Motivational interview, CBT combination improves schizophrenia symptoms

Combining motivational interviews with cognitive behavioral therapy improved negative symptoms of schizophrenia compared with mindfulness sessions, according to findings published in The American Journal of Psychiatry.

“Motivational deficits are pervasive in schizophrenia and hard to treat with existing pharmacological drugs,” L. Felice Reddy, PhD, research associate professor and associate director of First Episode Psychosis, North Carolina, at the University of North Carolina, told Healio. “We knew that in other populations with depression and substance use, combining two evidence-based practices — motivational interviewing and cognitive behavioral therapy — enhanced the efficacy above that of either treatment alone, so we wanted to test the integrated MI-CBT treatment for people with schizophrenia and debilitating levels of negative symptoms.”

Reddy and colleagues randomly assigned 79 participants with moderate to severe negative schizophrenia symptoms to combination MI-CBT or to mindfulness-based stress reduction sessions for 12 weeks. Each week, participants attended a 1-hour group session and completed the same worksheets and homework assignments.

The researchers evaluated symptoms at baseline, 12 weeks and at the end of follow-up at 24 weeks using the 13-item Clinical Assessment Interview for Negative Symptoms (CAINS) and the 24-item UCLA version of the Brief Psychiatric Rating Scale (BPRS). They also assessed cognition using the MATRICS Consensus Cognitive Battery and community function using the Specific Level of Functioning Scale. Pupillometry data were collected with the cognitive Deck Choice Effort Task.

CAINS analyses revealed a significant improvement in symptoms from baseline to 12 weeks among MI-CBT participants (P < .0001) but not in the control group. However, the improvement in symptoms did not remain significant from baseline until 24 weeks.

Similarly, the MI-CBT group had significant improvement in pupillometry outcomes at 12 weeks (P = .0066) compared with the control group, but this did not remain significant through follow-up.

“This is the first time it has been shown that negative symptoms can be treated relatively efficiently (in a group setting that meets 1 hour per week for 12 weeks),” Reddy said. “Our attendance and participation were really high, which suggests the group treatment is enjoyable. We focus on individual strengths and personal interests and goals, and lo and behold, everyone can make some progress.”

According to Reddy, replication studies are ongoing to further validate the findings.

“The next step is to disseminate this manualized approach to providers in many different settings working with all types of clients who struggle with motivation and goal achievement so we can help as many people as possible live fulfilling lives,” she said.