title: Randomized controlled trial of cognitive behavioral social skills training for older consumers with schizophrenia: defeatist performance attitudes and functional outcome.
abstract: OBJECTIVE
  To determine whether Cognitive Behavioral Social Skills Training (CBSST) is an effective psychosocial intervention to improve functioning in older consumers with schizophrenia, and whether defeatist performance attitudes are associated with change in functioning in CBSST.
  
  
  METHODS
  An 18-month, single-blind, randomized controlled trial.
  
  
  METHODS
  Outpatient clinic at a university-affiliated Veterans Affairs hospital.
  
  
  METHODS
  Veteran and non-veteran consumers with schizophrenia or schizoaffective disorder (N = 79) age 45-78.
  
  
  METHODS
  CBSST was a 36-session, weekly group therapy that combined cognitive behavior therapy with social skills training and problem-solving training to improve functioning. The comparison intervention, goal-focused supportive contact (GFSC), was supportive group therapy focused on achieving functioning goals.
  
  
  METHODS
  Blind raters assessed functioning (primary outcome: Independent Living Skills Survey), CBSST skill mastery, positive and negative symptoms, depression, anxiety, defeatist attitudes, self-esteem, and life satisfaction.
  
  
  RESULTS
  Functioning trajectories over time were significantly more positive in CBSST than in GFSC, especially for participants with more severe defeatist performance attitudes. Greater improvement in defeatist attitudes was also associated with better functioning in CBSST, but not GFSC. Both treatments showed comparable significant improvements in amotivation, depression, anxiety, positive self-esteem, and life satisfaction.
  
  
  CONCLUSIONS
  CBSST is an effective treatment to improve functioning in older consumers with schizophrenia, and both CBSST and other supportive goal-focused interventions can reduce symptom distress, increase motivation and self-esteem, and improve life satisfaction. Participants with more severe defeatist performance attitudes may benefit most from cognitive behavioral interventions that target functioning.
  
  
  BACKGROUND
  ClinicalTrials.Gov #NCT00237796 (http://clinicaltrials. gov/show/NCT00237796).
authors: Veterans Affairs San Diego Healthcare System, Department of Psychiatry, University of California, San Diego, CA 92161, USA. egranholm@ucsd.edu
authors: Eric
authors: E
authors: Granholm
authors: Jason
authors: J
authors: Holden
authors: Peter C
authors: PC
authors: Link
authors: John R
authors: JR
authors: McQuaid
authors: Dilip V
authors: DV
authors: Jeste
mesh_terms: D000368:Aged; D000375:Aging / Q000523:psychology*; D001290:Attitude; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011340:Problem Solving; D011615:Psychotherapy, Group; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D016037:Single-Blind Method; D012917:Social Adjustment; D016896:Treatment Outcome
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