Enhancing Assertive Community Treatment with Cognitive Behavioral Social Skills Training for Schizophrenia: I....

Effective psychosocial interventions help people with schizophrenia live full and productive lives, but these interventions are not available to most people with schizophrenia. To facilitate access, interventions must be adapted and tested for delivery in community practice settings. In this pragmatic effectiveness trial, Cognitive Behavioral Social Skills Training (CBSST) was modified and tested for delivery by Assertive Community Treatment (ACT) teams in community mental health settings.

Participants with schizophrenia or schizoaffective disorder (N = 178) were recruited from publicly funded ACT teams operating in community settings and randomized to receive ACT alone or ACT + CBSST. Functioning (primary outcome), CBSST skill learning, symptoms, and defeatist attitudes were assessed every 18 weeks after baseline for 18 months.

Significant treatment effects were not found for functioning or any other outcome. CBSST delivery was low, but CBSST skill learning improved significantly more in ACT + CBSST, and post hoc exploratory analyses showed that exposure to more CBSST sessions was associated with greater skill learning, which in turn was associated with greater improvement in experiential negative symptoms and ultimately functioning.

The effectiveness of CBSST when delivered by typical community ACT providers may have been compromised by low delivery. Greater delivery of CBSST sessions was associated with greater skill acquisition which improved outcomes. Adapting CBSST to fit into the ACT service delivery creates an opportunity to substantially increase the number of individuals with schizophrenia who could access interventions like CBSST, but implementation research is needed to identify factors to promote session delivery.

ClinicalTrials.gov NCT02254733.