Positive Emotion Upregulation for Schizophrenia
Recruiting in Palo Alto (17 mi)
Age: 18 - 65
Sex: Any
Travel: May be covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Rutgers, The State University of New Jersey
No Placebo Group
Trial Summary
What is the purpose of this trial?The goal of this clinical trial is to learn if attention and ways of thinking impact decision-making and brain processes related to decision-making in people with schizophrenia or schizoaffective disorder relative to people without either condition. It will also learn how brain functioning during decision-making relates to real-world decisions made during daily life. The main questions it aims to answer are:
* Does paying attention to specific information impact decision-making and brain processes?
* Does thinking in a certain way according to specific 'thinking strategies' improve brain processes related to decision-making?
* Does brain functioning during decision-making relate to real-world choices to engage in activities?
Researchers will compare brain functioning and decision-making on computer tasks of gambling after participants have been trained to use a positive thinking strategy. They will compare what is different in the brain and behavior when participants use this strategy and when they do not. Participants will also answer brief surveys about activities and feelings for a week in their daily lives.
Participants will:
* Complete several hours of clinical interviewing, cognitive tests, and surveys of about symptoms, experiences, and personality
* Complete computer tasks about gambling decisions during MRI brain scanning and while having their visual attention measured using eye-tracking
* Complete brief surveys about their activities and feelings 5 times a day for 1 week using a cell phone. Each survey only take several minutes.
How does the Positive Emotion Upregulation treatment differ from other treatments for schizophrenia?
The Positive Emotion Upregulation treatment, also known as the Positive Emotions Program for Schizophrenia (PEPS), is unique because it focuses on enhancing positive emotions and developing positive performance beliefs, which helps reduce negative symptoms like anhedonia (inability to feel pleasure) and apathy. Unlike traditional drug treatments, PEPS involves emotion regulation strategy training through sessions, leading to improved social functioning and reduced negative symptoms.
36789Is Positive Emotion Upregulation safe for humans?
The Positive Emotions Program for Schizophrenia (PEPS) has been tested in studies with participants who completed all sessions without reported safety issues, suggesting it is generally safe for humans.
12589Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. However, it mentions that currently untreated or unstable psychiatric and medical conditions are exclusion criteria, which might imply that stable medication use is allowed.
What data supports the effectiveness of the treatment Positive Emotion Upregulation for schizophrenia?
Research shows that the Positive Emotions Program for Schizophrenia (PEPS), which is similar to Positive Emotion Upregulation, effectively reduces negative symptoms like anhedonia (inability to feel pleasure) and apathy, and improves social functioning in people with schizophrenia.
456910Eligibility Criteria
This trial is for individuals with schizophrenia or schizoaffective disorder, as well as healthy controls without these conditions. Participants will undergo clinical interviews, cognitive tests, and surveys. They must be willing to complete computer tasks during MRI scans and eye-tracking sessions, and answer brief surveys on a cell phone multiple times a day for one week.Inclusion Criteria
I understand tasks well and have an IQ over 70.
I am between 18 and 45 years old.
Exclusion Criteria
I have never undergone electroconvulsive therapy.
I have never had seizures or epilepsy.
I have never had a severe head injury or brain trauma.
I do not have any untreated or unstable mental or physical health conditions.
Participant Groups
The study investigates how attention and positive thinking strategies affect decision-making and brain activity in people with schizophrenia compared to those without it. It examines the impact of these strategies on gambling decisions during computer tasks under MRI observation and real-world choices via daily surveys.
1Treatment groups
Experimental Treatment
Group I: Single ArmExperimental Treatment1 Intervention
There is only 1 arm in this study. In this arm of the study, participants are instructed to implement a cognitive strategy (i.e., way of thinking) during 1/2 of the trials of a behavioral, gambling task. On the other 1/2 of the trials they behave naturally without implementing the cognitive strategy.
Find A Clinic Near You
Research locations nearbySelect from list below to view details:
Center for Advanced Human Brain Imaging ResearchPiscataway, NJ
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Who is running the clinical trial?
Rutgers, The State University of New JerseyLead Sponsor
National Institute of Mental Health (NIMH)Collaborator
References
Positive and negative symptoms in schizophrenia. [2019]Negative and positive symptoms were determined for 46 drug-free patients who met Research Diagnostic Criteria (RDC) and/or Feighner criteria for schizophrenia. A modified version of the Scale for the Assessment of Negative Symptoms (SANS) was completed for each patient based on items from the Schedule for Affective Disorders and Schizophrenia (SADS) and other scales. Positive symptoms were scored from the SADS as well as from the following four diagnostic systems: RDC, Schneider's first-rank symptoms, the 12-point Flexible system, and Langfeldt's criteria for poor prognosis schizophrenia. For all patients, there was no correlation of negative symptoms and positive symptoms defined by any diagnostic system. Within the paranoid and undifferentiated subtypes, there was a positive correlation of positive and negative symptoms. Patients moving from stable to exacerbated states had an increase in both positive and negative symptoms, and patients with a poor history of treatment response had both more positive and more negative symptoms than responsive patients in a stable state. These results do not support the view that subgroups of patients have predominantly either negative or positive symptoms.
New pharmacotherapeutic modalities for negative symptoms in psychosis. [2019]Negative symptoms in schizophrenia comprise a psychopathologic and pathophysiologic syndrome which is absent from normal mental function. Renewed interest in negative symptoms has led to the development of better measuring instruments, among which is the Positive And Negative Syndrome Scale (PANSS), which provides a way of measuring and reporting positive and negative symptoms in a balanced and convenient form. A number of strategies are being investigated for treating negative symptoms. Dopamine agonists such as levodopa, amphetamines and bromocriptine have been shown to produce improvements in negative symptoms, although good, well-controlled clinical trials are lacking. Partial dopamine agonists, such as MAR 327, are also currently under investigation and results are expected soon. Tricyclic, selective serotonin reuptake inhibitors and monoamine oxidase antidepressants appear to be able to modify negative symptoms in schizophrenia, although, once again, carefully designed trials are needed. Modification of GABAergic transmission has shown little promise, but the use of glycine to augment transmission at N-methyl-D-aspartate (NMDA) synapses suggests that the strategy may be beneficial. These results also imply that altered glutamate receptor function may be partly responsible for negative symptoms. One strategy that has been shown to have a beneficial effect against negative symptoms is combined serotonin/dopamine antagonism. Clozapine was found to have this profile after its introduction, and the recently introduced antipsychotic, risperidone was developed intentionally to be a combined 5-HT2/D2 antagonist. Both risperidone and clozapine have been shown to be effective against negative symptoms. One problem associated with the assessment of drug effects on negative symptoms, however, is that drugs can act on both primary and secondary negative symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
Altered amygdala activation in schizophrenia patients during emotion processing. [2016]Dysfunctional emotion processing in patients suffering from schizophrenia is a prominent clinical feature of great importance for social functioning and subjective well-being. The neurobiological underpinnings are still poorly understood. Here we investigated a large sample of schizophrenia patients and matched healthy controls with an event-related fMRI task during emotion processing using emotional pictures from the International Affective Picture System (IAPS). Schizophrenia patients revealed stronger right amygdala activation during negative and attenuated response during positive affective picture processing compared to healthy controls. Further analysis indicated that medication status influences activation of the ventral anterior cingulate cortex during negative affective stimuli processing. These results might represent a correlate of altered emotional experience in schizophrenia patients who are known to report less positive and more negative affective states in daily life situations.
[The effect of two predictors' interaction on short- and long-term treatment outcomes of schizophrenia]. [2019]To monitor the effect of interaction of duration of untreated psychosis (DUP) and expressed emotion (EE) on treatment outcomes in schizophrenia.
Development of the Positive Emotions Program for Schizophrenia: An Intervention to Improve Pleasure and Motivation in Schizophrenia. [2020]The efficacy of drug-based treatments and psychological interventions on the primary negative symptoms of schizophrenia remains limited. Recent literature has distinguished negative symptoms associated with a diminished capacity to experience, from those associated with a limited capacity for expression. The positive emotions program for schizophrenia (PEPS) is a new method that specifically aims to reduce the syndrome of a diminished capacity to experience.
THE POSITIVITY OFFSET THEORY OF ANHEDONIA IN SCHIZOPHRENIA. [2020]Prior studies have concluded that schizophrenia patients are not anhedonic because they do not report reduced experience of positive emotion to pleasant stimuli. The current study challenged this view by applying quantitative methods validated in the Evaluative Space Model of emotional experience to test the hypothesis that schizophrenia patients evidence a reduction in the normative "positivity offset" (i.e., the tendency to experience higher levels of positive than negative emotional output when stimulus input is absent or weak). Participants included 76 schizophrenia patients and 60 healthy controls who completed an emotional experience task that required reporting the level of positive emotion, negative emotion, and arousal to photographs. Results indicated that although schizophrenia patients evidenced intact capacity to experience positive emotion at high levels of stimulus input, they displayed a diminished positivity offset. Reductions in the positivity offset may underlie volitional disturbance, limiting approach behaviors toward novel stimuli in neutral environments.
Neuroleptic-free youth at ultrahigh risk for psychosis evidence diminished emotion reactivity that is predicted by depression and anxiety. [2018]Although abnormalities in emotional response have long been considered a core feature of the chronic phase of schizophrenia, few investigations have examined emotional response in individuals at ultrahigh-risk (UHR) for psychosis. We investigated whether neuroleptic-free UHR (n=29) and healthy control (n=32) participants differed in emotional reactivity and emotion regulation on a laboratory-based task that required reporting levels of positive and negative affect to pleasant, unpleasant, and neutral stimuli. Results indicated that the UHR group evidenced reduced emotional reactivity, including decreased positive emotion to pleasant stimuli and decreased negative emotion to unpleasant stimuli. Furthermore, within the UHR group, attenuated positive emotion to pleasant stimuli was associated with greater severity of depression and anxiety. There were no group differences in self-reported emotion regulation effectiveness to unpleasant or pleasant stimuli. Findings suggest that UHR youth display a profile of emotional experience abnormalities that differs from the chronic phase of illness, which can be characterized as reduced positive emotion reactivity to pleasant stimuli (i.e., anhedonia) that may be driven by mood and anxiety symptoms.
Improving Pleasure and Motivation in Schizophrenia: A Randomized Controlled Clinical Trial. [2020]Negative symptoms are frequent in patients with schizophrenia and are associated with marked impairments in social functioning. The efficacy of drug-based treatments and psychological interventions on primary negative symptoms remains limited. The Positive Emotions Programme for Schizophrenia (PEPS) is designed to improve pleasure and motivation in schizophrenia patients by targeting emotion regulation and cognitive skills relevant to apathy and anhedonia. The main hypothesis of this study is that patients who attend 8 one-hour sessions of PEPS and treatment as usual (TAU) will have lower total apathy-avolition and anhedonia-asociality composite scores on the Scale for the Assessment of Negative Symptoms (SANS) than patients who attend only TAU.
Impact of Positive Emotion Regulation Training on Negative Symptoms and Social Functioning in Schizophrenia: A Field Test. [2020]Background: The poor efficacy of drug or psychological treatments on the primary negative symptoms of schizophrenia has led to the development of new interventions. The Positive Emotions Program for Schizophrenia (PEPS) is an emotion regulation strategy training that aims to intensify positive emotions and develop positive performance beliefs. A randomized controlled trial showed that PEPS is effective in reducing the composite score of the reduction of experience syndrome (anhedonia and apathy). The present study is designed to evaluate its feasibility in natural conditions to measure external validity of PEPS. Materials and Methods: Twenty-one participants recruited through the French national network of expert centers followed eight sessions of PEPS and were assessed pre- and posttest with the Scale for Assessment of Negative Symptoms (SANS) and the Personal and Social Performance (PSP). The scales of the SANS were divided into a composite score of the reduction of the ability to experience and a composite score of the reduction of expression. Results: All participants followed the 8 sessions of PEPS, and both composite scores were significantly and clinically improved at posttest. Social functioning assessed with the PSP was also improved. Conclusions: This field test shows that participation in PEPS is accompanied by a reduction of negative symptoms and an improvement of social functioning. Both negative syndromes, reduction of expression and reduction of experience, are improved. Participants are younger than those in previous studies, which may explain this unexpected result. However, this calls for a controlled study with younger participants.
The impact of emotion dysregulation on positive and negative symptoms in schizophrenia spectrum disorders: A systematic review. [2021]Accumulating research evidence supports the role of emotion dysregulation in the etiology of schizophrenia spectrum disorders. The present systematic review synthesized the extant literature and aimed to determine the effects of cognitive emotion regulation strategies and global emotion dysregulation on positive and negative symptoms in schizophrenia spectrum disorders.