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Perceived Autonomy Support in the NIMH RAISE Early Treatment Program
Julia Browne1, David L Penn1, Daniel J Bauer1
1Ms. Browne, Dr. Penn, and Dr. Bauer are with the Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill. Dr. Penn is also with the School of Psychology, Australian Catholic University, Melbourne. Dr. Meyer-Kalos is with the School of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Robinson, Dr. Schooler, Ms. Marcy, and Dr. Kane are with the Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, New York. Dr. Robinson is also with Departments of Psychiatry and Molecular Medicine, Hofstra University-North Shore Long Island Jewish School of Medicine, Hempstead, New York. Dr. Schooler is also with the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York. Dr. Addington is with the Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. Dr. Glynn is with the Semel Institute for Neuroscience and Brain Behavior, University of California, Los Angeles, Los Angeles. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania.
Objective:
This study examined perceived support for autonomy-the extent to which individuals feel empowered and supported to make informed choices-among participants in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE ETP). The aims of this study were to evaluate whether NAVIGATE, the active treatment studied in RAISE ETP, was associated with greater improvements in perceived autonomy support over the two-year intervention, compared with community care, and to examine associations between perceived autonomy support and quality of life and symptoms over time and across treatment groups.
Methods:
This study examined perceived autonomy support among the 404 individuals with first-episode psychosis who participated in the RAISE ETP trial (NAVIGATE, N=223; community care, N=181). Three-level conditional linear growth modeling was used given the nested data structure.
Results:
The results indicated that perceived autonomy support increased significantly over time for those in NAVIGATE but not in community care. Once treatment began, higher perceived autonomy support was related to higher quality of life at six, 12, and 18 months in NAVIGATE and at 12, 18, and 24 months in community care. Higher perceived autonomy support was related to improved scores on total symptoms and on excited symptoms regardless of treatment group and time.
Conclusions:
Overall, perceived autonomy support increased in NAVIGATE but not for those in community care and was related to improved quality of life and symptoms across both treatment groups. Future research should examine the impact of perceived autonomy support on a wider array of outcomes, including engagement, medication adherence, and functioning.
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