Treatment motivation in adolescents with psychosis or at high risk: Determinants and impact on improvements in symptoms and cognitive functioning, preliminary results

Abstract

Low motivation is frequent in chronic disorders such as psychosis and may limit treatment efficacy. Although some evidence supports this view in adults, few studies so far have focused on adolescents. We assessed the impact of baseline symptoms, cognitive deficits and cognitive treatment characteristics on treatment motivation (TM), and examined whether TM affected treatment outcome. Twenty-eight adolescents with psychotic disorders participated in 16 sessions of computerized cognitive remediation or games. TM was assessed for each session. Lower TM was predicted by more severe symptoms at baseline, and was associated with smaller improvements in symptoms and both cognitive and psychosocial functioning at the end of the intervention. Experiencing success in the treatment exercises enhanced TM in all patients.

La falta de motivación para el tratamiento es algo conocido en relación a los trastornos crónicos y, en especial, los cuadros psicóticos. Si bien existe evidencia que sostiene este concepto en relación a pacientes adultos, hay muy poca literatura en relación a pacientes adolescentes. Evaluamos el impacto de la sintomatología de base, los déficits cognitivos y las características cognitivas de los tratamientos sobre la motivación para el tratamiento (TM) y cómo la TM afectaba el resultado de los tratamientos, Veintiocho adolescentes con trastornos psicóticos participaron en 16 sesiones de terapéutica cognitiva o juegos terapéuticos, en ambos casos en formato computarizado. Se evaluó la TM en cada sesión. La TM más baja se asoció a síntomas más graves de patología de base, así como con menor mejoría en los síntomas y peor funcionamiento cognitivo y psicosocial al final del estudio. Tener éxito en los ejercicios aumentó la TM en todos los pacientes.

Eine niedrige Motivationslage ist häufig bei chronischen Erkrankungen wie Psychosen zu finden und könnte die Behandlungseffektivität beschränken. Obwohl sich für diesen Standpunkt Evidenz im Erwachsenenbereich finden lässt, haben bisher nur wenige Studien diese Fragestellung bei Jugendlichen untersucht. Wir haben den Einfluss der Anfangssymptomatik, kognitiver Defizite und kognitiver Behandlungscharakteristika auf die Behandlungsmotivation (TM) gemessen und überprüft, inwiefern TM das Behandlungsergebnis beeinflusst hat. 28 Jugendliche mit psychotischen Störungen nahmen an 16 Sitzungen einer computerbasierten kognitiven Remediation, oder Computerspielen teil. TM wurde jede Sitzung erhoben. Geringere TM konnte durch eine stärkere Eingangssymptomatik vorhergesagt werden und stand im Zusammenhang mit geringeren Verbesserungen in der Symptomatik und der kognitiven und psychosozialen Funktionsfähigkeit am Ende der Behandlung. Erfolgserfahrungen während der Behandlung erhöhten die TM bei allen Patienten.

Una scarsa motivazione è frequente nei disturbi cronici come la psicosi, e può limitare l'efficacia del trattamento. Anche se alcune evidenze sostengono questo punto di vista negli adulti, pochi studi finora si sono concentrati sugli adolescenti. Abbiamo valutato l'impatto dei sintomi di base, deficit cognitivi e le caratteristiche di un trattamento cognitivo sulla motivazione al trattamento (TM), ed abbiamo esaminato se TM influenza l'esito del trattamento. Ventotto adolescenti con disturbi psicotici hanno partecipato a 16 sedute di cognitive remediation al computer o giochi. La TM è stata valutata per ogni seduta. Una TM più bassa era predittiva di sintomi più gravi alla prima valutazione, ed era associata con minori miglioramenti nei sintomi e nel funzionamento sia cognitivo che psico-sociale alla fine dell'intervento. Esperire il successo nel trattamento favorisce una maggiore TM in tutti i pazienti.

Keywords:

• motivation
• psychosis
• adolescent
• cognitive remediation
• negative symptoms
• cognitive deficits

Acknowledgments

The present research was supported by a grant from the Swiss National Science Foundation (n°32003B_112160). The authors wish to express their gratitude to Mrs Laure Perraudin, Aurélie Aeberhard, Sonja Suter, Muriel Hafil and Virginie Van Craenenbroek, for their engagement in conducting the interventions, to Mrs Antje Horsch, Chloé Eva Dyson, and Helen Rodger for their careful proof-reading and editing of the manuscript, as well as to the patients for their participation in the study.

Notes

1. Since sessions were conducted by one trainer and were not videorecorded, no inter-rater reliability could be assessed. However, all trainers were psychologists holding a Master's degree, and had received extensive training in using the rating scale in the context of CR/CG sessions from the project leader. Furthermore, at the session level, motivation was significantly correlated with an objective measure, EWT (β=.02, p=.001), suggesting it can be considered valid.

2. The quadratic slope was not retained as a predictor here, given that preliminary analyses had revealed high multi-collinearity between predictors leading to spurious results; for the same reason, group was only controlled for when differences had been demonstrated in previous analyses, i.e., for visual-spatial abilities.

3. As suggested by an anonymous reviewer, the engagement item assessing persistence in the face of failure might be partly confounded with success and failure rates. These analyses were thus conducted on the single item assessing interest in the treatment tasks and not on the composite treatment motivation score.