Improving Negative Symptoms & Community Engagement in Veterans with Schizophrenia

描述（由申请人提供）： 对退伍军人医疗保健的预期影响：阴性症状是精神分裂症的核心和持久特征，与患有这种疾病的退伍军人的居住独立性，职业功能和生活质量的普遍缺陷有关。目前，对于这种疾病的关键领域没有有效的治疗方法。根据VA心理健康 战略计划，制定和实施战略，以加强社区功能和促进退伍军人精神分裂症康复是VHA的优先事项。这项研究将评估一个量身定制的干预包，称为参与社区角色和经验（EnCoRE），针对退伍军人精神分裂症的阴性症状。项目背景：阴性症状是精神分裂症的独特临床特征，是社区功能不良和长期预后不良的主要决定因素，也是照顾者负担的主要来源。最近的报告记录了缺乏针对阴性症状的关键临床领域的有效干预措施，并呼吁制定专门针对这一关键未满足的治疗需求的干预措施。我们关于干预发展、阴性症状评估、情感体验和功能障碍性认知的初步数据表明，干预应结合循证治疗策略，以情感动机缺陷、行为技能缺陷和对成功的负面期望为目标，将其作为疾病的关键方面，这些方面是参与目标导向行为的动机的基础。项目目标：该应用程序的重点是评估针对在3个VAMC接受精神卫生服务的精神分裂症退伍军人的阴性症状的定制干预包。EnCoRE将包括动机，认知和行为技能培训策略，旨在教授个人如何（1）理解和克服预期快乐的缺陷，（2）增加愉快和目标导向活动的内在动机，（3）减少对成功和表现的负面预期，（4）在新的社会情境中熟练地表现。该项目的主要目标是（1）培训治疗师并在10名患有精神分裂症和阴性症状的退伍军人的初步试验中完善EnCoRE手册;（2）进行随机临床试验（RCT; n=108，中等效应，α = 0.05），以测试EnCoRE在治疗后和3个月随访时产生积极变化的疗效。对阴性症状和社会和社区功能的主要结果进行评估;和（3）检查参加EnCoRE和心理健康提供者的退伍军人完成的定性访谈，以确定EnCoRE的哪些方面被认为或多或少有帮助，有趣，有价值，以便告知更大的，多地实施试点。次要目的包括 评估认知能力和精神病症状对干预效果的修正作用，并检查恢复、自我效能和项目满意度。项目方法：该项目将包括一段时间的培训，然后是一个有108名参与者的RCT。受试者将在基线、治疗后和3个月时完成评估。我们将监测保真度，可行性和可接受性;研究退伍军人在该计划中的经验;测量症状和功能结果;并评估结果的潜在调节因素。

DESCRIPTION (provided by applicant): Anticipated Impacts on Veteran's Healthcare: Negative symptoms are a central and enduring feature of schizophrenia and are related to pervasive deficits in residential independence, occupational functioning, and quality of life for veterans living with this illness. Currently ther is no effective treatment for this critical domain of the illness. As outlined in the VA Mental Health Strategic Plan, the development and implementation of strategies to enhance community functioning and promote recovery among veterans with schizophrenia is a VHA priority. This study will evaluate a tailored intervention package called Engaging in Community Roles and Experiences (EnCoRE) targeting negative symptoms in Veterans with schizophrenia. Project Background: Negative symptoms are distinct clinical features of schizophrenia that are major determinants of the poor community functioning and poor long-term outcome that characterize the disorder, as well as a major source of burden for caregivers. Recent reports document the lack of effective interventions that target the key clinical domains of negative symptoms and call for the development of interventions designed specifically to address this critical unmet treatment need. Our preliminary data on intervention development, negative symptom assessment, affective experience, and dysfunctional cognitions argues for an intervention that incorporates evidence-based treatment strategies to target affective- motivational deficits, behavioral skills deficits, and negative expectations of success as the key aspects of the illness that underlie motivation to engage in goal directed behavior. Project Objectives: This application is focused evaluating a tailored intervention package targeting negative symptoms in Veterans with schizophrenia who receive mental health services at 3 VAMCs. EnCoRE will include motivational, cognitive, and behavioral skills training strategies aimed at teaching individuals ways to (1) understand and overcome deficits in anticipatory pleasure, (2) increase intrinsic motivation for pleasant and goal directed activities, (3) reduce negative expectancies for success and performance, and (4) perform skillfully in new social situations. The primary objectives of this project are to (1) Train therapists and refine the EnCoRE manual in a preliminary trial with 10 Veterans with schizophrenia and negative symptoms; (2) Conduct a randomized clinical trial (RCT; n=108, medium effect, alpha=.05) to test the efficacy of EnCoRE in producing positive changes at post-treatment and 3-month follow-up on the primary outcomes of negative symptoms and social and community functioning; and (3) Examine qualitative interviews completed by Veterans who participated in EnCoRE and Mental Health Providers to determine aspects of EnCoRE that were perceived as more or less helpful, interesting, and valuable in order to inform a larger, multi-site implementation trial. Secondary objectives include assessing the modifying effects of cognitive ability and psychotic symptoms on intervention effectiveness, and examining recovery, self-efficacy, and program satisfaction. Project Methods: This project will include a period of training followed by an RCT with 108 participants. Participants will complete assessments at baseline, post-treatment, and 3-months. We will monitor fidelity, feasibility, and acceptability; study Veteran's experience in the program; measure symptom and functional outcomes; and evaluate potential moderators of outcomes.