The role of motivation in clinical presentation, treatment engagement and response in schizophrenia-spectrum disorders: A systematic review

• Published in: Clinical psychology review Vol. 113; p. 102471
• Main Authors: Thai, Helen, Audet, Élodie C., Koestner, Richard, Lepage, Martin, O'Driscoll, Gillian A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.11.2024
• Subjects: Humans; Interventions; Motivation; Motivation - physiology; Personal Autonomy; Schizophrenia; Schizophrenia - physiopathology; Schizophrenia - therapy; Schizophrenic Psychology; Self-determination theory; Self-determination theory; Schizophrenia; Interventions; Motivation
• ISSN: 0272-7358; 1873-7811; 1873-7811
• DOI: 10.1016/j.cpr.2024.102471

Schizophrenia, a debilitating psychiatric disorder, has a long-term impact on social and occupational functioning. While negative symptoms, notably amotivation, are recognized as poor prognostic factors, the positive force of patient motivation (autonomous motivation) remains underexplored. This systematic review, guided by Self-Determination Theory (SDT), investigated the impact of motivation on clinical presentation, and treatment engagement and response in schizophrenia-spectrum disorders. Fifty-five independent studies (N = 6897), using 23 different motivation scales, met inclusion criteria. Results were categorized into cross-sectional and longitudinal correlates of autonomous motivation, and the effects of motivational interventions. Cross-sectionally, autonomous motivation was positively associated with social/occupational functioning, and negatively associated with negative and positive symptom severity. In longitudinal studies, baseline autonomous motivation predicted engagement in and response to social/occupational treatments, with mixed results in cognitive interventions. In the 16 randomized controlled trials (RCTs), the most common motivational interventions were individualized goal setting and goal attainment support, followed by increasing sense of competence by challenging defeatist beliefs, and enhancing relatedness by increasing contact time. Motivational interventions consistently increased autonomous motivation, treatment engagement and response. More studies are needed, particularly studies that monitor motivation during treatment: proximal assessments could facilitate the identification of treatment elements that impact motivation and engagement and inform treatment modifications to enhance the patient experience and improve treatment efficacy. •Motivation is important in schizophrenia treatment, not only in its absence but as a positive force that can be fostered.•Baseline motivation linked to clinical status, with the magnitude of response to treatments targeting social/work functioning.•Motivation changes over time, with increases in motivation associated with treatment response.•RCTs showed motivational interventions to established treatments increase motivation, treatment engagement, and response.•More studies are needed that monitor motivation during treatment and antecedents of motivation.