Alexandra Nguyen

Positive Emotions Program for Schizophrenia (PEPS): a pilot intervention to reduce anhedonia and apathy

BackgroundRecent literature has distinguished the negative symptoms associated with a diminished capacity to experience (apathy, anhedonia) from symptoms associated with a limited capacity for expression (emotional blunting, alogia). The apathy-anhedonia syndrome tends to be associated with a poorer prognosis than the symptoms related to diminished expression. The efficacy of drug-based treatments and psychological interventions for these symptoms in schizophrenia remains limited. There is a clear clinical need for new treatments.MethodsThis pilot study tested the feasibility of a program to reduce anhedonia and apathy in schizophrenia and assessed its impact on 37 participants meeting the ICD-10 criteria for schizophrenia or schizoaffective disorders. Participants were pre- and post-tested using the Scale for the Assessment of Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS). They took part in eight sessions of the Positive Emotions Program for Schizophrenia (PEPS)—an intervention that teaches participants skills to help overcome defeatist thinking and to increase the anticipation and maintenance of positive emotions.ResultsThirty-one participants completed the program; those who dropped out did not differ from completers. Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes. Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size. Emotional blunting and alogia remain stable during the intervention.DiscussionFindings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy. However, these findings are limited by the absence of control group and the fact that the rater was not blind to the treatment objectives.ConclusionsPEPS is a promising intervention to improve anhedonia and apathy which need to be tested further in a controlled study.Trial registration numberISRCTN registry ISRCTN74048461, registered 18 may 2015

Development of the Positive Emotions Program for Schizophrenia: An Intervention to Improve Pleasure and Motivation in Schizophrenia

Objectives The efficacy of drug-based treatments and psychological interventions on the primary negative symptoms of schizophrenia remains limited. Recent literature has distinguished negative symptoms associated with a diminished capacity to experience, from those associated with a limited capacity for expression. The positive emotions program for schizophrenia (PEPS) is a new method that specifically aims to reduce the syndrome of a diminished capacity to experience. Methods The intervention’s vital ingredients were identified through a literature review of emotion in schizophrenia and positive psychology. The program has been beta-tested on various groups of health-care professionals. Results A detailed description of the final version of PEPS is presented here. The French version of the program is freely downloadable. Conclusion PEPS is a specific, short, easy to use, group-based intervention to improve pleasure, and motivation in schizophrenia. It was built considering a recovery-oriented approach to schizophrenia.

Safety-seeking behaviours and verbal auditory hallucinations in schizophrenia

Verbal auditory hallucinations can have a strong impact on the social and professional functioning of individuals diagnosed with schizophrenia. The safety-seeking behaviours used to reduce the threat associated with voices play a significant role in explaining the functional consequences of auditory hallucinations. Nevertheless, these safety-seeking behaviours have been little studied. Twenty-eight patients with schizophrenia and verbal auditory hallucinations were recruited for this study. Hallucinations were evaluated using the Psychotic Symptom Rating Scale and the Belief About Voice Questionnaire and safety behaviours using a modified version of the Safety Behaviour Questionnaire. Our results show that the vast majority of patients relies on safety behaviours to reduce the threat associated with voices. This reliance on safety behaviours is mostly explained by beliefs about origin of voices the omnipotence attributed to hallucinations and the behavioural and emotional reactions to the voices. Safety-seeking behaviours play an important role in maintaining dysfunctional beliefs with respect to voices. They should be better targeted within the cognitive and behavioural therapies for auditory hallucinations.

Projecting Oneself into the Future, an Intervention for Improving Pleasure in Patients with Anhedonia

In clinical practice, anhedonia and apathy are challenging symptoms of schizophrenia. Anhedonia in schizophrenia appears to be associated with impairment in anticipatory pleasure. However, the problem is complicated since comorbid depression occurs in 50 % of patients and the symptoms of the different disorders may overlap. This chapter presents an intervention to train anticipatory pleasure in patients with schizophrenia. This intervention has been evaluated in an exploratory pilot study. Results show that the patients improved on the anticipatory scale of the Temporal Experience of Pleasure Scale. Patients also increased their daily activities. The program is still being improved and should be tested in a controlled study.

Confirmatory Factor Analysis of the French Version of the Anticipatory and Consummatory Interpersonal Pleasure Scale

The Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS), a measure specifically designed to assess hedonic capacity for social and interpersonal pleasure, was used to evaluate the presence of social anhedonia in patients as well as the general population. The first goal of this study was to validate the structure of the French version of the ACIPS. The second objective was to verify whether a one, two or three factor solution is most appropriate for the ACIPS scale. The French version of the ACIPS was tested on 263 French-speaking pre-graduate students or professional volunteers. For the confirmatory factor analysis, data were treated as categorical ordinal and all the models were estimated using a robust weighted least squares estimator with adjustments for the mean and variance. Three models were estimated. A one-factor model representing a general undifferentiated “pleasure” latent construct was first tested on the 17 ACIPS items. A two-factor model distinguishing anticipatory-pleasure and consummatory-pleasure was tested next. Finally, a three-factor model including subdomains of intimate social interactions, group social interactions, and social bonding was tested. The one and two-factor models showed a somewhat poor fit to the data. However, the goodness of fit of the three factor model was adequate. These results suggest that individuals who enjoyed interaction in one of these three subdomains were more likely to enjoy doing so in the two other domains. However, on the basis of the comparison between the one and three factor models, these three types of interactions may not be considered as indistinguishable. Rather, they represent distinct and theoretically meaningful dimensions. These results show the French version of the ACIPS is a useful and valid scale to measure the capacity of savoring different kinds of social relationships.

Confirmatory Factor Analysis of the French Version of the Savoring Beliefs Inventory

The Savoring Beliefs Inventory (SBI) is a measure designed to assess attitudes toward savoring positive experience within three temporal orientations: the past (reminiscence), the present moment (present enjoyment), and the future (anticipation). The aim of this study was to validate the structure of the SBI—French version. The scale was tested with 335 French-speaking participants. Two models were estimated: a one-factor model representing a general construct of savoring and a three-factor model differentiating between anticipation, present enjoyment, and reminiscence. Several indicators of model fit were used: the root mean square error of approximation (RMSEA), the comparison fit index (CFI), the Tucker–Lewis fit index (TLI), and the standardized root mean residual (SRMR). A chi-square difference test was used to compare the two models. The model fit of the three-factor model assessed by the SRMR showed to be excellent, while it could be considered as satisfactory according to the CFI and TLI coefficients. RMSEA, however, was slightly less adequate. The model fit for the one-factor model seemed less adequate than the three-factor solution. Further, the chi-square difference test revealed that the three-factor model had significantly better fit than the one-factor model. Finally, the reliability of the four scores (anticipating pleasure, present moment pleasure, reminiscing pleasure, and total score) was very good. These results show that the French version of the SBI is a valid and valuable scale to measure attitudes regarding the ability to savor positive experience, whether it be in anticipation, reminiscence, or the present moment.

Sustained antipsychotic effect and delayed self-esteem improvement of metacognitive training for schizophrenia

ABSTRACT FROM: Moritz S, Veckenstedt R, Andreou C, et al . Sustained and “sleeper” effects of group metacognitive training for schizophrenia: a randomized clinical trial. JAMA Psychiatry 2014;71:1103–11. Metacognitive training (MCT) is an intervention that aims to raise patients’ awareness for cognitive biases involved in the formation and maintenance of psychotic symptoms. The programme is freely downloadable in 31 languages at http://clinical-neuropsychology.de/metacognitive_training-psychosis.html. The majority of studies confirm that MCT is effective in improving delusion, cognitive biases and insight.1 ,2 However the long-term effects of MCT were not known. 150 patients between 18 and 65 years with DSM-IV schizophrenia spectrum disorders, with present or prior delusional symptoms were randomly assigned to either MCT or COGPACK, a programme that aims to improve basic neuropsychological functions. As they may have been a distraction to other group members, severely psychotic patients were excluded as well as participants with substance dependence, IQ <70 or severe organic brain damage. Participants were …