A brief intervention to improve exercising in patients with schizophrenia: a controlled pilot study with mental contrasting and implementation intentions (MCII)

Pascal Sailer, Frank Wieber, Karl Pröpster, Steffen Stoewer, Daniel Nischk, Franz Volk, Michael Odenwald, Pascal Sailer, Frank Wieber, Karl Pröpster, Steffen Stoewer, Daniel Nischk, Franz Volk, Michael Odenwald

Abstract

Background: Regular exercise can have positive effects on both the physical and mental health of individuals with schizophrenia. However, deficits in cognition, perception, affect, and volition make it especially difficult for people with schizophrenia to plan and follow through with their exercising intentions, as indicated by poor attendance and high drop-out rates in prior studies. Mental Contrasting and Implementation Intentions (MCII) is a well-established strategy to support the enactment of intended actions. This pilot study tests whether MCII helps people with schizophrenia in highly structured or autonomy-focused clinical hospital settings to translate their exercising intentions into action.

Methods: Thirty-six inpatients (eleven women) with a mean age of 30.89 years (SD = 11.41) diagnosed with schizophrenia spectrum disorders from specialized highly structured or autonomy-focused wards were randomly assigned to two intervention groups. In the equal contact goal intention control condition, patients read an informative text about physical activity; they then set and wrote down the goal to attend jogging sessions. In the MCII experimental condition, patients read the same informative text and then worked through the MCII strategy. We hypothesized that MCII would increase attendance and persistence relative to the control condition over the course of four weeks and this will be especially be the case when applied in an autonomy-focused setting compared to when applied in a highly structured setting.

Results: When applied in autonomy-focused settings, MCII increased attendance and persistence in jogging group sessions relative to the control condition. In the highly structured setting, no differences between conditions were found, most likely due to a ceiling effect. These results remained even when adjusting for group differences in the pre-intervention scores for the control variables depression (BDI), physical activity (IPAQ), weight (BMI), age, and education. Whereas commitment and physical activity apart from the jogging sessions remained stable over the course of the treatment, depression and negative symptoms were reduced. There were no differences in pre-post treatment changes between intervention groups.

Conclusions: The intervention in the present study provides initial support for the hypothesis that MCII helps patients to translate their exercising intentions into real-life behavior even in autonomously-focused settings without social control.

Trial registration: ClinicalTrials.gov ID; URL: NCT01547026 Registered 3 March 2012.

Figures

Fig. 1
Fig. 1
Flow chart of participants’ progress through each stage of the randomized controlled trial
Fig. 2
Fig. 2
Average program attendance over the course of four weeks in percent by group (MCII vs. control) and setting (autonomy-focused vs. highly structured). Standard errors are represented in the figure by the error bars attached to each column

References

    1. Aarts H, Dijksterhuis A, Midden C. To plan or not to plan? Goal achievement of interrupting the performance of mundane behaviors. Eur J Soc Psychol. 1999;29:971–979. doi: 10.1002/(SICI)1099-0992(199912)29:8<971::AID-EJSP963>;2-A.
    1. Achtziger A, Bayer U, Gollwitzer PM. Committing to implementation intentions: Attention and memory effects for selected situational cues. Motiv Emot. 2012;36:287–300. doi: 10.1007/s11031-011-9261-6.
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. fith. Washington, DC: American Psychiatric Association; 2013.
    1. an der Heiden W, Hafner H. The epidemiology of onset and course of schizophrenia. Eur Arch Psychiatry Clin Neurosci. 2000;250:292–303.
    1. Ananth J, Venkatesh R, Burgoyne K, Gadasalli R, Binford R, Gunatilake S. Atypical antipsychotic induced weight gain: Pathophysiology and management. Ann Clin Psychiatry. 2004;16:75–85. doi: 10.1080/10401230490453293.
    1. Archie S, Wilson JH, Osborne S, Hobbs H, McNiven J. Pilot study: Access to fitness facility and exercise levels in olanzapine-treated patients. Can J Psychiatry. 2003;48:628–32.
    1. Beck AT, Steer RA, Ball R, Ranieri WF. Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. J Pers Assess. 1996;67:588–597. doi: 10.1207/s15327752jpa6703_13.
    1. Beck AT, Steer RA, Brown C. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996.
    1. Beebe L, Smith K, Burk R, McIntyre K, Dessieux O, Tavakoli A, et al. Effect of a motivational intervention on exercise behavior in persons with schizophrenia spectrum disorders. Community Ment Health J. 2011;47:628–636. doi: 10.1007/s10597-010-9363-8.
    1. Beebe L, Tian L, Morris N, Goodwin A, Allen S, Kuldau J. Effects of exercise on mental and physical health parameters of persons with schizophrenia. Issues Ment Health Nurs. 2005;26:661–76. doi:10.1080/01612840590959551.
    1. Bell M, Milstein R, Beam-Goulet J, Lysaker P, Cicchetti D. The Positive and Negative Syndrome Scale and the Brief Psychiatric Rating Scale: Reliability, comparability and predictive validity. J Nerv Ment Disord. 1992;180:723–728. doi: 10.1097/00005053-199211000-00007.
    1. Brandstätter V, Lengfelder A, Gollwitzer PM. Implementation intentions and efficient action initiation. J Pers Soc Psychol. 2001;81:946–960. doi: 10.1037/0022-3514.81.5.946.
    1. Buckels EE, Jones DN, Paulhus DL. Behavioral confirmation of everyday sadism. Psychol Sci. 2013
    1. Christianesen S, Oettingen G, Dahme B, Klinger R. A short goal-pursuit intervention to improve physical capacity: a randomized clinical trial in chronic back pain patients. Pain. 2010;149:444–52. doi:10.1016/j.pain.2009.12.015.
    1. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–95. doi:10.1249/01.MSS.0000078924.61453.FB.
    1. Daniel TO, Stanton CM, Epstein LH. The future is now: Reducing impulsivity and energy intake using episodic future thinking. Psychol Sci. 2013;24:2339–2342. doi: 10.1177/0956797613488780.
    1. Deci EL, Ryan RM. Self-determination theory: A consideration of human motivational universals. In: Corr PJ, Matthews G, editors. The Cambridge handbook of personality psychology. New York, NY US: Cambridge University Press; 2009. pp. 441–456.
    1. Duraiswamy G, Thirthalli J, Nagendra HR, Gangadhar BN. Yoga therapy as an add-on treatment in the management of patients with schizophrenia - a randomized controlled trial. Acta Psychiatr Scand. 2007;116:226–232. doi: 10.1111/j.1600-0447.2007.01032.x.
    1. Faulkner G, Biddle S. Exercise as an adjunct treatment for schizophrenia: A review of the literature. J Ment Health. 1999;8:441–457. doi: 10.1080/09638239917157.
    1. Faulkner G, Cohn T, Remington G. Validation of a physical activity assessment tool for individuals with schizophrenia. Schizophr Res. 2006;82:225–231. doi: 10.1016/j.schres.2005.10.020.
    1. Gollwitzer PM. Goal achievement: The role of intentions. Eur Rev Soc Psychol. 1993;4:141–185. doi: 10.1080/14792779343000059.
    1. Gollwitzer PM. Implementation intentions: Strong effects of simple plans. Am Psychol. 1999;54:493–503. doi: 10.1037/0003-066X.54.7.493.
    1. Gollwitzer PM. Weakness of the will: Is a quick fix possible? Motiv Emot. 2014;38:305–322. doi: 10.1007/s11031-014-9416-3.
    1. Gollwitzer PM, Sheeran P. Implementation intentions and goal achievement: A meta-analysis of effects and processes. Adv Exp Soc Psychol. 2006;38:69–119. doi: 10.1016/S0065-2601(06)38002-1.
    1. Gorczynski P, Faulkner G. Exercise therapy for schizophrenia. Cochrane Database Syst Rev. 2010;5
    1. Handelzalts JE, Keinan G. The effect of choice between test anxiety treatment options on treatment outcomes. Psychother Res. 2010;20:100–112. doi: 10.1080/10503300903121106.
    1. Hautzinger, M., Keller, F., & Kühner, C. (2006). Beck Depressions-Inventar II (BDI 2). Frankfurt/Main: Harcourt Test Services.
    1. Janney C, Ganguli R, Richardson C, Holleman R, Tang G, Cauley J, et al. Sedentary behavior and psychiatric symptoms in overweight and obese adults with schizophrenia and schizoaffective disorders (WAIST Study) Schizophr Res. 2013;145:63–68. doi: 10.1016/j.schres.2013.01.010.
    1. Kanfer FH, Grimm LG. Freedom of choice and behavioral change. J Consult Clin Psychol. 1978;46:873–878. doi: 10.1037/0022-006X.46.5.873.
    1. Kappes A, Singmann H, Oettingen G. Mental contrasting instigates goal pursuit by linking obstacles of reality with instrumental behavior. J Exp Soc Psychol. 2012;48:811–818. doi: 10.1016/j.jesp.2012.02.002.
    1. Kappes A, Oettingen G. The emergence of goal pursuit: Mental contrasting connects future and reality. J Exp Soc Psychol. 2014;54:25–39. doi: 10.1016/j.jesp.2014.03.014.
    1. Kay SR. Positive and negative symptom assessment in schizophrenia: psychometric issues and scale comparison. Psychiatry Q. 1990;61:163–178. doi: 10.1007/BF01064966.
    1. Kay SR, Fiszbein A, Opler LA. The Positive and Negative Syndrome Scale for schizophrenia. Schizophr Bull. 1987;13:261–276. doi: 10.1093/schbul/13.2.261.
    1. Kay SR, Opler LA, Lindenmayer JP. Reliability and validity of the PANSS for schizophrenics. Psychiatry Res. 1987;23:99–110. doi: 10.1016/0165-1781(88)90038-8.
    1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.
    1. Locke EA, Latham GP. Building a practically useful theory of goal setting and task motivation: A 35-year odyssey. Am Psychol. 2002;57:705–717. doi: 10.1037/0003-066X.57.9.705.
    1. Look AHEAD Research Group Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial. Diabetes Care. 2007;30:1374–1383. doi: 10.2337/dc07-0048.
    1. Marzolini S, Jensen B, Melville P. Feasibility and effects of a group-based resistance and aerobic exercise program for individuals with severe schizophrenia: a multidisciplinary approach. Ment Health Phys Activ. 2009;2:29–36. doi:10.1016/j.mhpa.2008.11.001.
    1. Oettingen G. Culture and future thought. Cult Psychol. 1997;3:353–81. doi:10.1177/1354067X9733008.
    1. Oettingen G. Future thought and behavior change. Eur Rev Soc Psychol. 2012;23:1–63. doi: 10.1080/10463283.2011.643698.
    1. Oettingen G, Gollwitzer PM. Strategies of setting and implementing goals: Mental contrasting and implementation intentions. In: Maddux JE, Tangney JP, editors. Social psychological foundations of clinical psychology. New York: Guilford; 2010. pp. 114–135.
    1. Oettingen G, Mayer D, Sevincer AT, Stephens EJ, Pak H, Hagenah M. Mental contrasting and goal commitment: The mediating role of energization. Personal Soc Psychol Bull. 2009;35:608–622. doi: 10.1177/0146167208330856.
    1. Oettingen G, Sevincer T, Gollwitzer PM. Goal pursuit in the context of culture. In: Sorrentino RM, Yamaguchi S, editors. The handbook of motivation and cognition across cultures. San Diego: Elsevier/Academic Press; 2008. pp. 191–211.
    1. Oettingen GA, Wittchen M, Gollwitzer PM. Regulating goal pursuit through mental contrasting with implementation intentions. In: Locke AE, Latham G, editors. New developments in goal setting and task performance. New York, NY: Routledge; 2013. pp. 523–548.
    1. Papies EK, Aarts H, De Vries NK. Planning is for doing: Implementation intentions go beyond the mere creation of goal-directed associations. J Exp Soc Psychol. 2009;45:1148–1151. doi: 10.1016/j.jesp.2009.06.011.
    1. Pearsall R, Smith D, Pelosi A, Geddes J. Exercise therapy in adults with serious mental illness: a systematic review and meta-analysis. BMC Psychiatry. 2014;14:117. doi: 10.1186/1471-244X-14-117.
    1. Richardson CR, Faulkner G, McDevitt J, Skrinar GS, Hutchinson DS, Piette JD. Integrating physical activity into mental health services for persons with serious mental illness. Psychiatr Serv. 2005;56:324–331. doi: 10.1176/appi.ps.56.3.324.
    1. Roick C, Fritz-Wieacker A, Matschinger H, Heider D, Schindler J, Riedel-Heller S, et al. Health habits of patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2007;42:268–276. doi: 10.1007/s00127-007-0164-5.
    1. Rosenbaum S, Tiedemann A, Sherrington C, Curtis J, Ward PB. Physical Activity Interventions for People with Mental Illness: A Systematic Review and Meta-Analysis. J Clin Psychiatry. 2014;75(9):964–74. doi:10.4088/JCP.13r08765.
    1. Savla GN, Vella L, Armstrong CC, Penn DL, Twamley EW. Deficits in domains of social cognition in Schizophrenia: A meta-analysis of the empirical evidence. Schizophr Bull. 2013;39:979–992. doi: 10.1093/schbul/sbs080.
    1. Scheewe T, Backx F, Takken T, Jörg F, van Strater A, Kroes A, et al. Exercise therapy improves mental and physical health in schizophrenia: a randomised controlled trial. Acta Psychiatr Scand. 2013;127:464–473. doi: 10.1111/acps.12029.
    1. Schennach R, Meyer S, Seemuller F, Jager M, Schmauss M, Laux G, et al. Insight in schizophrenia-course and predictors during the acute treatment phase of patients suffering from a schizophrenia spectrum disorder. Eur Psychiatry. 2012;27:625–33.
    1. Sevincer AT, Busatta PD, Oettingen G. Mental contrasting and transfer of energization. Personal Soc Psychol Bull. 2014;40:139–152. doi: 10.1177/0146167213507088.
    1. Sheeran P. Intention-behavior relations: A conceptual and empirical review. Eur Rev Soc Psychol. 2002;12:1–36. doi: 10.1080/14792772143000003.
    1. Soundy A, Roskell C, Stubbs B, Vancampfort D. Selection, use and psychometric properties of physical acitivity measures to assess individuals with severe mental illness: A narrative synthesis. Arch Psychiatr Nurs. 2014;28:135–151. doi: 10.1016/j.apnu.2013.12.002.
    1. Soundy A, Freeman P, Stubbs B, Probst M, Coffee P, Vancampfort D. The transcending benefits of physical activity for individuals with schizophrenia: A systematic review and meta-ethnography. Psychiatry Res. 2014;220:11–19. doi: 10.1016/j.psychres.2014.07.083.
    1. Stanton R, Happell B. A Systematic Review of the Aerobic Exercise Program Variables for People with Schizophrenia. Curr Sports Med Rep. 2014;13:260–6.
    1. Ussher M, Stanbury L, Cheeseman V, Faulkner G. Physical activity preferences and perceived barriers to activity among persons with severe mental illness in the United Kingdom. Psychiatr Serv. 2007;58:405–408. doi: 10.1176/appi.ps.58.3.405.
    1. Vancampfort D, De Hert M, Vansteenkiste M, De Herdt A, Scheewe TW, Soundy A, et al. The importance of self-determined motivation towards physical activity in patients with schizophrenia. Psychiatry Research. 2013;210:812–818. doi:
    1. Vancampfort D, Knapen J, Probst M, Scheewe T, Remans S, De Hert M. A systematic review of correlates of physical activity in patients with schizophrenia. Acta Psychiatr Scand. 2012;125:352–362. doi: 10.1111/j.1600-0447.2011.01814.x.
    1. Vancampfort D, De Hert M, De Herdt A, Soundy A, Stubbs B, Bernard P, et al. Associations between perceived neighbourhood environmental attributes and self-reported sitting time in patients with schizophrenia: A pilot study. Psychiatry Res. 2014;215:33–38. doi: 10.1016/j.psychres.2013.11.011.
    1. Vancampfort D, De Hert M, Stubbs B, Ward PB, Rosenbaum S, Soundy A, et al. Negative symptoms are associated with lower autonomous motivation towards physical activity in people with schizophrenia. Compr Psychiatry. 2015;56:128–132. doi: 10.1016/j.comppsych.2014.10.007.
    1. van Os J, Kapur S. Schizophrenia. Lancet. 2009;374:635–645. doi: 10.1016/S0140-6736(09)60995-8.
    1. Warren KR, Ball MP, Feldman S, Liu F, McMahon RP, Kelly DL. Exercise program adherence using a 5-kilometer (5 K) event as an achievable goal in people with schizophrenia. Biol Res Nurs. 2011;13:383–90. doi:10.1177/1099800410393272.
    1. Webb TL, Sheeran P. How do implementation intentions promote goal attainment? A test of component processes. J Exp Soc Psychol. 2007;43:295–302. doi: 10.1016/j.jesp.2006.02.001.
    1. Webb TL, Sheeran P. Mechanisms of implementation intention effects: The role of goal intentions, self-efficacy, and accessibility of plan components. Br J Soc Psychol. 2008;47:373–395. doi: 10.1348/014466607X267010.
    1. Wieber F, Sassenberg K. I can't take my eyes off of it. Attention attraction effects of implementation intentions. Soc Cogn. 2006;24:723–752. doi: 10.1521/soco.2006.24.6.723.

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