Improving Pleasure and Motivation in Schizophrenia: A Randomized Controlled Clinical Trial

Abstract

Background: Negative symptoms are frequent in patients with schizophrenia and are associated with marked impairments in social functioning. The efficacy of drug-based treatments and psychological interventions on primary negative symptoms remains limited. The Positive Emotions Programme for Schizophrenia (PEPS) is designed to improve pleasure and motivation in schizophrenia patients by targeting emotion regulation and cognitive skills relevant to apathy and anhedonia. The main hypothesis of this study is that patients who attend 8 one-hour sessions of PEPS and treatment as usual (TAU) will have lower total apathy-avolition and anhedonia-asociality composite scores on the Scale for the Assessment of Negative Symptoms (SANS) than patients who attend only TAU. Methods: Eighty participants diagnosed with schizophrenia or schizoaffective disorder were randomized to receive either TAU or PEPS + TAU. The participants were assessed by independent evaluators before randomization (T0), in a post-test after 8 weeks of treatment (T1) and at a 6-month follow-up (T2). Results: The post-test results and 6-month follow-up assessments according to an intention-to-treat analysis showed that the apathy and anhedonia composite scores on the SANS indicated statistically greater clinical improvements in PEPS participants than in non-PEPS participants. In the post-test, anhedonia but not apathy was significantly improved, thus favouring the PEPS condition. These results were sustained at the 6-month follow-up. Conclusions: PEPS is an effective intervention to reduce anhedonia in schizophrenia. PEPS is a short, easy-to-use, group-based, freely available intervention that is easy to implement in a variety of environments (ClinicalTrials.gov ID: NCT02593058).

Changing the Future: An Initial Test of Future Specificity Training (FeST)

“…Although future thinking relies on memory to construct mental simulations (Schacter et al, 2007), the outcomes of MeST on future thinking are currently unknown. Programs such Future-Directed Therapy (Vilhauer et al, 2012(Vilhauer et al, , 2013 and The Positive Emotions Programme for Schizophrenia (Favrod et al, 2019) were developed to emphasise future thinking in terms of goal-setting, and planning, and to anticipate a more positive future. However, they focus more on the practical aspects and applications of utilising EFT, rather than particular training in improving this type of cognitive ability.…”

Switch, a new intervention that targets motivational negative symptoms in people with schizophrenia: An uncontrolled pilot study

“…Finally, models of negative symptoms have not always been the foundation of the developed psychosocial interventions. However, for example, model-based interventions would ensure that underlying processes are targeted (e.g., Favrod et al, 2019). Thus, to enhance the development and validation of negative symptom interventions, a number of changes need to occur.…”

“…Switch was specifically developed to tackle all of the difficulties involved in motivation. Thus, the potential of the intervention is maximized as strategies are available across all processes (e.g., Chen et al, 2019;Farquharson & MacLeod, 2014;Favrod et al, 2019), from the premises of motivation to goal attainment and maintenance.…”

Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms

“…We developed an intervention, Switch, that targets the multiple elements and processes identified in the aforementioned model (hidden for review), using various strategies that have proven to be beneficial as delivered separately or in other clinical populations (e.g., [11][12][13][14][15][16]). A pilot study was conducted with 8 participants with schizophrenia spectrum disorders who followed Switch for a year (30 sessions on average).…”