Motive-specific Intervention for Negative Symptoms in Schizophrenia (MoNSS)

Treating Negative Symptoms of Schizophrenia With a Motive-specific Intervention: A Randomised Controlled Trial

The aim of this study is to test a therapeutic intervention to reduce negative symptomatic among schizophrenia patients. Since the intervention can take place within an inpatient stay, it is a short intervention. Three appointments are made with the patients within two weeks. With an adaptation of the Autobiographical Memory Test (AMT) participants will be asked to recall events from the past and to imagine future events. Patients are additionally asked to complete tasks between the sessions. One pre- and one post-measurement of negative symptoms, motives, level of functioning, hope for recovery and other co-variables are part of the study. A follow-up appointment four weeks later is intended to provide information on the longer-term impact.

Clinically relevant negative symptoms are present in almost 60% of all patients suffering from schizophrenia. Motivational deficits seem to be one of the main barriers in the process of "functional recovery" among those patients and have been shown to be very treatment resistant. Effects of pharmacological compounds are at best moderate. There are some psychotherapeutic intervention studies that show promise but further controlled trials are needed to clarify the specific treatment effects. Therefore, patients shall be encouraged to remember memories that stand in an association with specific motives. Motives are conscious and unconscious affect-based needs that are activated by behavior and influence behavior toward specific incentives in specific circumstances. They influence the selection of everyday goals and have influence on the degree of the progress people are making towards these goals. The intervention is based on the assumption that a positive expectation of the future is constituted among others by positive experiences from the past and at the same time increases the motivation for future behaviour. The activation of specific, motive-associated memories from autobiographical memory and their transformation into images of the future by means of imaginative methods could be a possible way of strengthening certain motives and thus increasing motivation for certain behaviour. This is mainly because there is evidence that psychosis patients have difficulties specifically remembering memories, i.e. those that happened on only one day. In addition, there is a diminished ability to create specific images of their personal future.

Three appointments are made with the patients of the intervention group within two weeks. With an adaptation of the Autobiographical Memory Test (AMT) participants will be asked to recall events from the past and to imagine future events. The time frame of 45 minutes for each intervention must be strictly adhered to. Patients are additionally asked to complete tasks between the sessions. All appointments take place in the Psychiatric University Hospital directly on the ward.

Since we want to check whether the patients benefit from the specific intervention and not only from getting more speaking time, patients without the motive-specific intervention should also be given three sessions, in which no intervention takes place. They will be carried out in the sense of supportive conversations (i.e. conversations that do not follow a specific psychotherapy concept). All appointments take place in the Psychiatric University Hospital directly on the ward.

The primary outcome criterion is the change and expected reduction of the severity of the negative symptoms in schizophrenia patients before and after the three-week motive-specific intervention. We compare the change of severity between the patients of the intervention group and those in the control group. Negative symptoms are measured with the Brief Negative Symptom Scale (BNSS) and items are rated on a 7-point-scale (0 = absent, 6 = severe).

Another primary outcome criterion is the change of the severity of the negative symptoms in schizophrenia patients who have received the motive-specific intervention compared to the control group patients in a follow-up appointment four weeks after termination of the intervention. Negative symptoms are measured with the Brief Negative Symptom Scale (BNSS) and items are rated on a 7-point-scale (0 = absent, 6 = severe).

Correlation between the severity of negative symptoms and explicit motives measured with the Questionnaire for the Zurich Model of Social Motivation

Secondary outcome criterion is the statistical significance and quality of the relationship between negative symptoms (measured with the Brief Negative Symptom Scale; items are rated on a 7-point-scale with 0 = absent and 6 = severe) and explicit reported motives.

Correlation between the severity of negative symptoms and implicit motives measured with the Multi Motive Gitter

Another secondary outcome criterion is the statistical significance and quality of the relationship between negative symptoms (measured with the Brief Negative Symptom Scale; items are rated on a 7-point-scale with 0 = absent and 6 = severe) and implicit motives.

Inclusion Criteria: Informed Consent as documented by signature Male and female inpatients between 18 and 65 years of age ICD-10 diagnosis of psychosis (F2) Clinical relevant negative symptoms Ability to judge with regard to decisions on study participation Fluent in German and able to understand the instructions Exclusion Criteria: Florid positive psychotic symptoms (measured with PANSS; that is any positive-subscale item score higher than five) Post-schizophrenic depression (ICD: F20.4) Organic schizophrenia-like disorder (ICD: F0.6) Known or suspected non-compliance, drug or alcohol abuse during treatment Cognitive impairments: strongly below average values in cognitive tests Complete stop or restart of taking antipsychotic medication during the study (dose adjustments are not a reason for exclusion) Previous enrolment in the current study Enrolment of the investigator, his/her family members, employees and other dependent persons.