Avolition

Avolition, as a symptom of various forms of psychopathology, is the decrease in the motivation to initiate and perform self-directed purposeful activities. Such activities that appear to be neglected usually include routine activities, including hobbies, going to work and/or school, and most notably, engaging in social activities. A person experiencing avolition may stay at home for long periods of time, rather than seeking out work or peer relations.

Psychopathology

Identified as a negative symptom of the psychotic disorder Schizophrenia by the National Institute of Mental Health (NIMH) in 2006, avolition can be confused with other similar symptoms. Negative symptoms can be understood as the decrease or removal of an otherwise normative affective or motivational feature of cognition. Asociality, anhedonia, blunted affect, and alogia are negative symptoms frequently confused with avolition.

• Asociality is the decrease in interest and motivation in forming relationships.
• Anhedonia is the absence of experiencing pleasure.
• Blunted affect (sometimes referred to as “flat” or “restricted” affect) is the reduction in outward displays of emotional expression.
• Alogia is the significant decrease or reduction in speech output.

Although each negative symptom does reflect similar aspects, each needs to be differentiated properly in order to provide effective treatment.

Avolition is also one of the predominant symptoms of clinical depression. It is sometimes mistaken for disinterest, anhedonia and amotivation, but is distinct. People with avolition may want to complete certain tasks but lack the ability to initiate behaviors necessary to complete them. Literally meaning "poverty of will," avolition is a restriction in the initiation of activity, including, but not limited to, goal directed behavior. In contrast, abulia (poverty of motivated behavior) - is a restriction in motivation and initiation, often characterized by an inability to set goals or make decisions.

Clinical and social implications

Implications of avolition are tied closely to social deficits. It may be difficult to engage an individual experiencing avolition in active participation of psychotherapy. Several first person accounts of mental illness report being physically and mentally unable to eat, drink, sleep, work, initiate nor maintain relationships. It is important to keep in mind that just because someone experiencing avolition may also experience blunted affect, that does not mean they do not feel strong emotions. Also, the social consequences of unexpressive behavior are likely great. As social beings, humans want to belong; but without being able to express emotion or initiate relationships, interactions with both familiar and unfamiliar people are disrupted. At this time, the APA reports there are currently “no treatments with proven efficacy for primary negative symptoms.”

Treatment

Treating negative symptoms is notoriously difficult. Several medications are available; however, as many as 30% of people do not respond favorably to first-generation antipsychotics. First-generation antipsychotics are called such because they came out of the first wave of empirically supported medication treatments. First-generation antipsychotics include Navane and Haldol. Unfortunately, these are not effective in treating negative symptoms. Second-generation antipsychotics were produced by a second wave of research. These include Zyprexa and Risperdal. These drugs were supposed to be a remedy for the deficiencies of the first-generations', but there is no strong evidence these drugs are more effective at treating avolition and other negative symptoms, and are also prone to troubling side effects including pancreatitis and weight gain linked to type 2 diabetes. As a result, psychosocial interventions show more promise.

Two of the most promising psychosocial treatments are cognitive-behavioral therapy (CBT) and social skills training. CBT is a type of psychotherapy that helps individuals understand how thoughts and feelings influence behavior. Psychotherapy, sometimes referred to as "talk therapy", can complement the role of medication, by helping patients, families, and friends work through these emotional challenges. If a clinician were to choose this form of treatment it is likely it would be structured to challenge belief structures (schemas) that are tied to low expectations for success. Does CBT really help in treating avolition? Studies offer a tentative “yes”. But like many topics in psychology, more research is needed.

Social skills treatment focuses on teaching the individual how to successfully manage interpersonal situations. These could include job interviews, discussing medications, interacting with co-workers or friends, or riding a bus. Does social skills training really help in treating avolition? Obviously its largest impact is on social skills, but research suggests that this type of training does have a significant impact on negative symptoms as well.

Psychopathology in which avolition is a symptom may be a chronic experience. Although medications are often a first line of defense, several aspects of a patient's life are not likely to improve as a result of psychopharmacology. Within a biopsychosocial model, the manifestation of schizophrenia and depression are influenced by psychological, social, and genetic factors.

Patients are faced with the stresses of coping with and accepting a mental illness and the stigma that often accompanies such a diagnosis. Among others, loss, anger, and denial are likely emotions that have to be processed. Family and friends of individuals suffering mental disorders, are also affected, and thus need to learn to live, and cope, with the consequences of having a loved one diagnosed with a mental illness. These are all aspects of illness that cannot be treated with medication.

See also

• Aboulia
• Amotivational syndrome
• Apathy
• Lethargy
• Motivation
• Volition (psychology)