Several articles have now demonstrated that the neurocognitive deficits are not causally related to negative symptoms (Hughes et al, 2002; Bell & Mishara, 2006; Harvey et al, 2006; Möller, 2007). Thus, neurocognitive deficits cannot account for the negative symptoms. However, as has been demonstrated, defeatist attitudes do lead to both cognitive impairment and negative symptoms.
Our current approach: The role of social stimulation underlines two articles from Japan (Oshima et al, 2003; Oshima et al, 2005), which show, in a nationwide study, two national surveys from Japan indicate that the absence of social stimulation, in the various hospitals, is a major factor in the production and maintenance of negative symptoms. If the absence of stimulation leads to negative symptoms, then logically, the provision of social stimulation should mitigate the negative symptoms. This is where we come in. Although we have not as of yet collected empirical data to support this, we have found that the introduction of a socially stimulating environment, plus the engagement of the individuals either in therapy or in other person-to-person contact, does make a noticeable impact. Patients who are totally socially withdrawn, spending most of their time lying in bed in their rooms become animated, etc. (as I have mentioned previously). The next step is to be able to demonstrate empirically that this type of social stimulation has more than just a transient effect.
From the above, it would appear that the mechanism is as follows: the individuals do not experience stimulation, and therefore they regress to the negative symptom state; however, not everybody, in fact, the majority of the people has enough innate motivation, so that, even under conditions under a lack of stimulation, they get up, walk around, make phone calls, etc (Cella, Edwards, & Wykes, 2016). So, what differentiates the sub-stimulated individuals in hospitals from ordinary people in the community? The difference appears to lie in the fact that the hospitalized individuals, and in fact, all those with negative symptoms, have defeatist/asocial attitudes. These attitudes tend to activate negative motivations, such as avoidance or desire to retreat. On the other hand, the positive adaptive motives are deactivated by negative beliefs, such as “There’s no sense in trying, I’m only going to fail.” In the negative symptoms the positive beliefs are deactivated (motivation, pleasure-seeking, social seeking, etc.). This leads to amotivation, anhedonia, and asociality. The factor 2 symptoms also represent an (involuntary) suppression of normal functions: speaking, facial expression, and communicative motor activities. In addition, defeatist beliefs lead to active avoidance of goal-directed activity and social relations.
To sum it up, our job is a) to stimulate the positive functions, and b) to undercut the dysfunctional attitudes. We accomplish this through experiential learning: the individuals learn that they can enjoy and participate in meaningful activities, and at the same time, they learn that they have the energy to do this and can succeed in participating in these activities. In summary, as I have indicated before, the activation of the dysfunctional attitudes triggers avoidance and withdrawal, whereas stimulation stimulates adaptation and activity. When planting a garden, you need to provide the right soil and nourishment, and at the same time remove the weeds.
Bell, M. D., & Mishara, A. L. (2006). Does negative symptom change relate to neurocognitive change in schizophrenia? Implications for targeted treatments. Schizophrenia Research, 81(1), 17-27.
Cell, M., Edward, C., & Wykes, T. (2016) A question of time: A study of time use in people with schizophrenia. Schizophrenia Research176(2-3), 480-484.
Harvey, P. D., Koren, D., Reichenberg, A., & Bowie, C. R. (2006). Negative symptoms and cognitive deficits: what is the nature of their relationship?. Schizophrenia Bulletin, 32(2), 250-258.
Hughes, C., Kumari, V., Soni, W., Das, M., Binneman, B., Drozd, S., … & Sharma, T. (2002). Longitudinal study of symptoms and cognitive function in chronic schizophrenia. Schizophrenia research, 59(2), 137-146.
Möller, H. J. (2007). Clinical evaluation of negative symptoms in schizophrenia. European Psychiatry,