Enhancing Assertive Community Treatment With Cognitive Behavioral Social Skills Training for Schizophrenia: II. Ecological Momentary Assessment Outcomes in a Pragmatic Randomized-Controlled Trial

Background and Hypothesis Individuals with schizophrenia experience severe impairments in everyday functioning. Cognitive behavioral social skills training (CBSST) has demonstrated moderate effects on functional outcomes in controlled trials. This study examined whether CBSST, when integrated into assertive community treatment (ACT), improves daily-life functioning as assessed by ecological momentary assessment (EMA). Study Design This was a secondary analysis of a pragmatic randomized controlled trial involving 155 participants diagnosed with schizophrenia or schizoaffective disorder. Participants were randomized to receive either ACT + CBSST (n = 75) or ACT alone (n = 80). Assessments occurred at baseline, 9 months (n = 100), and 18 months (n = 67) to capture real-time reports of “productive” and “non-productive” activities. The primary outcome was productive activity. Secondary outcomes included non-productive activity, the productive/non-productive activity ratio, anhedonia, and defeatist beliefs. Linear mixed models were used to test for differential changes over time between groups. Study Results Although the groups differed at baseline, the ACT + CBSST group showed significantly greater improvements over time relative to the ACT group in productive activities, the productive/non-productive activity ratio, and in reductions in anhedonia and defeatist beliefs. However, between-group differences at follow-up were not statistically significant. Conclusions Adding CBSST to ACT may yield greater improvements in daily-life functioning than ACT alone. While these results support the potential added value of integrating CBSST into routine care, further research is needed to confirm its superiority. Together with the companion report from this study, these findings suggest that EMA may offer a sensitive approach for detecting changes in real-world functioning in clinical trials. Trial Registration: ClinicalTrials.gov (NCT02254733; https://clinicaltrials.gov/)