title: 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.
authors.affiliation: Department of Psychology, VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale University School of Medicine, New Haven, CT; Joanna.fiszdon@yale.edu.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Fiszdon
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT; Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Middletown, CT;
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Kurtz
authors.affiliation: Olin Neuropsychiatry Research Center, The Institute of Living, Hartford Hospital, Hartford, CT.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Choi
authors.affiliation: Department of Psychology, VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale University School of Medicine, New Haven, CT;
authors.forename: Morris D
authors.initials: MD
authors.lastname: Bell
authors.affiliation: Department of Psychology, VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale University School of Medicine, New Haven, CT;
authors.forename: Steve
authors.initials: S
authors.lastname: Martino
mesh_terms: D000328:Adult; D060825:Cognitive Dysfunction / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007858:Learning / Q000502:physiology*; D008297:Male; D008433:Mathematics; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D010349:Patient Compliance / Q000523:psychology*; D012559:Schizophrenia / Q000150:complications / Q000534:rehabilitation*; D016896:Treatment Outcome
keywords: cognitive remediation; compliance; motivation; psychosis; treatment