The effectiveness of behavioral activation for persons with a psychotic disorder and negative symptoms: a multicentre randomized controlled trial

Negative symptoms are highly prevalent in psychotic disorders and have been associated with poor prognosis, lower social functioning and reduced quality of life. Despite the attention these symptoms receive, so far no evident treatment strategies are available. Major depression shares several features with negative symptoms: loss of goal directed behavior and amotivation. Moreover, anticipatory pleasure, or the ability to experience pleasure related to future activities, is diminished in both. Behavioral activation (BA) is a well-researched and effective treatment strategy for depression. BA focuses on stimulating behavior, in which therapist and patient cooperatively analyse potential rewarding activities and plan these activities subsequently. Recent pilot data showed that behavioral activation might be effective in patients with negative symptoms in schizophrenia.
Primary objective of the study is to investigate whether Behavioral Activation for Negative Symptoms (BANS) improves negative symptoms. Secondary objective is to investigate whether effects of BANS on negative symptoms is mediated or moderated by the ability to experience anticipatory pleasure. We also want to examine whether improvement in negative symptoms is associated with frontal hypo-activity. Finally, we want to examine whether Behavioral Activation for Negative Symptoms leads to better social functioning, improved quality of life and objective increase in activities.

T0: baseline assessment
T1: post treatment assessment (15 weeks)
T2: follow-up assessment (6 months)

Participants in the treatment condition will receive the Behavioral Activation for Negative Symptoms (BANS). This behavioral therapy focuses on regaining activities. Increased pleasurable activities and associated reward, is expected to diminish apathy. The therapy will consist of 15 hours of individual therapy, carried out by a nurse. In this therapy, the activity level of the patient increases gradually, with activities that are in accordance with patients personal life values.
Participants in the control group will receive 15 weekly individual sessions of befriending, carried out by a nurse.