Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms

Abstract

Background: Motivational negative symptoms hinder quality of life and daily functioning of individuals with schizophrenia spectrum disorders. A recently developed intervention, Switch, has shown promising effects on negative symptoms and functional outcomes. Switch targets multiple cognitive, emotional and behavioural processes associated with motivation and goal directed behaviours. We aimed to investigate its effects on motivation and associated processes in a naturalistic setting, and to explore the dynamics between the processes.

Methods: We used a single case approach (n = 3), with a pre-post and follow-up assessment design, which also included ambulatory assessments (experience sampling method, ESM; and step count). We computed autoregressive lag 1 models to evaluate the effects of the intervention on daily motivation levels and related processes, descriptive pie-charts, and vector autoregressive modelling to reveal the dynamics of the processes over time.

Results: The intervention was beneficial for each participant according to traditional evaluations of motivational negative symptoms, apathy, daily functioning and quality of life. The effects on the ESM variables revealed distinct outcomes for each individual. The dynamics between the various processes differed between participants, and fluctuated within participants (when comparing baseline, intervention phase, and follow-up).

Conclusions: This study used an innovative approach to look at the effectiveness of an intervention. The intervention seems to lead to meaningful improvements in motivational negative symptoms and functional outcomes. The mechanisms of change need to be further investigated.

Trial registration number: ClinicalTrials.gov, NCT04325100 . Registered 27 March 27, 2020 -retrospectively registered.

Reporting: Guidelines from the Transparent Reporting of Evaluations with Non-randomized Designs (TREND) statement were followed.

Keywords: Apathy; Ecological momentary assessment; Intervention; Single case; Timeseries analyses, dynamics.

Fig. 1

Three-level model of motivation (reproduced with permission from [9])

Fig. 2

Design of the study and assessment procedure. BNSS = Brief Negative Symptom Scale; LARS = Lille Apathy Rating Scale patient and informant; FROGS = Functional Remission of General Schizophrenia, S-QoL = Schizophrenia Quality of Life questionnaire

Fig. 3

The motivation’s switch. Updated version of the decisional balance

Fig. 4

Pie charts for nominal variables of participant 2i-1

Fig. 5

Network models of participant 2i-1. Positive associations appear in green (continuous lines) and negative associations appear in red (dashed lines). The stronger the relationships, the thicker the edges. Only associations with p-values < .05 are plotted. For a colour version of this figure, see the digital version of the paper

Fig. 6

Pie charts for nominal variables of participant 2i-2

Fig. 7

Network models of participant 2i-1. Positive associations appear in green (continuous lines) and negative associations appear in red (dashed lines). The stronger the relationships, the thicker the edges. Only associations with p-values < .05 are plotted. For a colour version of this figure, see the digital version of the paper

Fig. 8

Pie charts for nominal variables of participant 2i-4

Fig. 9

Network models of participant 2i-4. Positive associations appear in green (continuous lines) and negative associations appear in red (dashed lines). The stronger the relationships, the thicker the edges. Only associations with p-values < .05 are plotted. For a colour version of this figure, see the digital version of the paper