Approach and withdrawal from cognitively effortful activities: Development, validation, and transdiagnostic clinical utility of a cognitive motivation scale.

ABSTRACT

BACKGROUND: Deficits in cognition and motivation predict functioning in depressive and psychotic disorders. However, experimental tasks of cognitive motivation are inconsistently correlated with functioning, time-intensive, and not intuitive in clinical practice. We aimed to develop and validate a self-report instrument to assess motivation processes pertinent to engagement with cognitive activities in daily life. METHOD: Following item generation, scale dimensionality, reliability, and validity were evaluated iteratively over Studies 1-3 with online general adult participants (n1 = 205; n2 = 235; n3 = 181). The 20-item Cognitive Motivation scale was also validated in a Study 3 sub-sample reporting high levels of depressive symptoms (n = 74) and Study 4 early psychosis outpatients (n = 25). RESULTS: Two-factor model of cognitive approach and cognitive withdrawal, each with good internal consistency, convergent validity, discriminant validity was supported. Cognitive withdrawal showed stronger associations with cognitive difficulties, depressive symptoms, and functional impairments than traditional motivation scale. Participants reporting high depression levels showed more severe difficulties with cognitive motivation than participants reporting low depression levels. In early psychosis outpatients, correlations with functioning and cognitive effort expenditure provided support for scale validity. LIMITATIONS: Cross-sectional data collection restricted evaluation of repeated administration psychometric properties. Scale validation was mostly established in online community samples and a small patient sample during the COVID-19 pandemic, thereby limiting generalizability of clinical applications. CONCLUSIONS: Cognitive Motivation scale is a promising tool for future intervention trials seeking to target motivational processes associated with functioning in the general population and potentially across patient groups with amotivation symptoms.