Schizophrenia affects more than 2 million Americans and leads to profound disability. Medications can reduce positive symptoms but do not specifically target functioning. Functional outcome shows stronger relationships with cognitive impairments and social skills deficits than with positive symptoms. Psychosocial interventions combined with pharmacotherapy can improve cognitive and social functioning, but the appropriate cognitive targets and optimal combination of intervention techniques are unclear. Well-controlled trials of psychosocial interventions that amplify pharmacotherapy by alleviating cognitive impairments and improving community functioning are needed. We developed, manualized and piloted cognitive-behavioral social skills training (CBSST), which targets cognitive and metacognitive impairments, social skills deficits, and thoughts that interfere with functioning in schizophrenia patients. The proposed project is a randomized controlled trial comparing CBSST with Supportive Contact (SC). Patients with schizophrenia (N=236) will be randomized to one of the 2 conditions, treated for 1 year and followed longitudinally for 1 year after treatment. A multi-dimensional evaluation of outcomes will include social functioning (primary outcome), neuropsychological functioning, cognitive insight, psychiatric symptoms, and health services utilization. The short-term objectives are to examine the effectiveness of CBSST over SC and potential predictors and mechanisms of change. Key questions are: (1) Does adding CBSST to standard care improve rehabilitation outcomes relative SC in schizophrenia patients? (2) Does severity of neurocognitive impairment at baseline or improvement in neurocognitive impairment in treatment differentially predict social functioning outcome? (3) Does improvement in cognitive insight mediate improvement in psychotic symptoms in CBSST? If CBSST continues to produce incremental effectiveness, future larger effectiveness and dissemination trials would be justified. ? ? ?

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Application #
Study Section
Special Emphasis Panel (ZMH1-ERB-S (01))
Program Officer
Goldstein, Amy B
Project Start
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Veterans Medical Research Fdn/San Diego
San Diego
United States
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Granholm, Eric; Holden, Jason; Worley, Matthew (2018) Improvement in Negative Symptoms and Functioning in Cognitive-Behavioral Social Skills Training for Schizophrenia: Mediation by Defeatist Performance Attitudes and Asocial Beliefs. Schizophr Bull 44:653-661
Granholm, Eric; Ruiz, Ivan; Gallegos-Rodriguez, Yuliana et al. (2016) Pupillary Responses as a Biomarker of Diminished Effort Associated With Defeatist Attitudes and Negative Symptoms in Schizophrenia. Biol Psychiatry 80:581-8
Ng, Rowena; Fish, Scott; Granholm, Eric (2015) Insight and theory of mind in schizophrenia. Psychiatry Res 225:169-174
Quinlan, Thomas; Roesch, Scott; Granholm, Eric (2014) The role of dysfunctional attitudes in models of negative symptoms and functioning in schizophrenia. Schizophr Res 157:182-9
Granholm, Eric; Holden, Jason; Link, Peter C et al. (2014) Randomized clinical trial of cognitive behavioral social skills training for schizophrenia: improvement in functioning and experiential negative symptoms. J Consult Clin Psychol 82:1173-85
Granholm, Eric; Ben-Zeev, Dror; Fulford, Daniel et al. (2013) Ecological Momentary Assessment of social functioning in schizophrenia: impact of performance appraisals and affect on social interactions. Schizophr Res 145:120-4
Granholm, Eric; Holden, Jason; Link, Peter C et al. (2012) Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older Consumers With Schizophrenia: Defeatist Performance Attitudes and Functional Outcome. Am J Geriatr Psychiatry :
Ben-Zeev, Dror; Morris, Scott; Swendsen, Joel et al. (2012) Predicting the occurrence, conviction, distress, and disruption of different delusional experiences in the daily life of people with schizophrenia. Schizophr Bull 38:826-37
Ben-Zeev, Dror; Ellington, Kemp; Swendsen, Joel et al. (2011) Examining a cognitive model of persecutory ideation in the daily life of people with schizophrenia: a computerized experience sampling study. Schizophr Bull 37:1248-56
Couture, Shannon M; Granholm, Eric L; Fish, Scott C (2011) A path model investigation of neurocognition, theory of mind, social competence, negative symptoms and real-world functioning in schizophrenia. Schizophr Res 125:152-60

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