Effects of Behavioral Activation Therapy on Negative Symptoms in Women with Chronic Schizophrenia

 Schizophrenia (SC) is the most severe mental disorder. SC can adversely affect interpersonal interactions, family relationships, and job performance. Using antipsychotic drugs, despite their effectiveness on hallucinations and delusions presents little effect on negative and cognitive symptoms; thus, the need for more effective therapeutic strategies is of significance. Behavioral Activation Therapy (BAT) is a short–term, solution–based intervention that aims to increase activity regularly to help clients access rewards resources and solve their life problems. Accordingly, the present study aimed to investigate the effects of BAT on negative symptoms in women with chronic SC.

 This was a quasi–experimental study with pretest–posttest–follow–up (2–month) and a control group design. The statistical population of the study consisted of all women with chronic SC in Paravar Comprehensive Rehabilitation Center for Chronic Psychiatric Patients in Shahreza City, Iran. in 2019. Of them, 30 volunteer patients were selected by the convenience sampling method. They were then randomly assigned to two groups of experimental and control (n=15/group). The inclusion criteria of the study were a confirmed schizophrenia diagnosis per the centers’ records; ≥2months have elapsed since the patients were treated at the center; having a higher level of education than primary school, and the age range of 20–50 years. The exclusion criteria included the recurrence and exacerbation of symptoms preventing the patient from attending the sessions, absence therefrom >3 sessions, and unwillingness to continue cooperation with the study. The experimental group participated in twelve 90–minute BAT sessions; however, the control group received no intervention. BAT sessions were performed based on the Behavioral Activation Protocol of Lijouz and associates (2011). The study subjects completed the Scale for Assessment of Negative Symptoms (Andreasen, 1989) in 3 stages. The obtained data were analyzed by descriptive statistics (central & dispersion indices, e.g., mean & standard deviation) and inferential statistics, including t–test, Chi–squared test, repeated–measures Analysis of Variance (ANOVA), and LSD post hoc test in SPSS. The significance level of the tests was 0.05.

 There was a significant difference between the 3 measurement stages concerning the superficiality of affect (p=0.003), the lack of pleasure (p=0.003), the lack of speech (p=0.026), infertility (p=0.049), attention deficit (p<0.001), and the total score of negative symptoms (p<0.001); thus, the assumption of homogeneity of responses over time was rejected. The results also revealed that the interaction of time and group respecting the lack of speech (p=0.048), infertility (p=0.003), the lack of pleasure (p=0.017), and the total score of negative symptoms (p=0.007) was significant. Furthermore, concerning the group source, the results indicated a significant difference between the mean scores of the study groups, including affect (p=0.048), the lack of speech (p=0.014), the lack of pleasure (p=0.007), infertility (p<0.001), attention deficit (p<0.001), and the total negative symptom score (p<0.001). Besides, the obtained findings suggested that in the posttest and follow–up stages, compared to the pretest stage, ABT reduced negative symptoms (p<0.001, p<0.001, respectively) and its components, including the superficiality of affect (p>0.001, p=0.005 respectively), attention deficit (p>0.001, p<0.001, respectively), and the lack of pleasure (p=0.003, p=0.005, respectively) in the experimental group. Comparing the posttest and follow–up stages in reducing negative symptoms (p=0.076) and its components, including superficiality of affect (p=0.570), attention deficit (p=0.243), and the lack of pleasure (p=0.077) reveled no significant difference, indicating that the effect of the intervention remained constant over time (at the follow–up stage). Also, there was a significant difference between the pretest and posttest stages in infertility (p=0.026); thus, the treatment intervention reduced the lack of affect in experimental group at posttest; however, no significant difference was observed between the pretest and follow–up stages in this regard (p=0.058). Therefore, the effect of the intervention was not maintained over time.

 Based on the present research findings, BAT effectively reduced negative symptoms in women with SC and its effect remained stable over time.