Improvement in Negative Symptoms and Functioning in Cognitive-Behavioral Social Skills Training for Schizophrenia: Mediation by Defeatist Performance Attitudes and Asocial Beliefs

Eric Granholm, Jason Holden, Matthew Worley, Eric Granholm, Jason Holden, Matthew Worley

Abstract

Psychosocial interventions have significant but modest impact on negative symptoms and functioning in schizophrenia. Identifying mechanisms of change in these interventions can inform treatment targets to strengthen these interventions. A number of studies have found associations between dysfunctional attitudes negative symptoms and functioning in schizophrenia. We previously found improvement in experiential negative symptoms and functioning in cognitive-behavioral social skills training (CBSST) in participants with schizophrenia (N = 149), and the present study examined whether improvements in CBSST in that trial were mediated by the group effect on defeatist performance attitudes and asocial beliefs. In multilevel mediation analyses, the effect of treatment group on experiential negative symptoms and functioning was mediated prospectively through defeatist attitudes but asocial beliefs only mediated effects on experiential negative symptoms. The findings suggest that cognitive-behavioral therapy interventions that target dysfunctional attitudes can lead to improvement in negative symptoms and functioning in schizophrenia.

Figures

Fig. 1.
Fig. 1.
Results of models estimating the prospective mediation effects of treatment group on Diminished Motivation (Scale for Assessment of Negative Symptoms [SANS]) and functioning (Independent Living Skills Survey [ILSS] and Maryland Assessment of Social Competence [MASC]) through prior defeatist performance attitudes (Defeatist Performance Attitudes Scale [DPAS]). *P < .05.
Fig. 2.
Fig. 2.
Results of models estimating the prospective mediation effects of treatment group on Diminished Motivation (Scale for Assessment of Negative Symptoms [SANS]) and functioning (Independent Living Skills Survey [ILSS], Maryland Assessment of Social Competence [MASC]) through prior asocial beliefs (Asocial Beliefs Scale [ABS]). *P < .05.

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