Neurocognitive Resource Sparing PT I

A large proportion of hospitalized individuals who are diagnosed with chronic, non-affective psychosis (or schizophrenia) have the full set of negative symptoms such as amotivation, anergia, inactivity, etc. These individuals have also been shown to perform poorly on tests of attention, memory, executive function, cognitive processing, and emotional discrimination. It is through their psychobiological thermostat is set at a very low level. Notwithstanding, these observations and performance on objective tests, the individuals may surprise the staff by occasionally performing at high levels of efficiency. For example, withdrawn individuals may on occasion, successfully train another individual at mastering chess, win at games of charades, or perform adequately in plays. We have also found that these individuals generally improve in their activity under a specialized program of Recovery Oriented Cognitive Therapy ( CT-R). How do we account for this discrepancy in behavior? We speculate that the practical thermostat, as it were, is set at a very low level during the negative syndrome. This low level indicates that the individual is not drawing on the various functions that are apparently depleted in the negative syndrome. Depending on the circumstances, however, these apparently depleted functions can be reactivated and can manifest in a higher level in a given performance/ activity (we turn up the thermostat).

Various studies have suggested that the key element in the individuals’ poor performance is their lack of motivation (for the review of the literature, see Beck et al., 2017). The question still remains as to what factors lead to poor motivation. We have shown that defeatist attitudes can account for the negative symptoms (Grant et al,____). We believe that the critical element in the production and maintenance of the negative symptoms are the negative beliefs and expectancies. If individuals believe that they are going to fail at whatever task they undertake or would be rejected if they make any kind of social advance, they will not be motivated to take the risk of being thwarted or diminished. This then leads to the next question which is how do we increase the individuals’ motivation with recovery Oriented Cognitive Therapy. We spend a good deal of time engaging the individuals’ interests and aspirations. When their aspirations are set, their motivation is increased and their performance improves in a stepwise progression.