Psychiatric Nurse-Led Assertiveness Therapy: A Standardized Protocol for the Reduction of Violent Behavior in Schizophrenia

Violent behavior (VB) in schizophrenia contributes to rehospitalization in 15% of high-risk cases. Scalable, nurse-led interventions are needed in low-resource settings.
To evaluate the effectiveness of a standardized, psychiatric nurse-led five CBT-based session Assertiveness Training (AT) protocol, delivered alongside Standard Nursing Intervention (SNI), in reducing VB among hospitalized patients with schizophrenia. This quasi-experimental study assigned 60 inpatients to control (SNI) or intervention (SNI + AT). Outcomes were assessed at baseline and Days 5, 11, and 17 using validated instruments for VB ability and symptoms. Mixed ANOVA controlled for baseline differences.
Significant Group × Time interactions were found for Total Ability (F = 45.67, p < 0.001, ηp² = 0.44), Recognizing VB (p < 0.001), Controlling VB (p < 0.001), Behavioral Symptoms (p < 0.001, ηp² = 0.08), Cognitive Symptoms (p = 0.024, ηp² = 0.05), and Affective Symptoms (p = 0.007, ηp² = 0.07). Physiological and social symptoms did not show significant interactions. Regression confirmed direct effects of the intervention on Day 17 outcomes for Total Ability, Recognizing VB, Controlling VB, and Behavioral Symptoms (all p < 0.001), but not for Cognitive Symptoms (p = 0.225). The five-session AT protocol produced robust behavioral improvements. Its modular design supports scalability and task-shifting in resource-limited settings. Integration with emotion-focused approaches may further enhance affective outcomes.