Randomized clinical trial of cognitive behavioral social skills training for schizophrenia: improvement in functioning and experiential negative symptoms

Abstract

Objective: Identifying treatments to improve functioning and reduce negative symptoms in consumers with schizophrenia is of high public health significance.

Method: In this randomized clinical trial, participants with schizophrenia or schizoaffective disorder (N = 149) were randomly assigned to cognitive behavioral social skills training (CBSST) or an active goal-focused supportive contact (GFSC) control condition. CBSST combined cognitive behavior therapy with social skills training and problem-solving training to improve functioning and negative symptoms. GFSC was weekly supportive group therapy focused on setting and achieving functioning goals. Blind raters assessed functioning (primary outcome: Independent Living Skills Survey [ILSS]), CBSST skill knowledge, positive and negative symptoms, depression, and defeatist performance attitudes.

Results: In mixed-effects regression models in intent-to-treat analyses, CBSST skill knowledge, functioning, amotivation/asociality negative symptoms, and defeatist performance attitudes improved significantly more in CBSST relative to GFSC. In both treatment groups, comparable improvements were also found for positive symptoms and a performance-based measure of social competence.

Conclusions: The results suggest CBSST is an effective treatment to improve functioning and experiential negative symptoms in consumers with schizophrenia, and both CBSST and supportive group therapy actively focused on setting and achieving functioning goals can improve social competence and reduce positive symptoms.

Trial registration: ClinicalTrials.gov NCT00338975.

Figure 1

Flow of consumers with schizophrenia through the 21-month randomized clinical trial comparing Cognitive Behavioral Social Skills Training (CBSST) with an active Goal-Focused Supportive Contact (GFSC) control treatment. Participants who attended at least one therapy session and had at least one assessment on a given outcome were included in analyses.

Figure 2

Trajectories across assessment points from baseline to 21-month follow-up are shown for hypothetical participants with a median number (14.5) of therapy sessions attended in Cognitive Behavioral Social Skills Training (CBSST) and Goal-Focused Supportive Contact (GFSC). Trajectories were estimated from mixed-effects regression models that showed significant group X time interactions for functioning (Independent Living Skills Survey (ILSS), p=.010), negative symptoms (Scale for Assessment of Negative Symptoms (SANS) Diminished Motivation Factor, p=.018), dysfunctional attitudes (Defeatist Performance Attitude Scale (DPAS), p=.017) and CBSST skills acquisition (Comprehensive Modules Test (CMT), p=.017). Improvement is indicated by increasing scores for ILSS and CMT, and decreasing scores for the DPAS and SANS.

Figure 3

Trajectories across assessment points from baseline to 21-month follow-up are shown for hypothetical participants with a median number (14.5) of therapy sessions attended in Cognitive Behavioral Social Skills Training (CBSST) and Goal-Focused Supportive Contact (GFSC). Trajectories were estimated from mixed-effects regression models that showed a significant time effect for positive symptoms (Positive and Negative Syndrome Scale (PANSS) Positive Subscale, p=.006) and a marginally significant time effect for social competence (Maryland Assessment of Social Competence (MASC), p=.065). Improvement is indicated by decreasing scores for the PANSS and increasing scores for the MASC.