Meanings, Motivation & Affect
We have often observed individuals suffering from schizophrenia who have completed a pre-programmed set of activities but still appear apathetic with flat affect. On the other hand, we have observed these same individuals becoming animated after getting out of bed or going for a walk. The difference in the impact of these different sets of activities is in the meaning the individual attributes to the activities. In the former circumstances, the individual perceives the activities as mechanical, as something he/she is expected to do. In the latter case, there is positive meaning attached to the activity, i.e., “I have more energy than I thought. Going for a walk can be enjoyable.”
Clinicians need to pay attention to the inferences individuals have about their activities. More specifically, clinicians need to draw out the patient’s expected reactions, which may reflect cognitions such as, “I won’t have the energy for the activity. I won’t enjoy it. People will reject me if I approach them.” Clinicians should subtly set up a hypothesis regarding the activity to determine whether individuals’ hypotheses are confirmed or negated. When individuals find their negative predictions to be untrue, clinicians can help them relate the enjoyment or acceptance they experienced to more positive beliefs about the self, the outside world, and the future. Given a series of successful experiences in which positive conclusions are drawn, individuals can start to see themselves as more capable and acceptable and others as more supportive and accepting.
The meanings of the experiences are reflected in the enhancement of individuals’ self-image (connected, competent, and in control) and their image of others as agreeable, trustworthy, and cooperative. We have found that many individuals do very well when their activity consists of helping another person. They begin to see themselves as effective and considerate and other people as collaborative and appreciative.
When individuals approach a task that seems formidable and challenging, clinicians can influence the meanings attached to the task by being supportive and encouraging. An experiment by Grant, Perivoliotis, Luther, Bredemeier & Beck (2018) demonstrated that in a card-sorting task, individuals did significantly better than a control group when they were given positive feedback at each stage of the trial. The individuals showed improvement in self-concept and mood and a reduction in endorsed defeatist beliefs. We attributed the fact that the experimental group did better than the control group to enhanced motivation resulting from the positive feedback from the examiner interacting with the individual’s actual performance.
Theoretical Framework of Meanings
The meanings attached to experiences are derived from the activation of specific beliefs. In terms of cognitive theory, the beliefs are embedded in cognitive schemas that have the characteristics of a) intensity or charge, b) permeability, and c) size. Some beliefs are relatively flexible and can be energized, while others are rigid and may have a delusional characteristic. Some schemas are relatively small and may be relevant to only a discrete environmental stimulus/fear (e.g., fear of heights), whereas others are broad (i.e. fears of other people). The beliefs serve as formulas or algorithms for translating an experience into a specific attribute. There are parallel sets of these attributes, which are summarized in the table below:
| Negative Attribute | Positive Attribute |
| Timid | Assertive |
| Worried | Self-Confident |
| Resistant | Open |
| Hostile | Friendly |
| Avoidant | Proactive |
| Threatened/Unsafe | Safe |
| Suspicious | Trusting |
| Demeaning | Praising |
| Controlling | Permissive |
The attributes may have a specific charge, and whether the belief is negative or positive, it is possible to diminish or activate it. At times, two opposite beliefs with varying degrees of intensity or believability may be present. The beliefs themselves are dimensional. In other words, they have a degree of believability from 0%-100%. While the individual may have 100% believability for both opposing beliefs, it is likely that instead, one belief will be more believable than the other. The clinician can gain insight from the respective percentages of believability and use strategies to increase the positive and diminish the negative. It is important to keep in mind that the positive beliefs can be activated even though they are latent. When this is accomplished, the individual is in the adaptive mode.
References
Grant, P., Perivoliotis, D., Luther, L., Bredemeier, K., & Beck, A. (2018). Rapid improvement in beliefs, mood, and performance following an experimental success experience in an analogue test of recovery-oriented cognitive therapy. Psychological Medicine, 48(2), 261-268. doi:10.1017/S003329171700160X