Motivation Skills Training for Serious Mental Illness

(MST Trial)

Recruiting at 1 trial location

Overseen By Alice Medalia, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Columbia University

Disqualifiers: Intellectual disability, Severe substance use, Neurologic condition, Cognitive impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 12

Duration: 12-14 weeks

80 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems likely that you can continue your medications since the trial focuses on motivation skills training and not on medication changes.

What data supports the effectiveness of the treatment Motivation Skills Training for Serious Mental Illness?

Research shows that motivation-enhancing techniques can improve treatment outcomes in cognitive remediation therapy for schizophrenia, suggesting that Motivation Skills Training may help increase motivation and engagement in individuals with serious mental illness. ^{1 2 3 4 5}

Is Motivation Skills Training safe for people with serious mental illness?

The research articles reviewed do not provide specific safety data for Motivation Skills Training or its variants. They focus on the effectiveness of skills training for improving social and independent living skills in individuals with severe mental illness, particularly schizophrenia. ^{2 5 6 7 8}

How is Motivation Skills Training (MST) different from other treatments for serious mental illness?

Motivation Skills Training (MST) is unique because it focuses on enhancing both intrinsic (internal) and extrinsic (external) motivation to improve treatment engagement and outcomes, particularly in individuals with schizophrenia who often experience motivational impairments. This approach is distinct from other treatments as it directly targets motivation to facilitate learning and skill acquisition, which is crucial for improving psychosocial functioning. ^{1 2 4 6 9}

What is the purpose of this trial?

This study will take place at four outpatient clinics serving adults with serious mental illness. Informed consent will be obtained from N=80 individuals with a Diagnostic and Statistical Manual of Mental Illnesses (DSM)-5 diagnosis of schizophrenia or schizoaffective disorder meeting inclusion/exclusion criteria to participate in a randomized controlled trial comparing Motivation Skills Training (MST) to a Healthy Behaviors Control (HBC) group. Eligible participants will receive a baseline assessment including sociodemographic and psychosocial assessments, measures of motivation, goal attainment, and quality of life, as well as measures of executive skills, community functioning, and psychiatric symptoms severity. Both MST and HBC will be implemented as once weekly group therapies. The treatment phase is approximately 12-14 weeks. MST will focus on motivation knowledge and self-regulation skills while HBC will focus on physical health and health-related skills.

Research Team

Alice Saperstein, PhD

Principal Investigator

Columbia University

Eligibility Criteria

Adults aged 18-65 with schizophrenia or schizoaffective disorder, who speak English and are stable enough to attend outpatient therapy. They shouldn't have intellectual disabilities (IQ <70), severe recent substance use, or brain diseases due to neurological conditions.

Inclusion Criteria

I have been diagnosed with Schizophrenia or Schizoaffective Disorder.

I am stable both physically and mentally.

English Fluency

Exclusion Criteria

I have a brain condition due to a neurological issue.

Indications of Intellectual Disability as documented in medical history or measured by < 70 premorbid full scale Intelligence Quotient (IQ) estimate

I am over 60 and have a MMSE score below 20, indicating cognitive impairment.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Participants undergo baseline assessments including sociodemographic and psychosocial assessments, measures of motivation, goal attainment, and quality of life, as well as measures of executive skills, community functioning, and psychiatric symptoms severity

1 week

Treatment

Participants receive weekly group-based interventions, either Motivation Skills Training (MST) or Healthy Behaviors Control (HBC), focusing on motivation and self-regulation skills or physical health and health-related skills, respectively

12-14 weeks

12-14 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments of functional outcomes, motivation, and quality of life

5 months

Treatment Details

Interventions

• Healthy Behaviors Control Group
• Motivation Skills Training

Trial Overview The trial is testing Motivation Skills Training (MST) against a Healthy Behaviors Control group in people with serious mental illness. Participants will attend weekly group sessions for about 12-14 weeks focusing on either motivation and self-regulation skills (MST) or physical health (HBC).

Participant Groups

Group I: Motivation Skills Training (MST) Experimental Treatment 1 Intervention

MST is a weekly group-based skills training intervention that aims to improve knowledge about one's level and sources of motivation, the ability to monitor and regulate (understand and manage) motivation so that one can better initiate and sustain goal-directed behavior

Group II: Healthy Behaviors Control Group Active Control 1 Intervention

HBC is a weekly group-based intervention that provides psychoeducation and skills training to help individuals improve physical health

Who Is Running the Clinical Trial?

Columbia University

Lead Sponsor

Trials

1,529

Recruited

2,832,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Findings from Research

Intrinsic motivation is often impaired in individuals with schizophrenia, which negatively affects their engagement in treatment and the effectiveness of psychosocial interventions.

Therapeutic techniques designed to enhance intrinsic motivation have been shown to improve outcomes in cognitive remediation therapy and other behavioral interventions for schizophrenia, suggesting that addressing motivation can lead to better treatment results.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Role of Motivation in Cognitive Remediation for People with Schizophrenia. Saperstein, AM., Medalia, A.[2018]

Motivation plays a crucial role in the success of skills-based psychosocial treatments for schizophrenia, particularly in cognitive remediation, where intrinsic motivation (IM) is linked to better learning outcomes.

The article explores whether IM in individuals with schizophrenia is changeable and how manipulating motivation can enhance learning, suggesting that tailored motivational strategies could improve treatment effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of motivation for treatment success. Medalia, A., Saperstein, A.[2021]

In a study of 404 individuals with a first episode of psychosis, those who participated in four or more sessions of Individual Resiliency Training (IRT) showed significant improvements in motivation and role functioning compared to those receiving standard Community Care.

However, participants who attended three or fewer IRT sessions did not experience any notable differences in motivation or functioning, indicating that a higher level of engagement with goal-focused IRT is necessary for meaningful change.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Focusing on recovery goals improves motivation in first-episode psychosis. Fulford, D., Meyer-Kalos, PS., Mueser, KT.[2023]

In a study of 38 participants with schizophrenia-spectrum disorders, higher attendance in cognitive training sessions and more homework completion were significantly linked to improvements in neurocognition, indicating that active engagement is crucial for effective treatment outcomes.

Homework completion was found to mediate the relationship between session attendance and neurocognitive improvements, suggesting that encouraging participants to complete homework could enhance the effectiveness of cognitive remediation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motivation and engagement during cognitive training for schizophrenia spectrum disorders. Best, MW., Milanovic, M., Tran, T., et al.[2022]

A meta-analysis of 68 studies showed that skills training is moderately to strongly effective in helping individuals with severe mental illness acquire skills and reduce psychiatric symptoms, indicating its potential as a valuable therapeutic intervention.

The effectiveness of skills training varied based on the type of outcome measure used, with greater improvements seen in situationally specific measures compared to general skill usage and role functioning, highlighting the need for more comprehensive assessments in future research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Meta-analytic evaluation of skills training research for individuals with severe mental illness. Dilk, MN., Bond, GR.[2019]

Social skills training is effective for individuals with schizophrenia, helping them acquire essential interpersonal and independent living skills, which can improve their functioning in the community.

Recent advancements in social skills training have tailored approaches for various groups, including those with dual diagnoses and older adults, enhancing the generalization of skills to real-life situations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Recent advances in social skills training for schizophrenia. Kopelowicz, A., Liberman, RP., Zarate, R.[2022]

A novel psychosocial intervention combining motivational interviewing and cognitive-behavioral therapy (MI-CBT) significantly improved motivational negative symptoms in 79 participants with schizophrenia over a 12-week treatment period, with effects maintained during follow-up.

While the MI-CBT treatment showed promise in reducing negative symptoms, improvements in community functioning and cognitive effort markers were not statistically significant, indicating that further research is needed to enhance the impact of this intervention on daily functioning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Novel Psychosocial Intervention for Motivational Negative Symptoms in Schizophrenia: Combined Motivational Interviewing and CBT. Reddy, LF., Glynn, SM., McGovern, JE., et al.[2023]

Social skills training is an effective strategy for improving the social competence of patients with schizophrenia and other major mental disorders, helping to reduce relapses and enhance psychosocial functioning.

Training models, such as the 'basic' model with role playing and feedback, and the 'problem-solving' model that focuses on processing social messages, are essential components of a comprehensive rehabilitation program that includes ongoing support and appropriate medication.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Training skills in the psychiatrically disabled: learning coping and competence. Liberman, RP., Mueser, KT., Wallace, CJ., et al.[2019]

In a study of 404 individuals aged 15-40 who experienced their first episode of schizophrenia spectrum disorder, motivation was found to significantly influence later work and school participation, but not vice versa.

Social functioning at 6 months was linked to increased motivation at 12 months, suggesting that enhancing social interactions may help improve motivation in patients following their first psychotic episode.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prospective Relationships Between Motivation and Functioning in Recovery After a First Episode of Schizophrenia. Fulford, D., Piskulic, D., Addington, J., et al.[2019]

References

1. Germany pubmed.ncbi.nlm.nih.gov

The Role of Motivation in Cognitive Remediation for People with Schizophrenia. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

The role of motivation for treatment success. [2021]

3. Germany pubmed.ncbi.nlm.nih.gov

Focusing on recovery goals improves motivation in first-episode psychosis. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Motivation and engagement during cognitive training for schizophrenia spectrum disorders. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Meta-analytic evaluation of skills training research for individuals with severe mental illness. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Recent advances in social skills training for schizophrenia. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

A Novel Psychosocial Intervention for Motivational Negative Symptoms in Schizophrenia: Combined Motivational Interviewing and CBT. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Training skills in the psychiatrically disabled: learning coping and competence. [2019]

9. United States pubmed.ncbi.nlm.nih.gov

Prospective Relationships Between Motivation and Functioning in Recovery After a First Episode of Schizophrenia. [2019]