Focusing on recovery goals improves motivation in first-episode psychosis

Daniel Fulford, Piper S. Meyer-Kalos, Kim T. Mueser

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1629-1637
Number of pages9
JournalSocial Psychiatry and Psychiatric Epidemiology
Volume55
Issue number12
DOIs
StatePublished - Dec 1 2020

Bibliographical note

Funding Information:
This study was funded by National Institute of Mental Health grant 271200900019C-7?0-1. We thank all of our core collaborators and consultants for their invaluable contributions, without whom this study would not have been possible. Executive Committee: John M. Kane, M.D., Delbert G. Robinson, M.D., Nina R. Schooler, Ph.D.,?Kim T. Mueser, Ph.D., David L. Penn, Ph.D., Robert A. Rosenheck, M.D., Jean Addington, Ph.D., Mary F. Brunette, M.D., Christoph U. Correll, M,D., Sue E. Estroff, Ph,D., Patricia Marcy, B.S.N., James Robinson, M.Ed.?NIMH Collaborators: Robert K. Heinssen, Ph.D., ABPP, Joanne B. Severe, M.S., Susan T. Azrin, Ph.D., Amy B. Goldstein, Ph.D. Additional contributors to design and implementation of NAVIGATE: Susan Gingerich, M.S.W., Shirley M. Glynn, Ph.D., Jennifer D. Gottlieb, Ph.D., Benji T. Kurian, M.D., M.P.H., David W. Lynde, M.S.W., Piper S. Meyer-Kalos, Ph.D., L.P., Alexander L. Miller, M.D.?Ronny Pipes, M.A., LPC-S. MedAvante for the conduct of the centralized, masked diagnostic interviews and assessments; the team at the Nathan Kline Institute for data management. Thomas Ten Have and Andrew Leon played key roles in the design of the study, particularly for the statistical analysis plan. We mourn the untimely deaths of both. We gratefully acknowledge the contributions of Haiqun Lin and Kyaw (Joe) Sint to statistical analysis planning and conduct. We are indebted to the many clinicians, research assistants and administrators at the participating sites for their enthusiasm and terrific work on the project as well as the participation of the hundreds of patients and families who made the study possible with their time, trust and commitment. The participating sites include: Burrell Behavioral Health (Columbia), Burrell Behavioral Health (Springfield), Catholic Social Services of Washtenaw County, Center for Rural and Community Behavior Health New Mexico, Cherry Street Health Services, Clinton-Eaton-Ingham Community Mental Health Authority, Cobb County Community Services Board, Community Alternatives, Community Mental Health Center of Lancaster County, Community Mental Health Center, Inc., Eyerly Ball Iowa, Grady Health Systems, Henderson Mental Health Center, Howard Center, Human Development Center, Lehigh Valley Hospital, Life Management Center of Northwest Florida, Mental Health Center of Denver, Mental Health Center of Greater Manchester, Nashua Mental Health, North Point Health and Wellness, Park Center, PeaceHealth Oregon/Lane County Behavioral Health Services, Pine Belt Mental HC, River Parish Mental Health Center, Providence Center, San Fernando Mental Health Center, Santa Clarita Mental Health Center, South Shore Mental Health Center, St. Clare?s Hospital, Staten Island University Hospital, Terrebonne Mental Health Center, United Services and University of Missouri-Kansas City School of Pharmacy.

Funding Information:
This study was funded by National Institute of Mental Health grant 271200900019C-7–0-1. We thank all of our core collaborators and consultants for their invaluable contributions, without whom this study would not have been possible. Executive Committee: John M. Kane, M.D., Delbert G. Robinson, M.D., Nina R. Schooler, Ph.D., Kim T. Mueser, Ph.D., David L. Penn, Ph.D., Robert A. Rosenheck, M.D., Jean Addington, Ph.D., Mary F. Brunette, M.D., Christoph U. Correll, M,D., Sue E. Estroff, Ph,D., Patricia Marcy, B.S.N., James Robinson, M.Ed. NIMH Collaborators: Robert K. Heinssen, Ph.D., ABPP, Joanne B. Severe, M.S., Susan T. Azrin, Ph.D., Amy B. Goldstein, Ph.D. Additional contributors to design and implementation of NAVIGATE: Susan Gingerich, M.S.W., Shirley M. Glynn, Ph.D., Jennifer D. Gottlieb, Ph.D., Benji T. Kurian, M.D., M.P.H., David W. Lynde, M.S.W., Piper S. Meyer-Kalos, Ph.D., L.P., Alexander L. Miller, M.D. Ronny Pipes, M.A., LPC-S. MedAvante for the conduct of the centralized, masked diagnostic interviews and assessments; the team at the Nathan Kline Institute for data management. Thomas Ten Have and Andrew Leon played key roles in the design of the study, particularly for the statistical analysis plan. We mourn the untimely deaths of both. We gratefully acknowledge the contributions of Haiqun Lin and Kyaw (Joe) Sint to statistical analysis planning and conduct. We are indebted to the many clinicians, research assistants and administrators at the participating sites for their enthusiasm and terrific work on the project as well as the participation of the hundreds of patients and families who made the study possible with their time, trust and commitment. The participating sites include: Burrell Behavioral Health (Columbia), Burrell Behavioral Health (Springfield), Catholic Social Services of Washtenaw County, Center for Rural and Community Behavior Health New Mexico, Cherry Street Health Services, Clinton-Eaton-Ingham Community Mental Health Authority, Cobb County Community Services Board, Community Alternatives, Community Mental Health Center of Lancaster County, Community Mental Health Center, Inc., Eyerly Ball Iowa, Grady Health Systems, Henderson Mental Health Center, Howard Center, Human Development Center, Lehigh Valley Hospital, Life Management Center of Northwest Florida, Mental Health Center of Denver, Mental Health Center of Greater Manchester, Nashua Mental Health, North Point Health and Wellness, Park Center, PeaceHealth Oregon/Lane County Behavioral Health Services, Pine Belt Mental HC, River Parish Mental Health Center, Providence Center, San Fernando Mental Health Center, Santa Clarita Mental Health Center, South Shore Mental Health Center, St. Clare’s Hospital, Staten Island University Hospital, Terrebonne Mental Health Center, United Services and University of Missouri-Kansas City School of Pharmacy.

Keywords

  • First-episode psychosis
  • Goal setting
  • Motivation
  • Psychosocial treatment

PubMed: MeSH publication types

  • Journal Article

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