Pilot Study of Behavioral Activation Treatment for Negative Symptoms in Older Adults With Schizophrenia Spectrum...

Behavioral activation (BA) is an established treatment for depression in older adults, yet BA has been relatively less examined as a treatment for the negative symptoms (NS) of schizophrenia spectrum disorder (SSD). We here aimed to demonstrate the feasibility and proof-of-concept that BA can improve NS and function in older adults with SSD. We also evaluated if changes in putative targets correlate with health improvements.

Older adults (n = 19; mean age = 58.6 years [standard deviation = 10]) with SSD were offered 12 weekly BA sessions. Primary outcomes were: feasibility of administration, measured as session attendance; and pre/post NS changes, assessed with the Clinical Assessment Interview for Negative Symptoms (CAINS) total scores. Secondary measures were expressive symptoms (CAINS-Expressive subscale), adaptive functioning (Role Functioning Scale), and disability (World Health Organization Disability Assessment Schedule 2.0 scores). Target measures were: avolition and anhedonia (CAINS items), BA (Behavioral Activation for Depression Scale-activation subscale), and actigraphy-measured inactivity (activity level during most active 10 h) and behavioral rigidity (inter-daily stability). Analyses evaluated post- to pre-BA changes using Cohen's d and 95% confidence intervals.

Participants attended 95% of the sessions. All health outcomes improved, including expressive symptoms (d = -0.69; 95% CI: -1.14, -0.23) and health-related disability (d = -0.45; 95% CI: -0.80, -0.11). Of target measure changes, notably, improved avolition (d = -0.46; 95% CI: -0.82, -0.10) correlated with clinical benefits, including reduced disability r = 0.48 (p = 0.04).

High engagement and health improvements support the use of BA for NS in older patients with SSD.

In older adults, BA may reduce NS and improve function, but precision medicine trials are needed to determine how and for whom.