Schizophrenia Bulletin | 2019
18.3 IMPROVING COMMUNITY ENGAGEMENT IN VETERANS WITH SCHIZOPHRENIA: QUALITATIVE DATA ANALYSIS FROM AN ONGOING TREATMENT TRIAL
Abstract
Background: The generic cognitive model (CBT) can be applied to the treatment of negative symptoms in schizophrenia. Defeatist attitudes (e.g., “Why bother trying, I always fail”) contribute to amotivation and asociality and ultimately poor functioning in schizophrenia. Prior CBT clinical trials targeting defeatist attitudes have found that improvement in defeatist attitudes is associated with improvement in negative symptoms in schizophrenia. Methods: Using an experimental therapeutics approach (R61/R33), we tested a novel intervention for negative symptoms in schizophrenia called, Mobile-assisted CBT for Negative symptoms (mCBTn). mCBTn is an integration of CBT-informed components targeting defeatist attitudes from our Cognitive-Behavioral Social Skills Training (CBSST) group therapy and mobile smartphone interventions (“CBT2go” app) from our prior clinical trials research. We report here on the R61 phase, which was an open trial of mCBTn in 31 participants with schizophrenia with persistent moderate-to-severe negative symptoms. Weekly 90-min sessions of group CBT plus the CBT2go iPhone app targeted defeatist attitudes, pleasure savoring, and behavioral activation/goal setting. The primary aim was to test whether mCBTn can reduce severity of the treatment target: defeatist performance attitudes. Results: We recruited and assessed 67 participants; however, only 31 participants started the intervention, because 36 (54%) of participants did not meet the strict persistent negative symptoms entry criteria. After starting treatment, however, retention rates were excellent, especially for this negative symptom population: 87%, 84% and 79% at the 12-, 18and 24-week assessments, respectively. Significant improvements were found on the Defeatist Performance Attitudes Scale with medium to large effect sizes (DPAS; Week 12 d=.4, p=.034; Week 18 d=.7, p<.001; Week 24 d=.9, p=.002). Negative symptoms (CAINS Motivation and Pleasure) also showed significant reduction with large effect sizes at all assessment points (Week 12 d=.6, p=.048; Week 18 d=.8, p=.007; Week 24, d=.7, p=.014), and positive symptoms also showed significant reduction by week 24 (p=.014, d=.5). The large effect sizes for DPAS and CAINS MAP by week 18 suggest an 18-week intervention might be sufficient to produce meaningful improvements, which is faster than in our prior CBSST trials of group therapy alone. Conclusions: This preliminary open trial of mCBTn suggests that mobile apps can strengthen psychotherapy and targeting defeatist attitudes in participants with schizophrenia with persistent negative symptoms can lead to improvement in motivation and pleasure negative symptoms.