Intervention Targeting Motivational Negative Symptoms
Condition: Schizophrenia; Schizo Affective Disorder; Bipolar Disorder; Major Depressive Disorder
MeSH terms: Schizophrenia; Depressive Disorder; Depressive Disorder, Major; Bipolar Disorder; Mood Disorders; Psychotic Disorders
Study type: Interventional

Summary: 
      This study aims to investigate the effects of the Switch intervention on motivation and
      associated processes and explore the dynamics between the processes.

      A single case approach is followed, with a pre-post and follow-up assessment design, and
      continuous ambulatory assessments (experience sampling method (ESM) and step count).
    

Detailed description: 
      Motivational negative symptoms hinder quality of life and daily functioning of individuals
      with schizophrenia spectrum, bipolar and major depressive disorders.

      A recently developed intervention, Switch, has shown promising effects on negative symptoms
      and functional outcomes. Switch is based on a model that identifies various cognitive,
      behavioural and emotional processes related to motivation and goal-directed behaviours:
      pleasure anticipation, value-effort-probability computation, (dys)functional attitudes (e.g.,
      discouraging thoughts, self-efficacy), planning, initiation, in-the-moment enjoyment,
      reminiscence. The intervention combines a person-centred and recovery approach with
      cognitive, behavioural and 3rd wave techniques to tackle the obstacles related to motivation
      and goal-directed behaviours (i.e., targetting the various cognitive, behavioural and
      emotional processes listed above). Thus, an important part of the intervention focuses on the
      person's strengths, needs, goals and values. Furthermore, various strategies (e.g., cognitive
      defusion, pleasure anticipation, problem solving, reminiscence) are used to encourage
      engagement in meaningful personal goals and values.

      The Switch intervention is provided either in individual (one-hour sessions), or in a group
      setting (two-hour sessions), twice a week for around two months.

      There are three types of evaluation: traditional assessment scales of motivational deficits,
      apathy, quality of life and daily functioning (pre, post and follow-up at 3 months);
      ambulatory assessment including ESM (i.e., daily questionnaires); actigraphy (step count).

      The aims of this study is to evaluate the efficacy of Switch in two different settings (i.e.,
      individual sessions and a group programme) on motivation/apathy and functional
      outcomes/quality of life. Furthermore, we wish to explore the effects of Switch on process
      related to motivation and goal-directed behaviours (e.g., pleasure anticipation,
      reminiscence, defeatist beliefs, activities' meaningfulness) and on activity (i.e., step
      count). Finally, we wish to evaluate the dynamics between the different cognitive,
      behavioural and emotional processes related to motivation and goal-directed behaviours.
    

Intervention name(s): Switch - Individual sessions; Switch - Group programme
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants follow the Switch intervention through individual sessions (1 hour, twice a week, for around 2 months).
Participants are provided with a folder which presents the rational for each strategy. Take-home assignments are given and stored in the same folder. Participants are also given small cards (that can fit in their wallet) containing the key elements of each strategy.
The intervention manual can be obtained from the main investigator (in French).; Participants follow the Switch group programme (2 hours, twice a week, for around 2 months).
During the group sessions, a powerpoint presentation and different media are used to present the different parts of the motivation model. Participants learn the different strategies (e.g., cognitive defusion, pleasure anticipation, problem solving) through individual and group exercises.
Participants are provided with a folder which presents the rational for each strategy. Take-home assignments are given and stored in the same folder. Participants are also given small cards (that can fit in their wallet) containing the key elements of each strategy.
The intervention manual and the presentation material can be obtained from the main investigator (in French).
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment