Skip to main content

Table 1 An outline of adherence therapy

From: Effects of motivational interviewing-based adherence therapy for schizophrenia spectrum disorders: a randomized controlled trial

Phase/Session

Interventions

Main assignments

Phase 1 (2 sessions)

Purposes:

Reviewing antipsychotic medication use and the impacts of psychotic symptoms on medication (and treatment) adherence, the desired and unwanted effects of medication, neuroleptic side effects, and attitude and satisfaction with medication taking.

(1) To help participants review their past and present states of taking antipsychotics; and

(2) To assess knowledge, attitude, and barriers to medication adherence, and plan for problem-solving and improving adherence behaviour using a standard assessment form.

Participants identify the present beliefs and concerns, benefits and barriers related to medication and rated the level of distress (1 to 10) attached to each side effect.

Examining and addressing beliefs and concerns towards adherence, and plan for problem-solving.

Families are asked for their opinions and attitudes on their relative’s attitude towards medication taking.

Homework assignment: Weekly record of adherent behaviour and reasons for adherence or non-adherence.

Participants are asked to do homework by recording weekly medication adherent behaviors, and both they and nurse therapist keep a record of documentation.

The nurse therapist makes an attempt to link medication cessation with relapse. Negative treatment experiences and high level of distress regarding side effects are acknowledged and discussed. Denial of need for treatment is met with gentle enquiry into the ensuring social consequences and lifestyle disruptions.

Phase 2 (3 sessions)

Purposes:

Revisiting and revising previous goals or add new ones, and their actions.

(1) To educate about mental illness and the treatment and care required;

(2) To review the goals, actions, and adherence records of the last two weeks; and

Recognizing factors that may lead to poor adherence, and developing coping strategies to reduce urges for non-adherence

(3) To identify barriers to medication adherence and to develop coping strategies, new goals and actions.

Homework assignment:

Participants’ confusion between symptoms and side effects, and misconceptions of antipsychotic medication is further clarified.

Practicing new actions for maintaining or enhancing adherence. Weekly record of adherent behaviors and reasons for adherence/non-adherence to medication.

The natural tendency to stop medication whenever the participants feel well is to be discussed, and their meanings attached to medication are explored, that is, an identity as a ‘sick person’.

Participants are asked to weigh up the benefits and drawbacks of treatment, and the nurse therapist will focus on the benefits, especially when they emerge spontaneously.

Symptoms reported by the participants are fed back as their needs (‘symptoms’) for treatment.

Phase 3 (3 sessions)

Purposes:

Evaluation of the progress of medication adherence with each participant and his/her change in beliefs/insight into illness and treatment during session 6.

(1) To rationalize participants’ beliefs and concerns and to prevent relapse;

(2) To manage social stigma and enhance social support.

Participants are facilitated and encouraged to identify the characteristics of prodromal symptoms and analyze the importance of early intervention to prevent a full-blown episode.

Making future plan with participants to continue self-monitoring of medication adherence and its contractual agreement; and clarifications of means of support from the CPNS, family and services.

In sessions 7 and 8, the nurse therapist use normalizing rationale to deal with stigma towards the illness and/or medication; suggest an analogy with physical illness requiring maintenance treatment; and highlight illness prevalence with examples of ex-patients who have been successful in coping with similar difficulties as theirs.

Homework assignment:

Weekly record of medication behaviors and reasons for adherence and non-adherence.

Participants reframe medication use by participants as a freely chosen strategy to enhance control of quality of life and use metaphors of medication as an ‘insurance policy’ for staying well.

Risk assessment for relapse prevention and a list of risk factors identified and recorded on a standard form.

A future plan and contractual agreement are made to continue monitoring of medication adherence and means of support from the CPNS, family, and other mental health care services are clarified.