Cognitive Behavioral Social Skills Training Research Articles

Negative self‐reference as a component of subthreshold psychotic symptoms in clinical high‐risk youth

AbstractAimSchizophrenia is a leading cause of disability worldwide; early detection and intervention are critical. Early in their illness, individuals at clinical high‐risk (CHR) for psychosis have subthreshold psychotic symptoms that are often derogatory and self‐directed. We hypothesized that CHR participants with negative self‐reference (NSR) as a component of subthreshold psychosis would also have higher levels of social anxiety and depression, lower self‐esteem and lower social/role/global functioning as compared with CHR participants without NSR.MethodsOne hundred and sixty‐eight participants from the National Institute of Mental Health (NIMH) funded Regroup Cognitive Behavioural Social Skills Training (CBSST) study were included. Clinical vignettes that included the Scale of Psychosis‐Risk Symptoms were coded categorically to indicate whether NSR was present. t‐tests were used to determine the association between NSR, symptom, and functional measures.ResultsParticipants with NSR demonstrated significantly more social interaction anxiety (p < .001), negative beliefs about the self (p ≤ .001), defeatist beliefs (p < .05), depressive symptoms (p < .05) and positive symptoms (p < .005). There were no significant differences in social self‐efficacy, positive or negative beliefs about others, positive beliefs about the self or psychosocial functioning between the two groups.ConclusionsClinically significant differences were found between CHR participants with and without NSR, suggesting that this may be a useful factor to identify and address. Follow‐up studies are needed to determine whether NSR responds to CBSST and whether or not its resolution would be associated with improvement in other symptom domains.

Cognitive-Behavioral Social Skills Training: Outcome of a Randomized Controlled Trial for Youth at Risk of Psychosis.

Difficulties in social functioning have been observed in youth at clinical high-risk (CHR) of psychosis even in those who do not go on to develop a psychotic illness. Few treatment studies have attempted to improve social functioning in this population. The aim of this study was to conduct a randomized trial comparing the effects of Cognitive-Behavioral Social Skills Training (CBSST) with a supportive therapy (ST). Both CBSST and ST were weekly group therapies, delivered over 18 weeks. This was a 2-arm trial with single-blinded ratings and intention-to-treat analyses. Assessments occurred at baseline, end-of-treatment, and 12 months after the baseline assessment. The primary outcome was social and role functioning and defeatist performance attitudes were the secondary outcome. Attenuated positive and negative symptoms, anxiety, depression, self-efficacy, and beliefs about self and others were examined as exploratory outcomes. There were no significant differences between the 2 groups at baseline or either of the 2 follow-ups. However, at follow-ups, in each group there were significant improvements in clinical symptoms. These could not be attributed to group treatment since there was no control or wait-list group. Since poor social functioning is one of the most observed difficulties in CHR individuals, and a decline in social functioning may be a significant predictor of later transition to psychosis, future work will be needed to find effective treatments for this decline in functioning for CHR youth.

Feasibility and Effectiveness of a Psychosis-Specific Intensive Outpatient Program.

ObjectiveIntensive outpatient programs (IOPs) are rarely designed specifically to treat psychosis. In 2016 UCLA established the Thought Disorders Intensive Outpatient Program (TD IOP), combining a time‐limited, group‐based intervention called cognitive behavioral social skills training (CBSST) and medication management to treat individuals with psychosis. The purpose of this study is to assess the feasibility of developing an IOP for individuals with psychosis and the effectiveness of the program in improving psychotic symptom severity.MethodsAdults were referred to the TD IOP from inpatient and outpatient settings. Programming included 3 hours of CBSST and 6 hours of additional groups weekly as well as individual psychiatry and social work services. Primary outcomes were symptom changes as measured at intake and discharge by the Clinician‐Rated Dimensions of Psychosis Symptom Severity scale. Program feedback was solicited from a small subset of patients.ResultsOf the 92 enrolled subjects, 71 completed the program (77.2%). Average length of stay was 52 ± 30 days across all enrolled. Participants showed significant (p < 0.05) improvement with small‐moderate effect sizes across five of eight psychosis symptom domains (hallucinations, delusions, disorganized speech, depression, and mania). Patient‐reported program satisfaction was high (86.6 ± 12.7 score, range 0–100).ConclusionsThe current study indicates that targeted treatment for psychosis is successful within an IOP framework, with minimal additional training required for Master's level clinicians. Participants demonstrated significant symptomatic relief from group‐based, time‐limited treatment. Further work is needed to determine the full range of program benefits on patient well‐being and illness morbidity.

Peer specialists deliver cognitive behavioral social skills training compared to social skills training and treatment as usual to veterans with serious mental illness: study protocol for a randomized controlled trial

BackgroundSerious mental illness (SMI) affects 4.6% of the American population. While treatments are available, adherence to specific regimens is often suboptimal. Multiple organizations, such as the Substance Abuse and Mental Health Services Administration (SAMHSA), have called for more options that improve accessibility and engagement to treatment among individuals with SMI. This study protocol answers such calls by testing the effectiveness of peer specialists—individuals with SMI trained to use their experience to help others with SMI—in delivering social skills training (SST) and cognitive behavioral social skills training (CBSST), evidence-based treatments effective at engaging individuals with SMI to make behavioral and cognitive changes. Peer specialists have been shown to be adept at engaging those with SMI in treatment; however, their ability to deliver these structured treatments is unknown.MethodsThis study is a randomized, hybrid 1, research assistant-blinded, superiority trial. A total of 252 veterans with SMI will be recruited and randomized to one of three arms: CBSST-Peer vs. SST-Peer vs. treatment as usual. Participants randomized to CBSST-Peer or SST-Peer will participate in a 20-week group-based intervention that meets weekly for a 60-min class. All participants will complete 4 study assessments at baseline, 10 weeks, 20 weeks, and 32 weeks. A multidimensional battery of functional outcomes will be used with the Independent Living Skills Survey (ILSS) as the primary outcome measure. Post-study completion, veterans who participated in the CBSST-Peer or SST-Peer arms will randomly be invited to participate in focus groups, and peer specialists will complete interviews to further assess the effectiveness of each intervention.DiscussionImproving care and outcomes for individuals with SMI is a national priority. To improve care, it is imperative to think about new ways to improve engagement and accessibility to care. This study provides an innovative solution to this problem by evaluating how two different types of treatment, delivered by peer specialists, compare to usual care. The results of the study will allow for the expansion of treatment options that improve access and engagement among veterans with SMI.

Cognitive-Behavioral Social Skills Training Adapted for Youth at Clinical High Risk for Psychosis.

Interventions for functional impairments in adolescents and young adults at clinical high risk (CHR) for psychosis are needed. Cognitive-Behavioral Social Skills Training (CBSST) has been found to improve functioning in patients with schizophrenia. The CBSST manual was adapted for CHR and implemented across 3 sites. The key changes that were made were to present a focus of normalization and destigmatization of attenuated psychotic symptoms and since CBSST has a major focus on role plays, problem solving and challenging thoughts, examples of these were changed to be more appropriate for this young CHR population. We describe the manual modifications and present fidelity data to examine the success of training and supervision methods in a multi-site randomized controlled trial of CBSST in CHR youth. Fidelity was high and comparable across sites. Case vignettes are presented to demonstrate how CBSST techniques were adapted for UHR individuals to target functional impairments.

A Longitudinal Examination of Real-World Sedentary Behavior in Adults with Schizophrenia-Spectrum Disorders in a Clinical Trial of Combined Oxytocin and Cognitive Behavioral Social Skills Training.

Sedentary behavior contributes to a shortened life expectancy in individuals with schizophrenia-spectrum disorders (SSDs), highlighting the need for effective interventions to improve health. This study examined whether reduced ecological momentary assessment (EMA) measures of sedentary activities were observed in individuals with SSDs who participated in a 24-week randomized trial of cognitive behavioral social skills training (CBSST) and either intranasal oxytocin or placebo (NCT01752712). Participants (n = 57) were prompted with EMA surveys seven times per day for seven days during the baseline, 12-week, and 24-week timepoints to sample sedentary behavior ratings, positive and negative affect, interpersonal interactions, and interpersonal interaction appraisals. Results revealed that sedentary behavior and social interactions did not significantly change over the 24-week clinical trial; however, positive and negative affect and defeatist interaction appraisals improved with treatment, and oxytocin produced modest additional improvements in these EMA outcomes. Greater momentary positive affect was significantly associated with greater activity and greater frequency of interactions. Overall, CBSST was effective at improving functioning, momentary affect, and defeatist interaction appraisals, although it did not reduce sedentary behavior; therefore, targeting these factors is not sufficient to reduce sedentary behavior, and adjunct interventions are needed.

Cognitive-Behavioral Social Skills Training for patients with late-life schizophrenia and the moderating effect of executive dysfunction

The objectives of this study are to test the efficacy of Cognitive-Behavioral Social Skills Training (CBSST) in enhancing social function in a sample of older patients with schizophrenia, and to assess whether baseline cognition moderates response to CBSST. To address these objectives, we conducted a randomized controlled trial of 63 participants, randomized 1:1 into CBSST or Treatment-As-Usual (TAU). The setting was a community-based geriatric mental health outpatient clinic in Toronto, Ontario, Canada. Data were collected at baseline, and week 18, 36 and 52, between June 2008 and May 2014. Participants were outpatients, aged 60 or older, with a diagnosis of schizophrenia or schizoaffective disorder and no evidence of dementia or other conditions associated with cognitive or functional impairment. The intervention was a weekly group CBSST for 36 weeks. Cognition, including executive function, was assessed at baseline. Modified total score on the Independent Living Skills Survey (ILSS) at 18, 36, and 52 weeks was the primary outcome measure. In a linear mixed model analysis, the ILSS trajectory was better in the CBSST group than the TAU group, with significantly better function at 36 (Cohen's d = 0.75) and 52 weeks (Cohen's d = 0.92). Baseline executive dysfunction moderated CBSST response, whereby participants with more severe executive dysfunction experienced the most improvement in ILSS. CBSST was efficacious in patients with late-life schizophrenia and prevented decline in social function over a one-year period. CBSST was most beneficial for patients with more severe executive dysfunction, i.e., those who needed skills training the most.

Integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training for Negative Symptoms of Psychosis: Effects in a Pilot Randomized Controlled Trial.

Negative symptoms and cognitive impairment in schizophrenia (SZ) remain unmet treatment needs as they are highly prevalent, associated with poor functional outcomes, and resistant to pharmacologic treatment. The current pilot randomized controlled trial examined the efficacy of an integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training (CBSST-CCT) intervention compared to Goal-focused Supportive Contact (SC) on negative symptoms and cognitive performance. Fifty-five adults with SZ or schizoaffective disorder with moderate-to-severe negative symptoms were randomized to receive 25 twice-weekly, 1-h manualized group sessions (12.5 weeks total duration) of either CBSST-CCT or SC delivered by master's level clinicians in five community settings. Assessments of negative symptom severity (primary outcomes) and neuropsychological performance, functional capacity, social skills performance, and self-reported functional ability/everyday functioning, psychiatric symptom severity, and motivation (secondary outcomes) were administered at baseline, mid-treatment, post-treatment, and 6-month follow-up. Mixed-effects models using baseline, mid-treatment, and post-treatment data demonstrated significant CBSST-CCT-associated effects on negative symptom severity, as assessed by the Scale for the Assessment of Negative Symptoms (p = .049, r = 0.22), with improvements in diminished motivation driving this effect (p = .037, r = 0.24). The CBSST-CCT group also demonstrated improved verbal learning compared to SC participants (p = .026, r = 0.36). The effects of CBSST-CCT appeared to be durable at 6-month follow-up. CBSST-CCT improved negative symptom severity and verbal learning in high-negative-symptom individuals relative to SC. CBSST-CCT warrants larger investigations to examine its efficacy in treating negative symptoms, along with other symptoms, cognition, and, ultimately, real-world functional outcomes. Clinical Trial registration number NCT02170051.

Evaluation of the impact of a self-stigma reduction programme on psychosocial outcomes among people with schizophrenia spectrum disorder

Background Self stigma is assumed to be more prominent in Jordanian society than in Western countries, reflecting a poor understanding of mental illness, collectivistic culture, and delay in accessing psychiatric care Aim The purpose of the study is to evaluate the effectiveness of a self-stigma reduction programme on self-stigma. Methods A randomized controlled trial was conducted from November 2017 to December 2018 with 278 people diagnosed with schizophrenia (PDwS). Participants were randomly assigned to receive a self-stigma reduction programme (psychoeducation, cognitive behavioural therapy and social skills training), or treatment as usual (TAU). Results PDwS in the intervention group experienced a greater reduction in the level of self-stigma (20.19 vs −0.62; p < 0.001) at post-intervention and (37.35 vs −0.66; p < 0.001) at six-month follow-up. Conclusions The findings suggest that the self-stigma reduction programme has the potential to reduce self-stigma levels. Trial registration NCT04087954

Group Cognitive-Behavioral Therapy via Telebehavioral Health for Those With Psychotic Spectrum Disorders: A Case Series

Telebehavioral health emerged as an important practice during the coronavirus disease 2019 (COVID-19) pandemic as an opportunity for continued evidence-based mental health intervention, while minimizing exposure to coronavirus contagion. Though preliminary research suggests feasibility and positive outcomes of telebehavioral health practice for people with schizophrenia spectrum and other psychotic disorders, there is limited research about implementation and effectiveness of this practice (Kasckow et al., 2014). This case series highlights the transition from in-person to telebehavioral health practice of a Cognitive Behavioral Social Skills Training for Schizophrenia group due to the COVID-19 pandemic. This article summarizes: (a) the staff procedures needed to transition the group from in-person to telebehavioral health, (b) participant outcome data, (c) session attendance data, and (d) survey results from facilitators and participants about barriers and facilitators of the transition to telebehavioral health, and about how the virtual platform altered the therapeutic relationship and engagement. Participant outcome and engagement data suggest that, not only were two participants able to transition to telehealth and complete the program, but both participants also showed notable improvement in treatment engagement, goal progress, and skill acquisition. Surveys of six facilitators and one participant highlight how the transition to telebehavioral health had treatment advantages (e.g., therapeutic relationship, treatment engagement, group dynamics). Though survey results highlighted several implementation challenges in using the new virtual platform (e.g., technological connectivity, confidential space for engagement), no survey respondents reported that participation in this program resulted in harm to facilitators or participants. All facilitators and one participant agreed that the transition from in-person to virtual services was easy and reduced transportation barriers. Given the limited treatment engagement for this population (Lora et al., 2012) and the importance of early intervention to maximize clinical outcomes (Black et al., 2001; Bottlender et al., 2003), unanimous facilitator and participant report about improved patient attendance and participation in treatment after the transition to telebehavioral health was critically important. Though results of this case study are promising in suggesting telebehavioral health could be a viable modality for providing psychosocial treatment to people with schizophrenia spectrum and other psychotic disorders, more rigorous study is needed.

Combined Oxytocin and Cognitive Behavioral Social Skills Training for Social Function in People With Schizophrenia

A significant proportion of people with schizophrenia are characterized by impaired ability to socially engage with others. The development of effective interventions for social functioning remains a central therapeutic challenge. Cognitive-behavioral social skills training (CBSST) has been found to improve social functioning in schizophrenia, but with only medium effect sizes. Intranasal oxytocin also has prosocial effects, but also only with modest effect sizes. This study assessed whether the addition of intranasal oxytocin to CBSST can strengthen their impact on social function. Participants (N = 62) with schizophrenia or schizoaffective disorder entered a 24-week, double-blind, placebo-controlled, randomized clinical trial with a 3-month follow-up evaluation at 2 sites: Maryland and San Diego. Participants were randomized to either intranasal oxytocin 36 IU (3 sprays) twice a day (n = 31) or intranasal placebo-oxytocin (3 sprays) twice a day (n = 31). All participants received CBSST plus a social cognition skills training module (48 total sessions). There were no significant treatment group differences in social functioning, positive symptoms, negative symptoms, defeatist beliefs, or asocial beliefs. The interpretation of treatment effects was complicated by site effects, whereby participants in San Diego began the trial with greater severity of impairments and subsequently showed greater improvements compared with participants in Maryland. The results did not support the utility of add-on intranasal oxytocin to psychosocial rehabilitation interventions like CBSST for improvement in social function (ClinicalTrials.gov trial number: NCT01752712).

Concept mapping study of stakeholder perceptions of implementation of cognitive-behavioral social skills training on assertive community treatment teams.

This study aimed to identify factors associated with implementation of cognitive behavioral social skills training (CBSST) on assertive community treatment (ACT) teams in a large public sector behavioral health system. This study used concept mapping (a mixed-method approach) and involved a sample including diverse stakeholder participants including patients, ACT team members, team leaders, organization leaders, and system leaders. We identified 14 distinct issues related to implementing CBSST on ACT teams: (a) CBSST fit with ACT structure, (b) CBSST fit with ACT process, (c) provider perceptions about CBSST, (d) staff pressures/other demands; (e) CBSST and ACT synergy, (f) client characteristics, (g) benefits of CBSST, (h) coordination/interaction among ACT providers, (i) government/regulatory factors, (j) integration of CBSST into ACT, (k) training support, (l) training resources, (m) multilevel agency leadership, and (n) provider characteristics. Each of these dimensions were rated in regard to importance and changeability with the top 5 rated dimensions including effective training support; alignment of leadership across levels of the community-based organizations delivering services; perceived benefits of CBSST, CBSST and ACT synergy; and provider perceptions of CBSST. The most critical issues for CBSST implementation on ACT teams should be addressed in future studies. Implementation strategies that capitalize on enhancing leadership and organizational climate hold promise to address all of these issues. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cognitive behavioural social skills training: Methods of a randomized controlled trial for youth at risk of psychosis.

Poor functioning has become a hallmark of many youth at clinical high-risk (CHR) of psychosis. Even for those who do not make the transition to psychosis remain troubled by functional deficits and a decline in functioning increases the odds of transitioning to psychosis. There are very few treatment studies that have attempted to improve social and role functioning. The aim of this paper is to describe the methods of a treatment study to address social and role functioning in CHR. This was a randomized controlled trial of cognitive-behavioural social skills training (CBSST) versus a supportive therapy. CBSST combines elements of cognitive behaviour therapy (CBT) and social skills training (SST), two evidence-based treatments for schizophrenia. By adding CBT to SST to target functioning outcomes, SST can be used to train new social skills, and thoughts that interfere with skilled performance in the real world can be addressed using CBT. We developed an adapted version of CBSST, more appropriate for the age range and illness severity of typical CHR individuals, to attempt to show improvements in social and role functioning for these young people. Two hundred and three participants were recruited for this study. Results include initial baseline data. This article describes the baseline methodology of a CHR youth who have difficulties in social and/or role functioning. It is one of the first clinical trials to address this significant problem.

Reducing negative symptoms in schizophrenia: Feasibility and acceptability of a combined cognitive-behavioral social skills training and compensatory cognitive training intervention

The current study examined the feasibility and acceptability of an integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training (CBSST-CCT) intervention compared with Goal-Focused Supportive Contact (SC) in a pilot randomized controlled trial for people with schizophrenia with high negative symptom severity. The sample included 55 participants from five community settings; masters-level study clinicians delivered interventions on-site. Participants completed assessments of cognitive, functional, and psychiatric symptoms at baseline, mid-treatment, post-treatment (12.5 weeks), and 6-month follow-up. Enrollment goals were not initially met, necessitating the addition of a fifth site; however, all groups and assessments were completed on-site. Study procedures were acceptable, as evidenced by 100% enrollment and completion of baseline assessments following informed consent; however, over 1/3rd of participants dropped out. No modifications were necessary to the intervention procedures and CBSST-CCT fidelity ratings were acceptable. The intervention was deemed acceptable among participants who attended ≥1 session, as evidenced by similar attendance rates in CBSST-CCT compared to SC. Among CBSST-CCT participants, lower positive symptoms were significantly associated with better attendance. Overall, we found mixed evidence for the feasibility and acceptability of the CBSST-CCT protocol in people with schizophrenia with high negative symptoms. Challenges are highlighted and recommendations for future investigations are provided.

T65. EFFECTS OF AN INTEGRATED COGNITIVE BEHAVIORAL SOCIAL SKILLS TRAINING AND COMPENSATORY COGNITIVE TRAINING INTERVENTION ON NEGATIVE SYMPTOM SEVERITY AND NEUROCOGNITION

BackgroundNegative symptoms in schizophrenia (SZ) remain an unmet treatment need as they are highly prevalent, associated with poor functional outcomes, and resistant to pharmacologic treatment. Similarly, cognitive impairment is common in schizophrenia and is closely tied to negative symptoms and functional deficits. Two psychosocial interventions, Cognitive-Behavioral Social Skills Training (CBSST) and Compensatory Cognitive Training (CCT), have independently been linked to improved cognitive functioning, and have demonstrated clinically significant effect sizes in reducing negative symptoms; however, neither has been used to specifically target negative symptoms as the primary outcome and they have not yet been integrated. The two intervention strategies are likely to have different mechanisms of action, and bundling of these interventions may contribute to stronger, synergistic treatment effects. As such, the current pilot randomized controlled trial examined the efficacy of an integrated CBSST-CCT intervention compared to Goal-focused Supportive Contact (SC) on negative symptoms and objective cognitive performance.MethodsSixty-two adults with SZ or schizoaffective disorder with moderate-to-severe negative symptoms were randomized to receive 25 twice-weekly, 1-hour manualized group sessions (12.5 weeks total duration) of either CBSST-CCT or SC delivered by master’s level clinicians in five community settings. CBSST was modified to strengthen its impact on negative symptoms. CCT was included to bolster impaired functions in prospective memory, attention, learning, and memory, thereby enhancing attention to CBSST content, learning of content, and memory for content. SC was used as a robust control condition, supporting systematic recovery goal setting by teaching participants to break down goals into short-term goals and SMART goal steps. SC provided the same frequency and amount of therapist and group member contact as CBSST-CCT. Analyses of covariance (ANCOVAs) examined treatment-related improvements in negative symptom severity (Clinical Assessment Interview for Negative Symptoms and Scale for the Assessment of Negative Symptoms [SANS]) and neuropsychological performance (MATRICS Consensus Cognitive Battery) at post-treatment.ResultsThe sample consisted of mostly male (63%), White (65%) participants, aged 22–65 (M=49.5, SD=10.7), with a mean of 11.8 years of education (SD=2.6). Most participants were never married (61%), living independently (65%), and prescribed second generation antipsychotic medication (66%). Participants in the SC group were significantly older than those in the CBSST-CCT group (mean age=54 vs. 46; p=.004); thus, age was included as a covariate in analyses, along with baseline score on the outcome measure. ANCOVAs demonstrated that compared to the SC group, the CBSST-CCT group had more negative symptom improvement on the SANS (p=.036, η_p^2=.135), with improvements in diminished motivation/pleasure driving this effect (p=.004, η_p^2=.235). Moreover, CBSST-CCT participants demonstrated improved verbal learning at post-treatment compared to SC participants (p=.014, η_p^2=.174). No other significant group differences were found.DiscussionCBSST-CCT has the potential to improve negative symptom severity and cognitive functioning in high-negative-symptom patients. CBSST-CCT warrants larger investigations to examine its efficacy in treating negative symptoms, along with other symptoms, cognition, and functioning.

S23. EFFICACY OF COGNITIVE-BEHAVIORAL SOCIAL SKILLS TRAINING IMPROVING SYMPTOMS AND FUNCTIONING IN PATIENTS WITH EARLY-ONSET PSYCHOSIS: A RANDOMIZED CONTROLLED TRAIL

BackgroundThe onset of a psychotic disorder before age 18 (early-onset psychosis, EOP) is a marker of greater clinical severity and poor outcome. There is a lack of studies examining the efficacy of psychological treatment in this population. The Cognitive-Behavioral Social Skills Training (CBSST) is an evidence-based psychological intervention for patients with schizophrenia. OBJECTIVE: To analyze the efficacy of the adolescent version of CBSTT (CBSST-Adolt) versus an active psychological intervention, administered during the critical period, to improve symptoms and functioning in patients with EOP.MethodsRandomized controlled trail (RCT) of the adolescent version of the CBSST-Adol compared to an active control intervention. Interventions: The CBSTT-Adol included the 3 original modules (cognitive abilities, social skills, problem-solving skills) but number of sessions was reduced. It was administered in small groups. The active control intervention (PSYCHOED-Adol) included 3 modules (psychoeducation, relapse prevention, healthy life style) with the same format and number of sessions. The language and examples were adapted for adolescents in both interventions. Inclusion criteria: schizophrenia spectrum disorder (schizophrenia, schizoaffective disorder, psychotic disorder not otherwise specified), diagnosed before 18; being in the critical period of the illness (first 5 years after the onset); being clinically stabilized (outpatients). Exclusion criteria: IQ<70; having a substance dependence disorder; having a neurological disorder. Procedure: Patients (n=30) were randomized to both branches of the study after the baseline assessment and were re-assessed after the treatment (CBSST-Adol n=16, PSYCHOED-Adol n=14). The study included a group of healthy controls (HC, n=20) matched for age and sex, who were assessed only at baseline. Pharmacological treatment was supervised by patients’ clinical psychiatrists. Instruments: PANNS, GAF, GF:Role, GF:Social, Life Skills Profile (LSP), Caregivers’ Burden Inventory (CBI). Statistical analyses: T-test was used for comparisons between patients and HC. Lineal generalized models were run for examining group differences after the treatment between CBSST-Adol and PSYCHOED-Adol, controlling for baseline scores. Intention-to-treat analyses.ResultsThere were no significant differences in sex or age, but in socioeconomic status (p<0.001), between HC and EOP subjects. Patients with EOP had lower scores in all areas of functioning (global, role, social, daily living skills, caregivers’ burden, p<0.001). There were no significant differences in any of the baseline characteristic between patients allocated in the CBSST-Adol and the PSYCHOED-Adol groups (sociodemographic variables, symptoms, functioning, pharmacological treatment, duration of the illness, p>0.05). There was a similar rate of dropouts during the trail in both branches of the study (31% and 29%, p>0.05). Improvements in clinical symptoms (PANSS total, p=0.045; PANSS positive symptoms, p=0.009) and functioning (GAF, p=0.002; GF:Social, p=0.025, CBI, p=0.020) were found at post-treatment in all sample. However, there was no a superior effect of CBSST-Adol compared to PSYCHOED-Adol in any variable. There was only a trend to a higher improving of the Communication and social contact subscale of the Life Skills Profile in the CBSST-Adol intervention (p=0.061).DiscussionThe results support the efficacy of psychological intervention improving symptoms and functioning in EOP. We find a similar positive effect after the treatment in both CBSTT-Adol and PSYCHOED-Adol interventions. Main limitations: not having a non-active control group and the sample size.

Mobile-assisted cognitive-behavioral social skills training in older adults with schizophrenia

Abstract Psychosocial rehabilitation interventions are needed to improve functioning in people with schizophrenia, particularly for older adults. In multiple clinical trials, cognitive-behavioral social skills training (CBSST) has been found to improve community functioning in younger and older participants with schizophrenia. To reduce the burden and possibly strengthen CBSST, we developed a mobile-assisted CBSST intervention (MA-CBSST), in which therapist contact was reduced 50% and group sessions were supplemented by a mobile device that prompted at-home practice of CBSST skills. This study was a preliminary randomized clinical trial comparing: (1) the full CBSST program; (2) MA-CBSST and (3) a device contact (DC) control (only symptom and activity monitoring) in 57 older adults with schizophrenia (age > 45). Relative to DC-only, CBSST skill knowledge and self-reported functioning improved significantly more in the full CBSST program and full CBSST and MA-CBSST groups did not differ significantly, but improvements on these outcomes were only marginally significant for MA-CBSST relative to DC-only with smaller effect sizes. The results replicated multiple prior clinical trials showing improvement in functioning in schizophrenia in CBSST, but the effect of MA-CBSST on functioning was weaker than the full CBSST program.

Stakeholder Perspectives on Implementing Cognitive Behavioral Social Skills Training on Assertive Community Treatment Teams.

This study examined stakeholder perceptions of the "fit" between cognitive-behavioral social skills training (CBSST) and assertive community treatment (ACT) when implementing CBSST into existing community-based ACT teams. Focus group feedback was collected from a diverse set of stakeholders (i.e., clients, providers, supervisors, agency administrators, public sector representatives, and intervention developers). Results identified perceived client and provider benefits for integrating CBSST into ACT while highlighting the importance of purposeful adaptations, training, and implementation tools to facilitate structural and values fit between CBSST and ACT. Study findings will inform future endeavors to implement CBSST and other relevant EBPs into ACT. Trial Registry: ClinicalTrials.gov #NCT02254733.

The effects of combined oxytocin and cognitive behavioral social skills training on social cognition in schizophrenia.

Individuals with schizophrenia have deficits in social cognition that are associated with poor functional outcome. Unfortunately, current treatments result in only modest improvement in social cognition. Oxytocin, a neuropeptide with pro-social effects, has significant benefits for social cognition in the general population. However, studies examining the efficacy of oxytocin in schizophrenia have yielded inconsistent results. One reason for inconsistency may be that oxytocin has typically not been combined with psychosocial interventions. It may be necessary for individuals with schizophrenia to receive concurrent psychosocial treatment while taking oxytocin to have the context needed to make gains in social cognitive skills. The current study tested this hypothesis in a 24-week (48 session) double-blind, placebo-controlled trial that combined oxytocin and Cognitive-Behavioral Social Skills Training (CBSST), which included elements from Social Cognition and Interaction Training (SCIT). Participants included 62 outpatients diagnosed with schizophrenia (placebo n = 31; oxytocin n = 31) who received 36 IU BID, with supervised administration 45 min prior to sessions on CBSST group therapy days. Participants completed a battery of measures administered at 0, 12, and 24 weeks that assessed social cognition. CBSST generally failed to enhance social cognition from baseline to end of study, and there was no additive benefit of oxytocin beyond the effects of CBSST alone. Findings suggest that combined CBSST and oxytocin had minimal benefit for social cognition, adding to the growing literature indicating null effects of oxytocin in multi-dose trials. Methodological and biological factors may contribute to inconsistent results across studies.

Improvement in Negative Symptoms and Functioning in Cognitive-Behavioral Social Skills Training for Schizophrenia: Mediation by Defeatist Performance Attitudes and Asocial Beliefs

Psychosocial interventions have significant but modest impact on negative symptoms and functioning in schizophrenia. Identifying mechanisms of change in these interventions can inform treatment targets to strengthen these interventions. A number of studies have found associations between dysfunctional attitudes negative symptoms and functioning in schizophrenia. We previously found improvement in experiential negative symptoms and functioning in cognitive-behavioral social skills training (CBSST) in participants with schizophrenia (N = 149), and the present study examined whether improvements in CBSST in that trial were mediated by the group effect on defeatist performance attitudes and asocial beliefs. In multilevel mediation analyses, the effect of treatment group on experiential negative symptoms and functioning was mediated prospectively through defeatist attitudes but asocial beliefs only mediated effects on experiential negative symptoms. The findings suggest that cognitive-behavioral therapy interventions that target dysfunctional attitudes can lead to improvement in negative symptoms and functioning in schizophrenia.