Université de Liège, Belgium.
Intercommunale de Soins Spécialisés de Liège, Belgium.
Behav Modif. 2022 Sep;46(5):1167-1197. doi: 10.1177/01454455211047605. Epub 2021 Sep 28.
Motivational deficits are an important predictor of functional outcomes in individuals with a serious mental illness such as schizophrenia and mood spectrum disorders. The aim of the present study was to explore the feasibility, acceptability, and preliminary efficacy of a group version of "Switch," an intervention that targets motivational deficits, enriched with an ecological momentary intervention (EMI) approach (i.e., prompts on the participants' smartphone to encourage the use of trained strategies in their daily life). Eight participants with schizophrenia, schizoaffective, or major depressive disorder entered the study. The intervention took place twice a week for 2 months. Assessment measures included traditional evaluations of motivational negative symptoms, apathy, quality of life and daily functioning, in addition to ambulatory assessment methods strategies, including the experience sampling method (ESM) to assess motivation and related processes, and actigraphy (daily step-count) to assess participants' activity level. Four participants were considered as non-completers (followed less than 2/3 of the program) and four were considered as completers. Only completers presented a decrease in amotivation/apathy and an improvement in functional outcomes after the intervention and at follow-up. Furthermore, mixed-effects ESM models showed significant interaction effects on multiple processes related to motivation, indicating improvements only in completers: heightened motivation, increased engagement in meaningful and effortful activities, better mood, higher levels of confidence, increased frequency of projection into the future (pleasure anticipation), and of positive reminiscence. This preliminary investigation provides evidence that Switch may be an effective intervention, with specific effects on motivation and associated processes.
动机缺陷是精神分裂症和心境障碍等严重精神疾病患者功能结局的重要预测因素。本研究旨在探索一种针对动机缺陷的团体版“Switch”干预措施的可行性、可接受性和初步疗效，该干预措施采用了生态瞬时干预（EMI）方法（即通过参与者的智能手机发送提示，鼓励他们在日常生活中使用训练策略）。8 名患有精神分裂症、分裂情感障碍或重度抑郁症的患者参与了本研究。干预措施每周进行两次，持续 2 个月。评估措施包括传统的动机负性症状、淡漠、生活质量和日常功能评估，以及动态评估方法，包括经验抽样法（ESM）评估动机和相关过程，以及活动记录仪（每日步数）评估参与者的活动水平。有 4 名参与者被认为是未完成者（参加少于计划的 2/3），有 4 名参与者被认为是完成者。只有完成者在干预后和随访时表现出动机缺失/淡漠减少和功能结局改善。此外，混合效应 ESM 模型显示与动机相关的多个过程存在显著的交互效应，这表明只有完成者有改善：动机增强、更多地参与有意义和费力的活动、情绪更好、信心更高、对未来的展望（期待愉悦）和积极的怀旧频率增加。这项初步研究提供了证据表明 Switch 可能是一种有效的干预措施，对动机和相关过程有特定的影响。
