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From neurocognition to community participation in serious mental illness: the intermediary role of dysfunctional attitudes and motivation

Published online by Cambridge University Press:  25 November 2016

E. C. Thomas ,
L. Luther ,
L. Zullo ,
A. T. Beck  and
P. M. Grant
E. C. Thomas
Affiliation:
Department of Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
L. Luther
Affiliation:
Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
L. Zullo
Affiliation:
Department of Psychology, University of Texas Southwestern Medical Center, Dallas, TX, USA
A. T. Beck
Affiliation:
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
P. M. Grant*
Affiliation:
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
*
*Address for correspondence: P. M. Grant, Ph.D., Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Room 2032, Philadelphia, PA, USA. (Email: [email protected])
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Abstract

Background

Evidence for a relationship between neurocognition and functional outcome in important areas of community living is robust in serious mental illness research. Dysfunctional attitudes (defeatist performance beliefs and asocial beliefs) have been identified as intervening variables in this causal chain. This study seeks to expand upon previous research by longitudinally testing the link between neurocognition and community participation (i.e. time in community-based activity) through dysfunctional attitudes and motivation.

Method

Adult outpatients with serious mental illness (N = 175) participated, completing follow-up assessments approximately 6 months after initial assessment. Path analysis tested relationships between baseline neurocognition, emotion perception, functional skills, dysfunctional attitudes, motivation, and outcome (i.e. community participation) at baseline and follow-up.

Results

Path models demonstrated two pathways to community participation. The first linked neurocognition and community participation through functional skills, defeatist performance beliefs, and motivation. A second pathway linked asocial beliefs and community participation, via a direct path passing through motivation. Model fit was excellent for models predicting overall community participation at baseline and, importantly, at follow-up.

Conclusions

The existence of multiple pathways to community participation in a longitudinal model supports the utility of multi-modal interventions for serious mental illness (i.e. treatment packages that build upon individuals’ strengths while addressing the array of obstacles to recovery) that feature dysfunctional attitudes and motivation as treatment targets.

Keywords

Cognitive theorycommunity integrationpath analysisrecoveryschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 5 , April 2017 , pp. 822 - 836
Copyright
Copyright © Cambridge University Press 2016 

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