Friday, March 10, 2023

Combined Motivational Interviewing, CBT Found to Increase Motivation in People With Schizophrenia

People with schizophrenia are known to experience motivational deficits (for example, defeatist beliefs and social withdrawal) that can hinder their ability to engage in social and occupational activities. A study published yesterday in The American Journal of Psychiatry found that patients who participated in weekly group therapy sessions that combined motivational interviewing and cognitive-behavioral therapy (CBT) for three months experienced greater improvements in motivation and pleasure than those who did not receive the combined therapy.

“While there have been advances in pharmacological interventions for positive symptoms, they have had a minimal impact on daily functional outcomes for those living with the illness,” wrote L. Felice Reddy, Ph.D., of the Department of Veterans Affairs (VA) VISN 22 Mental Illness Research, Education, and Clinical Center in Los Angeles. “Our results are encouraging for psychosocial interventions aiming to improve quality of life for people with schizophrenia and indicate specific directions for future clinical research.”

For the study, Reddy and colleagues recruited adults with schizophrenia from outpatient clinics at the VA Greater Los Angeles Healthcare System. To be included, patients had to be clinically stable (for example, no inpatient hospitalizations during the three months prior to enrollment) and have moderate to severe levels of motivational negative symptoms (defined as a score of 15 or greater out of 36 on the motivation and pleasure subscale of the Clinical Assessment Interview for Negative Symptoms).

A total of 79 patients with schizophrenia experiencing moderate to severe negative symptoms were randomly assigned to one of two groups who received 12, one-hour weekly group therapy sessions:

  • One group received integrated motivational interviewing (MI) and CBT: These weekly sessions focused on building motivation for goals; establishing a commitment to change; and resolving ambivalence with CBT-based behavioral activation, problem solving, and cognitive restructuring exercises.
  • The other group (control) received mindfulness-based stress reduction therapy: These weekly sessions incorporated short videos, didactics, and experiential practice.

The researchers used several scales to evaluate the participants’ clinical symptoms and functioning three times over the course of the study, which included 12 weeks of active treatment and 12 weeks of follow-up. They also evaluated the participants’ pupillary response, as a biological marker of motivated effort on a cognitive task.

While the MI-CBT group showed significant improvement in motivational negative symptoms after 12 weeks, the active control group did not, Reddy and colleagues reported. At follow-up, participants in the MI-CBT group continued to show improvements in motivation and pleasure from baseline; however, the differences between the MI-CBT and control groups were less than during the active treatment period. Similarly, the MI-CBT group showed an increase in average pupil dilation from baseline to 12 weeks, but the control group did not; however, this effect did not persist over the follow-up period. There were no significant differences between the groups in terms of functioning.

“Evidence for the efficacy of negative symptom interventions is growing, and our results provide additional support,” Reddy and colleagues wrote. “A critical direction for future research is to translate these gains to lasting improvements in daily functioning.”

For related information, see the Psychiatric Services articles “Treatment Implications of Situational Variability in Cognitive and Negative Symptoms of Schizophrenia” and “Six-Month Follow-Up of Recovery-Oriented Cognitive Therapy for Low-Functioning Individuals With Schizophrenia.”

(Image: iStock/SeventyFour)

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