Mobile-Assisted Cognitive Behavioral Therapy for Negative Symptoms: Open Single-Arm Trial With Schizophrenia Patients.

Eric Granholm,Tanya Mikhael,Colin Depp,Kristen Dwyer,Jason Holden,Peter Link

doi:10.2196/24406

Eric Granholm, Tanya Mikhael + Show 4 more

Open Access

https://doi.org/10.2196/24406

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Abstract

BackgroundNegative symptoms are an important unmet treatment need for schizophrenia. This study is a preliminary, open, single-arm trial of a novel hybrid intervention called mobile-assisted cognitive behavioral therapy for negative symptoms (mCBTn).ObjectiveThe primary aim was to test whether mCBTn was feasible and could reduce severity of the target mechanism, defeatist performance attitudes, which are associated with experiential negative symptoms and poor functioning in schizophrenia.MethodsParticipants with schizophrenia or schizoaffective disorder (N=31) who met prospective criteria for persistent negative symptoms were enrolled. The blended intervention combines weekly in-person group therapy with a smartphone app called CBT2go. The app extended therapy group skills, including recovery goal setting, thought challenging, scheduling of pleasurable activities and social interactions, and pleasure-savoring interventions to modify defeatist attitudes and improve experiential negative symptoms.ResultsRetention was excellent (87% at 18 weeks), and severity of defeatist attitudes and experiential negative symptoms declined significantly in the mCBTn intervention with large effect sizes.ConclusionsThe findings suggest that mCBTn is a feasible and potentially effective treatment for experiential negative symptoms, if confirmed in a larger randomized controlled trial. The findings also provide support for the defeatist attitude model of experiential negative symptoms and suggest that blended technology-supported interventions such as mCBTn can strengthen and shorten intensive psychosocial interventions for schizophrenia.Trial RegistrationClinicalTrials.gov NCT03179696; https://clinicaltrials.gov/ct2/show/NCT03179696

Highlights

Negative symptoms account for much of the poor functional outcome in schizophrenia and are an unmet treatment need [1,2,3]
The findings provide support for the defeatist attitude model of experiential negative symptoms and suggest that blended technology-supported interventions such as mobile-assisted cognitive behavioral therapy for negative symptoms (mCBTn) can strengthen and shorten intensive psychosocial interventions for schizophrenia
In our cognitive behavioral social skills training (CBSST) intervention, which combines cognitive behavioral therapy (CBT) and SST [30], we have found significant improvements in defeatist attitudes and in experiential negative symptoms and functioning; improvements in experiential negative symptoms were mediated by improvements in defeatist attitudes [23]

Summary

Introduction

Negative symptoms account for much of the poor functional outcome in schizophrenia and are an unmet treatment need [1,2,3]. Experiential negative symptoms are important to treat, because they are strongly associated with functioning [5,7]. Beck and colleagues [10,11,12] have proposed that interventions that reduce defeatist attitudes may improve negative symptoms and functioning in schizophrenia. Several studies have found that cognitions such as defeatist performance (eg, “Why try, I always fail”) and social disinterest (eg, “I’m better off alone”) attitudes are associated with negative symptoms, and to some extent poor functioning, even after accounting for depression https://mental.jmir.org/2020/12/e24406. Negative symptoms are an important unmet treatment need for schizophrenia. This study is a preliminary, open, single-arm trial of a novel hybrid intervention called mobile-assisted cognitive behavioral therapy for negative symptoms (mCBTn)

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