Mobile Enhancement of Motivation in Schizophrenia: A Pilot Trial of a Personalized Text-Message Intervention for Motivation Deficits

Abstract

Motivation deficits remain an unmet treatment need in schizophrenia. Recent preclinical research has identified novel mechanisms underlying motivation deficits, namely impaired effort-cost computations and reduced future reward-value representation maintenance, that may serve as more effective treatment targets to improve motivation. The main aim of this study was to test the feasibility and preliminary effectiveness of a translational mechanism-based intervention, MEMS (Mobile Enhancement of Motivation in Schizophrenia), which leverages mobile technology to target these mechanisms with text-messages. Fifty-six participants with a schizophrenia-spectrum disorder were randomized to MEMS (n = 27) or a control condition (n = 29). All participants set recovery goals to complete over eight-weeks. The MEMS group also received personalized, interactive text-messages each weekday to support motivation. Retention and engagement in MEMS was high: 92.6% completed 8 weeks of MEMS, with an 86.1% text-message response rate, and 100% reported that they were satisfied with the text-messages. Compared to the control condition, the MEMS group had significantly greater improvements in interviewer-rated motivation and anticipatory pleasure and obtained significantly more recovery-oriented goals at the end of the 8-week period. There were no significant group differences in performance-based effort-cost computations and future reward-value representations, self-reported motivation, quality of life, functioning, or additional secondary outcomes of positive symptoms, mood symptoms, or neurocognition. Results suggest that MEMS is feasible as a relatively brief, low-intensity mobile intervention that could effectively improve interviewer-rated motivation, anticipatory pleasure, and recovery goal attainment in those with schizophrenia-spectrum disorders.