Development of the Demotivating Beliefs Inventory and Test of the Cognitive Triad of Amotivation
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Recent cognitive models of negative symptoms in psychosis posit that amotivation relevant beliefs are reflected in the cognitive triad of negative beliefs concerning the self, others and the future. The aim of this study was to test the proposed three-factor structure of putative ‘demotivating beliefs’ and to ascertain the strength of their association with self-reported amotivation. We combined existing scales assessing ‘demotivating beliefs’ to the Demotivating Beliefs Inventory. This scale was used for exploratory and confirmatory factor analyses as well as latent regression analyses with amotivation in two independent community (n1 = 98; n2 = 347) and one clinical sample (n = 36). We found a three-factor structure with satisfying model fit (‘selfdefeating beliefs’, ‘social indifference beliefs’ and ‘low-expectancy-of-pleasure beliefs’). Each factor showed moderate associations with amotivation (β-coefficients from 0.34 to 0.43; R2 = .30). Our results support the validity of the cognitive triad and its benefit as a framework to analyze demotivating beliefs.
KeywordsAvolition Apathy Motivation Reduced activity Dysfunctional attitudes Experiential negative symptoms
We thank Denise Fischer for her support in recruiting participants, Maik Erdas for his support in the item translation process and Esther Wolfram for her language editing.
Compliance with Ethical Standards
Conflict of Interest
Matthias Pillny, Katarina Krkovic and Tania M. Lincoln declare that they have no conflict of interest including any financial, personal or other relationships with other people or organizations within 3 years of beginning the work submitted that could inappropriately influence, or be perceived to influence, their work.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- Artaloytia, J. F., Arango, C., Lahti, A., Sanz, J., Pascual, A., Cubero, P., … Palomo, T. (2006). Negative signs and symptoms secondary to antipsychotics: A double-blind, randomized trial of a single dose of placebo, haloperidol, and risperidone in healthy volunteers. American Journal of Psychiatry, 163, 488–493. https://doi.org/10.1176/appi.ajp.163.3.488.CrossRefPubMedGoogle Scholar
- Beck, A. T. (1987). Cognitive models of depression. In R. Leahy & T. Dowd (Eds.), Journal of cognitive psychotherapy (1st ed.). New York: Springer.Google Scholar
- Beck, A. T., & Haigh, E. A. P. (2014). Advances in cognitive theory and therapy: The generic cognitive model. Annual Review of Clinical Psychology, 10, 1–24. https://doi.org/10.1146/annurev-clinpsy-032813-153734.CrossRefPubMedGoogle Scholar
- Beck, A. T., & Rector, N. A. (2005). Cognitive approaches to schizophrenia: Theory and therapy. Annual Review of Clinical Psychology, 1, 577–606. https://doi.org/10.1146/annurev.clinpsy.1.102803.144205.CrossRefPubMedGoogle Scholar
- Beck, A. T., Rector, N. A., Stolar, N., & Grant, P. (2009). A cognitive conceptualization of negative symptoms. In Schizophrenia: Cognitive theory research and therapy (pp. 142–159). New York: Guilford Press.Google Scholar
- Chan, R. C. K., Wang, Y., Huang, J., Shi, Y., Wang, Y., Hong, X., … Kring, A. M. (2010). Anticipatory and consummatory components of the experience of pleasure in schizophrenia: Cross-cultural validation and extension. Psychiatry Research, 175, 181–183. https://doi.org/10.1016/j.psychres.2009.01.020.CrossRefPubMedGoogle Scholar
- Christensen, H., Jorm, A. F., Mackinnon, A. J., Korten, A. E., Jacomb, P. A., Henderson, A. S., & Rodgers, B. (1999). Age differences in depression and anxiety symptoms: A structural equation modelling analysis of data from a general population sample. Psychological Medicine, 29, S0033291798008150. https://doi.org/10.1017/S0033291798008150.CrossRefGoogle Scholar
- Deusinger, I. M. (1986). Die Frankfurter Selbstkonzeptskalen: (FSKN). Göttingen: Hogrefe.Google Scholar
- Eckblad, M. L., Chapman, L. J., Chapman, J. P., & Mishlove, M. (1982). The revised social anhedonia scale. Unpublished test.Google Scholar
- Engel, M., Fritzsche, A., & Lincoln, T. M. (2015). Subclinical negative symptoms and the anticipation, experience and recall of emotions related to social interactions: An experimental study. Psychiatry Research, 230, 350–356. https://doi.org/10.1016/j.psychres.2015.09.015.CrossRefPubMedGoogle Scholar
- Engel, M., & Lincoln, T. M. (2016). Motivation and Pleasure Scale-Self-Report (MAP-SR): Validation of the German version of a self-report measure for screening negative symptoms in schizophrenia. Comprehensive Psychiatry, 65, 110–115. https://doi.org/10.1016/j.comppsych.2015.11.001.CrossRefPubMedGoogle Scholar
- Furr, M., & Bacharach, V. (2014). Test dimensionality and factor analysis. In Psychometrics: An introduction (2nd ed., pp. 71–98). Los Angeles: SAGE. https://doi.org/10.1111/j.1468-5922.2010.01872_2.x.Google Scholar
- Granholm, E., Holden, J., Link, P. C., McQuaid, J. R., & Jeste, D. V. (2013). Randomized controlled trial of cognitive behavioral social skills training for older consumers with schizophrenia: Defeatist performance attitudes and functional outcome. American Journal of Geriatric Psychiatry, 21, 251–262. https://doi.org/10.1016/j.jagp.2012.10.014.CrossRefPubMedGoogle Scholar
- Granholm, E., Holden, J., & Worley, M. (2017). Improvement in negative symptoms and functioning in cognitive-behavioral social skills training for schizophrenia: Mediation by defeatist performance attitudes and asocial beliefs. Schizophrenia Bulletin, 44, 653–661. https://doi.org/10.1093/schbul/sbx099.CrossRefGoogle Scholar
- Grant, P. M., Huh, G. A., Perivoliotis, D., Stolar, N. M., & Beck, A. T. (2012). Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Archives of General Psychiatry, 69, 121. https://doi.org/10.1001/archgenpsychiatry.2011.129.CrossRefPubMedGoogle Scholar
- Grant, P. M., Perivoliotis, D., Luther, L., Bredemeier, K., & Beck, A. T. (2018). Rapid improvement in beliefs, mood, and performance following an experimental success experience in an analogue test of recovery-oriented cognitive therapy. Psychological Medicine, 48, 261–268. https://doi.org/10.1017/S003329171700160X.CrossRefPubMedGoogle Scholar
- Hartmann, M. N., Hager, O. M., Reimann, A. V., Chumbley, J. R., Kirschner, M., Seifritz, E., … Kaiser, S. (2015). Apathy but not diminished expression in schizophrenia is associated with discounting of monetary rewards by physical effort. Schizophrenia Bulletin, 41, 503–512. https://doi.org/10.1093/schbul/sbu102.CrossRefPubMedGoogle Scholar
- Kluge, A., Kirschner, M., Hager, O. M., Bischof, M., Habermeyer, B., Seifritz, E., … Kaiser, S. (2017). Combining actigraphy, ecological momentary assessment and neuroimaging to study apathy in patients with schizophrenia. Schizophrenia Research, 195, 176–182. https://doi.org/10.1016/j.schres.2017.09.034.CrossRefPubMedGoogle Scholar
- Kring, A. M., Gur, R. E., Blanchard, J. J., Horan, W. P., & Reise, S. P. (2013). The Clinical Assessment Interview for Negative Symptoms (CAINS): Final development and validation. American Journal of Psychiatry, 170, 165–172. https://doi.org/10.1176/appi.ajp.2012.12010109.CrossRefPubMedGoogle Scholar
- Lincoln, T. M., Riehle, M., Pillny, M., Helbig-Lang, S., Fladung, A. K., Hartmann-Riemer, M., & Kaiser, S. (2017). Using functional analysis as a framework to guide individualized treatment for negative symptoms. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2017.02108.PubMedPubMedCentralGoogle Scholar
- Linscott, R. J., & van Os, J. (2010). Systematic reviews of categorical versus continuum models in psychosis: Evidence for discontinuous subpopulations underlying a psychometric continuum. Implications for DSM-V, DSM-VI, and DSM-VII. Annual Review of Clinical Psychology, 6, 391–419.CrossRefPubMedGoogle Scholar
- Llerena, K., Park, S. G., McCarthy, J. M., Couture, S. M., Bennett, M. E., & Blanchard, J. J. (2013). The Motivation and Pleasure Scale-Self-Report (MAP-SR): Reliability and validity of a self-report measure of negative symptoms. Comprehensive Psychiatry, 54, 568–574. https://doi.org/10.1016/j.comppsych.2012.12.001.CrossRefPubMedPubMedCentralGoogle Scholar
- Müller, M. J., Marx-Dannigkeit, P., Schlösser, R., Wetzel, H., Addington, D., & Benkert, O. (1999). The Calgary Depression Rating Scale for Schizophrenia: Development and interrater reliability of a German version (CDSS-G). Journal of Psychiatric Research, 33, 433–443. https://doi.org/10.1016/S0022-3956(99)00018-7.CrossRefPubMedGoogle Scholar
- Muthén, L. K., & Muthén, B. O. (2012). Mplus User’s Guide (7th ed.). Los Angeles, CA: Muthén & Muthén.Google Scholar
- Rabinowitz, J., Levine, S. Z., Garibaldi, G., Bugarski-Kirola, D., Berardo, C. G., & Kapur, S. (2012). Negative symptoms have greater impact on functioning than positive symptoms in schizophrenia: Analysis of CATIE data. Schizophrenia Research, 137, 147–150. https://doi.org/10.1016/j.schres.2012.01.015.CrossRefPubMedGoogle Scholar
- Riehle, M., Pillny, M., & Lincoln, T. M. (2017). Are the negative symptoms of schizophrenia treatable at all? A systematic review on efficacy studies for targeted psychological interventions for negative symptoms. Verhaltenstherapie, 27, 199–208. https://doi.org/10.1159/000478534.CrossRefGoogle Scholar
- Rosenberg, M. (1965). Rosenberg self-esteem scale (RSE). Acceptance and commitment therapy. Measures Package, 61, 52.Google Scholar
- Staring, A. B. P., ter Huurne, M.-A. B., & van der Gaag, M. (2013). Cognitive behavioral therapy for negative symptoms (CBT-n) in psychotic disorders: A pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 44, 300–306. https://doi.org/10.1016/j.jbtep.2013.01.004.CrossRefPubMedGoogle Scholar
- Velthorst, E., Koeter, M., van der Gaag, M., Nieman, D. H., Fett, A. J., & Smit, F. (2015). Adapted cognitive – behavioural therapy required for targeting negative symptoms in schizophrenia: Meta-analysis and meta-regression. Psychological Medicine, 45, 453–465. https://doi.org/10.1017/S0033291714001147.CrossRefPubMedGoogle Scholar
- Weissman, A. (1979). Dysfunctional Attitude Scale (DAS). Acceptance and commitment therapy. Measures 54. Retrieved from http://integrativehealthpartners.org/downloads/ACTmeasures.pdf.
- Westermann, S., Gantenbein, V., Caspar, F., & Cavelti, M. (in press). Maintaining delusional beliefs as means for the satisfaction and protection of psychological needs. Zeitschrift Für Psychologie, 226(3).Google Scholar
- Westermann, S., Grezellschak, S., Oravecz, Z., Moritz, S., Lüdtke, T., & Jansen, A. (2017). Untangling the complex relationships between symptoms of schizophrenia and emotion dynamics in daily life: Findings from an experience sampling pilot study. Psychiatry Research, 257, 514–518. https://doi.org/10.1016/j.psychres.2017.08.023.CrossRefPubMedGoogle Scholar