Abstract
Background
Negative symptoms in schizophrenia (SZ) remain an unmet treatment need as they are highly prevalent, associated with poor functional outcomes, and resistant to pharmacologic treatment. Similarly, cognitive impairment is common in schizophrenia and is closely tied to negative symptoms and functional deficits. Two psychosocial interventions, Cognitive-Behavioral Social Skills Training (CBSST) and Compensatory Cognitive Training (CCT), have independently been linked to improved cognitive functioning, and have demonstrated clinically significant effect sizes in reducing negative symptoms; however, neither has been used to specifically target negative symptoms as the primary outcome and they have not yet been integrated. The two intervention strategies are likely to have different mechanisms of action, and bundling of these interventions may contribute to stronger, synergistic treatment effects. As such, the current pilot randomized controlled trial examined the efficacy of an integrated CBSST-CCT intervention compared to Goal-focused Supportive Contact (SC) on negative symptoms and objective cognitive performance.
Methods
Sixty-two adults with SZ or schizoaffective disorder with moderate-to-severe negative symptoms were randomized to receive 25 twice-weekly, 1-hour manualized group sessions (12.5 weeks total duration) of either CBSST-CCT or SC delivered by master’s level clinicians in five community settings. CBSST was modified to strengthen its impact on negative symptoms. CCT was included to bolster impaired functions in prospective memory, attention, learning, and memory, thereby enhancing attention to CBSST content, learning of content, and memory for content. SC was used as a robust control condition, supporting systematic recovery goal setting by teaching participants to break down goals into short-term goals and SMART goal steps. SC provided the same frequency and amount of therapist and group member contact as CBSST-CCT. Analyses of covariance (ANCOVAs) examined treatment-related improvements in negative symptom severity (Clinical Assessment Interview for Negative Symptoms and Scale for the Assessment of Negative Symptoms [SANS]) and neuropsychological performance (MATRICS Consensus Cognitive Battery) at post-treatment.
Results
The sample consisted of mostly male (63%), White (65%) participants, aged 22–65 (M=49.5, SD=10.7), with a mean of 11.8 years of education (SD=2.6). Most participants were never married (61%), living independently (65%), and prescribed second generation antipsychotic medication (66%). Participants in the SC group were significantly older than those in the CBSST-CCT group (mean age=54 vs. 46; p=.004); thus, age was included as a covariate in analyses, along with baseline score on the outcome measure. ANCOVAs demonstrated that compared to the SC group, the CBSST-CCT group had more negative symptom improvement on the SANS (p=.036, η_p^2=.135), with improvements in diminished motivation/pleasure driving this effect (p=.004, η_p^2=.235). Moreover, CBSST-CCT participants demonstrated improved verbal learning at post-treatment compared to SC participants (p=.014, η_p^2=.174). No other significant group differences were found.
Discussion
CBSST-CCT has the potential to improve negative symptom severity and cognitive functioning in high-negative-symptom patients. CBSST-CCT warrants larger investigations to examine its efficacy in treating negative symptoms, along with other symptoms, cognition, and functioning.
Reducing negative symptoms in schizophrenia: Feasibility and acceptability of a combined cognitive-behavioral social skills training and compensatory cognitive training intervention
