A Group Intervention for Motivational Deficits: Preliminary Investigation of a Blended Care Approach Using Ambulatory Assessment

Abstract

Motivational deficits are an important predictor of functional outcomes in individuals with a serious mental illness such as schizophrenia and mood spectrum disorders. The aim of the present study was to explore the feasibility, acceptability, and preliminary efficacy of a group version of “Switch,” an intervention that targets motivational deficits, enriched with an ecological momentary intervention (EMI) approach (i.e., prompts on the participants’ smartphone to encourage the use of trained strategies in their daily life). Eight participants with schizophrenia, schizoaffective, or major depressive disorder entered the study. The intervention took place twice a week for 2 months. Assessment measures included traditional evaluations of motivational negative symptoms, apathy, quality of life and daily functioning, in addition to ambulatory assessment methods strategies, including the experience sampling method (ESM) to assess motivation and related processes, and actigraphy (daily step-count) to assess participants’ activity level. Four participants were considered as non-completers (followed less than 2/3 of the program) and four were considered as completers. Only completers presented a decrease in amotivation/apathy and an improvement in functional outcomes after the intervention and at follow-up. Furthermore, mixed-effects ESM models showed significant interaction effects on multiple processes related to motivation, indicating improvements only in completers: heightened motivation, increased engagement in meaningful and effortful activities, better mood, higher levels of confidence, increased frequency of projection into the future (pleasure anticipation), and of positive reminiscence. This preliminary investigation provides evidence that Switch may be an effective intervention, with specific effects on motivation and associated processes.

Motivational disturbances in rodent models of neuropsychiatric disorders

“…For example, in individuals with schizophrenia, apathy scores were more strongly linked to functional impairment than cognitive deficits ( Konstantakopoulos et al, 2011 ). Therapeutic group interventions targeting motivational deficits in individuals affected by schizophrenia or major depression have also proven effective in alleviating the disease burden, leading to positive outcomes such as increased engagement in meaningful activities, higher levels of confidence, and better mood ( Thonon et al, 2021 ).…”

A systematic review of the application of experience sampling methodology to measure anhedonia in psychiatry and mental health

“…Another school-based study in a universal sample of adolescents did not find beneficial and long-lasting effects of Mindfulness Therapy on mental health, including momentary anhedonia (Bogaert et al, 2023). Five studies examined interventions in adult samples with depression, anxiety, and/or schizophrenia (Fisher et al, 2019;Geschwind et al, 2011;Heininga et al, 2023;Thonon et al, 2022b;Thonon et al, 2020). Findings were generally positive.…”

“…for anticipatory anhedonia (Luther et al, 2023a). For anticipatory anhedonia, most studies (n = 25, 78.13%) assessed expected pleasure from future events; relatively few studies (n = 7, 21.88%) assessed current pleasure experienced in anticipation of future pleasant events (Bakker et al, 2019;Bakker et al, 2017;Webb et al, 2022), including looking forward to a future event (Kwapil et al, 2020;Thonon et al, 2022a;Thonon et al, 2022b;Thonon et al, 2020). Just over 30% (n = 29) of studies included both consummatory and anticipatory anhedonia.…”

“…Findings were generally positive. For example, Mindfulness Based Cognitive Therapy was associated with increases in positive affect, activity pleasantness, and reward experience in adults with remitted depression compared to the control group (Geschwind et al, 2011), and a novel blended psychological intervention targeting motivational processes improved pleasure anticipation in adults with schizophrenia and depression (for those who completed the intervention vs those who did not) (Thonon et al, 2022b).…”