DOMINIKUS DAVID BIONDI SITUMORANG
Cognitive Behavioral Therapy for negative symptoms (CBT-n) in psychotic disorders: A pilot study
Abstract
Background and objectives
The
treatment of negative symptoms in schizophrenia is a major challenge
for mental health care. One randomized controlled trial found that
cognitive therapy for low-functioning patients reduced avolition and
improved functioning, using an average of 50.5 treatment sessions over
the course of 18 months. The aim of our current pilot study was to
evaluate whether 20 sessions of Cognitive Behavioral Therapy for
negative symptoms (CBT-n) would reduce negative symptoms within 6
months. Also, we wanted to test the cognitive model of negative symptoms
by analyzing whether a reduction in dysfunctional beliefs mediated the
effects on negative symptoms.
Method
In
an open trial 21 adult outpatients with a schizophrenia spectrum
disorder with negative symptoms received an average of 17.5 sessions of
CBT-n. At baseline and end-of-treatment, we assessed negative symptoms
(PANSS) and dysfunctional beliefs about cognitive abilities,
performance, emotional experience, and social exclusion. Bootstrap
analysis tested mediation.
Results
The
dropout rate was 14% (three participants). Intention-to-treat analyses
showed a within group effect size of 1.26 on negative symptoms (t = 6.16, | Sig = 0.000). Bootstrap analysis showed that dysfunctional beliefs partially mediated the change.
Limitations
The uncontrolled design induced efficacy biases. Also, the sample was relatively small, and there were no follow-up assessments.
Conclusions
CBT-n
may be effective in reducing negative symptoms. Also, patients reported
fewer dysfunctional beliefs about their cognitive abilities,
performance, emotional experience, and social exclusion, and this
reduction partially mediated the change in negative symptoms. The
reductions were clinically important. However, larger and controlled
trials are needed.
Highlights
►
We propose a model for Cognitive Behavioral Therapy for negative
symptoms (CBT-n). ► This pilot study tested CBT-n in 21 outpatients,
using an uncontrolled design. ► CBT-n (av. 17.5 sessions) reduced
negative symptoms; within-group effect size 1.26. ► Dysfunctional
beliefs partially mediated the effect.
Keywords
Psychosis
Schizophrenia
Cognitive therapy
CBT
Negative symptoms
Self-stigma
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