Motivational interviewing, CBT combination improves schizophrenia symptoms

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

“Motivational deficits are widespread in schizophrenia and difficult to treat with existing pharmacological drugs,” L. Felice Reddy, Ph.D., associate professor and associate director of First Episode Psychosis, NC, at the University of North Carolina, said of Healio. “We knew that in other populations with depression and substance use, combining two evidence-based practices—motivational interviewing and cognitive-behavioral therapy—enhanced efficacy over 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 symptoms of schizophrenia to either a combination of MI-CBT or 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.

Researchers assessed symptoms at baseline, 12 weeks, and at the end of the 24-week follow-up 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 cognitive ability using the MATRICS Consensus Cognitive Battery and community function using the Specific Level of Functioning scale. Pupil data were collected with the Deck Choice Effort Task cognitive task.

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

Similarly, the MI-CBT group had a significant improvement in pupillometry scores at week 12 (P = .0066) compared to the control group, but this did not remain significant at follow-up.

“This is the first time it has been shown that negative symptoms can be treated relatively effectively (in a group setting that meets 1 hour a week for 12 weeks),” Reddy said. “Our attendance and participation was really high, which suggests that 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 roll out this hands-on approach to providers in many different settings, working with all types of clients who struggle with motivation and achieving goals, so we can help as many people as possible live fulfilling lives,” said she.