Motivational Interviewing to Increase Cognitive Rehabilitation Adherence in Schizophrenia

Abstract

Adherence to treatment in psychiatric populations is notoriously low. In this randomized, controlled, proof-of-concept study, we sought to examine whether motivational interviewing (MI) could be used to enhance motivation for, adherence to, and benefit obtained from cognitive rehabilitation. Dual diagnosis MI, developed specifically for individuals with psychotic symptoms and disorganization, was further adapted to focus on cognitive impairments and their impact. Sixty-four outpatients diagnosed with schizophrenia spectrum disorders completed baseline assessments and were randomized to receive either the 2-session MI focused on cognitive functioning or a 2-session sham control interview focused on assessment and feedback about preferred learning styles. Next, all participants were given 4 weeks during which they could attend up to 10 sessions of a computer-based math training program, which served as a brief analog for a full course of cognitive rehabilitation. As hypothesized, MI condition was associated with greater increases in task-specific motivation along with greater training program session attendance. Moreover, postinterview motivation level predicted session attendance. There were no significant differences in improvement on a measure of cognitive training content, which may have been due to the abbreviated nature of the training. While the literature on the efficacy of MI for individuals with psychosis has been mixed, we speculate that our positive findings may have been influenced by the adaptations made to MI as well as the focus on a nonpharmacological intervention.

Motivational interviewing to enhance treatment attendance in mental health settings: A systematic review and meta‐analysis

“…However, a majority of studies did not report on their intention to treat. This may have been due to treatment attendance being the goal (Baker et al., ; Fiszdon et al., ; Korte & Schmidt, ; Maltby & Tolin, ; Martino et al., ; Simpson et al., ; Swanson et al., ; Syzdek et al., ; Zanjani et al., ). Only one study (Seal et al., ) conducted follow‐up by checking medical records for evidence of attendance (at 4, 8 and 16 weeks) and five studies collected other follow‐up data at varying time‐points (4 weeks to 6 months).…”

Neurocognitive insight and objective cognitive functioning in schizophrenia

“…Critically, self-reports of cognitive functioning were not sensitive to treatment with encenicline despite beneficial effects detected with both objective and informant-based rates of cognitive change. Because individuals tend to be poor raters of their own cognitive functioning, particularly when they show evidence of objective cognitive impairment, it may be helpful to provide education and feedback regarding cognitive performance to increase awareness of cognitive impairment (Medalia et al, 2012), as well as incorporate motivational interviewing techniques addressing impaired cognition and its impact to increase adherence to cognitive remediation treatment (Fiszdon et al, 2015). Future studies may emphasize clinical features of those lacking neurocognitive insight, as well as the relationship between neurocognitive insight at baseline and outcome following cognitive remediation treatment.…”

Feasibility of training nurses in motivational interviewing to improve patient experience in mental health inpatient rehabilitation: a pilot study

“…, Fiszdon et al . ). Increasing engagement in other interventions may be the main mechanism of change (Romano & Peters ) and combining MI with other interventions may have an additive effect (Hettema et al .…”