University of Medicine and Dentistry of New Jersey-University Behavioral HealthCare and Department of Psychiatry, Robert Wood Johnson Medical School, 151 Centennial Avenue, Piscataway, NJ 08854, USA.
Schizophr Bull. 2010 Sep;36(5):949-56. doi: 10.1093/schbul/sbp160. Epub 2010 Jan 11.
An important development in cognitive remediation of schizophrenia is a focus on motivation. However, following a distinction between the concepts of intrinsic motivation (IM) and extrinsic motivation, discussions of IM-based methods have downplayed or misrepresented the role that extrinsic rewards can, and actually do, serve to promote positive treatment outcomes in cognitive remediation. Therefore, the purpose of this article is to explore the rationale for using techniques incorporating extrinsic rewards into cognitive treatment of people with schizophrenia. To do this, evidence is presented on each of the following points: (1) there is a long history of research demonstrating that delivery of extrinsic reward is associated with positive outcomes in both behavioral and cognitive rehabilitation; (2) basic human brain systems respond strongly to tangible rewards, and this can directly enhance attention, working memory, and other cognitive functions; (3) nearly all data on the negative effects of extrinsic reward on IM have come from studies of healthy children and adults in school or work settings who have adequate IM for target tasks; these findings do not generalize well to cognitive remediation settings for people with schizophrenia, who often have abnormally low levels of IM and low base rates of attentive behaviors; and (4) in real-world situations, cognitive remediation interventions already utilize a combination of intrinsic and extrinsic reinforcers. Future studies are needed to clarify state and trait factors responsible for individual differences in the extent to which extrinsic rewards are necessary to set the conditions under which IM can develop.
精神分裂症认知矫正的一个重要发展是关注动机。然而，在区分内在动机（IM）和外在动机的概念之后，基于 IM 的方法的讨论要么低估，要么错误地描述了外在奖励在认知矫正中促进积极治疗结果所发挥的作用。因此，本文的目的是探讨将外在奖励纳入精神分裂症患者认知治疗的基本原理。为此，本文就以下几点提供了证据：（1）有很长的研究历史表明，外在奖励的给予与行为和认知康复中的积极结果有关；（2）人类大脑系统对有形奖励有强烈的反应，这可以直接增强注意力、工作记忆和其他认知功能；（3）几乎所有关于外在奖励对 IM 的负面影响的数据都来自于对在学校或工作环境中有足够 IM 进行目标任务的健康儿童和成年人的研究，这些发现并不能很好地推广到精神分裂症认知矫正环境，因为精神分裂症患者的 IM 水平通常异常低，注意力行为的基础率也低；（4）在现实世界的情况下，认知矫正干预已经使用了内在和外在强化物的组合。需要进一步的研究来阐明负责个体差异的状态和特质因素，这些差异表现在外在奖励对设定 IM 可以发展的条件的必要性程度上。
