Association between motivation and engagement with changes in cognition and symptoms after digital cognitive training in schizophrenia

Luana G Mororó; Anna Luiza Guimarães; Ana Carolina Costa; Larissa Genaro; Maria T Cavalcanti; Linda Scoriels; Rogerio Panizzutti

doi:10.1016/j.schres.2022.12.002

Association between motivation and engagement with changes in cognition and symptoms after digital cognitive training in schizophrenia

Schizophr Res. 2023 Jan:251:1-9. doi: 10.1016/j.schres.2022.12.002. Epub 2022 Dec 15.

Authors

Luana G Mororó¹, Anna Luiza Guimarães¹, Ana Carolina Costa², Larissa Genaro¹, Maria T Cavalcanti², Linda Scoriels³, Rogerio Panizzutti⁴

Affiliations

¹ Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil.
² Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil.
³ Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris, Inserm 1266, Paris, France.
⁴ Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil. Electronic address: rogerio.panizzutti@ipub.ufrj.br.

PMID: 36527953
DOI: 10.1016/j.schres.2022.12.002

Abstract

Background: Digital cognitive training can remediate cognitive deficits present in schizophrenia. However, limited motivation and engagement may impact adherence to training. Therefore, identifying factors that may enhance (facilitators) or decrease (barriers) engagement in digital cognitive training and possibly modulate its effects are of great clinical relevance.

Methods: We measured cognition, symptom severity, motivation (semi-structured interview), and engagement (adapted Utrecht Work Engagement Scale - UWES) of 27 patients with schizophrenia after a 40-h digital cognitive training. The interview transcript quotes were coded and categorized into facilitators and barriers. Thereafter, we tested the association of motivation and engagement with changes in cognition and symptoms after training.

Results: The facilitator 'good performance' and the barrier 'difficult exercise' were associated with larger gains in attention (p = 0.03) and reasoning and problem solving (p = 0.02), respectively. 'Poor performance' was associated with smaller gains in global cognition (p < 0.01), attention (p = 0.03), and working memory (p = 0.02). The facilitator 'welcoming setting' was associated with larger reductions in the negative (p = 0.01) and total (p = 0.01) symptoms measured by the Positive and Negative Syndrome Scale. The UWES engagement scale was associated with different facilitators and barriers that emerged from the interview, an indication of consistency among both qualitative and quantitative assessments.

Discussion: Using a mixed quantitative and qualitative research design, we showed associations between motivation and engagement and the response to digital cognitive training in schizophrenia. Facilitators and barriers were associated with engagement, gains in cognition, and reduced symptoms after the intervention, providing insights on how to increase engagement in the digital cognitive training delivered to subjects with schizophrenia.

Keywords: Digital cognitive training; Engagement; Motivation; Schizophrenia.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Cognition
Cognitive Dysfunction* / etiology
Cognitive Dysfunction* / therapy
Cognitive Training
Humans
Motivation
Schizophrenia* / complications
Schizophrenia* / diagnosis
Schizophrenia* / therapy

Grants and funding

R03 TW009002/TW/FIC NIH HHS/United States