Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2015

Open Access 01-12-2015 | Research article

Positive Emotions Program for Schizophrenia (PEPS): a pilot intervention to reduce anhedonia and apathy

Authors: Jérôme Favrod, Alexandra Nguyen, Caroline Fankhauser, Alban Ismailaj, Jean-David Hasler, Abel Ringuet, Shyhrete Rexhaj, Charles Bonsack

Published in: BMC Psychiatry | Issue 1/2015

Login to get access

Abstract

Background

Recent literature has distinguished the negative symptoms associated with a diminished capacity to experience (apathy, anhedonia) from symptoms associated with a limited capacity for expression (emotional blunting, alogia). The apathy-anhedonia syndrome tends to be associated with a poorer prognosis than the symptoms related to diminished expression. The efficacy of drug-based treatments and psychological interventions for these symptoms in schizophrenia remains limited. There is a clear clinical need for new treatments.

Methods

This pilot study tested the feasibility of a program to reduce anhedonia and apathy in schizophrenia and assessed its impact on 37 participants meeting the ICD-10 criteria for schizophrenia or schizoaffective disorders. Participants were pre- and post-tested using the Scale for the Assessment of Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS). They took part in eight sessions of the Positive Emotions Program for Schizophrenia (PEPS)—an intervention that teaches participants skills to help overcome defeatist thinking and to increase the anticipation and maintenance of positive emotions.

Results

Thirty-one participants completed the program; those who dropped out did not differ from completers. Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes. Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size. Emotional blunting and alogia remain stable during the intervention.

Discussion

Findings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy. However, these findings are limited by the absence of control group and the fact that the rater was not blind to the treatment objectives.

Conclusions

PEPS is a promising intervention to improve anhedonia and apathy which need to be tested further in a controlled study.

Trial registration number

ISRCTN registry ISRCTN74048461, registered 18 may 2015
Literature
1.
Blanchard JJ, Cohen AS. The structure of negative symptoms within schizophrenia: implications for assessment. Schizophr Bull. 2006;32(2):238–45.CrossRefPubMed
2.
Hartmann MN, Hager OM, Reimann AV, Chumbley JR, Kirschner M, Seifritz E, et al. Apathy but not diminished expression in schizophrenia is associated with discounting of monetary rewards by physical effort. Schizophr Bull. 2015;41(2):503–12.CrossRefPubMed
3.
Ventura J, Wood RC, Hellemann GS. Symptom domains and neurocognitive functioning can help differentiate social cognitive processes in schizophrenia: a meta-analysis. Schizophr Bull. 2013;39(1):102–11.CrossRefPubMed
4.
Tsang HW, Leung AY, Chung RC, Bell M, Cheung WM. Review on vocational predictors: a systematic review of predictors of vocational outcomes among individuals with schizophrenia: an update since 1998. Aust N Z J Psychiatry. 2010;44(6):495–504.PubMed
5.
6.
Strauss GP, Horan WP, Kirkpatrick B, Fischer BA, Keller WR, Miski P, et al. Deconstructing negative symptoms of schizophrenia: avolition-apathy and diminished expression clusters predict clinical presentation and functional outcome. J Psychiatr Res. 2013;47(6):783–90.CrossRefPubMedPubMedCentral
7.
Turkington D, Morrison AP. Cognitive therapy for negative symptoms of schizophrenia. Arch Gen Psychiatry. 2012;69(2):119–20.CrossRefPubMed
8.
Kendall T. Treating negative symptoms of schizophrenia, vol. 344. 2012.
9.
Fusar-Poli P, Papanastasiou E, Stahl D, Rocchetti M, Carpenter W, Shergill S, et al. Treatments of Negative Symptoms in Schizophrenia: Meta-Analysis of 168 Randomized Placebo-Controlled Trials. Schizophr Bull. 2014;41:892–9.CrossRefPubMedPubMedCentral
10.
Swartz MS, Perkins DO, Stroup TS, Davis SM, Capuano G, Rosenheck RA, et al. Effects of antipsychotic medications on psychosocial functioning in patients with chronic schizophrenia: findings from the NIMH CATIE study. Am J Psychiatry. 2007;164(3):428–36.CrossRefPubMed
11.
Elis O, Caponigro JM, Kring AM. Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions. Clin Psychol Rev. 2013;33(8):914–28.CrossRefPubMedPubMedCentral
12.
Granholm E, Holden J, Link PC, McQuaid JR, Jeste DV. Randomized controlled trial of cognitive behavioral social skills training for older consumers with schizophrenia: defeatist performance attitudes and functional outcome. Am J Geriatr Psychiatry. 2013;21(3):251–62.CrossRefPubMed
13.
Couture SM, Blanchard JJ, Bennett ME. Negative expectancy appraisals and defeatist performance beliefs and negative symptoms of schizophrenia. Psychiatry Res. 2011;189(1):43–8.CrossRefPubMedPubMedCentral
14.
15.
Buck B, Lysaker PH. Consummatory and anticipatory anhedonia in schizophrenia: stability, and associations with emotional distress and social function over six months. Psychiatry Res. 2013;205(1–2):30–5.CrossRefPubMed
16.
Favrod J, Ernst F, Giuliani F, Bonsack C. Validation française de l'échelle d'expérience temporelle du plaisir. Encéphale. 2009;35(3):241–8.CrossRefPubMed
17.
Gard DE, Kring AM, Gard MG, Horan WP, Green MF. Anhedonia in schizophrenia: distinctions between anticipatory and consummatory pleasure. Schizophr Res. 2007;93(1–3):253–60.CrossRefPubMedPubMedCentral
18.
Raffard S, Esposito F, Boulenger JP, Van der Linden M. Impaired ability to imagine future pleasant events is associated with apathy in schizophrenia. Psychiatry Res. 2013;209(3):393–400.CrossRefPubMed
19.
Foussias G, Remington G. Negative symptoms in schizophrenia: avolition and Occam's razor. Schizophr Bull. 2010;36(2):359–69.CrossRefPubMed
20.
Strauss GP, Morra LF, Sullivan SK, Gold JM. The Role of Low Cognitive Effort and Negative Symptoms in Neuropsychological Impairment in Schizophrenia. Neuropsychology. 2014;29:281–91.
21.
Cassar R, Applegate E, Bentall RP. Poor savouring and low self-efficacy are predictors of anhedonia in patients with schizophrenia spectrum disorders. Psychiatry Res. 2013;210(3):830–4.CrossRefPubMed
22.
Bryant FB. The Process of Savoring: A New Model of Positive Experience. Mahwah, NJ: Lawrence Erlbaum; 2007.
23.
Ursu S, Kring AM, Gard MG, Minzenberg MJ, Yoon JH, Ragland JD, et al. Prefrontal cortical deficits and impaired cognition-emotion interactions in schizophrenia. Am J Psychiatry. 2011;168(3):276–85.CrossRefPubMedPubMedCentral
24.
Kring AM, Germans Gard M, Gard DE. Emotion deficits in schizophrenia: timing matters. J Abnorm Psychol. 2011;120(1):79–87.CrossRefPubMed
25.
Horan WP, Wynn JK, Kring AM, Simons RF, Green MF. Electrophysiological correlates of emotional responding in schizophrenia. J Abnorm Psychol. 2010;119(1):18–30.CrossRefPubMedPubMedCentral
26.
Quoidbach J, Berry EV, Hansenne M, Mikolajczak M. Positive emotion regulation and well-being: Comparing the impact of eight savoring and dampening strategies. Personality and Individual Differ. 2010;49(5):368–73.CrossRef
27.
28.
29.
Moritz S, Veckenstedt R, Andreou C, Bohn F, Hottenrott B, Leighton L, et al. Sustained and "sleeper" effects of group metacognitive training for schizophrenia: a randomized clinical trial. JAMA Psychiat. 2014;71(10):1103–11.CrossRef
30.
Turkington D, Sensky T, Scott J, Barnes TR, Nur U, Siddle R, et al. A randomized controlled trial of cognitive-behavior therapy for persistent symptoms in schizophrenia: a five-year follow-up. Schizophr Res. 2008;98(1–3):1–7.CrossRefPubMed
31.
Johnson DP, Penn DL, Fredrickson BL, Kring AM, Meyer PS, Catalino LI, et al. A pilot study of loving-kindness meditation for the negative symptoms of schizophrenia. Schizophr Res. 2011;129(2–3):137–40.CrossRefPubMed
32.
Favrod J, Giuliani F, Ernst F, Bonsack C. Anticipatory pleasure skills training: a new intervention to reduce anhedonia in schizophrenia. Perspect Psychiatr Care. 2010;46(3):171–81.CrossRefPubMed
33.
Kring AM, Elis O. Emotion deficits in people with schizophrenia. Annu Rev Clin Psychol. 2013;9:409–33.CrossRefPubMed
34.
Favrod J, Rexhaj S, Nguyen A, Cungi C, Bonsack C. Projecting Oneself into the Future, an Intervention for Improving Pleasure in Patients with Anhedonia. In: Ritsner MS, editor. Anhedonia: A Comprehensive Handbook Volume I: Conceptual Issues And Neurobiological Advances. Volume 1. Dordrecht: Springer Science+Business Media; 2014. p. 95–104.CrossRef
35.
Jeste DV, Palmer BW, Appelbaum PS, Golshan S, Glorioso D, Dunn LB, et al. A new brief instrument for assessing decisional capacity for clinical research. Arch Gen Psychiatry. 2007;64(8):966–74.CrossRefPubMed
36.
Lecrubier Y, Boyer P. L'utilisation de la SANS et de la SAPS. Psychiatr Psychobiol. 1987;2:6.
37.
Dollfus S, Langlois S, Assouly-Besse F, Petit M. Depressive symptoms and negative symptoms during schizophrenia]. Encéphale. 1995;21(Spec No 3):23–7.PubMed
38.
Lecrubier Y, Boyer P. Fiche descriptive et traduction française de la SANS. Psychiatrie & Psychobiologie. 1987;2:414–23.
39.
Addington D, Addington J, Maticka-Tyndale E. Assessing depression in schizophrenia: the Calgary Depression Scale. Br J Psychiatry Suppl. 1993;22:39–44.PubMed
40.
Reine G, Bernard D, Auquier P, Le Fur B, Lancon C. [Psychometric properties of French version of the Calgary depression scale for schizophrenics (CDSS)]. Encéphale. 2000;26(1):52–61.PubMed
41.
Bryant FB. Savoring Beliefs Inventory (SBI): A scale for measuring beliefs about savouring. J Ment Health. 2003;12:175–96.CrossRef
42.
Rector NA, Beck AT, Stolar N. The negative symptoms of schizophrenia: a cognitive perspective. Can J Psychiat Rev canadienne de psychiatrie. 2005;50(5):247–57.
43.
Grant PM, Beck AT. Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophr Bull. 2009;35(4):798–806.CrossRefPubMed
44.
Kolb AY, Kolb DA. The Learning Way: Meta-cognitive Aspects of Experiential Learning. Simulation & Gaming. 2008;40(3):297–327.CrossRef
45.
Borenstein M. Effect sizes for continuous data. In: Cooper H, Hedges LV, Valentine JC, editors. The handbook of research synthesis and meta analysis edn. New York: Russell Sage Foundation; 2009.
46.
Hayasaka Y, Purgato M, Magni LR, Ogawa Y, Takeshima N, Cipriani A, et al. Dose equivalents of antidepressants: Evidence-based recommendations from randomized controlled trials. J Affect Disord. 2015;180:179–84.CrossRefPubMed
47.
Schennach R, Obermeier M, Seemuller F, Jager M, Schmauss M, Laux G, et al. Evaluating depressive symptoms in schizophrenia: a psychometric comparison of the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale. Psychopathology. 2012;45(5):276–85.CrossRefPubMed
48.
Villeneuve K, Potvin S, Lesage A, Nicole L. Meta-analysis of rates of drop-out from psychosocial treatment among persons with schizophrenia spectrum disorder. Schizophr Res. 2010;121(1–3):266–70.CrossRefPubMed
49.
Meyer PS, Johnson DP, Parks A, Iwanski C, Penn DL. Positive living: A pilot study of group positive psychotherapy for people with schizophrenia. J Positive Psychol. 2012;7:3.CrossRef
50.
Buckley PF, Miller BJ, Lehrer DS, Castle DJ. Psychiatric comorbidities and schizophrenia. Schizophr Bull. 2009;35(2):383–402.CrossRefPubMed
Metadata
Title
Positive Emotions Program for Schizophrenia (PEPS): a pilot intervention to reduce anhedonia and apathy
Authors
Jérôme Favrod
Alexandra Nguyen
Caroline Fankhauser
Alban Ismailaj
Jean-David Hasler
Abel Ringuet
Shyhrete Rexhaj
Charles Bonsack
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2015
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-015-0610-y

Other articles of this Issue 1/2015

BMC Psychiatry 1/2015 Go to the issue

Study protocol

Study protocol for the randomised controlled trial: Ketamine augmentation of ECT to improve outcomes in depression (Ketamine-ECT study)

Research article

Association of decreased serum brain-derived neurotrophic factor (BDNF) concentrations in early pregnancy with antepartum depression

Study protocol

Parental intimate partner homicide and its consequences for children: protocol for a population-based study

Research article

Depression and anxiety disorder among epileptic people at Amanuel Specialized Mental Hospital, Addis Ababa, Ethiopia

Research article

Psychotic and schizotypal symptoms in non-psychotic patients with obsessive-compulsive disorder

Research article

The impact of age differences in couples on depressive symptoms: evidence from the Korean longitudinal study of aging (2006–2012)