Departments of Occupational Therapy, Rehabilitation Sciences, and Psychological and Brain Sciences, Boston University, Sargent College of Health and Rehabilitation Sciences, 635 Commonwealth Ave. SAR 509, Boston, MA, 02215, US.
Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, US.
Soc Psychiatry Psychiatr Epidemiol. 2020 Dec;55(12):1629-1637. doi: 10.1007/s00127-020-01877-x. Epub 2020 May 14.
Diminished motivation (e.g., low drive, curiosity, and engagement in activities) is associated with robust impairment in psychosocial functioning in schizophrenia, yet even the most effective evidence-based interventions rarely effect meaningful change in motivation. Individual Resiliency Training (IRT) is a psychosocial treatment for individuals following a first episode of psychosis, supporting motivation through recovery goal setting and pursuit. The extent to which such an approach might improve motivation over time is unknown.
We tested the impact of exposure to IRT modules focused on goal setting and attainment on motivation and functional outcomes among participants in the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP). In the sample of 404 individuals with a first episode of psychosis receiving treatment across 34 community sites, we ran mixed-effect models with group (exposed to four or more goal-focused IRT sessions vs. Community Care (CC)), time (baseline, six- and 12-month follow-up), and the group-by-time interaction as predictors of motivation, role and social functioning. We also ran these analyses with those exposed to three or fewer goal-focused IRT sessions compared to CC.
Controlling for gender, ethnicity, baseline cognition, and total number of outpatient mental health visits, exposure to four or more goal-focused IRT sessions was associated with greater improvements in motivation and role functioning compared to CC; effects were not observed for social functioning. Participants receiving three or fewer goal-focused IRT sessions did not differ from those in CC in these outcomes. Further, sensitivity analysis showed that general exposure to IRT was not associated with differential outcomes.
Findings suggest that sufficient focus on recovery goal setting and support in psychosocial intervention for first-episode psychosis may have specific impact on motivation.
动机减弱（例如，驱动力、好奇心和参与活动的意愿降低）与精神分裂症患者的社会心理功能严重受损有关，但即使是最有效的循证干预措施也很少能对动机产生有意义的改变。个体韧性训练（IRT）是一种针对首发精神病患者的心理社会治疗方法，通过设定和追求康复目标来支持动机。目前尚不清楚这种方法在多大程度上可以随着时间的推移改善动机。
我们测试了在康复后首次精神分裂症发作的早期治疗计划（RAISE-ETP）中，暴露于专注于目标设定和实现的 IRT 模块对参与者的动机和功能结果的影响。在接受 34 个社区站点治疗的 404 名首发精神病患者样本中，我们采用混合效应模型，以组（暴露于四个或更多以目标为导向的 IRT 会议与社区护理（CC）相比）、时间（基线、6 个月和 12 个月随访）和组-时间交互作为动机、角色和社会功能的预测因素。我们还对暴露于三个或更少以目标为导向的 IRT 会议的参与者与 CC 进行了这些分析。
控制性别、种族、基线认知和门诊心理健康就诊次数，暴露于四个或更多以目标为导向的 IRT 会议与 CC 相比，动机和角色功能的改善更大；社会功能则没有观察到这种效果。接受三个或更少以目标为导向的 IRT 会议的参与者在这些结果上与 CC 没有差异。此外，敏感性分析表明，一般暴露于 IRT 与不同的结果无关。
研究结果表明，在首发精神病的心理社会干预中，对康复目标设定和支持的足够关注可能对动机产生特定影响。
