Focusing on recovery goals improves motivation in first-episode psychosis

• Published in: Social Psychiatry and Psychiatric Epidemiology 2020-12, Vol.55 (12), p.1629-1637
• Main Authors: Fulford, Daniel, Meyer-Kalos, Piper S., Mueser, Kim T.
• Format: Article
• Language: English
• Subjects: Analysis; Care and treatment; Cognition; Community health care; Epidemiology; Exposure; Goal setting; Goals; Humans; Medicine; Medicine & Public Health; Mental health; Motivation; Original Paper; Psychiatry; Psychosis; Psychotic Disorders - therapy; Recovery; Schizophrenia; Schizophrenia - therapy; Sensitivity analysis
• ISSN: 0933-7954; 1433-9285
• DOI: 10.1007/s00127-020-01877-x

Introduction 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. Method 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. Results 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. Conclusions Findings suggest that sufficient focus on recovery goal setting and support in psychosocial intervention for first-episode psychosis may have specific impact on motivation.