Mobile-Assisted Cognitive Behavior Therapy for Negative Symptoms in Schizophrenia

The primary purpose of this project is to test whether a psychosocial intervention, Cognitive Behavioral Social Skills Training (CBSST) combined with a smartphone-based cognitive-behavioral therapy for negative symptoms called, Mobile-assisted Cognitive Behavioral Therapy for Negative Symptoms (mCBTn) can reduce defeatist performance attitudes in consumers with schizophrenia spectrum disorders with persistent moderate-to-severe experiential negative symptoms.The project will also identify the optimal dose to engage the defeatist attitude target. Pupillary responses, an objective psychophysiological biomarker of effort, will be recorded during a cognitive task as a secondary outcome to determine its potential as an end point in clinical trials of motivation and effort.

Inclusion criteria

• DSM-5 diagnosis of schizophrenia or schizoaffective disorder.
• Meets prospective criteria for persistent moderate-to-severe experiential negative symptoms in at least two of the three CAINS Motivation and Pleasure domains (mean of 2 -moderate- or greater for items averaged within the Social, Work or Recreational domains) at the beginning and end of a 2-week evaluation phase.
• Moderate-to-severe defeatist attitudes (DPAS > 50).
• ≥ 6th grade reading level on the Wide Range Achievement Test-4 Reading subtest (needed for reading treatment manual consumer workbook).
• Clinically stable and stable on current medications (no changes within 3 months prior to enrollment and meeting all inclusion/exclusion criteria during longitudinal baseline evaluation at both week -2 and 0).

Exclusion criteria

• Prior CBT in the past 2 years.
• Greater than moderate PANSS positive symptoms (P1-Delusions, P2- Disorganization, P3-Hallucinations, or P6-Suspiciousness - any item >5).
• Severe depression on the Calgary Depression Scale for Schizophrenia (CDS >8).
• Extrapyramidal symptoms (Simpson-Angus Scale >7).
• Ocular damage, disease, surgery or medications that affect pupil dilation.
• DSM-5 alcohol or substance use disorder in past 3 months.
• Level of care required interferes with outpatient therapy (e.g., hospitalized; severe medical illness).
• Unable to adequately see or manually manipulate the mobile device.