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Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older Consumers With Schizophrenia: Defeatist Performance Attitudes and Functional Outcome
Open accessAbstract
Objectives To determine whether Cognitive Behavioral Social Skills Training (CBSST) is an effective psychosocial intervention to improve functioning in older consumers with schizophrenia, and whether defeatist performance attitudes are associated with change in functioning in CBSST.Design An 18-month, single-blind, randomized controlled trial.Setting Outpatient clinic at a university-affiliated Veterans Affairs hospital.Participants Veteran and non-veteran consumers with schizophrenia or schizoaffective disorder (N = 79) age 45-78.Interventions CBSST was a 36-session, weekly group therapy that combined cognitive behavior therapy with social skills training and problem-solving training to improve functioning. The comparison intervention, goal-focused supportive contact (GFSC), was supportive group therapy focused on achieving functioning goals.Measurements Blind raters assessed functioning (primary outcome: Independent Living Skills Survey), CBSST skill mastery, positive and negative symptoms, depression, anxiety, defeatist attitudes, self-esteem, and life satisfaction.Results Functioning trajectories over time were significantly more positive in CBSST than in GFSC, especially for participants with more severe defeatist performance attitudes. Greater improvement in defeatist attitudes was also associated with better functioning in CBSST, but not GFSC. Both treatments showed comparable significant improvements in amotivation, depression, anxiety, positive self-esteem, and life satisfaction.Conclusions CBSST is an effective treatment to improve functioning in older consumers with schizophrenia, and both CBSST and other supportive goal-focused interventions can reduce symptom distress, increase motivation and self-esteem, and improve life satisfaction. Participants with more severe defeatist performance attitudes may benefit most from cognitive behavioral interventions that target functioning.Trial registry ClinicalTrials.Gov #NCT00237796 (http://clinicaltrials. gov/show/NCT00237796).
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“While there was no significant change in psychopathology in pharmacologically stabilized patients, there was significant improvement in social activities, cognitive insight and mastery of problem‐solving skills, as well as a reduction in defeatist attitudes, at the end of the intervention.”
From Mental health care for older adults: recent advances and new directions in clinical practice and research (2022) · cites this paper as [277]
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Metadata
- Authors
- Granholm, E., Holden, J., Link, P. C., McQuaid, J. R., & Jeste, D. V.
- Affiliations
- University of California San Diego (US)
- Corresponding author
- Granholm, Eric
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2013-03
- Volume
- 21
- Issue
- 3
- Pages
- 251-262
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC3467335
- OpenAlex
- W2001567631
- Cited by
- 135
- References
- 35
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 4 · 2023: 13 · 2022: 9 · 2021: 9 · 2020: 9 · 2019: 9 · 2018: 10 · 2017: 15 · 2016: 10 · 2015: 11 · 2014: 10 · 2013: 7
- FWCI
- 8.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH071410, P30MH66248, P30MH066248)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Keywords
- schizophrenia, older adults, functional outcome, independent living skills, schizoaffective disorder, veterans, supportive group therapy, amotivation, self-esteem, life satisfaction, problem-solving training, social skills training
- MeSH terms
- Aged, Aging, Attitude, Female, Humans, Male, Middle Aged, Patient Compliance, Problem Solving, Psychotherapy, Group, Schizophrenia, Schizophrenic Psychology, Social Adjustment, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome
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