Treatment Development Targeting Severe and Persistent Negative Symptoms

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DESCRIPTION (provided by applicant): Individuals with schizophrenia who have persistent and clinically significant negative symptoms (PNS) including, restricted affect, diminished emotional range, poverty of speech, decreased motivation and interests, diminished sense of purpose and diminished social drive typically have the poorest functional outcomes and quality of life. The NIMH-MATRICS Consensus Statement on Negative Symptoms indicated that these symptoms were a distinct therapeutic indication representing an unmet therapeutic need for large numbers of individuals with schizophrenia. In addition, the group suggested design features necessary to prove efficacy for PNS. While aspects of negative symptoms may be lessened with existing evidence-based practices, no model addresses the entire constellation of PNS. Based upon decades of work developing and employing evidence-based treatments for schizophrenia, we have developed a novel psychosocial treatment called the MOtiVation and Engagement (MOVE) Program specifically to target multiple domains of severe and persistent negative symptoms and their functional consequences. MOVE is a home based, manual-driven, multi-modal treatment that employs a number of cognitive and behavioral principles to address the broad range of factors contributing to a PNS presentation. The purpose of this study is to examine the feasibility of delivering this intervention while implementing the stringent sample selection and assessment procedures required to clearly demonstrate efficacy for PNS. We will further refine the treatment manual and test a measure to assess ongoing treatment fidelity, train a group of mental health clinicians to conduct MOVE, and examine the feasibility of recruiting and retaining PNS patients in a 9 month trial in which prospective evidence of persistent negative symptoms is required prior to randomization. We will randomize 60 individuals to either MOVE or treatment as usual and examine outcomes for global negative symptoms as well as specific symptom domains. PUBLIC HEALTH RELEVANCE: There are no currently available treatments for persistent negative symptoms in schizophrenia. The MOtiVation and Engagement (MOVE) Program is a novel psychosocial treatment developed specifically for negative symptoms which uses environmental cues, emotional processing training, reinforcement, and skills training to help people initiate and succeed at adaptive and social behaviors. The purpose of this study is to fine-tune the intervention and study procedures in preparation for a larger scale clinical trial. We will conduct a small scale study to examine the efficacy of MOVE compared to treatment as usual on negative symptoms in 60 individuals meeting criteria for persistent negative symptoms.