Motivation Skills Training to Enhance Functional Outcomes for People with Schizophrenia

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.