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The Clinical Assessment Interview for Negative Symptoms (CAINS): Final Development and Validation
Open accessAbstract
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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“Other forms of disorders, i.e. schizophrenia and bipolar disorder, can be evaluated with screenings such as the Clinical Assessment Interview for Negative Symptoms (CAINS) [60], Brief Negative Symptom Scale (BNSS) [61], the Social Skills Performance Assessment (SSPA) [53], and several others that measure the effects of thought and mood disorders.”
From A Review of Automated Speech and Language Features for Assessment of Cognitive and Thought Disorders (2020) · cites this paper as [60]
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“…(Andreasen, 1982), PANSS (Kay et al., 1987; Kay et al., 1988), BNSS (Kirkpatrick et al., 2011; Weigel et al., 2023), and CAINS (Forbes et al., 2010; Kring et al., 2013) has linked both the expression and experience domains to social functioning (Blanchard et al., 2017; Galderisi et al., 2018;…”
InfluentialMote, J., Gard, D. E., Mueser, K. T., & Fulford, D. (2026) · Schizophrenia Research · doi:10.1016/j.schres.2026.07.005
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“The primary outcome measure will be the Clinical Assessment Interview for Negative Symptoms (CAINS; [6, 43]) as it has been developed to measure negative symptoms as defined by the NIMH consensus development conference (i.e., blunted affect, alogia, anhedonia, asociality and avolition; [45].”
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InfluentialLlerena, K. (2014) · University Libraries (University of Maryland) · doi:10.13016/m2vg6h
“This measure also shows discriminant validity from depression (Kring et al., 2013).”
InfluentialThe Valuation of Social Reinforcement in Schizophrenia
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“Clinical Assessment Interview for Negative Symptoms (CAINS) (Kring et al., 2013).”
BackgroundInfluential
Metadata
- Authors
- Kring, A. M., Gur, R. E., Blanchard, J. J., Horan, W. P., & Reise, S. P.
- Affiliations
- University of California, Los Angeles (US)
- Venue
- American Journal of Psychiatry
- Published
- 2013-02
- Volume
- 170
- Issue
- 2
- Pages
- 165-172
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- 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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