Mobile Enhancement of Motivation in Schizophrenia: A Pilot Randomized Controlled Trial of a Personalized Text Message Intervention for Motivation Deficits

• Published in: Journal of consulting and clinical psychology 2020-10, Vol.88 (10), p.923-936
• Main Authors: Luther, Lauren, Fischer, Melanie W, Johnson-Kwochka, Annalee V, Minor, Kyle S, Holden, Richard, Lapish, Chris L, McCormick, Bryan, Salyers, Michelle P
• Format: Article
• Language: English
• Subjects: Adult; Brief interventions; Clinical trials; Feasibility; Female; Human; Humans; Intervention; Male; Middle Aged; Mobile Health; Motivation; Outpatient; Personalization; Pilot Projects; Pleasure; Positive and Negative Symptoms; Psychosis; Psychotic Disorders - psychology; Quality of life; Quality of Life - psychology; Recovery; Response rates; Reward; Rewards; Schizophrenia; Schizophrenic Psychology; Technology; Test Construction; Text Messaging; Treatment; Treatment needs; Treatment Outcome
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/ccp0000599

Objective: Motivation deficits remain an unmet treatment need in schizophrenia. Recent research has identified mechanisms underlying motivation deficits (i.e., impaired effort-cost computations, reduced future reward-value representation maintenance) that may be effective treatment targets to improve motivation. This study tested the feasibility and preliminary effectiveness of Mobile Enhancement of Motivation in Schizophrenia (MEMS), an intervention that leverages mobile technology to target these mechanisms with text messages. Method: Fifty-six participants with a schizophrenia-spectrum disorder were randomized to MEMS (n = 27) or a control condition (n = 29). All participants set recovery goals to complete over 8 weeks. Participants in the MEMS group additionally received personalized, interactive text messages on their personal cellphones each weekday. Results: Retention and engagement in MEMS were high: 92.6% completed 8 weeks of MEMS, with an 86.1% text message response rate, and 100% reported being satisfied with the text messages. Compared to participants in the control condition, the participants in the MEMS condition had significantly greater improvements in interviewer-rated motivation and anticipatory pleasure and attained significantly more recovery-oriented goals at 8 weeks. There were no significant group differences in purported mechanisms (performance-based effort-cost computations and future reward-value representations) or in self-reported motivation, quality of life, or functioning. Conclusion: Results demonstrate that MEMS is feasible as a brief, low-intensity mobile intervention that could effectively improve some aspects of motivation (i.e., initiation and maintenance of goal-directed behaviors) and recovery goal attainment for those with schizophrenia-spectrum disorders. More work is needed with larger samples and to understand the mechanisms of change in MEMS. What is the public health significance of this article? This study suggests that mobile text message interventions may improve motivation and help people with schizophrenia attain their personalized life goals. Further, this study suggests that text message interventions delivered via personal cell phones are feasible in those with schizophrenia.