Motivational Interviewing Plus CBT Improves Negative Symptoms in Schizophrenia

A novel approach of combining motivational interviewing (MI) with cognitive behavioral therapy (CBT) improved negative symptoms in patients with schizophrenia, according to study findings published in the American Journal of Psychiatry.

Researchers recruited patients with schizophrenia (N=79) from the outpatient clinic of the Veterans Affairs Greater Los Angeles Healthcare System. Patients were randomly assigned to receive MI-CBT (n=41) or active control (n=38) delivered in 1-hour sessions weekly over 12 weeks. The MI-CBT intervention was adapted from MI and CBT techniques with the objectives to resolve ambivalence, establish a commitment to change, and to build motivation. The active control was based on mindfulness and stress reduction techniques.

The primary outcomes of the study were the change in motivational negative symptoms and community functioning.

The MI-CBT and control cohorts comprised 95% and 95% men; mean age, 54.8 (SD, 8.8) and 54.1 (SD, 8.2) years; 56% and 53% were Black; MATRICS Consensus Cognitive Battery (MCCB) scores were 32.9 (SD, 12.8) and 33.3 (SD, 9.6) points; and UCSD Performance-Based Skills Assessment (UPSA-2) scores were 36.8 (SD, 6.6) and 36.3 (SD, 5.7) points, respectively.

On average, a total of 9.3 (SD, 3.1) sessions were attended and 5.8 (SD, 3.7) homework assignments were completed by participants in the MI-CBT cohort compared with individuals in the control cohort who attended 10.0 (SD, 2.2) sessions and completed 6.7 (SD, 3.6) homework assignments.

Significant acute treatment effects from baseline to week 12 were observed in the motivation and pleasure (MAP) subscale of the Clinical Assessment Instrument for Negative Symptoms instrument (F, 10.5; P =.0016), in which participants in the MI-CBT cohort had improved scores (F, 26.02; P <.0001) but control individuals did not (F, 0.16; P =.6855). A similar significant effect was observed between weeks 12 and 24 (F, 5.42; P =.0217).

In addition, a significant effect during a pupillometry task was observed in the first 12 weeks (F, 5.20; P =.0248), in which the MI-CBT group had an increase in average pupil dilation (F, 7.70; P =.0066) but control individuals did not (F, 0.24; P =.6274).

No overall treatment effects between baseline and week 24 were observed, however, the depression outcome of the Brief Psychiatric Rating Scale (BPRS) instrument was trending toward significance (F, 3.8; P =.05).

The average patient-reported tolerability rating was 9.2 (SD, 1.1), indicating uniform, high tolerability. The participants reported a high rating for trainer enthusiasm (mean, 8.9), trainer knowledgeability (mean, 9.4), and how much treatment helped with symptoms (mean, 8.6).

The limitations of this study included the short follow-up duration and the lack of patient diversity.

Study authors concluded, "[T]his was a rigorously controlled treatment study using an innovative and accessible intervention, and the results support the efficacy of MI-CBT for improving motivational negative symptoms."

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reddy LF, Glynn SM, McGovern JE, Sugar CA, Reavis EA, Green MF. A novel psychosocial intervention for motivational negative symptoms in schizophrenia: combined motivational interviewing and CBT. Am J Psychiatry. Published online March 9, 2023. doi:10.1176/appi.ajp.20220243