Anticipated Impacts on Veteran's Healthcare: Negative symptoms are a central and enduring feature of schizophrenia and are related to pervasive deficits in residential independence, occupational functioning, and quality of life for veterans living with this illness. Currently ther is no effective treatment for this critical domain of the illness. As outlined in the VA Mental Health Strategic Plan, the development and implementation of strategies to enhance community functioning and promote recovery among veterans with schizophrenia is a VHA priority. This study will evaluate a tailored intervention package called Engaging in Community Roles and Experiences (EnCoRE) targeting negative symptoms in Veterans with schizophrenia. Project Background: Negative symptoms are distinct clinical features of schizophrenia that are major determinants of the poor community functioning and poor long-term outcome that characterize the disorder, as well as a major source of burden for caregivers. Recent reports document the lack of effective interventions that target the key clinical domains of negative symptoms and call for the development of interventions designed specifically to address this critical unmet treatment need. Our preliminary data on intervention development, negative symptom assessment, affective experience, and dysfunctional cognitions argues for an intervention that incorporates evidence-based treatment strategies to target affective- motivational deficits, behavioral skills deficits, and negative expectations of success as the key aspects of the illness that underlie motivation to engage in goal directed behavior. Project Objectives: This application is focused evaluating a tailored intervention package targeting negative symptoms in Veterans with schizophrenia who receive mental health services at 3 VAMCs. EnCoRE will include motivational, cognitive, and behavioral skills training strategies aimed at teaching individuals ways to (1) understand and overcome deficits in anticipatory pleasure, (2) increase intrinsic motivation for pleasant and goal directed activities, (3) reduce negative expectancies for success and performance, and (4) perform skillfully in new social situations. The primary objectives of this project are to (1) Train therapists and refine the EnCoRE manual in a preliminary trial with 10 Veterans with schizophrenia and negative symptoms; (2) Conduct a randomized clinical trial (RCT; n=108, medium effect, alpha=.05) to test the efficacy of EnCoRE in producing positive changes at post-treatment and 3-month follow-up on the primary outcomes of negative symptoms and social and community functioning; and (3) Examine qualitative interviews completed by Veterans who participated in EnCoRE and Mental Health Providers to determine aspects of EnCoRE that were perceived as more or less helpful, interesting, and valuable in order to inform a larger, multi-site implementation trial. Secondary objectives include assessing the modifying effects of cognitive ability and psychotic symptoms on intervention effectiveness, and examining recovery, self-efficacy, and program satisfaction. Project Methods: This project will include a period of training followed by an RCT with 108 participants. Participants will complete assessments at baseline, post-treatment, and 3-months. We will monitor fidelity, feasibility, and acceptability; study Veteran's experience in the program; measure symptom and functional outcomes; and evaluate potential moderators of outcomes.
Negative symptoms are major determinants of poor community functioning in veterans with schizophrenia and available treatments are largely ineffective for these symptoms. This study aims to evaluate a tailored intervention package to treat negative symptoms that will teach Veterans with schizophrenia ways to overcome deficits in anticipatory pleasure, increase motivation for pleasant activities, reduce expectations of failure in community activities, and perform skillfully in new social situations. Results will inform us as to whether these strategies can improve negative symptoms, enhance community functioning, and promote recovery among Veterans with schizophrenia.
