Motivational interviewing to enhance psychosocial treatment attendance in people with SMI.

BACKGROUND: While there is increasing support for the efficacy of psychosocial interventions for people with SMI, the real-world effectiveness of such treatments is diminished by lack of motivation for treatment, leading to poor treatment engagement/dropout. We sought to evaluate the efficacy of motivational interviewing (MI) in improving attendance in a full course of cognitive training, examine motivation level as a potential mechanism of action, and examine variables associated with initial engagement in the training. METHODS: One hundred fourteen participants with SMI were randomized to MI or sham control interview (CI), both of which were followed by a 4-month active phase during which participants could attend up to 50 unpaid cognitive training sessions. RESULTS: Fidelity to the MI intervention was high, and MI condition was associated with increases in perceived value of training tasks and, to a lesser extent, how enjoyable/interesting they were rated. Twenty-nine percent of the full sample did not attend any training sessions. In ITT analyses, there was no significant between-group impact of MI on treatment attendance, though one emerged when participants who did not attend any sessions were excluded. Treatment attendance was predicted by the level of motivation achieved after the MI/CI intervention. Those who attended at least one training session (regardless of randomization) were more likely to believe they had cognitive impairments, had higher IQ and had less severe general psychiatric symptoms. CONCLUSIONS: MI showed some promise and may be a worthwhile addition to more comprehensive, robust efforts to promote initial treatment engagement and subsequent adherence.

Psychometrics of social cognitive measures for psychosis treatment research.

Social cognition represents an important treatment target, closely linked to everyday social function. While a number of social cognitive interventions have recently been developed, measures used to evaluate these treatments are only beginning to receive psychometric scrutiny. Study goals were to replicate recently-published psychometrics for several social cognitive measures, and to provide information for additional social cognitive measures not included in recent reports. Forty-eight outpatients with psychotic-spectrum disorders completed measures of emotion perception, theory of mind, and attributional bias on two occasions, one month apart. Measures were tested for distributional characteristics, test-retest reliability, utility as a repeated measure, and relationship to symptoms and functioning. For a subgroup of participants, information about sensitivity to social cognitive treatment was also available. We replicated aspects of prior work, including largely favorable psychometric characteristics for the Bell-Lysaker Emotion Recognition Task, and promising but weaker characteristics for The Awareness of Social Inferences Test subscales and Reading the Mind in the Eyes Task. The Hinting Task had adequate test-retest statistics but a more pronounced ceiling effect. Ambiguous Intentions and Hostility Questionnaire data showed evidence of validity but were limited by inconsistency over time. Our results strongly support the Davos Assessment of Cognitive Biases Scale for future evaluation as a social cognitive treatment outcome measure. Its scores were adequately distributed, consistent over time, related to symptoms and functioning, and sensitive to treatment effects. Other relatively novel assessments of attributional bias and theory of mind showed some promise, although more work is needed.