Effectiveness of Non-Face-to-Face Behavioral Activation Treatment for Negative Symptoms of Schizophrenia: A Prospective, Non-Randomized Study

OBJECTIVE: Negative symptoms significantly impact the psychosocial functioning of individuals with schizophrenia and remain difficult to address with pharmacological treatment alone. While effective psychosocial interventions are limited, online psychotherapy has emerged as a cost-effective and accessible alternative to traditional face-to-face therapy. This prospective, non-randomized study aimed to examine the effectiveness of non-face-to-face behavioral activation (BA) treatment of negative symptoms in patients with schizophrenia. METHODS: A total of 98 patients were recruited from community mental health centers, a hospital, and a clinic. Participants were assigned to either a BA treatment group (n=49, 69.4% from community centers) or a treatment-as-usual (TAU) group (n=49, 83.7% from a hospital or clinic). The BA program is conducted weekly for 40 minutes by psychologists. The TAU received case management, supportive psychotherapy, counseling, psychoeducation, and ongoing or planned treatments, excluding elements of cognitive behavior therapy or BA. Positive and Negative Syndrome Scale (PANSS), Clinical Assessment Interview for Negative Symptoms (CAINS), and Behavioral Activation for Depression Scale (BADS) were administered pre- and post-treatment to assess changes in negative symptoms and behavior activation. RESULTS: The BA group's PANSS negative scores improved by 2.94 (95% confidence interval [CI]=1.08-4.80, p=0.002), and CAINS total scores improved by 5.14 (95% CI=2.59-7.70, p