Mobile Enhancement of Motivation in Schizophrenia: A Pilot Trial of a Personalized Text-Message Intervention for Motivation Deficits

Indiana University-Purdue University Indianapolis (IUPUI)Motivation deficits remain an unmet treatment need in schizophrenia. Recent preclinical research has identified novel mechanisms underlying motivation deficits, namely impaired effort-cost computations and reduced future reward-value representation maintenance, that may serve as more effective treatment targets to improve motivation. The main aim of this study was to test the feasibility and preliminary effectiveness of a translational mechanism-based intervention, MEMS (Mobile Enhancement of Motivation in Schizophrenia), which leverages mobile technology to target these mechanisms with text-messages. Fifty-six participants with a schizophrenia-spectrum disorder were randomized to MEMS (n = 27) or a control condition (n = 29). All participants set recovery goals to complete over eight-weeks. The MEMS group also received personalized, interactive text-messages each weekday to support motivation. Retention and engagement in MEMS was high: 92.6% completed 8 weeks of MEMS, with an 86.1% text-message response rate, and 100% reported that they were satisfied with the text-messages. Compared to the control condition, the MEMS group had significantly greater improvements in interviewer-rated motivation and anticipatory pleasure and obtained significantly more recovery-oriented goals at the end of the 8-week period. There were no significant group differences in performance-based effort-cost computations and future reward-value representations, self-reported motivation, quality of life, functioning, or additional secondary outcomes of positive symptoms, mood symptoms, or neurocognition. Results suggest that MEMS is feasible as a relatively brief, low-intensity mobile intervention that could effectively improve interviewer-rated motivation, anticipatory pleasure, and recovery goal attainment in those with schizophrenia-spectrum disorders

F247. Internalized Stigma Has a Stronger Relationship with Intrinsic Motivation Compared to Amotivation in Early Phase and Prolonged Schizophrenia

Background Motivation deficits predict decreased functioning in schizophrenia. Recent work suggests deficits reflect challenges in separate domains: intrinsic motivation (one’s internal drive to engage in a behavior out of enjoyment or interest) and amotivation (one’s broader decrease in motivated behavior linked to avolition and anhedonia). Internalized stigma is another determinant of functioning for people with schizophrenia that may impact motivation. However, little is known about these relationships, including which aspects of motivation it may impact nor when these links emerge. Identifying the link between these constructs may help to identify whether internalized stigma may be a novel treatment target to facilitate improvements in motivation. Methods Forty adults with early phase schizophrenia and 66 adults with prolonged schizophrenia completed measures of internalized stigma, intrinsic motivation, and amotivation. Pearson’s correlations were examined followed by Fischer’s r-to-z transformations to compare differences in the magnitude of associations between internalized stigma and intrinsic motivation and internalized stigma and amotivation among the first episode and prolonged samples. Next, we conducted stepwise regressions to examine whether internalized stigma was associated with intrinsic motivation above and beyond associations with amotivation in each sample. Results In the early phase sample, the association between internalized stigma was greater with intrinsic motivation (r=-0.48, p=.00) compared to amotivation (r=0.27, p=0.10). Associations with internalized stigma in the prolonged sample were also greater with intrinsic motivation (r=-0.30, p=0.02) versus amotivation (r=0.19, p=0.12). The magnitude of the associations between internalized stigma and intrinsic motivation (z=1.03, p=0.15) and between internalized stigma and amotivation (z=0.41, p = 0.34) did not significantly differ when comparing phase of illness. Regression analyses indicated that, controlling for amotivation, internalized stigma predicted intrinsic motivation in both the prolonged sample (R2=0.09, F(1,64) =6.18, p=0.02) and the early phase schizophrenia sample (R2=0.23, F(1,37)=10.98, p=.00). Discussion Results suggest internalized stigma has a stronger relationship with intrinsic motivation separate from, and above and beyond, its association with amotivation. Findings support models of intrinsic and amotivation being distinct domains. Links between internalized stigma and motivation appear to emerge and persist from the early stages of schizophrenia, suggesting that targeting stigma in early intervention services may help to improve intrinsic motivation in people with schizophrenia

Is Cognitive Performance Affecting Your Social Life? Cognitive Performance and its Relation to Social Functioning in Psychometric Schizotypy

poster abstractInterpreting cues and appropriately performing in social situations are two skills that are crucial for an individual to function in a modern society. Assessing social functioning and social cognition are used to measure these abilities in first-episode and schizophrenia research. The current study addresses the relationship between social cognition, neurocognition, and social functioning in participants with psychometric schizotypy; a cluster of traits thought to denote increased risk of developing psychosis. Undergraduate students pre-screened for schizotypy were tested for social cognitive and neurocognitive deficits, and lower social functioning. Significant positive correlations were observed between sub-tests of neurocognition and the social cognition measures. The current study shows that there are some subareas of neurocognition that are more closely related to social cognition than others. Independent T-tests reveal that individuals with psychometric schizotypy exhibit lower social functioning. Also, within the schizotypy group, participants report lower social functioning, including in their ability to create and maintain romantic relationships. Future research on this topic could try to find further explanations for social functioning deficits, as they do not appear to be explained by problems with social cognition

Validation of the Beck Motivation Inventory in a Schizophrenia Sample

poster abstractObjectives: Low motivation is an obstacle to recovery for many individuals with schizophrenia, and assessing motivation remains challenging. The aim of this study was to examine the reliability and validity of a new measure of motivation, The Beck Motivation Inventory (BMI). The BMI is a 13-item measure created to assess self-reported behavior related to an individual’s ability to initiate and sustain task-related motivation, as opposed to relying on others to encourage task-related motivation. Methods: In a sample of 251 adult outpatients and inpatients with schizophrenia or schizoaffective disorder, the BMI was administered along with measures of social functioning and dependent and autonomy beliefs. A confirmatory factor analysis was conducted to test a two-factor model, which consisted of an inner- and other- directed motivation factor. The BMI’s internal consistency, test-retest reliability, and convergent and predictive validity were also assessed. Results: The BMI demonstrated acceptable internal consistency (α > .70) and adequate test-retest stability after six months (r > .5). Convergent validity was established with measures of dependent and autonomy beliefs, and predictive validity was demonstrated with a measure of social functioning. The two-factor model of the BMI was also supported. Conclusions: Results provide initial support for the validation of the BMI, suggesting that the BMI may be a useful and brief tool for evaluating behaviors linked to task-related motivation that may act as obstacles to recovery for individuals with schizophrenia

Stigma resistance at the personal, peer, and public levels: A new conceptual model.

Stigma resistance is consistently linked with key recovery outcomes, yet theoretical work is limited. This study explored stigma resistance from the perspective of individuals with serious mental illness (SMI). Twenty-four individuals with SMI who were either peer-service providers (those with lived experience providing services; N = 14) or consumers of mental health services (N = 10) engaged in semistructured interviews regarding experiences with stigma, self-stigma, and stigma resistance, including key elements of this process and examples of situations in which they resisted stigma. Stigma resistance is an ongoing, active process that involves using one’s experiences, knowledge, and sets of skills at the (1) personal, (2) peer, and (3) public levels. Stigma resistance at the personal level involves (a) not believing stigma or catching and challenging stigmatizing thoughts, (b) empowering oneself by learning about mental health and recovery, (c) maintaining one’s recovery and proving stigma wrong, and (d) developing a meaningful identity apart from mental illness. Stigma resistance at the peer level involves using one’s experiences to help others fight stigma and at the public level, resistance involved (a) education, (b) challenging stigma, (c) disclosing one’s lived experience, and (d) advocacy work. Findings present a more nuanced conceptualization of resisting stigma, grounded in the experiences of people with SMI. Stigma resistance is an ongoing, active process of using one’s experiences, skills, and knowledge to develop a positive identity. Interventions should consider focusing on personal stigma resistance early on and increasing the incorporation of peers into services

Essential Components of Early Intervention Programs for Psychosis: Available Intervention Services in the United States

Programs providing interventions for early psychosis are becoming commonplace in the United States (U.S.); however, the characteristics of existing services remain undocumented. We examined program characteristics, clinical services, and program eligibility criteria for outpatient early intervention programs across the U.S. using a semi-structured telephone interview. Content analysis was used to identify the presence or absence of program components, based in part on a recent list of essential evidence-based components recommended for early intervention programs (Addington, MacKenzie, Norman, Wang and Bond, 2013) as well as program characteristics, including eligibility criteria. A total of 34 eligible programs were identified; 31 (91.2%) program representatives agreed to be interviewed. Of the examined components, the most prevalent were individual psychoeducation and outcomes tracking; the least prevalent were outreach services and communication with inpatient units. The populations served by US programs were most frequently defined by restrictions on the duration of psychosis and age. This study provides critical feedback on services for the early psychosis population and identifies research to practice gaps and areas for future improvement

Clarifying the Overlap Between Motivation and Negative Symptom Measures in Schizophrenia Research: A Meta-Analysis

Motivation and negative symptom research has recently been hampered by a series of inconsistent findings, leading to calls for a greater consensus on the type of measures used across studies. To inform this issue, we conducted a meta-analysis that quantified the association between motivation measures (self-report, performance-based) and clinician-rated negative symptom measures as well as a series of moderator analyses to develop a greater understanding of the measurement factors impacting this relationship. Forty-seven eligible studies with people with schizophrenia-spectrum disorders were included. Using a random-effects meta-analytic model, a small but significant overall effect size emerged between motivation and clinician-rated negative symptoms (r = −.18). Several significant moderators were identified, including the generation of negative symptom measures such that there was a significantly stronger relationship between motivation and second-generation (r = −.38) than first-generation negative symptom measures (r = −.17). Further, the type of performance-based measure used moderated the relationship, with effort discounting tasks most strongly related to negative symptoms (r = −.44). The domain of motivation assessed (intrinsic, extrinsic, amotivation) also moderated the relationship. These findings help to identify sources of inconsistencies observed in prior studies and point to both second-generation and effort discounting tasks as the most promising types of measures, particularly for those interested in validating motivation measures or assessing the effectiveness of motivation treatments. Although additional research is needed, our results suggest that using these measures may help to reduce inconsistencies across studies and move the field forward

This progressive production: Agency, durability and keeping it contemporary

This is an Author's Accepted Manuscript of an article published in Performance Research: A Journal of the Performing Arts, 17(5), 71-77, 2012 [copyright Taylor & Francis], available online at: http://www.tandfonline.com/10.1080/13528165.2012.728447.Tino Sehgal is a Berlin based Anglo-German conceptual artist who creates ‘constructed situations’; a process whereby he hands over the delivery of the work to selected ‘interpreters’ or in the case of the Tate Modern (London) 2012 commission, to ‘participants’, who he rehearses and supports to carry out the instructions which embody his vision. Each time a Sehgal work is presented, it is animated by those he has asked and paid to participate, for an audience who are often called upon to engage with a question or conversation. In taking this approach, Sehgal explicitly rejects the idea of the artist as a making of objects. However, unlike the sorts of transitory and ephemeral works of art created in the 1970s which were a deliberate challenge to the commodification of art and by extension the artist, Sehgal constructs situations for other reasons which will be explored in this article. This article will also start to consider how dependence on interpreters or participants extends, transforms or circumscribes authorial control. It will begin to consider the extent to which the construction of live artworks that potentially exceed the life time and certainly the physical presence of the maker represent long-term duration. Does such an approach extend the field of influence and the potential for lasting impact? What impact does duration have on the re-enactor/interpreters capacity to comply with the artist's instructions and what investment do they have in embodying another's artistic vision, particularly if they are required to do so for an extended period of time

The role of metacognitive self-reflectivity in emotional awareness and subjective indices of recovery in schizophrenia

Emotional awareness deficits in people with schizophrenia have been linked to poorer objective outcomes, but, no work has investigated the relationship between emotional awareness and subjective recovery indices or metacognitive self-reflectivity. We hypothesized that increased emotional awareness would be associated with greater self-esteem, hope, and self-reflectivity and that self-reflectivity would moderate links between emotional awareness and self-esteem and hope -- such that significant relationships would only be observed at lower levels of self-reflectivity. Participants were 56 people with schizophrenia-spectrum disorders. Correlations revealed that better emotional awareness was significantly associated with increased self-esteem and hope but not self-reflectivity. Self-reflectivity moderated the relationship between emotional awareness and self-esteem but not hope. Overall, findings suggest that emotional awareness may affect self-esteem for those low in self-reflectivity, but other factors may be important for those with greater self-reflectivity. Results emphasize the importance of interventions tailored to enhance self-reflective capacity in clients with schizophrenia

Examining Affect in Psychometric Schizotypy Using Behavioral Experience Sampling Methodology

poster abstractIn schizophrenia, patients often experience more negative emotions in the form of anger, sadness, and anxiety when compared to the general population. One unique way of measuring affect outside of the laboratory has been to use Experience Sampling Methods (ESM) to assess how individuals perceive current emotions in their daily life. However, these methods are still subject to self-report bias. In this study, we examined affect using traditional ESM methods while also implementing the Electronically Activated Recorder (EAR), a behaviorally-based ESM measure that provides real-world assessments of speech. To examine the EAR, we evaluated affect in schizotypy and non-schizotypy groups. Research shows that schizophrenia-like experiences, like increased negative affect, run along a continuum. Schizotypy is a category on the healthier end of the schizophrenia-spectrum; it applies to individuals who are thought to have a putative genetic liability for schizophrenia. Using the Linguistic Inquiry and Word Count (LIWC), we compared affective word usage among schizotypy and non-schizotypy groups to provide a real-world, behavioral ESM measure. When traditional ESM measures were used, we found individuals with schizotypy reported less negative emotions compared to the non-schizotypy group, but results did not reach the level of significance. We also observed that non-schizotypy individuals reported slightly higher positive emotions, and the schizotypy group reported slightly higher negative emotions. A similar pattern was observed when examining EAR data. Overall, results suggested that traditional and behavioral ESM measures of affect had significant overlap. In general, those with schizotypy demonstrated slightly more negative emotion and slightly less positive emotion than the non-schizotypy group. Findings did not reach the level of significance. This study demonstrates that the EAR provides behavioral ratings of affect that are on par with traditional ESM ratings. Future work should examine the EAR at different points on the schizophrenia-spectrum