Improving Negative Symptoms of Psychosis In Real-World Environments - INSPIRE

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DESCRIPTION (provided by applicant): Identifying treatments to reduce the negative symptoms associated with schizophrenia is of high public health significance, due to the relationship between negative symptoms and poor functioning and quality of life, and the lack of effective treatments for negative symptoms. There is also a need for treatments of cognitive impairment to improve daily functioning in schizophrenia. Pharmacologic treatments for negative symptoms and cognitive/functional impairment have largely failed, but psychosocial treatments have been moderately effective. Two interventions, Cognitive Behavioral Social Skills Training (CBSST) and Compensatory Cognitive Training (CCT), show promise for treating negative symptoms (Granholm et al., 2005, 2007, 2012; Twamley et al., 2008, 2012), along with other symptoms, cognition, and functioning. Because of the significant effects of both CBSST and CCT on negative symptoms, we aim to develop a combined CBSST-CCT intervention specifically targeted toward negative symptom reduction, and to gather pilot data regarding its efficacy. CBSST (Granholm) and CCT (Twamley) are both manualized, group-based interventions that can be delivered in community settings to enhance generalization of training effects. CBSST combines elements of Cognitive Behavioral Therapy with Social Skills Training, two of the evidence-based treatments for schizophrenia. CCT uses compensatory strategy training and habit learning to improve cognition and everyday functioning. Both interventions have significant but moderate effects on negative symptoms (e.g., .4 at follow-up). The proposed project will bundle and refine a combined CBSST-CCT intervention to strengthen their impact on negative symptoms in schizophrenia and will test this combined intervention in a pilot randomized controlled trial comparing CBSST-CCT with a goal-focused supportive contact (SC) control group. We propose to randomly assign 64 participants with schizophrenia with persistent negative symptoms to one of the two treatments for 9 months, and follow them for 3 months after treatment. The primary goal of this project is to obtain feasibility and effect size data regarding this new intervention in order to plan a larger trial of CBSST-CCT. The primary outcome is negative symptom severity, and secondary outcomes include cognitive performance and everyday functioning. We will also examine mechanisms that mediate reduction in negative symptom severity in CBSST- CCT, including defeatist beliefs, cognitive and social skills, and pupillary responses during cognitive and social tasks (a biomarker of goal-directed effort allocation).