Intrinsic motivation as a mediator between metacognition deficits and impaired functioning in psychosis

Luther, Lauren; Firmin, Ruth L.; Vohs, Jenifer L.; Buck, Kelly D.; Rand, Kevin L.; Lysaker, Paul H.

doi:10.1111/bjc.12104

Cited by 35 publications

(31 citation statements)

References 83 publications

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“…These findings are consistent with prior analyses and studies that identified whether on average, higher levels of metacognition lead to higher levels of motivation in people with schizophrenia (Luther et al, 2016a; Luther et al, 2016b; Tas et al, 2012; Vohs et al, 2014). Notably, our findings build on these prior studies by identifying the specific level of metacognition necessary to enable high motivation.…”

Section: Discussionsupporting

confidence: 91%

“…Included participants had a mean age of 48.67 ( SD = 9.90) and were primarily male ( n = 153, 87%) and African American ( n = 97, 55%) with an average of 12.74 ( SD = 2.12 ) years of education. Of note, although we have previously presented regression-based analyses with metacognition and motivation (Luther et al, 2016b), this is the first study to explicitly test whether specific levels of metacognition are needed for motivation to emerge.…”

Section: Methodsmentioning

confidence: 99%

“…To date, studies have established cross-sectional associations between increased metacognition and motivation (Luther et al, 2016a; Tas et al, 2012). Increased motivation has also been found to mediate the relationship between greater metacognition and functioning in people with schizophrenia spectrum disorders (Luther et al, 2016b). Further, small longitudinal studies have identified that greater metacognition is a significant predictor of improved motivation over six months (Luther et al, 2016a; Vohs et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Metacognition Is Necessary for the Emergence of Motivation in People With Schizophrenia Spectrum Disorders

Luther¹,

Bonfils²,

Firmin³

et al. 2017

J Nerv Ment Dis

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Metacognition deficits are a putative cause of reduced motivation in people with schizophrenia spectrum disorders. However, it is unclear whether certain levels of metacognition are necessary for motivation to emerge. This study used a Necessary Condition Analysis (NCA) to test whether metacognition was necessary for the presence of motivation and to identify the minimum level of metacognition necessary for high motivation to be possible in people with schizophrenia spectrum disorders (N=175). Participants completed clinician-rated measures of metacognition and motivation. NCA revealed that metacognition is a necessary condition for motivation and that high levels of motivation were only possible, although not guaranteed, when at least a basic level of metacognition was present. Findings suggest that metacognition is a necessary building block for the development of motivation. Results suggest that targeting metacognition may be essential for improving motivation among people with schizophrenia spectrum disorders who do not meet this metacognition threshold.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Metacognition Is Necessary for the Emergence of Motivation in People With Schizophrenia Spectrum Disorders

Luther¹,

Bonfils²,

Firmin³

et al. 2017

J Nerv Ment Dis

Self Cite

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“…Previous work, including our own, has shown significant interrelationships between motivation and cognitive test performance (Choi, Choi, Felice Reddy, & Fiszdon, 2014;Fervaha, Siddiqui, Foussias, Agid, & Remington, 2015;Fervaha, Zakzanis, et al, 2014;Gard, Fisher, Garrett, Genevsky, & Vinogradov, 2009;Luther, Firmin, Vohs, & Buck, 2016;Nakagami, Xie, Hoe, & Brekke, 2008). Two studies using personality assessments of trait motivation in schizophrenia have, however, failed to find a significant relationship with cognitive performance in this population (Barch et al, 2008;Choi et al, 2012).…”

Section: Discussionmentioning

confidence: 75%

Achievement motivation in early schizophrenia: Relationship with symptoms, cognition and functional outcome

Fervaha

Takeuchi

Foussias

et al. 2017

Early Intervention Psych

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Our results serve to highlight the occurrence and prevalence of motivational deficits in patients with schizophrenia who are in the early stages of their illness. Subjective accounts of motivation in this population were found to be related to important outcomes such as community functioning, highlighting the importance of this domain of illness. Targeting these deficits early in the course of the illness offers the potential to curb potential prospective poor outcomes and sets the stage for recovery.

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“…One possible explanation may be found in case reports detailing a very long course of treatment (32 months; Lysaker et al ., , 5 years; Buck & George, ) where the first changes in understanding the Other are found only after 16 months of psychotherapy. With disturbances in self‐experience frequently considered central to schizophrenia (Andresen, Oades, & Caputi, ; Hasson‐Ohayon, Goldzweig, Lavi‐Rotenberg, Luther, & Lysaker, ; Hasson‐Ohayon et al ., ; Hasson‐Ohayon, Mashiach‐Eizenberg, Lysaker, & Roe, ; Kukla, Lysaker, & Salyers, ; Luther et al ., ), it is possible that increases in Self‐Reflectivity are the first stage of improvement, as it allows one to develop motives for change and take responsibility over the process of changing (Hasson‐Ohayon et al ., ).…”

Section: Discussionmentioning

confidence: 99%

A qualitative evaluation of the effects of Metacognitive Reflection and Insight Therapy: ‘Living more consciously’

Jong

Hasson‐Ohayon

Donkersgoed³

et al. 2018

Psychol Psychother

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Objectives Extensive research showed that one of the major difficulties that people with schizophrenia spectrum disorders are struggling with involves their ability to reflect on their own and others’ mental activities, also defined as metacognition. Several new psychotherapies have been developed to assist patients (re)gain metacognitive capacity, including Metacognitive Reflection and Insight Therapy (MERIT). The current study investigated the client's subjective experience of psychotherapy, to determine whether service users found MERIT effective and whether these gains align with quantitative findings, which processes they considered responsible for these benefits, in which ways participants found MERIT similar or different from other interventions, and whether they experienced non‐desirable factors and outcomes. Design All participants who had participated in a randomized controlled trial investigating the efficacy of MERIT were offered a structured post‐therapy interview by an independent assessor. Fourteen out of 18 (77%) participants, all of whom had completed therapy, responded. Results Most participants (10/14) indicated that they had experienced the therapy as beneficial to their recovery, and in general contributed to their understanding of their own thinking, which maps closely onto the quantitative findings reported elsewhere. They mainly attributed these changes to their own active role in therapy, the intervention letting them vent and self‐express, and forming an alliance with the therapist. Conclusions Participants reports of change map closely onto the quantitative findings from the randomized controlled trial. Findings are discussed in the frameworks of the metacognitive model of psychosis and the integrative intersubjective model of psychotherapy for psychosis emphasizing the role of the clients as active agent of change. Practitioner points The use of a systematic, qualitative interview at the conclusion of therapy may yield important information regarding process and outcome. Analysis of the interview revealed that clients’ perceptions regarding change within themselves closely maps onto quantitative findings. MERIT may not be the appropriate intervention for all clients; some may prefer a more solution‐oriented approach such as CBTp or Metacognition‐Oriented Social Skills training. Self‐expressing with a trained clinician may be therapeutic in itself.

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Intrinsic motivation as a mediator between metacognition deficits and impaired functioning in psychosis

Cited by 35 publications

References 83 publications

Metacognition Is Necessary for the Emergence of Motivation in People With Schizophrenia Spectrum Disorders

Metacognition Is Necessary for the Emergence of Motivation in People With Schizophrenia Spectrum Disorders

Achievement motivation in early schizophrenia: Relationship with symptoms, cognition and functional outcome

A qualitative evaluation of the effects of Metacognitive Reflection and Insight Therapy: ‘Living more consciously’

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