Abstract
Few psychosocial approaches address the negative symptoms of schizophrenia, which shares common features with depression and anxiety. Behavioral activation (BA) is effective for addressing depression and anxiety in adults with various mental disorders. Motivational interviewing (MI) has been successfully applied to address ambivalence or lack of motivation toward treatment. Motivational and behavioral activation (mBA) has been developed by incorporating the core principles from BA and MI with recent findings on the negative symptoms of schizophrenia. In this study, we aimed to examine the feasibility and preliminary efficacy of mBA in a non-randomized controlled pilot study that included individuals with schizophrenia with mild to moderate negative symptoms receiving psychiatric rehabilitation. A total of 73 individuals with schizophrenia were recruited. Forty-seven of the participants who met the study inclusion and exclusion criteria were assigned to either an mBA + usual psychiatric rehabilitation group (mBA) or a usual psychiatric rehabilitation only group (treatment as usual, TAU). Administering mBA to individuals with schizophrenia with mild to moderate negative symptoms was feasible in a community mental health setting. Relative to TAU, mBA was associated with large effects in reducing negative symptoms measured using the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS). However, after considering PANSS cognitive deficits and marital status as covariates due to significant differences in their baseline levels, the treatment effects on the BNSS were partially observed. In addition, participants in the mBA group showed improved verbal learning and memory compared with those in the TAU group. In individuals with schizophrenia receiving the usual forms of psychiatric rehabilitation in a community mental health setting, mBA appears to offer a promising adjunctive approach for addressing mild to moderate negative symptoms. Further investigations are needed to replicate the current findings in a randomized controlled trial.
Highlights
Many individuals with schizophrenia experience negative symptoms, which are a key determinant of poor functioning and quality of life (Pogue-Geile and Harrow, 1985; Rabinowitz et al, 2012)
Dropout rates (4.35% for Motivational and behavioral activation (mBA) vs. 20.83% for treatment as usual (TAU)) were similar between the mBA and the TAU groups (χ2 = 2.87, p = 0.09), indicating that mBA would be tolerable and feasible to administer to individuals with schizophrenia with mild to moderate negative symptoms participating in the usual psychiatric rehabilitation services
The findings indicate that participants in the mBA improved their negative, cognitive, and depressive symptoms compared to those in the TAU group
Summary
Many individuals with schizophrenia experience negative symptoms, which are a key determinant of poor functioning and quality of life (Pogue-Geile and Harrow, 1985; Rabinowitz et al, 2012). Few studies have reported the efficacy of psychosocial treatments for negative symptoms (Dobson et al, 1995; Rector and Beck, 2001; Tarrier et al, 2004; Kurtz and Mueser, 2008; Staring et al, 2013; Velligan et al, 2015), and the estimated effect size reported in a recent meta-analysis was small and inconsistent across studies (Velthorst et al, 2015) Another meta-analysis indicates that social skills training had small to moderate effects (d = 0.40; 95% CI = 0.19, 0.61) on negative symptoms; the benefits only appear to be stable for younger patients with schizophrenia or in studies of greater design quality (Kurtz and Mueser, 2008). The effective and cost-efficient treatment of negative symptoms is a high priority when developing interventions
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