Correlates of Real-world Goal-directed Behavior in Schizophrenia

Background: Deficits in goal-directed behavior (i.e. behavior conducted to achieve a specific goal or outcome) are core to schizophrenia, difficult to treat, and associated with poor functional outcomes. Factors such as negative symptoms, effort-cost decision-making, cognition, and functional skills have all been associated with goal-directed behavior in schizophrenia as indexed by clinical interviews or laboratory-based tasks. However, little work has examined whether these factors relate to the real-world pursuit of goal-directed activities in this population.

Methods: This study aimed to fill this gap by using Ecological Momentary Assessment (four survey prompts per day for 1 week) to test hypotheses about symptom, effort allocation, cognitive, and functional measures associated with planned and completed goal-directed behavior in the daily lives of 63 individuals with schizophrenia.

Results: Individuals with schizophrenia completed more goal-directed activities than they planned [(62) = -4.01, < 0.001]. Motivation and pleasure (i.e. experiential) negative symptoms, controlling for depressive symptoms, negatively related to planned goal-directed behavior [odds ratio (OR) 0.92, 0.005]. Increased effort expenditure for high probability rewards (planned: OR 1.01, 0.034, completed: OR 1.01, 0.034) along with performance on a daily functional skills task (planned: OR 1.04, 0.002, completed: OR 1.03, 0.047) negatively related to both planned and completed goal-directed activity.

Conclusions: Our results present correlates of real-world goal-directed behavior that largely align with impaired ability to make future estimations in schizophrenia. This insight could help identify targeted treatments for the elusive motivated behavior deficits in this population.