Pilot Study of Behavioral Activation Treatment for Negative Symptoms in Older Adults With Schizophrenia Spectrum Disorder.

Abstract

Objective: Behavioral activation (BA) is an established treatment for depression in older adults, yet BA has been relatively less examined as a treatment for the negative symptoms (NS) of schizophrenia spectrum disorder (SSD). We here aimed to demonstrate the feasibility and proof-of-concept that BA can improve NS and function in older adults with SSD. We also evaluated if changes in putative targets correlate with health improvements.

Methods: Older adults (n = 19; mean age = 58.6 years [standard deviation = 10]) with SSD were offered 12 weekly BA sessions. Primary outcomes were: feasibility of administration, measured as session attendance; and pre/post NS changes, assessed with the Clinical Assessment Interview for Negative Symptoms (CAINS) total scores. Secondary measures were expressive symptoms (CAINS-Expressive subscale), adaptive functioning (Role Functioning Scale), and disability (World Health Organization Disability Assessment Schedule 2.0 scores). Target measures were: avolition and anhedonia (CAINS items), BA (Behavioral Activation for Depression Scale-activation subscale), and actigraphy-measured inactivity (activity level during most active 10 h) and behavioral rigidity (inter-daily stability). Analyses evaluated post- to pre-BA changes using Cohen's d and 95% confidence intervals.

Results: Participants attended 95% of the sessions. All health outcomes improved, including expressive symptoms (d = -0.69; 95% CI: -1.14, -0.23) and health-related disability (d = -0.45; 95% CI: -0.80, -0.11). Of target measure changes, notably, improved avolition (d = -0.46; 95% CI: -0.82, -0.10) correlated with clinical benefits, including reduced disability r = 0.48 (p = 0.04).

Conclusions: High engagement and health improvements support the use of BA for NS in older patients with SSD.

Relevance to clinical practice: In older adults, BA may reduce NS and improve function, but precision medicine trials are needed to determine how and for whom.