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Schizophrenia Bulletin Advance Access originally published online on July 23, 2009
Schizophrenia Bulletin 2009 35(5):874-883; doi:10.1093/schbul/sbp072
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© The Author 2009. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Social Disinterest Attitudes and Group Cognitive-Behavioral Social Skills Training for Functional Disability in Schizophrenia

Eric Granholm1,2,3, Dror Ben-Zeev4 and Peter C. Link2
2 Veterans Affairs San Diego Healthcare System, San Diego, CA
3 Department of Psychiatry, University of California, San Diego, CA
4 Institute of Psychology, Illinois Institute of Technology, Chicago, IL

1 To whom correspondence should be addressed; Veterans Affairs San Diego Healthcare System (116B), 3350 La Jolla Village Drive, San Diego, CA 92161; tel: 858-552-8585 ext 7768, fax: 858-642-6416, e-mail: egranholm{at}ucsd.edu.

The majority of clinical trials of cognitive-behavioral therapy (CBT) for schizophrenia have used individual therapy to target positive symptoms. Promising results have been found, however, for group CBT interventions and other treatment targets like psychosocial functioning. CBT for functioning in schizophrenia is based on a cognitive model of functional outcome in schizophrenia that incorporates dysfunctional attitudes (eg, social disinterest, defeatist performance beliefs) as mediators between neurocognitive impairment and functional outcome. In this report, 18 clinical trials of CBT for schizophrenia that included measures of psychosocial functioning were reviewed, and two-thirds showed improvements in functioning in CBT. The cognitive model of functional outcome was also tested by examining the relationship between social disinterest attitudes and functional outcome in 79 people with schizophrenia randomized to either group cognitive-behavioral social skills training or a goal-focused supportive contact intervention. Consistent with the cognitive model, lower social disinterest attitudes at baseline and greater reduction in social disinterest during group therapy predicted better functional outcome at end of treatment for both groups. However, the groups did not differ significantly with regard to overall change in social disinterest attitudes during treatment, suggesting that nonspecific social interactions during group therapy can lead to changes in social disinterest, regardless of whether these attitudes are directly targeted by cognitive therapy interventions.

Keywords: functioning / cognitive-behavioral treatment / social disinterest attitudes / group therapy


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