31.3 COMMUNITY-BASED MULTI-SITE RANDOMIZED CONTROLLED TRIAL OF BEHAVIORAL ACTIVATION FOR PATIENTS WITH NEGATIVE SYMPTOMS

Abstract

Background: Few psychosocial approaches address the negative symptoms of schizophrenia, which shares common features with depression and anxiety. Behavioral activation (BA) is a recommended treatment option with strong evidence for addressing depression and anxiety in adults with various mental disorders. BA is such a promising candidate for community dwelling individuals with negative symptoms since it not only provides comparable clinical effects to CBT, but also can be delivered more cost‐effectively than traditional CBT due to its relatively brief format (Cuijpers, Van Straten, & Warmerdam, 2007; Dimidjian et al., 2006; Ekers, Richards, & Gilbody, 2008; Jacobson et al., 1996). Furthermore, BA is proven its feasibility and preliminary benefits in community dwelling individuals with negative symptoms (Choi et al., 2016). The primary aims of the current study was to investigate whether BA would be more effective than treatment as usual (TAU) to reduce negative symptoms and increase behavior activation level, when delivered by retrained community mental health professionals (e.g., clinical psychologists, psychiatry fellows, psychiatric nurses, social workers) who have limited psychotherapy or BA experiences. Methods: In a single‐blind, multi‐site randomized controlled trial, 84 participants with schizophrenia were recruited from community based mental health service institutes. Seventy‐two of the participants who met the study inclusion and exclusion criteria were assigned to either an BA or BA + TAU, with assessments of both clinician rated and self‐reported negative symptoms, other psychiatric symptoms, and global functioning conducted at baseline, end of the 10‐week intervention, and 6‐month follow‐up. The BA treatment was delivered by qualified mental health professionals including psychiatrists, psychiatry fellows, clinical psychologists, psychiatric nurses, and psychiatric social workers and doctoral level clinical psychology graduate research assistants who received clinical supervision from licensed clinical psychologist. Participating therapists received a full‐day training via workshop sessions. While delivering the BA treatment, therapists were provided an on‐site consultation meeting and off‐site supervision through telephone. Results: Administering BA to individuals with schizophrenia with mild to moderate negative symptoms was feasible in a community mental health setting. Relative to TAU, BA was associated with moderate to large effects in reducing negative symptoms measured using PANSS, CAINS, and BNSS at the end of 10‐week intervention. However, the treatment gains were not maintained at 6‐month follow‐up. Conclusions: In individuals with schizophrenia receiving the usual forms of psychiatric rehabilitation in a community mental health setting, BA appears to offer an adjunctive and efficacious approach for addressing mild to moderate negative symptoms. A potential role of treatment duration (i.e., longer than 10 weeks) and levels of clinical expertise should be further investigated to maximize treatment gains.