M103. Treating Motivation Deficits in Schizophrenia With a Virtual Reality Motivation Training Program

Abstract

Background: Motivation defcits have emerged as a critical determinant of functional disability in schizophrenia. Effective therapeutic strategies for motivation defcits, however, remain elusive. This has ultimately hindered our ability to promote recovery for affected individuals. To address this unmet therapeutic need, this open-label pilot study investigated a novel virtual reality-based (VR) training strategy for the treatment of motivation defcits in schizophrenia over the course of 8 weeks of training, along with concomitant effects on community functioning and brain structure and function. Methods: Stable adult outpatients with schizophrenia between the ages of 18 and 35, with prominent motivation defcits were recruited for this study. Participants underwent baseline and post-treatment clinical assessments, evaluation of community functioning with the Quality of Life Scale (QLS), as well as structural (diffusion tensor imaging [DTI]) and functional MRI. Treatment consisted of 8 weeks of VR motivation training using a progressive effort task in a virtual environment for 1 hour per week. Motivation defcits were evaluated using the Apathy Evaluation Scale (AES) every 2 weeks. Our primary outcome of interest was change in AES scores over time, with secondary outcomes consisting of change in overall community functioning (QLS), and frontostriatal white matter microstructural integrity and functioning during motivated behavior. Results: To date, 8 participants have completed this study. Preliminary analyses revealed a signifcant reduction in AES scores as a result of treatment (F(4,28) = 5.025, P =.004), with on average a 13% reduction in AES score. Participants also exhibited a mean improvement of 29% in QLS score, with 63% of the sample showing more than 20% improvement, although the difference for the overall sample was nonsignifcant. Changes in DTI indices of frontostriatal white matter microstructural integrity, and brain function during motivated behavior, as a result of treatment will also be presented. Conclusion: This pilot study investigated the use of a novel VR-based training strategy to treat motivation defcits in young adults with schizophrenia. Preliminary fndings suggest that this VR-based training resulted in a signifcant reduction in the severity of motivation defcits, along with a notable improvement in overall community functioning. With the ongoing search for effective treatments for motivation defcits and their functional consequences in schizophrenia, these fndings provide an early promising signal for a potential novel treatment strategy for these defcits that may improve outcomes for patients.