The Influence of Working Memory and Psychological Beliefs on Effort-Based Decision-Making in Schizophrenia Spectrum Disorders: Implications for Daily Functioning

Poor motivation to engage in goal-oriented behavior has been recognized as a hallmark feature of schizophrenia that significantly interferes with a patient's ability to function independently in the community. Negative symptoms have been shown to underlie impairments related to effort-cost decision-making. The present study examined how fifty-seven inpatients with schizophrenia and schizoaffective disorder performed on the "Effort-Cost Computation Task" in relation to negative symptoms. Specifically, this study examined whether patients with low levels of negative symptoms exert more effort for higher rewards and more certain/probable rewards than patients with high levels of negative symptoms. Working memory performance and beliefs about self-efficacy and satisfaction for future rewards (i.e. anticipatory pleasure) were explored as possible variables underlying differences in effort-based decision-making. Impairments in effort allocation were then examined in relation to daily living skills to explore how these findings extend to functioning in the community. Results revealed that patients with low levels of negative symptoms chose the high effort option more often in the 100% (i.e. certain) probability condition, while patients with high levels of negative symptoms did not, despite more certain rewards. Working memory deficits and poor anticipatory pleasure helped explain this impairment. The strongest predictor of daily functioning skills was the percentage of times patients chose the high effort option in the certain probability condition.