A Randomized, Controlled Trial of Cognitive Behavioral Social Skills Training for Middle-Aged and Older Outpatients With Chronic Schizophrenia

Granholm, Eric; McQuaid, John R.; McClure, Fauzia Simjee; Auslander, Lisa A.; Perivoliotis, Dimitri; Pedrelli, Paola; Patterson, Thomas L.; Jeste, Dilip V.

doi:10.1176/appi.ajp.162.3.520

Cited by 286 publications

(267 citation statements)

References 46 publications

(56 reference statements)

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“…Functioning trajectories over time were significantly more positive in CBSST than in GFSC. These findings replicated the results of our prior trial (6, 14) and showed that the benefits of CBSST cannot be attributed to nonspecific therapist factors, alone. Self-reported everyday functioning improved to a greater extent in CBSST than in GFSC, suggesting specific CBT and SST interventions were more potent interventions than goal-setting and supportive contact.…”

Section: Discussionsupporting

confidence: 89%

“…Other researchers have pointed out the benefits of supportive contact interventions to consumers with schizophrenia (37). In our prior study (6,14) comparing CBSST with treatment as usual (TAU), participants in TAU did not show meaningful improvement in symptom domains and showed a decline in functioning over time, so the improvements found in the present study for GFSC are greater than would be expected in standard care. However, functioning improved to a greater extent in CBSST than in GFSC, suggesting CBT and SST interventions may be more potent interventions to improve functioning, especially for individuals with more severe defeatist attitudes and social skills deficits.…”

Section: Discussioncontrasting

confidence: 61%

“…CBSST integrates CBT and SST techniques to target the different factors that contribute to poor functioning (6,12,13,20). CBSST is a group therapy intervention delivered in three, six-session modules that are intended to be completed twice, for a total of 36 weekly sessions (9 months).…”

Section: Methodsmentioning

confidence: 99%

“…CBSST was specifically designed to help older people with schizophrenia attain personalized functioning goals. 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. 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).…”

mentioning

confidence: 99%

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Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older Consumers With Schizophrenia: Defeatist Performance Attitudes and Functional Outcome

Granholm

Holden

Link

et al. 2013

The American Journal of Geriatric Psychiatry

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109

108

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Objectives To determine whether cognitive behavioral social skills training (CBSST) is an effective psychosocial intervention to improve functioning in older consumers with schizophrenia, and whether defeatist performance attitudes are associated with change in functioning in CBSST. Design An 18-month, single-blind, randomized controlled trial. Setting Outpatient clinic at a university-affiliated Veterans Affairs hospital. Participants Veteran and non-veteran consumers with schizophrenia or schizoaffective disorder (N=79) age 45–78. Interventions CBSST was a 36-session, weekly group therapy that combined cognitive behavior therapy with social skills training and problem solving training to improve functioning. The comparison intervention, goal-focused supportive contact (GFSC), was supportive group therapy focused on achieving functioning goals. Measurements Blind raters assessed functioning (primary outcome: Independent Living Skills Survey) CBSST skill mastery, positive and negative symptoms, depression, anxiety, defeatist attitudes, self-esteem, and life satisfaction. Results Functioning trajectories over time were significantly more positive in CBSST than in GFSC, especially for participants with more severe defeatist performance attitudes. Greater improvement in defeatist attitudes was also associated with better functioning in CBSST, but not GFSC. Both treatments showed comparable significant improvements in amotivation, depression, anxiety, positive self-esteem and life satisfaction. Conclusions CBSST is an effective treatment to improve functioning in older consumers with schizophrenia, and both CBSST and other supportive goal-focused interventions can reduce symptom distress, increase motivation and self esteem, and improve life satisfaction. Participants with more severe defeatist performance attitudes may benefit most from cognitive behavioral interventions that target functioning.

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Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 61%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older Consumers With Schizophrenia: Defeatist Performance Attitudes and Functional Outcome

Granholm

Holden

Link

et al. 2013

The American Journal of Geriatric Psychiatry

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109

108

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“…Future intervention studies should incorporate QOL as an outcome measure to assess the effects of treatment on QOL. Mounting evidence suggests that psychosocial treatments (e.g., cognitive behavioral therapy, supported employment, social skills training, assertive community treatment, and cognitive training) are a necessary adjunct to antipsychotic medications (Granholm et al, 2005;Lehman et al, 2004;Twamley et al, 2003a;Twamley et al, 2003b). With aggressive use of adjunctive treatments to target depression and negative symptoms, QOL in schizophrenia may be improved.…”

Section: Discussionmentioning

confidence: 99%

Subjective and objective quality of life in schizophrenia

Narvaez¹,

Twamley²,

McKibbin³

et al. 2008

Schizophrenia Research

224

139

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Objective-Quality of life (QOL) is considered an important outcome in the treatment of schizophrenia, but the determinants of QOL are poorly understood in this population. Furthermore, previous studies have relied on combined measures of subjective QOL (usually defined as life satisfaction) and objective QOL (usually defined as participation in activities and relationships). We examined separately the clinical, functional, and cognitive predictors of subjective and objective QOL in outpatients with schizophrenia. We hypothesized that better subjective QOL would be associated with less severe negative and depressive symptoms, better objective QOL, and greater everyday functioning capacity, and that better objective QOL would be associated with less severe negative and depressive symptoms, better cognitive performance, and greater functional capacity.Method-Participants included 88 outpatients with schizophrenia or schizoaffective disorder who completed a comprehensive series of assessments, including measures of positive, negative, and depressive symptoms; performance-based functional skills; a neuropsychological battery; and an interview measure of subjective and objective QOL.Results-In the context of multiple predictor variables, more severe depressive symptoms and better neuropsychological functioning were independent predictors of worse subjective QOL. More severe negative symptoms predicted worse objective QOL. Functional capacity variables were not associated with subjective or objective QOL.Conclusion-Treatments to improve QOL in schizophrenia should focus on negative symptoms and depressive symptoms.

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Randomized Trial to Evaluate the Efficacy of Cognitive Therapy for Low-Functioning Patients With Schizophrenia

Grant

Huh²,

Perivoliotis³

et al. 2012

Arch Gen Psychiatry

298

226

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A Randomized, Controlled Trial of Cognitive Behavioral Social Skills Training for Middle-Aged and Older Outpatients With Chronic Schizophrenia

Cited by 286 publications

References 46 publications

Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older Consumers With Schizophrenia: Defeatist Performance Attitudes and Functional Outcome

Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older Consumers With Schizophrenia: Defeatist Performance Attitudes and Functional Outcome

Subjective and objective quality of life in schizophrenia

Randomized Trial to Evaluate the Efficacy of Cognitive Therapy for Low-Functioning Patients With Schizophrenia

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