Positive Emotions Program for Schizophrenia (PEPS): a pilot intervention to reduce anhedonia and apathy

Abstract

Background: Recent literature has distinguished the negative symptoms associated with a diminished capacity to experience (apathy, anhedonia) from symptoms associated with a limited capacity for expression (emotional blunting, alogia). The apathy-anhedonia syndrome tends to be associated with a poorer prognosis than the symptoms related to diminished expression. The efficacy of drug-based treatments and psychological interventions for these symptoms in schizophrenia remains limited. There is a clear clinical need for new treatments.Methods: This pilot study tested the feasibility of a program to reduce anhedonia and apathy in schizophrenia and assessed its impact on 37 participants meeting the ICD-10 criteria for schizophrenia or schizoaffective disorders. Participants were pre-and post-tested using the Scale for the Assessment of Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS). They took part in eight sessions of the Positive Emotions Program for Schizophrenia (PEPS)-an intervention that teaches participants skills to help overcome defeatist thinking and to increase the anticipation and maintenance of positive emotions. Results: Thirty-one participants completed the program; those who dropped out did not differ from completers. Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes. Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size. Emotional blunting and alogia remain stable during the intervention. Discussion: Findings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy. However, these findings are limited by the absence of control group and the fact that the rater was not blind to the treatment objectives.

Ist Negativsymptomatik bei Schizophrenie überhaupt behandelbar? Ein systematisches Literaturreview zur Wirksamkeit psychotherapeutischer Interventionen für Negativsymptomatik

“…In neueren Studien [Choi et al, 2016;Favrod et al, 2015;Velligan et al, 2015] waren die Behandlungsansätze stärker auf Interventionen fokussiert, die gezielt auf ätiologische Erkenntnisse zu einzelnen Negativsymptomen ausgerichtet sind (z.B. Förderung der Antizipation von Freude).…”

“…Förderung der Antizipation von Freude). In Pilotstudien haben diese Studien mit unterschiedlicher methodischer Genauigkeit jeweils positive Effekte auf die motivationale Negativsymptomatik im mittleren [Favrod et al, 2015;Velligan et al, 2015] bis großen Effektstärken-bereich [Choi et al, 2016] gefunden.…”

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

“…All statistical tests were two tailed, and significance was set at the 0.05 level. From the pilot study [28], the sample size was calculated with an α set at 0.05, a β set conservatively at 0.95 and an effect size f of 0.44 for the apathy and anhedonia SANS composite score. Using an a priori computation for an ANCOVA, the proposed trial required a total sample size of 70 participants for the two arms.…”

“…The programme uses visual and audio materials as part of a PowerPoint presentation of slides projected onto a screen. A pilot study was conducted with participants who met the ICD-10 criteria for schizophrenia or schizoaffective disorders [28]. Thirty-one participants completed the programme.…”

Prevenção primária em psiquiatria: possibilidade ou utopia?

“…Além disso, muitos estudos têm surgido com o objeti vo de fazer diagnósti co e intervenção precoces 6,7 , diminuição de recaídas 8,9 (prevenção secundária) e reabilitação [10][11][12] (prevenção terciária). Pelo menos em parte, a prevenção dentro da psiquiatria vem sendo estudada e aplicada.…”