In a recent publication in The American Journal of Psychiatry, researchers conducted a randomized, controlled study to evaluate the role of an innovative psychosocial intervention that employed two evidence-based practices—motivational interviewing and cognitive-behavioral therapy (MI-CBT)—for the treatment of motivational negative symptoms often associated with schizophrenia.
The randomized, controlled trial involved 79 subjects aged between 18 and 65 years who were diagnosed with schizophrenia and also had moderate-to-severe negative schizophrenia symptoms. For 12 weeks, the subjects were randomly assigned to combination MI-CBT or mindfulness-based stress sessions. During the study period, participants attended a 1-hour group session weekly and completed the same worksheets and homework assignments. The treatment and control conditions were matched for location, format, duration, peer interaction, didactic instruction, worksheets, and homework assignments.
The primary outcome measures for this study included motivational negative symptoms and community functioning. The assigned secondary outcomes involved a posited biomarker of negative symptoms: pupillometric response to the cognitive effort. The researchers assessed patient symptoms at baseline, at 12 weeks, and at the end of follow-up at 24 weeks using the 13-item Clinical Assessment Interview for Negative Symptoms and the 24-item UCLA version of the Brief Psychiatric Rating Scale.
To evaluate cognition, the researchers used the MATRICS Consensus Cognitive Battery and community function using the Specific Level of Functioning Scale. Pupillometry data were gathered with the cognitive Deck Choice Effort Task.
The authors noted that at baseline, there were no meaningful variances between the groups with regard to demographic characteristics, symptoms, cognition, or the primary and secondary outcome variables.
The results revealed that over the acute treatment period, participants in the MI-CBT group displayed notably better improvements in motivational negative symptoms than those in the control group. Additionally, at follow-up, the gains relative to baseline were sustained, although the differential benefit relative to control subjects was offset. There were insignificant effects regarding improvements in community functioning and differential change in the pupillometric markers of cognitive effort.
Based on their findings, the authors indicated that for managing motivational negative symptoms in schizophrenia, the use of MI-CBT was a well-tolerated and practical intervention.
The authors indicated that results from their rigorously controlled treatment study utilizing an innovative and straightforward intervention support the effectiveness of MI-CBT for improving motivational negative symptoms.
The authors concluded, “The results show that combining motivational interviewing with CBT yields improvements in negative symptoms, a feature of schizophrenia generally thought of as resistant to intervention. Motivational negative symptoms not only responded to the novel treatment but also maintained gains over the follow-up period. Implications for future studies and for improving the generalization of the negative symptom gains to daily functioning domains are discussed.”
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