Les symptômes négatifs tels que l’apathie, l’anhédonie ou l’émoussement des affects ont des effets délétères sur la qualité de vie et le devenir fonctionnel de l’individu. Aucun traitement, qu’il soit pharmacologique, via les techniques de stimulations transcrâniennes, ou psychologique, n’a clairement démontré une efficacité quant à leur prise en charge. Toutefois, des données récentes suggèrent que certaines approches cognitivo-comportementales pourraient avoir des effets positifs dans l’amélioration des symptômes négatifs. L’objectif de cet article est de présenter ces prises en charge, en détaillant les modèles théoriques sous-jacents ainsi que les preuves empiriques mettant en évidence leur efficacité. Ces interventions seront présentées selon différents axes de prise en charge : cognitif, comportemental, émotionnel et motivationnel. Bien que les traitements TCC soient prometteurs pour le traitement des symptômes négatifs, certaines limitations existent, notamment concernant la conceptualisation et la prise en compte de la complexité des différents symptômes négatifs, ainsi que le manque de modèles psychologiques intégratifs proposés dans la littérature. Comme recommandation clinique, il nous apparaît important de souligner qu’une formulation psychologique fonctionnelle de chaque symptôme négatif est nécessaire avant toute prise en charge, afin de déterminer l’influence et les interactions entre les différents facteurs psychologiques, biologiques et environnementaux à l’œuvre. Nous fournirons dans cet article un exemple et un modèle d’analyse fonctionnelle des symptômes négatifs. Par ailleurs, une approche intégrative et individualisée, mêlant réhabilitation neuropsychologique, habiletés sociales et thérapie cognitive, nous semble être particulièrement prometteuse pour la prise en charge des symptômes négatifs dans la schizophrénie.

Negative symptoms, such as a lack of motivation, anhedonia or poverty of speech, constitute a major difficulty in schizophrenia. Indeed, these symptoms have deleterious effects on quality of life and functional outcome of individuals with schizophrenia. However, although multiple interventions have been the subject of investigation, to date, including pharmacological strategies, brain stimulation, physical activity and psychosocial interventions, none reached the threshold for clinically significant improvement. Therefore the treatment of negative symptoms represents a major challenge for mental health care in schizophrenia. If recent advances in CBT have clearly shown their efficiency on positive symptom and are now recommended as first line treatment for schizophrenia, CBT trials mainly focused on positive symptoms and investigated change in negative symptoms only as a secondary outcome. The aim of this article is to describe and to provide a brief description of the different CBT interventions targeting negative symptoms, the theoretical models on which they are based and empirical evidence highlighting their effectiveness. Of the interventions reviewed, cognitive interventions, behavioral activations and social skills training appear to have the most empirical support. The cognitive approach suggests the role of negative cognitions, or dysfunctional attitudes in the maintenance and exacerbation of behaviors is associated with negative symptoms in schizophrenia (Rector et. al., 2005 ; Beck et. al., 2009). Consequently, cognitive therapy interventions focus primarily on changing generalized beliefs that prevent patients with prominent negative symptoms from goal attainment. Clinical trials showed improvements on apathy, avolition, and functioning but not on anhedonia, blunted affects, and alogia suggesting that cognitive models of negative symptoms would be valid for the dimension avolition but less for the dimension diminished expression. Regarding behavioral interventions, there is now clear evidence that social skills training should be routinely recommended in treatment guidelines for psychological intervention targeting negative symptoms as a whole (Turner et al., 2018). However, its distinct impact on the two main dimensions of negative symptoms is still unknown. Behavioral activation appears particularly promising in the treatment of negative symptoms secondary to depression. Although psychosocial treatments show promise for the treatment of negative symptoms, certain limitations exist, particularly regarding the conceptualization of the different negative symptoms and the lack of integrative psychological models proposed in the literature. However, cognitive and behavioral therapy offer interesting possibilities for the improvement of negative symptomatology, particularly recovery-oriented cognitive therapy, focusing on dysfunctional beliefs, and adaptations to circumvent neurocognitive and engagement difficulties. As recommendations, we emphasize the need for a detailed and integrative functional analysis of each negative symptom before any interventions in order to understand the influence of the different environmental factors and psychological processes. Specific CBT interventions have utility in ameliorating negative symptoms in psychosis but validated and integrative psychological models need to be developed to increase their effectiveness.