Treatment Implications of Situational Variability in Cognitive and Negative Symptoms of Schizophrenia

Cognitive impairments and negative symptoms in schizophrenia are associated with poorer outcomes and are typically resistant to pharmacological interventions. However, these features can vary dramatically in their level of expression, and they can improve as a function of external context (by providing performance-contingent incentives and a more stimulating environment) and internal context (by challenging defeatist performance beliefs and by reducing stress and improving physical health). This Open Forum briefly reviews some of this evidence for the situational variability of cognitive impairments and negative symptoms in schizophrenia and highlights psychosocial treatments that capitalize on this variability. The authors' goals are to stimulate development and implementation of interventions and to show practitioners how they can achieve more positive outcomes in their clinical work with what is often seen as a hard-to-treat population.