title: The effects of motivation feedback in patients with severe mental illness: a cluster randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of providing clinicians with regular feedback on the patient's motivation for treatment in increasing treatment engagement in patients with severe mental illness.
  
  
  METHODS
  
  
  
  METHODS
  cluster randomized controlled trial (Dutch Trials Registry NTR2968).
  
  
  METHODS
  adult outpatients with a primary diagnosis of a psychotic disorder or a personality disorder and their clinicians, treated in 12 community mental health teams (the clusters) of two mental health institutions in the Netherlands.
  
  
  METHODS
  monthly motivation feedback (MF) generated by clinicians additional to treatment as usual (TAU) and TAU by the community mental health teams.
  
  
  METHODS
  treatment engagement at patient level, assessed at 12 months by clinicians.
  
  
  METHODS
  teams were allocated to MF or TAU by a computerized randomization program that randomized each team to a single treatment by blocks of varying size. All participants within these teams received similar treatment. Clinicians and patients were not blind to treatment allocation at the 12-month assessment.
  
  
  RESULTS
  The 294 randomized patients (148 MF, 146 TAU) and 57 clinicians (29 MF, 28 TAU) of 12 teams (6 MF, 6 TAU) were analyzed according to the intention-to-treat principle. No statistically significant differences between treatment groups on treatment engagement were found (adjusted mean difference =0.1, 95% confidence interval =-2.2 to 2.3, P=0.96, d=0). Preplanned ancillary analyses showed statistically significant interaction effects between treatment group and primary diagnosis on treatment motivation and quality of life (secondary outcomes), which were beneficial for patients with a primary diagnosis of a personality disorder but not for those with a psychotic disorder. There were no reports of adverse events.
  
  
  CONCLUSIONS
  The current findings imply that monitoring and discussing the patient's motivation is insufficient to improve motivation and treatment engagement, and suggests that more elaborate interventions for severe mental illness patients are needed.
authors.affiliation: Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands ; GGz Breburg, Top Clinical Center for Body, Mind and Health, Tilburg, the Netherlands.
authors.forename: Eline C
authors.initials: EC
authors.lastname: Jochems
authors.affiliation: Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands ; GGz Breburg, Top Clinical Center for Body, Mind and Health, Tilburg, the Netherlands ; Tilburg University, Faculty of Social Sciences, Tranzo Department, Tilburg, the Netherlands.
authors.forename: Christina M
authors.initials: CM
authors.lastname: van der Feltz-Cornelis
authors.affiliation: Tilburg University, Faculty of Social Sciences, Tranzo Department, Tilburg, the Netherlands ; GGZ Westelijk Noord Brabant, Bergen op Zoom, the Netherlands.
authors.forename: Arno
authors.initials: A
authors.lastname: van Dam
authors.affiliation: Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Hugo J
authors.initials: HJ
authors.lastname: Duivenvoorden
authors.affiliation: Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands ; BavoEuropoort, Parnassia Psychiatric Institute, Rotterdam, the Netherlands.
authors.forename: Cornelis L
authors.initials: CL
authors.lastname: Mulder
keywords: adherence; feedback; motivation; personality disorders; psychotic disorders; randomized controlled trial