Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles (Reddy, Glynn, McGovern, Green); UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles (Reddy, Glynn, McGovern, Sugar, Reavis, Green); Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles (Sugar).
Am J Psychiatry. 2023 May 1;180(5):367-376. doi: 10.1176/appi.ajp.20220243. Epub 2023 Mar 9.
Negative symptoms are a primary cause of disability in schizophrenia for which there are no established pharmacotherapies. This study evaluated a novel psychosocial intervention that combined two evidence-based practices-motivational interviewing and cognitive-behavioral therapy (MI-CBT)-for the treatment of motivational negative symptoms.
Seventy-nine participants with schizophrenia and moderate to severe negative symptoms were included in a randomized controlled trial comparing the 12-session MI-CBT treatment with a mindfulness control condition. Participants were assessed at three time points through the study period, which included 12 weeks of active treatment and 12 weeks of follow-up. The primary outcome measures were motivational negative symptoms and community functioning; the secondary outcomes included a posited biomarker of negative symptoms: pupillometric response to cognitive effort.
Compared with the control group, participants in the MI-CBT group showed significantly greater improvements in motivational negative symptoms over the acute treatment period. Their gains relative to baseline were maintained at follow-up, although the differential benefit relative to control subjects was attenuated. There were nonsignificant effects toward improvements in community functioning and differential change in the pupillometric markers of cognitive effort.
The results show that combining motivational interviewing with CBT yields improvements in negative symptoms, a feature of schizophrenia generally thought of as resistant to intervention. Motivational negative symptoms not only responded to the novel treatment, but the gains were maintained over the follow-up period. Implications for future studies and for improving the generalization of the negative symptom gains to daily functioning domains are discussed.
阴性症状是精神分裂症致残的主要原因，但目前尚无既定的药物治疗方法。本研究评估了一种新的心理社会干预措施，该措施结合了两种循证实践——动机性访谈和认知行为疗法（MI-CBT），用于治疗动机性阴性症状。
79 名患有精神分裂症且存在中度至重度阴性症状的参与者被纳入一项随机对照试验，该试验比较了 12 节 MI-CBT 治疗与正念对照条件。参与者在研究期间接受了三次评估，包括 12 周的积极治疗和 12 周的随访。主要结局指标是动机性阴性症状和社区功能；次要结局指标包括负性症状的假定生物标志物：认知努力的瞳孔反应。
与对照组相比，MI-CBT 组的参与者在急性治疗期间表现出明显更大的动机性阴性症状改善。与基线相比，他们的收益在随访时得到了维持，尽管相对于对照组的差异收益有所减弱。社区功能改善和认知努力的瞳孔标记物的差异变化方面没有显著效果。
结果表明，将动机性访谈与 CBT 相结合可改善阴性症状，这是一种通常被认为难以干预的精神分裂症特征。动机性阴性症状不仅对新的治疗方法有反应，而且在随访期间也能保持收益。讨论了对未来研究和改善阴性症状收益向日常功能领域推广的影响。
