Motivation Skills Training to Enhance Functional Outcomes for People with Schizophrenia

动机技能培训可增强精神分裂症患者的功能结果

• 批准号: 10572192
• 负责人: ALICE M. SAPERSTEIN
• 金额: $ 19.28万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-10 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10572192
• 关键词: Address; Adult; Aftercare; Age; Ambulatory Care Facilities; Behavior; Behavior Control; Belief; Client; Clinic; Clinical; Communities; Control Groups; Data; Data Collection; Diagnosis; Education; Educational process of instructing; Effectiveness; Employment; Enrollment; Feasibility Studies; Fostering; Funding; Goals; Impairment; Individual; Informal Social Control; Intervention; Knowledge; Life; Literature; MASP2 gene; Manuals; Measures; Mental Health; Methods; Modeling; Monitor; Motivation; National Institute of Mental Health; New York; Outcome; Outcome Measure; Outpatients; Participant; Performance; Persons; Phase; Pilot Projects; Process; Provider; Public Health; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Recovery of Function; Schizoaffective Disorders; Schizophrenia; Science; Self Direction; Services; Severities; Source; Students; Symptoms; Techniques; Testing; Training; Work; acceptability and feasibility; community clinic; daily functioning; design; effectiveness evaluation; effectiveness study; effectiveness testing; effectiveness trial; empowerment; evidence base; executive function; feasibility testing; follow-up; functional disability; functional improvement; functional outcomes; future implementation; improved; motivated behavior; novel; participant retention; pharmacologic; pleasure; primary outcome; psychiatric symptom; psychosocial; recruit; schizophrenia spectrum disorder; skills; skills training; treatment comparison; treatment effect; uptake

Schizophrenia is a major public health problem associated with core motivational deficits that are amongst the strongest predictors of impaired functional outcomes. Without motivation, people are unable to maintain their pursuit of employment or educational goals, engage in treatment, and regularly participate in healthy life decisions. Current pharmacological and psychosocial treatments for schizophrenia have demonstrated limited effectiveness for improving this core symptom. Motivation Skills Training (MST) is a novel intervention that addresses this clinical need. The premise of MST is that knowledge about one’s level and sources of motivation underlies the ability to regulate (i.e., understand and manage) motivation, and that motivation self- regulation can in turn facilitate task initiation and persistence. By facilitating goal-directed behavior, MST aims to enhance daily functioning and goal attainment in people with schizophrenia. MST is unique from existing interventions in that it directly teaches people about motivation and how to self-regulate motivation, empowering individuals to become active agents in controlling their own motivation and behavior. Preliminary work provides a clear conceptual rationale for targeting motivation skills in people with schizophrenia. Pilot efficacy data support the next phase of intervention testing, to evaluate the effectiveness of MST in a randomized controlled trial (RCT). This study uses a 2-phase deployment-focused model of intervention testing to establish the feasibility, acceptability and pilot effectiveness of MST for adults ages 18-65 with a schizophrenia spectrum diagnosis. An initial open trial of MST in one outpatient clinic (N=10) will evaluate target engagement and yield valued stakeholder input on the acceptability and clinical utility of MST content and format, informing refinements to the treatment manual. A subsequent RCT (N=80) conducted at four outpatient clinics will test the effectiveness of MST versus a Healthy Behaviors Control (HBC) group, both conducted in the context of routine recovery-oriented services. Clinic staff will be trained to provide MST and HBC in weekly groups over approximately 12 weeks. We will test the hypothesis that MST is superior to HBC for improving motivation, goal attainment, and quality of life. We will evaluate change in motivation as the mechanism through which functional outcomes improve from baseline to post-treatment and 2-month follow- up. We will explore the generalizability of MST effects by expanding outcome measures to include changes in executive functioning, clinically rated community functioning and psychiatric symptom severity. This study will provide the preliminary effectiveness data as well as data on the feasibility of recruiting, enrolling, randomizing, and retaining participants to guide the design of a larger fully powered trial. If teaching people with schizophrenia the knowledge and skills needed to self-regulate motivation improves volitional behavior, MST will have the potential to have a widespread impact on improving the lives of people with schizophrenia.

精神分裂症是一个主要的公共卫生问题，与核心动机缺陷有关