Psychological treatments for negative symptoms.

Psychological training programmes for patients presenting with negative symptoms have developed from an environmentally based approach (the token economy) through interactive programmes (social and life skills training) to programmes which focus directly on facilitating and enhancing the cognitive skills of the individual patient (self-instructional training and problem-solving). It is clear that this sequence of research has generated a range of approaches which are probably undervalued in the management of patients suffering from negative symptoms. Problems remain with respect to the generalisation of some procedures but it seems likely that these problems may be overcome by tailoring treatments to the particular cognitive deficits of different groups of patients. This will obviously require a detailed analysis of the structure of negative symptoms and the deficits associated with them. The distinction between difficulties in initiating behavior and difficulties in organising behaviour may prove to be particularly important in this respect.