Title: Improving cognitive rehabilitation engagement and adherence in schizophrenia Background: Schizophrenia is a disabling illness, characterized by severe impairments in social, occupational, and community function. There is also ample evidence of significant cognitive impairments in schizophrenia, and these cognitive impairments directly relate to poorer functional outcomes. While a number of reviews and meta-analyses provide support for the efficacy of cognitive rehabilitation in schizophrenia, the (real-world) effectiveness of this psychosocial treatment is diminished by the participants'lack of motivation for treatment, leading to poor treatment engagement, adherence, and efficacy. Since many of the techniques used by research studies to increase adherence cannot be practicably carried over to real-world clinical settings, there is a need to develop other, more clinically-feasible approaches for increasing adherence to psychosocial treatments. One such approach that has successfully been used to increase adherence and efficacy of various treatments is motivational interviewing. Objectives: In the proposed pilot study, the primary aim is to evaluate dual diagnosis motivational interviewing adapted for cognitive rehabilitation (DDMI-CR), compared to interview control (IC), in increasing adherence to, engagement in, and efficacy of a brief cognitive rehabilitation treatment analog. Secondary aim is to determine whether DDMI-CR increases self-reported intrinsic motivation. We will also explore the potential role of cognition as a moderator of DDMI-CR efficacy. Methods: This is a randomized, controlled, proof-of-concept pilot study using a learning paradigm as an analog for learning that occurs during a full course of cognitive rehabilitation. Sixty participants with schizophrenia spectrum diagnoses will be randomized to two sessions of DDMI-CR or IC, followed by 10, 30- minute sessions of a learning paradigm targeting attention, memory and problem-solving skills, to be completed over a 1 month period. Assessments will include cognition, intrinsic motivation, and a measure of skills targeted by the learning paradigm. Significance: Support for the efficacy of motivational interviewing in increasing engagement in and adherence to the cognitive rehabilitation analog proposed in this pilot study would provide valuable data to support a larger and more rigorous trial of the efficacy of DDMI-CR for a full course of cognitive rehabilitation. Increasing engagement and adherence, and thereby efficacy of the treatment, may in turn lead to improved functional outcomes, including better community functioning and greater social integration, in veterans suffering from schizophrenia spectrum illness.
Patients with schizophrenia represent one of the largest, most chronic psychiatric groups served by the VA. Impaired social and community function is a hallmark of schizophrenia, and though empirically validated psychosocial treatments exist, their effectiveness is limited by poor treatment adherence. The proposed study evaluates motivational interviewing as a potential method for improving real-world adherence to one type of psychosocial treatment, cognitive rehabilitation, and will advance a line of research aimed at increasing the efficacy and effectiveness of psychosocial treatments in decreasing disability, improving community function, and promoting social integration in veterans suffering from schizophrenia.