Several researchers ( 15– 18) recently found that defeatist performance attitudes (e.g., “Why bother, I always fail,” “It’s not worth the effort”) are associated with poor functioning and negative symptoms in schizophrenia. To strengthen the efficacy of interventions like CBSST and identify consumers most likely to benefit from such interventions, it is important to identify potential moderators and mechanisms of change. GFSC was an enhanced supportive contact intervention focused on helping consumers set and work toward functioning goals in a support group that provided the same amount of therapist and group contact as CBSST.
BLIND OPTIMISM TRIAL
We, therefore, conducted the present trial comparing CBSST with an active psychosocial control condition, goal-focused supportive contact (GFSC). This trial showed that CBSST was more effective than TAU, but did not control for nonspecific therapist contact. Participants in CBSST showed significantly greater CBSST skill mastery on ( d=.61) and functioning ( d=.50) relative to participants in TAU, and these improvements were maintained at one-year follow-up ( 14).
In a prior clinical trial ( 6, 14), we randomized 76 people with schizophrenia or schizoaffective disorder ( M age = 54) to treatment as usual (TAU) or CBSST. CBSST was specifically designed to help older people with schizophrenia attain personalized functioning goals. By adding CBT to SST, thoughts that interfere with skill performance in the real world (e.g., low self-efficacy, defeatist performance attitudes) can be addressed in therapy. Given the established efficacy of CBT and SST in schizophrenia trials, we developed a group therapy intervention that combined these two treatments called, Cognitive Behavioral Social Skills Training (CBSST) ( 12, 13). A meta-analysis of 22 SST trials ( 11) found a large effect size for proximal content-mastery outcomes ( d=1.20), moderate effect sizes for intermediate outcomes, including performance-based measures of social and daily living skills ( d=0.52), community functioning ( d=0.52), and negative symptoms ( d=0.40), and small effect sizes for more distal outcomes, like other symptoms ( d=0.15) and relapse ( d=0.23). Numerous studies of consumers with schizophrenia have also shown that SST improves functioning ( 10, 11). Fifteen of the studies reviewed included functioning measures and the average effect size for improvement in functioning ( d=0.38) and negative symptoms ( d=0.44) was comparable to that for positive symptoms ( d=0.37). A meta-analysis of 35 CBT clinical trials ( 9) recently showed that, although the vast majority of studies focused on positive symptoms as the primary treatment target, CBT also had beneficial impact on functioning. There has been very little research on psychosocial interventions for older consumers with schizophrenia ( 4– 8).Ĭognitive behavioral therapy (CBT) and social skills training (SST) are effective interventions to improve functioning in schizophrenia. Evidence-based psychosocial interventions that improve functioning have been identified and recommended in best practice guidelines, but these practices are rarely available to most people with schizophrenia, especially older consumers ( 3). It has become a national research priority to identify treatments to improve community role functioning and quality of life in people with severe mental illnesses ( 2). Medications that reduce positive symptoms do not improve daily life functioning. Aging in schizophrenia is typically associated with improvement in positive symptoms and reduced hospitalization, but impairments in functioning persist ( 1).
This will mean a dramatic increase in demand for treatments targeting the unique needs of older consumers with schizophrenia. By 2020, 41% of the United States population will be over age 45( 1).
The number of older consumers with schizophrenia, like the number of older persons in the general population, is growing rapidly.
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