Cited by 726Schizophrenia research and treatmentPsychological Testing and AssessmentMental Health and Psychiatry

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The Clinical Assessment Interview for Negative Symptoms (CAINS): Final Development and Validation

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Kring, Ann M., Gur, Raquel E., Blanchard, Jack J., Horan, William P., Reise, Steven P.·2013·American Journal of Psychiatry

DOI 10.1176/appi.ajp.2012.12010109PMC PMC3785242

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Abstract

OBJECTIVE: A major barrier to developing treatments for negative symptoms has been measurement concerns with existing assessment tools. Fulfilling the top recommendation of the National Institute of Mental Health's Consensus Development Conference on Negative Symptoms, the Clinical Assessment Interview for Negative Symptoms (CAINS) was developed using an iterative, empirical approach, and includes items assessing motivation, pleasure, and emotion expression. The authors employed multiple analytic techniques to develop the CAINS and here provide final development and validation results. METHOD: The CAINS structure, interrater agreement, test-retest reliability, and convergent and discriminant validity were assessed in a large and diverse sample of 162 outpatients with schizophrenia or schizoaffective disorder recruited from four sites. RESULTS: Three items with poor psychometric properties were removed, resulting in a 13-item CAINS. The CAINS factor structure was replicated, demonstrating two modestly correlated scales: expression (four items) and motivation/pleasure (nine items). The scales demonstrated good internal consistency, test-retest stability, and interrater agreement. Strong convergent validity was demonstrated by linkages with other negative symptom measures, self-report scales of sociality, pleasure, and motivation, and coded facial expressions. Discriminant validity was shown by independence from depression, medication side effects, and cognition. Notably, the CAINS scales were related to real-world vocational, independent living, and social/familial functioning. CONCLUSIONS: The CAINS is an empirically developed and evaluated measure of negative symptoms. Findings indicate that the CAINS is brief yet comprehensive and employable across a wide range of research and clinical contexts.

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“The Clinical Assessment Interview for Negative Symptoms (CAINS) (Kring et al. 2013; Chan et al. 2015), a semi-structured clinical interview, was used to assess patients' motivation and pleasure (MAP) and expression (EXP) factors, and higher scores of each factor represent more impairments.”
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“The CAINS is a newly developed clinical rating scale designed to assess negative symptoms across multiple domains, which contains one tapping emotion expression (four items) and the other measuring motivation and expected pleasure (nine items) (Kring et al., 2013).”
Background
Additional file 1 of Assessment of the efficacy of a fatigue management therapy in schizophrenia: study protocol for a randomized, controlled multi-centered study (ENERGY)
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Additional file 1 of Psychometric properties of the Clinical Assessment Interview for Negative Symptoms (CAINS) in patients with depression and its relationship to affective symptoms
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“Our exploratory correlation analyses for the active treatment group showed significant negative correlations between change in CAINS ratings and neural activity in the ACC to positive anticipation ( r = (cid:0) 0.638, p = 0.019) and positive processing ( r = (cid:0) 0.670, p = 0.012), indicating that increases in ACC…”
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“In addition, the Positive and Negative Syndrome Scale (PANSS) (Kay, Fiszbein, & Opler, 1987; Si et al., 2004) and the Clinical Assessment Interview for Negative Symptoms (CAINS) (Chan et al., 2015; Kring et al., 2013) were administered to assess the clinical symptoms in SCZ patients.”
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“Consensus frameworks such as MATRICS and CAINS validation studies emphasize the centrality of negative symptoms in long-term disability [50,51], while contemporary cognitive models suggest that dysfunctional beliefs may contribute to the persistence of negative symptoms [52], potentially…”
Computerized assessments of emotional expression and emotional reactivity predict negative symptoms in individuals at clinical high-risk for psychosis
Bertrand, C. E., Pokorny, V., Gold, J. M., Waltz, J. A., Schiffman, J. E., Ellman, L. M., Strauss, G. P., Walker, E. F., Woods, S. W., Powers, A. R., et al. (2026) · Psychological Medicine · doi:10.1017/s0033291726104826
“Although once conceptualized as a single construct, negative symptoms are now understood to include at least two separable domains: experiential (e.g. anhedonia, avolition, asociality) and expressive symptoms (e.g. blunted affect, alogia) (Kring et al., 2013).”

Authors: Kring, A. M., Gur, R. E., Blanchard, J. J., Horan, W. P., & Reise, S. P.
Affiliations: University of California, Los Angeles (US)
ORCID: Kring, Ann M.
Gur, Raquel E.
Blanchard, Jack J.
Horan, William P.
Reise, Steven P.
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2013-02
Volume: 170
Issue: 2
Pages: 165-172
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.2012.12010109
PMC: PMC3785242
OpenAlex: W2131925003
Cited by: 726
References: 43
Citations by year: 2026: 55 · 2025: 55 · 2024: 51 · 2023: 62 · 2022: 62 · 2021: 48 · 2020: 70 · 2019: 51 · 2018: 61 · 2017: 46 · 2016: 52 · 2015: 51 · 2014: 37 · 2013: 24
FWCI: 38.03
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (5r01mh082782-03, 5r01mh082890-03)
National Institute of Mental Health (1R01MH082890, R01-MH082890, R01-MH082782, R01MH082839, R01MH082783, 1R01MH082782)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords: negative symptoms, schizophrenia, schizoaffective disorder, motivation, pleasure, emotional expression, interview assessment, psychometric validation, factor structure, convergent validity, discriminant validity, vocational functioning, independent living, social functioning
MeSH terms: Adult, Female, Humans, Interview, Psychological, Male, Middle Aged, Motivation, Outpatients, Psychiatric Status Rating Scales, Psychological Tests, Psychotic Disorders, Schizophrenia, Schizophrenic Psychology, Social Behavior, Socioeconomic Factors, Volition, Reproducibility of Results, Expressed Emotion, Diagnostic and Statistical Manual of Mental Disorders, Pleasure, Anhedonia

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The Clinical Assessment Interview for Negative Symptoms (CAINS): Final Development and Validation

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