The goal of this project is to complete the development and pilot testing of a mobile health app to improve motivation, thereby improving functional outcomes in individuals with recent-onset (RO) schizophrenia. Motivational impairment, a core feature of schizophrenia, is arguably the single most important factor in determining a patient's ability to engage in and adhere to effective treatment, and is the strongest predictor of functioning, accounting for 74% of the variance of psychosocial outcomes. Prior approaches to improve functional outcomes in schizophrenia are limited in their efficacy and high dropout rates remain a significant problem. In light of this pressing public health problem, an innovative approach is necessary. We propose to develop a new intervention, PRIME (Personalized Real-Time Intervention for Motivational Enhancement), a mobile app, which will use the latest innovations in mobile software to improve functional outcomes in individuals early in the course of illness. PRIME will require less motivational engagement while also being available at greater frequency than traditional therapeutic strategies would allow (e.g. psychotherapy). PRIME will be theoretically grounded in an evidence-based model of motivated behavior (Expectancy Value Theory) and target known motivational deficits, such as reward prediction, behavioral activation, and reward learning. This project will use a participatory desig strategy to enhance the likelihood that PRIME will be feasible and well tolerated in the target population. After a series of focus groups and field tests, we will conduct a small, randomized controlled trial to test the extent to which PRIME improves motivated behavior in three key domains: social, role, and health functioning, over a one-month period, relative to RO individuals in a wait-list control condition. This study will result in the first mobile app designed for individuals with schizophrenia, while also holding promise for other health conditions in which motivational impairments impede health outcomes.

Public Health Relevance

This project will result in the development of an innovative mobile health app to improve motivation and functional outcomes in individuals with schizophrenia. The results will pave the way forward for other health conditions in which motivational impairments impede health outcomes. By enhancing motivation, patients will be able to engage more fully with treatment and develop full and productive lives.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Special Emphasis Panel (ZMH1-ERB-I (01))
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Juliano-Bult, Denise M
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University of California San Francisco
Schools of Medicine
San Francisco
United States
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Schlosser, Danielle A; Fisher, Melissa; Gard, David et al. (2014) Motivational deficits in individuals at-risk for psychosis and across the course of schizophrenia. Schizophr Res 158:52-7