsa condition compared to the TAU condition. Treatment response rate (i.e. ≥ 5-point decrease on the PANSS) was not significantly different. However, the add-on CBT intervention was associated with higher costs. This did not support the idea that CBTsa is a cost-effective adjunct. Various sensitivity analyses attested to the robustness of these findings. Conclusions In the Dutch context where TAU for psychosis is guideline congruent and well implemented there appears no added value for adjunct CBTsa. In other settings where the treatment for the schizophrenia spectrum disorders solely relies on antipsychotics, add-on CBTsa may lead to clinically superior outcomes, but it should still be evaluated if adjunct CBTsa therapy is a cost-effective alternative. Trial registration ClinicalTrials.gov registry under NCT03217955.
Collapse
Affiliation(s)
- Ben F. M. Wijnen
- Centre for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands
- * E-mail:
| | - Karin Pos
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States of America
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Frederike Schirmbeck
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Hoi Yau Chan
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Silvia M. A. A. Evers
- Centre for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands
| | - Filip Smit
- Centre for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University medical center, Amsterdam, the Netherlands
| |
Collapse
|
27
|
Reddy LF, Horan WP, Barch DM, Buchanan RW, Gold JM, Marder SR, Wynn JK, Young J, Green MF. Understanding the Association Between Negative Symptoms and Performance on Effort-Based Decision-Making Tasks: The Importance of Defeatist Performance Beliefs. Schizophr Bull 2018; 44:1217-1226. [PMID: 29140501 PMCID: PMC6192468 DOI: 10.1093/schbul/sbx156] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Effort-based decision-making paradigms are increasingly utilized to gain insight into the nature of motivation deficits. Research has shown associations between effort-based decision making and experiential negative symptoms; however, the associations are not consistent. The current study had two primary goals. First, we aimed to replicate previous findings of a deficit in effort-based decision making among individuals with schizophrenia on a test of cognitive effort. Second, in a large sample combined from the current and a previous study, we sought to examine the association between negative symptoms and effort by including the related construct of defeatist beliefs. The results replicated previous findings of impaired cognitive effort-based decision making in schizophrenia. Defeatist beliefs significantly moderated the association between negative symptoms and effort-based decision making such that there was a strong association between high negative symptoms and deficits in effort-based decision making, but only among participants with high levels of defeatist beliefs. Thus, our findings suggest the relationship between negative symptoms and effort performance may be understood by taking into account the role of defeatist beliefs, and finding that might explain discrepancies in previous studies.
Collapse
Affiliation(s)
- L Felice Reddy
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA,UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA,To whom correspondence should be addressed; tel: (310) 478–3711, fax: (310) 268–4056, e-mail:
| | - William P Horan
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA,UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Deanna M Barch
- Departments of Psychology, Psychiatry, and Radiology, Washington University, St. Louis, MO
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Stephen R Marder
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA,UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Jonathan K Wynn
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA,UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Jared Young
- Department of Psychiatry, University of California, San Diego,Research Service, VA San Diego Healthcare System, San Diego, CA
| | - Michael F Green
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA,UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| |
Collapse
|
28
|
Identifying the "Therapy Targets" for Treating the Negative Symptoms of Psychosis Using Cognitive Behavioral Therapy. J Cogn Psychother 2018; 32:203-220. [PMID: 32746436 DOI: 10.1891/0889-8391.32.3.203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The division of psychotic symptoms into positive and negative categories has largely divided the research on them. While the research on positive symptoms of psychosis has rapidly developed over the last three decades, the literature on negative symptoms has noticeably lagged behind. Negative symptoms have likely been ignored in the treatment literature because they were previously thought to remit following the treatment of positive symptoms. Recent evidence does not consistently support this theory and indicates that the different manifestations of negative symptoms require distinct approaches to treatment. The current review provides a re-evaluation of the theoretical literature on negative symptoms to inform and identify "treatment targets" to reduce them. The "treatment targets" are then translated into intervention strategies using a cognitive behavioral framework. A review of the empirical literature on cognitive behavior therapy for treating negative symptoms is then offered along with a critical discussion of where cognitive behavior therapy stands compared to other interventions and what research is still needed.
Collapse
|
29
|
Pillny M, Krkovic K, Lincoln TM. Development of the Demotivating Beliefs Inventory and Test of the Cognitive Triad of Amotivation. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9940-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
30
|
Turner DT, McGlanaghy E, Cuijpers P, van der Gaag M, Karyotaki E, MacBeth A. A Meta-Analysis of Social Skills Training and Related Interventions for Psychosis. Schizophr Bull 2018; 44:475-491. [PMID: 29140460 PMCID: PMC5890475 DOI: 10.1093/schbul/sbx146] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective Evidence suggests that social skills training (SST) is an efficacious intervention for negative symptoms in psychosis, whereas evidence of efficacy in other psychosis symptom domains is limited. The current article reports a comprehensive meta-analytic review of the evidence for SST across relevant outcome measures, control comparisons, and follow-up assessments. The secondary aim of this study was to identify and investigate the efficacy of SST subtypes. Methods A systematic literature search identified 27 randomized controlled trials including N = 1437 participants. Trials assessing SST against active controls, treatment-as-usual (TAU), and waiting list control were included. Risk of bias was assessed using the Cochrane risk of bias assessment tool. A series of 70 meta-analytic comparisons provided effect sizes in Hedges' g. Heterogeneity and publication bias were assessed. Results SST demonstrated superiority over TAU (g = 0.3), active controls (g = 0.2-0.3), and comparators pooled (g = 0.2-0.3) for negative symptoms, and over TAU (g = 0.4) and comparators pooled (g = 0.3) for general psychopathology. Superiority was indicated in a proportion of comparisons for all symptoms pooled and social outcome measures. SST subtype comparisons were underpowered, although social-cognitive approaches demonstrated superiority vs comparators pooled. SST treatment effects were maintained at proportion of follow-up comparisons. Conclusions SST demonstrates a magnitude of effect for negative symptoms similar to those commonly reported for cognitive-behavioral therapy (CBT) for positive symptoms, although unlike CBT, SST is not routinely recommended in treatment guidelines for psychological intervention. SST may have potential for wider implementation. Further stringent effectiveness research alongside wider pilot implementation of SST in community mental health teams is warranted.
Collapse
Affiliation(s)
- David T Turner
- Department of Clinical Psychology, Vrije Universitiet, Amsterdam, The Netherlands
| | - Edel McGlanaghy
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh
| | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universitiet, Amsterdam, The Netherlands
| | - Mark van der Gaag
- Department of Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical Psychology, Vrije Universitiet, Amsterdam, The Netherlands
| | - Angus MacBeth
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh
| |
Collapse
|
31
|
Granholm E, Holden J, Worley M. Improvement in Negative Symptoms and Functioning in Cognitive-Behavioral Social Skills Training for Schizophrenia: Mediation by Defeatist Performance Attitudes and Asocial Beliefs. Schizophr Bull 2018; 44:653-661. [PMID: 29036391 PMCID: PMC5890456 DOI: 10.1093/schbul/sbx099] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Psychosocial interventions have significant but modest impact on negative symptoms and functioning in schizophrenia. Identifying mechanisms of change in these interventions can inform treatment targets to strengthen these interventions. A number of studies have found associations between dysfunctional attitudes negative symptoms and functioning in schizophrenia. We previously found improvement in experiential negative symptoms and functioning in cognitive-behavioral social skills training (CBSST) in participants with schizophrenia (N = 149), and the present study examined whether improvements in CBSST in that trial were mediated by the group effect on defeatist performance attitudes and asocial beliefs. In multilevel mediation analyses, the effect of treatment group on experiential negative symptoms and functioning was mediated prospectively through defeatist attitudes but asocial beliefs only mediated effects on experiential negative symptoms. The findings suggest that cognitive-behavioral therapy interventions that target dysfunctional attitudes can lead to improvement in negative symptoms and functioning in schizophrenia.
Collapse
Affiliation(s)
- Eric Granholm
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Psychology Service, VA San Diego Healthcare System, San Diego, CA,To whom correspondence should be addressed; Psychology Service, VA San Diego Healthcare System (116B), 3350 La Jolla Village Drive, San Diego, CA 92161, US; tel: 858-552-8585 ext. 7563, fax: 858-552-7414, e-mail:
| | - Jason Holden
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Matthew Worley
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Psychology Service, VA San Diego Healthcare System, San Diego, CA
| |
Collapse
|
32
|
Stiekema APM, Islam MA, Liemburg EJ, Castelein S, van den Heuvel ER, van Weeghel J, Aleman A, Bruggeman R, van der Meer L. Long-term course of negative symptom subdomains and relationship with outcome in patients with a psychotic disorder. Schizophr Res 2018. [PMID: 28648915 DOI: 10.1016/j.schres.2017.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The longitudinal course of the negative symptoms subdomains social amotivation (SA) and expressive deficits (ED) remains largely unknown. We investigated i) the longitudinal course of SA and ED subdomain scores, ii) whether subgroups based on the course of SA and ED subdomain scores could be identified, iii) whether baseline SA and ED subdomain scores were related to functioning and quality of life six years later and iv) the longitudinal relationship between subgroups and outcomes. METHODS Measurements at baseline, three and six years from 1067 patients participating in the Genetic Risk and Outcome of Psychosis (GROUP) project were used. We applied mixed models analysis, regression analysis and trajectory analyses. RESULTS SA and ED subdomain scores decreased over time. Within both subdomains, four subgroups were identified: for both SA and ED a steady low course (±60%), increased (±15%) and decreased course (±15%). Within SA only, a higher level decreased course (±6%) and within ED only, a course with relatively stable high ED scores (±6%) was found. Lower symptom levels at baseline were related to better functioning (SA & ED) and quality of life (SA) at six years. Overall, low SA and low ED subgroups showed better outcomes than the other subgroups. CONCLUSION In many patients the course of negative symptoms is unstable and related to the course of outcome. Patients who do show steady low negative symptom levels (60%) may complicate the interpretation of treatment evaluation studies, as they may average out possible effects in subgroups with fluctuating symptom levels.
Collapse
Affiliation(s)
- Annemarie P M Stiekema
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Md Atiqul Islam
- University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, Rob Giel Research Center, University Medical Center Groningen, Groningen, The Netherlands; Department of Statistics, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Edith J Liemburg
- University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, Rob Giel Research Center, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, Department of Neuroscience, Groningen, University Medical Center Groningen, The Netherlands; Research Department, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Stynke Castelein
- University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Research Department, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Edwin R van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jaap van Weeghel
- Parnassia Group, Dijk en Duin Mental Health Center, Castricum, The Netherlands; Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
| | - André Aleman
- University of Groningen, Department of Neuroscience, Groningen, University Medical Center Groningen, The Netherlands; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, Rob Giel Research Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands; University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
33
|
Lincoln TM, Riehle M, Pillny M, Helbig-Lang S, Fladung AK, Hartmann-Riemer M, Kaiser S. Using Functional Analysis as a Framework to Guide Individualized Treatment for Negative Symptoms. Front Psychol 2017; 8:2108. [PMID: 29259567 PMCID: PMC5723417 DOI: 10.3389/fpsyg.2017.02108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/17/2017] [Indexed: 12/19/2022] Open
Abstract
Although numerous interventions are available for negative symptoms, outcomes have been unsatisfactory with pharmacological and psychological interventions producing changes of only limited clinical significance. Here, we argue that because negative symptoms occur as a complex syndrome caused and maintained by numerous factors that vary between individuals they are unlikely to be treated effectively by the present "one size fits all" approaches. Instead, a well-founded selection of those interventions relevant to each individual is needed to optimize both the efficiency and the efficacy of existing approaches. The concept of functional analysis (FA) can be used to structure existing knowledge so that it can guide individualized treatment planning. FA is based on stimulus-response learning mechanisms taking into account the characteristics of the organism that contribute to the responses, their consequences and the contingency with which consequences are tied to the response. FA can thus be flexibly applied to the level of individual patients to understand the factors causing and maintaining negative symptoms and derive suitable interventions. In this article we will briefly introduce the concept of FA and demonstrate-exemplarily-how known psychological and biological correlates of negative symptoms can be incorporated into its framework. We then outline the framework's implications for individual assessment and treatment. Following the logic of FA, we argue that a detailed assessment is needed to identify the key factors causing or maintaining negative symptoms for each individual patient. Interventions can then be selected according to their likelihood of changing these key factors and need to take interactions between different factors into account. Supplementary case vignettes exemplify the usefulness of functional analysis for individual treatment planning. Finally, we discuss and point to avenues for future research guided by this model.
Collapse
Affiliation(s)
- Tania M. Lincoln
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Marcel Riehle
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Sylvia Helbig-Lang
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Anne-Katharina Fladung
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Matthias Hartmann-Riemer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Kaiser
- Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospital, Geneva, Switzerland
| |
Collapse
|
34
|
Aleman A, Lincoln TM, Bruggeman R, Melle I, Arends J, Arango C, Knegtering H. Treatment of negative symptoms: Where do we stand, and where do we go? Schizophr Res 2017; 186:55-62. [PMID: 27293137 DOI: 10.1016/j.schres.2016.05.015] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 12/16/2022]
Abstract
Negative symptoms, e.g. social withdrawal, reduced initiative, anhedonia and affective flattening, are notoriously difficult to treat. In this review, we take stock of recent research into treatment of negative symptoms by summarizing psychosocial as well as pharmacological and other biological treatment strategies. Major psychosocial approaches concern social skills training, cognitive behavior therapy for psychosis, cognitive remediation and family intervention. Some positive findings have been reported, with the most robust improvements observed for social skills training. Although cognitive behavior therapy shows significant effects for negative symptoms as a secondary outcome measure, there is a lack of data to allow for definite conclusions of its effectiveness for patients with predominant negative symptoms. With regard to pharmacological interventions, antipsychotics have been shown to improve negative symptoms, but this seems to be limited to secondary negative symptoms in acute patients. It has also been suggested that antipsychotics may aggravate negative symptoms. Recent studies have investigated glutamatergic compounds, e.g. glycine receptor inhibitors and drugs that target the NMDA receptor or metabotropic glutamate 2/3 (mGlu2/3) receptor, but no consistent evidence of improvement of negative symptoms was found. Finally, some small studies have suggested improvement of negative symptoms after non-invasive electromagnetic neurostimulation, but this has only been partly replicated and it is still unclear whether these are robust improvements. We address methodological issues, in particular the heterogeneity of negative symptoms and treatment response, and suggest avenues for future research. There is a need for more detailed studies that focus on different dimensions of negative symptoms.
Collapse
Affiliation(s)
- André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Groningen, The Netherlands.
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Hamburg, Germany
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen and Rob Giel Research Center, Department of Psychiatry, Groningen, The Netherlands
| | - Ingrid Melle
- NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Johan Arends
- GGZ Drenthe Mental Health Center, Department of Psychotic Disorders, Assen, The Netherlands
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - Henderikus Knegtering
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Groningen, The Netherlands; GGZ Lentis Mental Health Center, Department of Psychotic Disorders, Groningen, The Netherlands
| |
Collapse
|
35
|
Kaiser S, Lyne J, Agartz I, Clarke M, Mørch-Johnsen L, Faerden A. Individual negative symptoms and domains - Relevance for assessment, pathomechanisms and treatment. Schizophr Res 2017; 186:39-45. [PMID: 27453425 DOI: 10.1016/j.schres.2016.07.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 07/07/2016] [Accepted: 07/15/2016] [Indexed: 12/12/2022]
Abstract
The negative symptoms of schizophrenia can be divided into two domains. Avolition/apathy includes the individual symptoms of avolition, asociality and anhedonia. Diminished expression includes blunted affect and alogia. Until now, causes and treatment of negative symptoms have remained a major challenge, which is partially related to the focus on negative symptoms as a broad entity. Here, we propose that negative symptoms may become more tractable when the different domains and individual symptoms are taken into account. There is now increasing evidence that the relationship with clinical variables - in particular outcome - differs between the domains of avolition/apathy and diminished expression. Regarding models of negative symptom formation, those relevant to avolition/apathy are now converging on processes underlying goal-directed behavior and dysfunctions of the reward system. In contrast, models of the diminished expression domains are only beginning to emerge. The aim of this article is to review the specific clinical, behavioral and neural correlates of individual symptoms and domains as a better understanding of these areas may facilitate specific treatment approaches.
Collapse
Affiliation(s)
- Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
| | - John Lyne
- Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland; North Dublin Mental Health Services, Ashlin Centre, Beaumont Road, Dublin 9, Ireland; Dublin and East Treatment and Early Care Team (DETECT) Services, Dublin, Ireland
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Mary Clarke
- Dublin and East Treatment and Early Care Team (DETECT) Services, Dublin, Ireland; College of Life Sciences, University College Dublin, Dublin, Ireland
| | - Lynn Mørch-Johnsen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Ann Faerden
- NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
36
|
Osborne PJ, Jimenez-Torres GJ, Landa Y, Mahoney J, Madan A. Chronic pain management group psychotherapy for psychiatric inpatients: A pilot study. Bull Menninger Clin 2017; 81:123-149. [PMID: 28609146 DOI: 10.1521/bumc.2017.81.2.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Individuals with serious mental illness (SMI) experience significant comorbid chronic pain (CP). Little is known about CP management in psychiatric inpatient settings. To address this gap in clinical practice, the authors developed CP management group psychotherapy for adult inpatients with SMI. In this report, the authors highlight (1) the theoretical underpinnings of and execution of the psychotherapy group, (2) the characteristics of participants in the pilot phase of the group, and (3) outcomes of group participants. Data were collected from 16 participants in the pain management psychotherapy group. The mean number of groups attended was two (SD = 1.7). Participants endorsed pain across five regions of the body with high pain intensity and severity. Improvements in depression, anxiety, somatic, and emotional regulation symptoms were evidenced during the course of treatment. CP group psychotherapy may be an effective modality to disseminate "best practices" and prevent diagnostic overshadowing for SMI patients.
Collapse
Affiliation(s)
- Patricia J Osborne
- VISN 2 South Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Yulia Landa
- VISN 2 South Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jane Mahoney
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Alok Madan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
37
|
Orfanos S, Priebe S. Group therapies for schizophrenia: initial group climate predicts changes in negative symptoms. PSYCHOSIS 2017. [DOI: 10.1080/17522439.2017.1311360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Stavros Orfanos
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| |
Collapse
|
38
|
Orfanos S, Akther SF, Abdul-Basit M, McCabe R, Priebe S. Using video-annotation software to identify interactions in group therapies for schizophrenia: assessing reliability and associations with outcomes. BMC Psychiatry 2017; 17:65. [PMID: 28183293 PMCID: PMC5301334 DOI: 10.1186/s12888-017-1217-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research has shown that interactions in group therapies for people with schizophrenia are associated with a reduction in negative symptoms. However, it is unclear which specific interactions in groups are linked with these improvements. The aims of this exploratory study were to i) develop and test the reliability of using video-annotation software to measure interactions in group therapies in schizophrenia and ii) explore the relationship between interactions in group therapies for schizophrenia with clinically relevant changes in negative symptoms. METHODS Video-annotation software was used to annotate interactions from participants selected across nine video-recorded out-patient therapy groups (N = 81). Using the Individual Group Member Interpersonal Process Scale, interactions were coded from participants who demonstrated either a clinically significant improvement (N = 9) or no change (N = 8) in negative symptoms at the end of therapy. Interactions were measured from the first and last sessions of attendance (>25 h of therapy). Inter-rater reliability between two independent raters was measured. Binary logistic regression analysis was used to explore the association between the frequency of interactive behaviors and changes in negative symptoms, assessed using the Positive and Negative Syndrome Scale. RESULTS Of the 1275 statements that were annotated using ELAN, 1191 (93%) had sufficient audio and visual quality to be coded using the Individual Group Member Interpersonal Process Scale. Rater-agreement was high across all interaction categories (>95% average agreement). A higher frequency of self-initiated statements measured in the first session was associated with improvements in negative symptoms. The frequency of questions and giving advice measured in the first session of attendance was associated with improvements in negative symptoms; although this was only a trend. CONCLUSION Video-annotation software can be used to reliably identify interactive behaviors in groups for schizophrenia. The results suggest that proactive communicative gestures, as assessed by the video-analysis, predict outcomes. Future research should use this novel method in larger and clinically different samples to explore which aspects of therapy facilitate such proactive communication early on in therapy.
Collapse
Affiliation(s)
- Stavros Orfanos
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK.
| | - Syeda Ferhana Akther
- 0000 0001 2171 1133grid.4868.2Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - Muhammad Abdul-Basit
- 0000 0001 2171 1133grid.4868.2Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - Rosemarie McCabe
- 0000 0004 1936 8024grid.8391.3Mental Health Research Group, University of Exeter Medical School, Exeter, UK
| | - Stefan Priebe
- 0000 0001 2171 1133grid.4868.2Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| |
Collapse
|
39
|
Choi KH, Jaekal E, Lee GY. Motivational and Behavioral Activation as an Adjunct to Psychiatric Rehabilitation for Mild to Moderate Negative Symptoms in Individuals with Schizophrenia: A Proof-of-Concept Pilot Study. Front Psychol 2016; 7:1759. [PMID: 27895602 PMCID: PMC5107574 DOI: 10.3389/fpsyg.2016.01759] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/26/2016] [Indexed: 12/31/2022] Open
Abstract
Few psychosocial approaches address the negative symptoms of schizophrenia, which shares common features with depression and anxiety. Behavioral activation (BA) is effective for addressing depression and anxiety in adults with various mental disorders. Motivational interviewing (MI) has been successfully applied to address ambivalence or lack of motivation toward treatment. Motivational and behavioral activation (mBA) has been developed by incorporating the core principles from BA and MI with recent findings on the negative symptoms of schizophrenia. In this study, we aimed to examine the feasibility and preliminary efficacy of mBA in a non-randomized controlled pilot study that included individuals with schizophrenia with mild to moderate negative symptoms receiving psychiatric rehabilitation. A total of 73 individuals with schizophrenia were recruited. Forty-seven of the participants who met the study inclusion and exclusion criteria were assigned to either an mBA + usual psychiatric rehabilitation group (mBA) or a usual psychiatric rehabilitation only group (treatment as usual, TAU). Administering mBA to individuals with schizophrenia with mild to moderate negative symptoms was feasible in a community mental health setting. Relative to TAU, mBA was associated with large effects in reducing negative symptoms measured using the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS). However, after considering PANSS cognitive deficits and marital status as covariates due to significant differences in their baseline levels, the treatment effects on the BNSS were partially observed. In addition, participants in the mBA group showed improved verbal learning and memory compared with those in the TAU group. In individuals with schizophrenia receiving the usual forms of psychiatric rehabilitation in a community mental health setting, mBA appears to offer a promising adjunctive approach for addressing mild to moderate negative symptoms. Further investigations are needed to replicate the current findings in a randomized controlled trial.
Collapse
Affiliation(s)
- Kee-Hong Choi
- Department of Psychology, Korea University Seoul, Republic of Korea
| | - Eunju Jaekal
- Department of Psychology, Korea University Seoul, Republic of Korea
| | - Ga-Young Lee
- Department of Psychology, Korea University Seoul, Republic of Korea
| |
Collapse
|
40
|
Campellone TR, Sanchez AH, Kring AM. Defeatist Performance Beliefs, Negative Symptoms, and Functional Outcome in Schizophrenia: A Meta-analytic Review. Schizophr Bull 2016; 42:1343-1352. [PMID: 26980144 PMCID: PMC5049520 DOI: 10.1093/schbul/sbw026] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Negative symptoms are a strong predictor of poor functional outcome in people with schizophrenia. Unfortunately there are few effective interventions for either negative symptoms or functional outcome, despite the identification of potential mechanisms. Recent research, however, has elucidated a new potential mechanism for negative symptoms and poor functional outcome: defeatist performance beliefs (DPB), or negative thoughts about one's ability to successfully perform goal-directed behavior that can prevent behavior initiation and engagement. We conducted 2 meta-analyses examining the relationship between DPB and both negative symptoms (n = 10 studies) and functional outcome (n = 8 studies) in people with schizophrenia. We found a small effect size for the relationship between DPB and negative symptoms, regardless of how negative symptoms were measured. We also found a small effect size for the relationship between DPB and functional outcome, which was significantly moderated by the method of assessing DPB and moderated by the sex composition of the study at a trend level. These findings highlight the potential of targeting DPB in psychosocial interventions for both negative symptoms and functional outcome.
Collapse
Affiliation(s)
- Timothy R. Campellone
- First authorship is shared between these 2 authors.,*To whom correspondence should be addressed; Department of Psychology, University of California, Berkeley, 3210 Tolman Hall, Berkeley, CA 94720-1690, US; tel: 510-643-4098, fax: 510-642-5293, e-mail:
| | | | | |
Collapse
|
41
|
Granholm E, Ruiz I, Gallegos-Rodriguez Y, Holden J, Link PC. Pupillary Responses as a Biomarker of Diminished Effort Associated With Defeatist Attitudes and Negative Symptoms in Schizophrenia. Biol Psychiatry 2016; 80:581-8. [PMID: 26475673 PMCID: PMC4792801 DOI: 10.1016/j.biopsych.2015.08.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 08/07/2015] [Accepted: 08/25/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND The hypothesis that defeatist performance attitudes are associated with decreased goal-directed task effort and negative symptoms in consumers with schizophrenia was investigated by using pupillary responses as a biomarker of task effort. Pupillary dilation during cognitive tasks provides a biomarker of effort devoted to the task, with greater dilation indicating greater effort. METHODS Defeatist attitudes were assessed in 149 consumers with schizophrenia or schizoaffective disorder and 50 healthy control subjects, and consumers were divided into three groups (tertile split) with respect to severity of defeatist attitudes. Pupillary dilation responses were recorded during a digit-span task with three-, six-, and nine-digit spans. RESULTS Effort allocation (pupillary responses) to the task increased as the processing load increased from low (three-digit) to moderate (six-digit) demands in healthy control subjects and consumers with schizophrenia with mild and moderate severity of defeatist attitudes. In contrast, consumers with severe defeatist attitudes did not increase their effort when processing demands increased from low to moderate loads. These consumers showed significantly less effort in the six-digit condition relative to consumers with mild defeatist attitudes. Moreover, consumers with severe defeatist attitudes showed significantly greater severity of negative symptoms relative to consumers with mild defeatist attitudes and negative symptoms were significantly correlated with defeatist attitudes. CONCLUSIONS These results suggest a relationship between defeatist performance attitudes, goal-directed task effort indexed by pupillary responses, and negative symptoms in schizophrenia. The findings have implications for using cognitive therapy to reduce defeatist attitudes that may contribute to diminished effort and negative symptoms in schizophrenia.
Collapse
Affiliation(s)
- Eric Granholm
- Veterans Affairs San Diego Healthcare System (EG, IR, YG-R, JH, PCL), San Diego; Department of Psychiatry (EG), University of California, San Diego, La Jolla, California.
| | | | | | | | | |
Collapse
|
42
|
Stigma resistance is positively associated with psychiatric and psychosocial outcomes: A meta-analysis. Schizophr Res 2016; 175:118-128. [PMID: 27102423 DOI: 10.1016/j.schres.2016.03.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 01/21/2023]
Abstract
To better understand how stigma resistance impacts functioning-related domains, we examined mean effect sizes between stigma resistance and: 1) symptoms (overall, positive, negative, and mood symptoms); 2) self-stigma; 3) self-efficacy; 4) quality of life; 5) recovery; 6) hope; 7) insight, and 8) overall outcomes (the average effect size across the constructs examined in each study). The mean effect size between stigma resistance and overall outcomes was significant and positive (r=0.46, p<0.001, k=48). A large, negative effect size was found between stigma resistance and self-stigma (r=-0.57, p<0.001, k=40). Large, positive effect sizes were found with self-efficacy (r=0.60, p<0.001, k=25), quality of life (r=0.51, p<0.001, k=17), hope (r=0.54, p<0.001, k=8), and recovery (r=0.60, p<0.001, k=7). Stigma resistance had a significant medium and small relationship with insight and symptoms, respectively. Race significantly moderated overall outcomes, self-stigma, mood symptoms, functioning, and hope associations. Education significantly moderated symptoms, functioning, and mood symptoms associations, and age significantly moderated self-stigma and negative symptom associations. Stigma resistance may be a key requirement for recovery. Individual characteristics influence resisting stigma and future work should prioritize cultural factors surrounding stigma resistance.
Collapse
|
43
|
Tsang HWH, Ching SC, Tang KH, Lam HT, Law PYY, Wan CN. Therapeutic intervention for internalized stigma of severe mental illness: A systematic review and meta-analysis. Schizophr Res 2016; 173:45-53. [PMID: 26969450 DOI: 10.1016/j.schres.2016.02.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Internalized stigma can lead to pervasive negative effects among people with severe mental illness (SMI). Although prevalence of internalized stigma is high, there is a dearth of interventions and meanwhile a lack of evidence as to their effectiveness. This study aims at unraveling the existence of different therapeutic interventions and the effectiveness internalized stigma reduction in people with SMI via a systematic review and meta-analysis. METHODS Five electronic databases were searched. Studies were included if they (1) involved community or hospital based interventions on internalized stigma, (2) included participants who were given a diagnosis of SMI>50%, and (3) were empirical and quantitative in nature. RESULTS Fourteen articles were selected for extensive review and five for meta-analysis. Nine studies showed significant decrease in internalized stigma and two showed sustainable effects. Meta-analysis showed that there was a small to moderate significant effect in therapeutic interventions (SMD=-0.43; p=0.003). Among the intervention elements, four studies suggested a favorable effect of psychoeducation. Meta-analysis showed that there was small to moderate significant effect (SMD=-0.40; p=0.001). CONCLUSION Most internalized stigma reduction programs appear to be effective. This systematic review cannot make any recommendation on which intervention is more effective although psychoeducation seems most promising. More Randomized Controlled Trials (RCT) on particular intervention components using standard outcome measures are recommended in future studies.
Collapse
Affiliation(s)
- Hector W H Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| | - S C Ching
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - K H Tang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - H T Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Peggy Y Y Law
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - C N Wan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| |
Collapse
|
44
|
Stiekema APM, Liemburg EJ, van der Meer L, Castelein S, Stewart R, van Weeghel J, Aleman A, Bruggeman R. Confirmatory Factor Analysis and Differential Relationships of the Two Subdomains of Negative Symptoms in Chronically Ill Psychotic Patients. PLoS One 2016; 11:e0149785. [PMID: 26895203 PMCID: PMC4760738 DOI: 10.1371/journal.pone.0149785] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 02/04/2016] [Indexed: 01/30/2023] Open
Abstract
Research suggests a two factor structure for negative symptoms in patients with psychotic disorders: social amotivation (SA) and expressive deficits (ED). Applying this two-factor structure in clinical settings may provide valuable information with regard to outcomes and to target treatments. We aimed to investigate 1) whether the factor structure is also supported in chronically ill patients with a psychotic disorder and 2) what the relationship is between these factors and functioning (overall functioning and living situation), depressive symptoms and quality of life. 1157 Patients with a psychotic disorder and a duration of illness of 5 years or more were included in the analysis (data selected from the Pharmacotherapy Monitoring Outcome Survey; PHAMOUS). A confirmatory factor analysis was performed using items of the Positive and Negative Syndrome Scale that were previously identified to reflect negative symptoms (N1-4, N6, G5, G7, G13, G16). Subsequently, regression analysis was performed on outcomes. The results confirmed the distinction between SA (N2, N4, G16) and ED (N1, N3, N6, G5, G7, G13) in chronically ill patients. Both factors were related to worse overall functioning as measured with the Health of the Nation Outcome Scales, ED was uniquely associated with residential living status. Higher scores for SA were associated with more depressive symptoms and worse quality of life. Thus, SA is most strongly related to level of social-emotional functioning, while ED are more related to living situation and thereby are indicative of level of everyday functioning. This subdivision may be useful for research purposes and be a valuable additional tool in clinical practice and treatment development.
Collapse
Affiliation(s)
- Annemarie P. M. Stiekema
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, the Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- * E-mail:
| | - Edith J. Liemburg
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Department, Lentis Center for Mental Health Care, Groningen, the Netherlands
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, the Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stynke Castelein
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Department, Lentis Center for Mental Health Care, Groningen, the Netherlands
| | - Roy Stewart
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jaap van Weeghel
- Parnassia Group, Dijk en Duin Mental Health Center, Castricum, the Netherlands
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific center for Care and Welfare, Tilburg, the Netherlands
- Phrenos, Center of Expertise on severe mental illness, Utrecht, the Netherlands
| | - André Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- University Center of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
45
|
Engel M, Fritzsche A, Lincoln TM. Anticipation and experience of emotions in patients with schizophrenia and negative symptoms. An experimental study in a social context. Schizophr Res 2016; 170:191-7. [PMID: 26673972 DOI: 10.1016/j.schres.2015.11.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/19/2015] [Accepted: 11/29/2015] [Indexed: 01/02/2023]
Abstract
Negative symptoms play a central role in the impairment of social functioning in schizophrenia. Healthy individuals use anticipated emotions to guide their decisions to seek out social interactions. It is unknown whether social withdrawal in negative symptoms is related to a biased anticipation of emotions that will arise in social situations. This study thus examined differences between patients with negative symptoms of schizophrenia and healthy controls in the anticipation and experience of positive and negative emotions related to a social interaction. In a between-subject factorial design, participants were instructed to either predict or to experience emotions related to a simulated social inclusion and exclusion interaction. Overall, patients anticipated more intense negative emotions than controls. Divided by the type of social situation, however, patients reported less intense positive emotions than controls with regard to social inclusion, but not with regard to social exclusion. The lack of an overall deficit in anticipation of positive emotions speaks against the assumption that anticipation abnormalities in negative symptoms are due to a neurocognitive deficit. Rather, the findings seem to reflect negative beliefs about potentially rewarding social situations in people with negative symptoms.
Collapse
Affiliation(s)
- Maike Engel
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146, Hamburg, Germany.
| | - Anja Fritzsche
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146, Hamburg, Germany.
| | - Tania M Lincoln
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146, Hamburg, Germany.
| |
Collapse
|
46
|
Hesse K, Kriston L, Wittorf A, Herrlich J, Wölwer W, Klingberg S. Longitudinal relations between symptoms, neurocognition, and self-concept in schizophrenia. Front Psychol 2015; 6:917. [PMID: 26191025 PMCID: PMC4490211 DOI: 10.3389/fpsyg.2015.00917] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/19/2015] [Indexed: 12/18/2022] Open
Abstract
Objective: Cognitive models suggest that the self-concept of persons with psychosis can be fundamentally affected. Self-concepts were found to be related to different symptom domains when measured concurrently. Longitudinal investigations to disentangle the possible causal associations are rare. Method: We examined a sample of 160 people with a diagnosis of schizophrenia who took part in a psychotherapy study. All participants had the DSM-IV diagnosis of a schizophrenia and pronounced negative symptoms. Neurocognition, symptoms, and self-concepts were assessed at two time points 12 months apart. Structural equation modeling was used to test whether symptoms influence self-concepts (scar-model) or self-concepts affect symptoms (vulnerability model). Results: Negative symptoms correlated concurrently with self-concepts. Neurocognitive deficits are associated with more negative self-concepts 12 months later. Interpersonal self-concepts were found to be relevant for paranoia. Conclusion: The findings implicate that if deficits in neurocognition are present, fostering a positive self-concept should be an issue in therapy. Negative interpersonal self-concept indicates an increased risk for paranoid delusions in the course of 1 year. New aspects for cognitive models in schizophrenia and clinical implications are discussed.
Collapse
Affiliation(s)
- Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
| | - Jutta Herrlich
- Department of Psychiatry and Psychotherapy, University of Frankfurt Frankfurt, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duesseldorf Duesseldorf, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
| |
Collapse
|
47
|
The Mediating Role of Acceptance in Multidisciplinary Cognitive-Behavioral Therapy for Chronic Pain. THE JOURNAL OF PAIN 2015; 16:606-15. [PMID: 25840330 DOI: 10.1016/j.jpain.2015.03.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/06/2015] [Accepted: 03/22/2015] [Indexed: 11/24/2022]
Abstract
UNLABELLED Cognitive-behavioral therapy (CBT) is the most frequently delivered psychological intervention for adults with chronic pain. The treatment yields modest effect sizes, and the mechanisms of action remain understudied and unclear. Efforts are needed to identify treatment mediators that could be used to refine CBT and improve outcomes. The primary aim of this study was to investigate whether pain-related acceptance, from the psychological flexibility model, mediates changes in outcome over time in a CBT-based treatment program. This includes comparing how this variable relates to 3 other variables posited as potential mediators in standard CBT: life control, affective distress, and social support. Participants attended a 5-week outpatient multidisciplinary program with self-report data collected at assessment, posttreatment, and 12-month follow-up. Multilevel structural equation modeling was used to test for mediation in relation to 3 outcomes: pain interference, pain intensity, and depression. Results indicate that effect sizes for the treatment were within the ranges reported in the CBT for pain literature. Pain-related acceptance was not related to pain intensity, which is in line with past empirical evidence and the treatment objectives in acceptance and commitment therapy. Otherwise, pain-related acceptance was the strongest mediator across the different indices of outcome. Accumulated results like these suggest that acceptance of pain may be a general mechanism by which CBT-based treatments achieve improvements in functioning. More specific targeting of pain-related acceptance in treatment may lead to further improvements in outcome. PERSPECTIVE Potential mediators of outcome in a CBT-based treatment for adult chronic pain were investigated using multilevel structural equation modeling. The results highlight the role of pain-related acceptance as an important treatment process even when not explicitly targeted during treatment. These data may help clinicians and researchers better understand processes of change and improve the choice and development of treatment methods.
Collapse
|
48
|
Velthorst E, Koeter M, van der Gaag M, Nieman DH, Fett AKJ, Smit F, Staring ABP, Meijer C, de Haan L. Adapted cognitive-behavioural therapy required for targeting negative symptoms in schizophrenia: meta-analysis and meta-regression. Psychol Med 2015; 45:453-465. [PMID: 24993642 DOI: 10.1017/s0033291714001147] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is an increasing interest in cognitive-behavioural therapy (CBT) interventions targeting negative symptoms in schizophrenia. To date, CBT trials primarily focused on positive symptoms and investigated change in negative symptoms only as a secondary outcome. To enhance insight into factors contributing to improvement of negative symptoms, and to identify subgroups of patients that may benefit most from CBT directed at ameliorating negative symptoms, we reviewed all available evidence on these outcomes. METHOD A systematic search of the literature was conducted in PsychInfo, PubMed and the Cochrane register to identify randomized controlled trials reporting on the impact of CBT interventions on negative symptoms in schizophrenia. Random-effects meta-analyses were performed on end-of-treatment, short-term and long-term changes in negative symptoms. RESULTS A total of 35 publications covering 30 trials in 2312 patients, published between 1993 and 2013, were included. Our results showed studies' pooled effect on symptom alleviation to be small [Hedges' g = 0.093, 95% confidence interval (CI) -0.028 to 0.214, p = 0.130] and heterogeneous (Q = 73.067, degrees of freedom = 29, p < 0.001, τ 2 = 0.081, I 2 = 60.31) in studies with negative symptoms as a secondary outcome. Similar results were found for studies focused on negative symptom reduction (Hedges' g = 0.157, 95% CI -0.10 to 0.409, p = 0.225). Meta-regression revealed that stronger treatment effects were associated with earlier year of publication, lower study quality and with CBT provided individually (as compared with group-based). CONCLUSIONS The co-occurring beneficial effect of conventional CBT on negative symptoms found in older studies was not supported by more recent studies. It is now necessary to further disentangle effective treatment ingredients of older studies in order to guide the development of future CBT interventions aimed at negative symptom reduction.
Collapse
Affiliation(s)
- E Velthorst
- Academic Medical Center,Department of Psychiatry, Amsterdam,The Netherlands
| | - M Koeter
- Academic Medical Center,Department of Psychiatry, Amsterdam,The Netherlands
| | - M van der Gaag
- Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - D H Nieman
- Academic Medical Center,Department of Psychiatry, Amsterdam,The Netherlands
| | - A-K J Fett
- Academic Medical Center,Department of Psychiatry, Amsterdam,The Netherlands
| | - F Smit
- Department of Clinical Psychology, EMGO Institute for Health and Care Research,VU University,Amsterdam,The Netherlands
| | - A B P Staring
- Altrecht Psychiatric Institute,Utrecht,The Netherlands
| | - C Meijer
- Academic Medical Center,Department of Psychiatry, Amsterdam,The Netherlands
| | - L de Haan
- Academic Medical Center,Department of Psychiatry, Amsterdam,The Netherlands
| |
Collapse
|
49
|
Reddy LF, Horan WP, Green MF. Motivational Deficits and Negative Symptoms in Schizophrenia: Concepts and Assessments. Curr Top Behav Neurosci 2015; 27:357-73. [PMID: 26164592 DOI: 10.1007/7854_2015_379] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recent years have seen a resurgence of interest in motivational disturbances in schizophrenia . This is largely driven by the recognition that these disturbances are central to the "experiential" subdomain of negative symptoms and are particularly important determinants of functional disability. Research into the causes and treatment of experiential negative symptoms is therefore a high priority. This chapter reviews findings from experimental psychopathology and affective science relevant to understanding the neurobehavioral processes that underlie these negative symptoms. We focus on abnormalities in four processes that have received the most attention as likely contributors: anticipatory pleasure, reward learning, effort-based decision-making, and social motivation. We also review the research literature on pharmacological and psychosocial approaches to reduce functional deficits attributable to negative symptoms. Translational research is beginning to inform the development of new treatments specifically designed to target the experiential subdomain of negative symptoms.
Collapse
Affiliation(s)
- L Felice Reddy
- VA Greater Los Angeles Healthcare System, University of California, MIRECC 210A, Bldg. 210, 11301 Wilshire Blvd., Los Angeles, CA, 90073, USA.
| | - William P Horan
- VA Greater Los Angeles Healthcare System, University of California, MIRECC 210A, Bldg. 210, 11301 Wilshire Blvd., Los Angeles, CA, 90073, USA
| | - Michael F Green
- VA Greater Los Angeles Healthcare System, University of California, MIRECC 210A, Bldg. 210, 11301 Wilshire Blvd., Los Angeles, CA, 90073, USA
| |
Collapse
|
50
|
McLeod HJ, Gumley AI, Macbeth A, Schwannauer M, Lysaker PH. Metacognitive functioning predicts positive and negative symptoms over 12 months in first episode psychosis. J Psychiatr Res 2014; 54:109-15. [PMID: 24725651 DOI: 10.1016/j.jpsychires.2014.03.018] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/12/2014] [Accepted: 03/19/2014] [Indexed: 12/24/2022]
Abstract
The negative symptoms of schizophrenia are a major source of impairment and distress but both pharmacological and psychological treatment options provide only modest benefit. Developing more effective psychological treatments for negative symptoms will require a more sophisticated understanding of the psychological processes that are implicated in their development and maintenance. We extended previous work by demonstrating that metacognitive functioning is related to negative symptom expression across the first 12 months of first episode psychosis (FEP). Previous studies in this area have either been cross-sectional or have used much older participants with long-standing symptoms. In this study, forty-five FEP participants were assessed three times over 12 months and provided data on PANSS rated symptoms, premorbid adjustment, metacognitive functioning, and DUP. Step-wise linear regression showed that adding metacognition scores to known predictors of negative symptoms (baseline symptom severity, gender, DUP, and premorbid academic and social adjustment) accounted for 62% of the variance in PANSS negative symptom scores at six months and 38% at 12 months. The same predictors also explained 47% of the variance in positive symptoms at both six and 12 months. However, exploration of the simple correlations between PANSS symptom scores and metacognition suggests a stronger univariate relationship between metacognition and negative symptoms. Overall, the results indicate that problems with mental state processing may be important determinants of negative symptom expression from the very early stages of psychosis. These results provide further evidence that metacognitive functioning is a potentially relevant target for psychological interventions.
Collapse
Affiliation(s)
- Hamish J McLeod
- Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK.
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK.
| | - Angus Macbeth
- NHS Grampian, Psychiatry Research Group, Clinical Research Centre, Royal Cornhill Hospital, Aberdeen AB25 2ZD, UK; University of Aberdeen, Psychiatry Research Group, Clinical Research Centre, Royal Cornhill Hospital, Aberdeen AB25 2ZD, UK.
| | - Matthias Schwannauer
- Section of Clinical & Health Psychology, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
| | - Paul H Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, USA; Department of Psychiatry, Indiana University School of Medicine, USA.
| |
Collapse
|