In a recent article first published online in the Archives of General Psychiatry, Douglas Turkington, M.D., and Anthony Morrison, Ph.D., describe the paucity of research on the treatment of negative symptoms in schizophrenia. They describe a groundbreaking randomized controlled trial conducted by Paul Grant, Ph.D., Aaron Beck, M.D., and colleagues, in which they found that patients with chronic cases of severe schizophrenia treated with recovery-oriented cognitive therapy showed clinically significant improvements in negative symptoms. Turkington and Morrison note that negative symptoms, such as alogia, anhedonia, asociality, and avolition, "are frequently the most disabling and distressing" to patients. Yet most cognitive behavior therapy protocols for schizophrenia have focused on ameliorating positive symptoms (hallucinations, delusions, disorganization). Interestingly, the patients in the Grant, Beck, et al. study also improved in positive symptoms.
Aaron Beck proposes that the cognitive model resides at the foundation of the maintenance of negative symptoms in schizophrenia. He theorizes that patients with schizophrenia have a schema of failure and so they give up soon after they are diagnosed, believing they will be unable to achieve in any capacity (from tasks of everyday living and thinking to emoting and reasoning.) Racked with anxiety, patients may conclude, "I'll never make it," (deterioration is inescapable), "I'll never have friends," (relationships will be impossible), "I'm a walking time bomb," (outbursts will be likely). Essentially patients believe that their minds are irreparably "broken." Two major interventions, among others, are activity scheduling and decreasing avoidance, a safety behavior they employ to reduce overwhelming anxiety.
Dr. Paul Grant and Dr. Aaron Brinen will present the treatment program at a workshop in Philadelphia on May 2-4, 2012, immediately before the American Psychiatric Association annual conference. Dr. Aaron Beck, who developed the treatment protocol and trained the therapists involved in this study, will conduct a question and answer session during the workshop.