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Overload, Not Apathy: Breaking Goals into Smaller Steps to Overcome the Motivation Gap in Schizophrenia

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For the most part, the medications people take for schizophrenia treat only one symptom of the illness: the psychosis associated with delusions and hallucinations. Some of the most harmful effects of schizophrenia are the “negative symptoms” of flat affect, inability to take interest or pleasure in everyday life, lack of ability to begin and sustain planned activity, and social withdrawal, none of which are addressed by medication. At the core of these negative symptoms, which are so isolating to people living with schizophrenia, is what looks like apathy or lack of motivation.

For years, low motivation has been treated as an inevitable and unchangeable feature of the illness. New research on the cognitive impairment associated with schizophrenia paints a different picture. The study, reported in the Journal of Abnormal Psychology, found that many people living with schizophrenia are able to engage in low-impact, pleasurable goals, such as watching television, but have a much harder time with complex undertakings or goals requiring effort and planning. The research found that people with schizophrenia have a hard time assessing the amount of effort involved with a particular task relative to the pleasure derived from it.

One lesson family members can draw from these findings is that the withdrawal and low activity levels we see in people with schizophrenia are not just the result of apathy. We can actually help them work past motivational deficits by breaking up larger, complex tasks into smaller, simpler ones with small rewards along the way. This approach can also boost self-esteem, by giving the individual many smaller successes to celebrate, in place of larger, overwhelming goals that feel beyond their reach. A related study reported in JAMA Psychiatry found that motivational impairment can also impact cognition.


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Jay Boll, Editor in Chief www.rtor.org