Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms

Abstract

Background Motivational negative symptoms hinder quality of life and daily functioning of individuals with schizophrenia spectrum disorders. A recently developed intervention, Switch, has shown promising effects on negative symptoms and functional outcomes. Switch targets multiple cognitive, emotional and behavioural processes associated with motivation and goal directed behaviours. We aimed to investigate its effects on motivation and associated processes in a naturalistic setting, and to explore the dynamics between the processes. Methods We used a single case approach (n = 3), with a pre-post and follow-up assessment design, which also included ambulatory assessments (experience sampling method, ESM; and step count). We computed autoregressive lag 1 models to evaluate the effects of the intervention on daily motivation levels and related processes, descriptive pie-charts, and vector autoregressive modelling to reveal the dynamics of the processes over time. Results The intervention was beneficial for each participant according to traditional evaluations of motivational negative symptoms, apathy, daily functioning and quality of life. The effects on the ESM variables revealed distinct outcomes for each individual. The dynamics between the various processes differed between participants, and fluctuated within participants (when comparing baseline, intervention phase, and follow-up). Conclusions This study used an innovative approach to look at the effectiveness of an intervention. The intervention seems to lead to meaningful improvements in motivational negative symptoms and functional outcomes. The mechanisms of change need to be further investigated. Trial registration number ClinicalTrials.gov, NCT04325100. Registered 27 March 27, 2020 -retrospectively registered. Reporting Guidelines from the Transparent Reporting of Evaluations with Non-randomized Designs (TREND) statement were followed.

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

“…This study followed the same evaluation protocol as the one used in a previous study that evaluated the Switch intervention in individual sessions (see Thonon, Van Aubel et al, 2020). In short, three types of evaluation measures were used: traditional assessment scales of motivational deficits, apathy, quality of life and daily functioning; ambulatory assessment that included ESM questionnaires to evaluate the processes related to motivation and goal-directed behaviors; and actigraphy to measure step-count, as a proxy measure of motivational negative symptoms (Kluge et al, 2018).…”

“…The ESM questionnaire (see Thonon, Van Aubel et al, 2020) included 14 questions, plus three supplementary (branched) questions, that is, which appeared depending on participant's answer to previous questions. Variables measured via the questionnaire included Activity's meaning (how important is the activity), Motivation, Wanting to give up, Effort, Energy, Mood, Confidence, Discouraging thoughts, Present enjoyment, Projection into the future, Reminiscence.…”

“…The ESM questionnaire (see Thonon, van Aubel, et al, 2020) Participants were provided with an activity band (MiBand 3, Xiaomi) which they had to wear at all times, during the baseline, intervention, post-measurement, and follow-up phases of the study. The total amount of steps per day was collected through the Mi Fit app.…”

“…The Switch intervention was created based on a model of motivation and goal directed behaviours and followed the same principles as previously described (Thonon, Levaux, et al, 2020;Thonon, Van Aubel, et al, 2020). Furthermore, different principles of learning were adhered to in order to enhance the potential of the intervention in the group format.…”

“…In the past few years, however, new interventions that specifically target motivational deficits have been developed and tested (e.g., Favrod et al, 2019; Thonon, Levaux, et al, 2020). For example, our research group has found promising results from the “Switch” intervention provided in individual sessions, with specific improvements on motivational negative symptoms and functional outcomes (Thonon, Levaux, et al, 2020), as well as particular effects on daily life measures of savoring abilities, cognition (e.g., discouraging beliefs), and the engagement in meaningful and effortful activities (Thonon, Van Aubel, et al, 2020).…”