Development of the Positive Emotions Program for Schizophrenia: An Intervention to Improve Pleasure and Motivation in Schizophrenia

Alexandra Nguyen, Laurent Frobert, Iannis McCluskey, Philippe Golay, Charles Bonsack, Jérôme Favrod, Alexandra Nguyen, Laurent Frobert, Iannis McCluskey, Philippe Golay, Charles Bonsack, Jérôme Favrod

Abstract

Objectives: The efficacy of drug-based treatments and psychological interventions on the primary negative symptoms of schizophrenia remains limited. Recent literature has distinguished negative symptoms associated with a diminished capacity to experience, from those associated with a limited capacity for expression. The positive emotions program for schizophrenia (PEPS) is a new method that specifically aims to reduce the syndrome of a diminished capacity to experience.

Methods: The intervention's vital ingredients were identified through a literature review of emotion in schizophrenia and positive psychology. The program has been beta-tested on various groups of health-care professionals.

Results: A detailed description of the final version of PEPS is presented here. The French version of the program is freely downloadable.

Conclusion: PEPS is a specific, short, easy to use, group-based intervention to improve pleasure, and motivation in schizophrenia. It was built considering a recovery-oriented approach to schizophrenia.

Keywords: anhedonia; apathy; motivation; pleasure; psychosocial interventions; schizophrenia.

References

    1. Foussias G, Agid O, Fervaha G, Remington G. Negative symptoms of schizophrenia: clinical features, relevance to real world functioning and specificity versus other CNS disorders. Eur Neuropsychopharmacol (2014) 24:693–709.10.1016/j.euroneuro.2013.10.017
    1. Tsang HW, Leung AY, Chung RC, Bell M, Cheung WM. Review on vocational predictors: a systematic review of predictors of vocational outcomes among individuals with schizophrenia: an update since 1998. Aust N Z J Psychiatry (2010) 44:495–504.10.3109/00048671003785716
    1. Marder SR. Clinician perceptions, expectations, and management of negative symptoms in schizophrenia. J Clin Psychiatry (2013) 74:e01.10.4088/JCP.12045tx4c
    1. Ventura J, Wood RC, Hellemann GS. Symptom domains and neurocognitive functioning can help differentiate social cognitive processes in schizophrenia: a meta-analysis. Schizophr Bull (2013) 39:102–11.10.1093/schbul/sbr067
    1. Fervaha G, Foussias G, Agid O, Remington G. Impact of primary negative symptoms on functional outcomes in schizophrenia. Eur Psychiatry (2014) 29:449–55.10.1016/j.eurpsy.2014.01.007
    1. Moller HJ. Clinical evaluation of negative symptoms in schizophrenia. Eur Psychiatry (2007) 22:380–6.10.1016/j.eurpsy.2007.03.010
    1. Erhart SM, Marder SR, Carpenter WT. Treatment of schizophrenia negative symptoms: future prospects. Schizophr Bull (2006) 32:234–7.10.1093/schbul/sbj055
    1. Turkington D, Morrison AP. Cognitive therapy for negative symptoms of schizophrenia. Arch Gen Psychiatry (2012) 69:119–20.10.1001/archgenpsychiatry.2011.141
    1. Fusar-Poli P, Papanastasiou E, Stahl D, Rocchetti M, Carpenter W, Shergill S, et al. Treatments of negative symptoms in schizophrenia: meta-analysis of 168 randomized placebo-controlled trials. Schizophr Bull (2015) 41(4):892–9.10.1093/schbul/sbu170
    1. Elis O, Caponigro JM, Kring AM. Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions. Clin Psychol Rev (2013) 33:914–28.10.1016/j.cpr.2013.07.001
    1. Eack SM, Greenwald DP, Hogarty SS, Cooley SJ, Dibarry AL, Montrose DM, et al. Cognitive enhancement therapy for early-course schizophrenia: effects of a two-year randomized controlled trial. Psychiatr Serv (2009) 60:1468–76.10.1176/appi.ps.60.11.1468
    1. Eack SM, Mesholam-Gately RI, Greenwald DP, Hogarty SS, Keshavan MS. Negative symptom improvement during cognitive rehabilitation: results from a 2-year trial of cognitive enhancement therapy. Psychiatry Res (2013) 209:21–6.10.1016/j.psychres.2013.03.020
    1. Farreny A, Aguado J, Ochoa S, Huerta-Ramos E, Marsa F, Lopez-Carrilero R, et al. REPYFLEC cognitive remediation group training in schizophrenia: looking for an integrative approach. Schizophr Res (2012) 142:137–44.10.1016/j.schres.2012.08.035
    1. Hogarty GE, Greenwald D, Ulrich RF, Kornblith SJ, Dibarry AL, Cooley S, et al. Three-year trials of personal therapy among schizophrenic patients living with or independent of family, II: effects on adjustment of patients. Am J Psychiatry (1997) 154:1514–24.10.1176/ajp.154.11.1514
    1. Petersen L, Jeppesen P, Thorup A, Abel MB, Ohlenschlaeger J, Christensen TO, et al. A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. BMJ (2005) 331:602.10.1136/bmj.38565.415000.E01
    1. Thorup A, Petersen L, Jeppesen P, Ohlenschlaeger J, Christensen T, Krarup G, et al. Integrated treatment ameliorates negative symptoms in first episode psychosis – results from the Danish OPUS trial. Schizophr Res (2005) 79:95–105.10.1016/j.schres.2004.12.020
    1. Blanchard JJ, Cohen AS. The structure of negative symptoms within schizophrenia: implications for assessment. Schizophr Bull (2006) 32:238–45.10.1093/schbul/sbj013
    1. Foussias G, Remington G. Negative symptoms in schizophrenia: avolition and Occam’s razor. Schizophr Bull (2010) 36:359–69.10.1093/schbul/sbn094
    1. Strauss GP, Horan WP, Kirkpatrick B, Fischer BA, Keller WR, Miski P, et al. Deconstructing negative symptoms of schizophrenia: avolition-apathy and diminished expression clusters predict clinical presentation and functional outcome. J Psychiatr Res (2013) 47:783–90.10.1016/j.jpsychires.2013.01.015
    1. Hartmann MN, Hager OM, Reimann AV, Chumbley JR, Kirschner M, Seifritz E, et al. Apathy but not diminished expression in schizophrenia is associated with discounting of monetary rewards by physical effort. Schizophr Bull (2015) 41:503–12.10.1093/schbul/sbu102
    1. Ergul C, Ucok A. Negative symptom subgroups have different effects on the clinical course of schizophrenia after the first episode: a 24-month follow up study. Eur Psychiatry (2015) 30:14–9.10.1016/j.eurpsy.2014.07.005
    1. Chadwick P, Birchwood M, Trower P. Cognitive Therapy for Delusions, Voices and Paranoia. Chichester: John Wiley & Sons Ltd; (1996).
    1. Favrod J, Vianin P, Pomini V, Mast FW. A first step toward cognitive remediation of voices: a case study. Cogn Behav Ther (2006) 35:159–63.10.1080/16506070600802993
    1. Zimmermann G, Favrod J, Trieu VH, Pomini V. The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophr Res (2005) 77:1–9.10.1016/j.schres.2005.02.018
    1. Favrod J, Rexhaj S, Bardy S, Ferrari P, Hayoz C, Moritz S, et al. Sustained antipsychotic effect of metacognitive training in psychosis: a randomized-controlled study. Eur Psychiatry (2014) 29:275–81.10.1016/j.eurpsy.2013.08.003
    1. Kumar D, Menon M, Moritz S, Woodward TS. Using the back door: metacognitive training for psychosis. Psychosis (2015) 7:166–178.10.1080/17522439.2014.913073
    1. Moritz S, Veckenstedt R, Andreou C, Bohn F, Hottenrott B, Leighton L, et al. Sustained and “sleeper” effects of group metacognitive training for schizophrenia: a randomized clinical trial. JAMA Psychiatry (2014) 71:1103–11.10.1001/jamapsychiatry.2014.1038
    1. Couture SM, Blanchard JJ, Bennett ME. Negative expectancy appraisals and defeatist performance beliefs and negative symptoms of schizophrenia. Psychiatry Res (2011) 189:43–8.10.1016/j.psychres.2011.05.032
    1. Raffard S, Esposito F, Boulenger JP, Van Der Linden M. Impaired ability to imagine future pleasant events is associated with apathy in schizophrenia. Psychiatry Res (2013) 209:393–400.10.1016/j.psychres.2013.04.016
    1. Strauss GP, Morra LF, Sullivan SK, Gold JM. The role of low cognitive effort and negative symptoms in neuropsychological impairment in schizophrenia. Neuropsychology (2015) 29:282–91.10.1037/neu0000113
    1. Favrod J, Nguyen A, Fankhauser C, Ismailaj A, Hasler JD, Ringuet A, et al. Positive emotions program for schizophrenia (PEPS): a pilot intervention to reduce anhedonia and apathy. BMC Psychiatry (2015) 15:231.10.1186/s12888-015-0610-y
    1. Blanchard JJ, Horan WP, Brown SA. Diagnostic differences in social anhedonia: a longitudinal study of schizophrenia and major depressive disorder. J Abnorm Psychol (2001) 110:363–71.10.1037/0021-843X.110.3.363
    1. Herbener ES, Harrow M. Are negative symptoms associated with functioning deficits in both schizophrenia and nonschizophrenia patients? A 10-year longitudinal analysis. Schizophr Bull (2004) 30:813–25.10.1093/oxfordjournals.schbul.a007134
    1. Harrow M, Grossman LS, Jobe TH, Herbener ES. Do patients with schizophrenia ever show periods of recovery? A 15-year multi-follow-up study. Schizophr Bull (2005) 31:723–34.10.1093/schbul/sbi026
    1. Herbener ES, Harrow M, Hill SK. Change in the relationship between anhedonia and functional deficits over a 20-year period in individuals with schizophrenia. Schizophr Res (2005) 75:97–105.10.1016/j.schres.2004.12.013
    1. Kring AM. Emotion in schizohrenia: old mystery, new understanding. Curr Dir Psychol Sci (1999) 8:160–3.10.1111/1467-8721.00038
    1. Kring AM, Earnst KS. Stability of emotional responding in schizophrenia. Behav Ther (1999) 30:373–88.10.1016/S0005-7894(99)80016-1
    1. Gold JM, Waltz JA, Prentice KJ, Morris SE, Heerey EA. Reward processing in schizophrenia: a deficit in the representation of value. Schizophr Bull (2008) 34:835–47.10.1093/schbul/sbn068
    1. Germans MK, Kring AM. Hedonic deficit in anhedonia: support for the role of approach motivation. Pers Individ Dif (2000) 28:659–72.10.1016/S0191-8869(99)00129-4
    1. Gard DE, Germans Gard M, Kring AM, John OP. Anticipatory and consummatory components of the experience of pleasure: a scale development study. J Res Pers (2006) 40:1086–102.10.1016/j.jrp.2005.11.001
    1. Gard DE, Kring AM, Gard MG, Horan WP, Green MF. Anhedonia in schizophrenia: distinctions between anticipatory and consummatory pleasure. Schizophr Res (2007) 93(1–3):253–60.10.1016/j.schres.2007.03.008
    1. Favrod J, Ernst F, Giuliani F, Bonsack C. Validation francaise de l’echelle d’experience temporelle du plaisir. Encephale (2009) 35:241–8.10.1016/j.encep.2008.02.013
    1. Favrod J, Giuliani F, Ernst F, Bonsack C. Anticipatory pleasure skills training: a new intervention to reduce anhedonia in schizophrenia. Perspect Psychiatr Care (2010) 46:171–81.10.1111/j.1744-6163.2010.00255.x
    1. Kring AM, Elis O. Emotion deficits in people with schizophrenia. Annu Rev Clin Psychol (2013) 9:409–33.10.1146/annurev-clinpsy-050212-185538
    1. Favrod J, Rexhaj S, Nguyen A, Cungi C, Bonsack C. Projecting oneself into the future, an intervention for improving pleasure in patients with anhedonia. In: Ritsner MS, editor. Anhedonia: A Comprehensive Handbook Volume I: Conceptual Issues and Neurobiological Advances. Dordrecht: Springer Science+Business Media; (2014). p. 95–104.
    1. Strauss GP. Translating basic emotion research into novel psychosocial interventions for anhedonia. Schizophr Bull (2013) 39:737–9.10.1093/schbul/sbt082
    1. Bryant FB. The Process of Savoring: A New Model of Positive Experience. Mahwah, NJ: Lawrence Erlbaum; (2007).
    1. Quoidbach J, Berry EV, Hansenne M, Mikolajczak M. Positive emotion regulation and well-being: comparing the impact of eight savoring and dampening strategies. Pers Indiv Differ (2010) 49:368–73.10.1016/j.paid.2010.03.048
    1. Cassar R, Applegate E, Bentall RP. Poor savouring and low self-efficacy are predictors of anhedonia in patients with schizophrenia spectrum disorders. Psychiatry Res (2013) 210:830–4.10.1016/j.psychres.2013.09.017
    1. Horan WP, Wynn JK, Kring AM, Simons RF, Green MF. Electrophysiological correlates of emotional responding in schizophrenia. J Abnorm Psychol (2010) 119:18–30.10.1037/a0017510
    1. Kring AM, Germans Gard M, Gard DE. Emotion deficits in schizophrenia: timing matters. J Abnorm Psychol (2011) 120:79–87.10.1037/a0021402
    1. Ursu S, Kring AM, Gard MG, Minzenberg MJ, Yoon JH, Ragland JD, et al. Prefrontal cortical deficits and impaired cognition-emotion interactions in schizophrenia. Am J Psychiatry (2011) 168:276–85.10.1176/appi.ajp.2010.09081215
    1. Kring AM, Moran EK. Emotional response deficits in schizophrenia: insights from affective science. Schizophr Bull (2008) 34:819–34.10.1093/schbul/sbn071
    1. Smith MJ, Horan WP, Karpouzian TM, Abram SV, Cobia DJ, Csernansky JG. Self-reported empathy deficits are uniquely associated with poor functioning in schizophrenia. Schizophr Res (2012) 137:196–202.10.1016/j.schres.2012.01.012
    1. Rector NA. Dysfunctional attitudes and symptom expression in schizophrenia: differential associations with paranoid delusions and negative symptoms. J Cogn Psychother (2004) 18:163–73.10.1891/jcop.18.2.163.65959
    1. Grant PM, Beck AT. Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophr Bull (2009) 35:798–806.10.1093/schbul/sbn008
    1. Bryant FB. Savoring beliefs inventory (SBI): a scale for measuring beliefs about savouring. J Ment Health (2003) 12:175–96.10.1080/0963823031000103489
    1. Gard DE, Gard MG, Kring AM, John OP. Anticipatory and consummatory components of the experience of pleasure: a scale development study. J Res Pers (2006) 40:1086–102.10.1016/j.jrp.2005.11.001
    1. Gooding DC, Pflum MJ. The assessment of interpersonal pleasure: introduction of the Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS) and preliminary findings. Psychiatry Res (2014) 215:237–43.10.1016/j.psychres.2013.10.012
    1. Gooding DC, Pflum MJ. Further validation of the ACIPS as a measure of social hedonic response. Psychiatry Res (2014) 215:771–7.10.1016/j.psychres.2013.11.009
    1. Morris SB, DeShon RP. Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol Methods (2002) 7:105–25.10.1037/1082-989X.7.1.105
    1. Kolb AY, Kolb DA. The learning way: meta-cognitive aspects of experiential learning. Simul Gaming (2009) 40:297–327.10.1177/1046878108325713
    1. Balleux A. Évolution de la notion d’apprentissage expérientiel en éducation des adultes: vingt-cinq ans de recherche. Rev Sci Edu (2000) 26:263–86.10.7202/000123ar
    1. Faerden A, Vaskinn A, Finset A, Agartz I, Ann Barrett E, Friis S, et al. Apathy is associated with executive functioning in first episode psychosis. BMC Psychiatry (2009) 9:1.10.1186/1471-244X-9-1
    1. Konstantakopoulos G, Ploumpidis D, Oulis P, Patrikelis P, Soumani A, Papadimitriou GN, et al. Apathy, cognitive deficits and functional impairment in schizophrenia. Schizophr Res (2011) 133:193–8.10.1016/j.schres.2011.07.003
    1. Hartmann MN, Kluge A, Kalis A, Mojzisch A, Tobler PN, Kaiser S. Apathy in schizophrenia as a deficit in the generation of options for action. J Abnorm Psychol (2015) 124(2):309–18.10.1037/abn0000048
    1. Wykes T, Huddy V, Cellard C, Mcgurk SR, Czobor P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatry (2011) 168:472–85.10.1176/appi.ajp.2010.10060855
    1. Engel M, Fritzsche A, Lincoln TM. Anticipation and experience of emotions in patients with schizophrenia and negative symptoms. An experimental study in a social context. Schizophr Res (2016) 170(1):191–7.10.1016/j.schres.2015.11.028
    1. Kirsch P, Ronshausen S, Mier D, Gallhofer B. The influence of antipsychotic treatment on brain reward system reactivity in schizophrenia patients. Pharmacopsychiatry (2007) 40:196–8.10.1055/s-2007-984463
    1. MacDonald AW, Schulz SC. What we know: findings that every theory of schizophrenia should explain. Schizophr Bull (2009) 35:493–508.10.1093/schbul/sbp017

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