Motivation

• Ferguson (1994) defined motivation as “the internal states of the organism that lead to the instigation, persistence, energy, and direction of behavior

• Chaplin (1968) defined motivation as concept “to account for factors within the organism which arouse, maintain, and channel behavior toward a goal”

• the internal states of the organism that lead to the instigation, persistence, energy, and direction of behavior towards a goal.”

THE CENTRALITY OF MOTIVATION IN BRAIN AND MIND

• close connections between virtually all psychological processes and those associated with emotion and goal-striving.

• Ledoux (e.g., 1995) showed that, in the brain sensory systems, pathways bifurcate—some leading from sense organs to the cerebral cortex, and others from sense organs to the limbic system

• This suggests that sensory signals begin to trigger emotional reactions at least as quickly as they trigger cognitive processes that analyze the signals in order to make more detailed sense of them

• pathways from the limbic system to the cortex and from the cortex to the limbic system,

• provides a system for mutual alerting, refinement, and correction between emotional and cognitive responses to the signal

• Neurons in the anterior cingulate fire according to expectancy of reward

• Brain anatomy indicates that emotional response and closely related motivational processes are a central part of responding to something

• The ventromedial prefrontal cortex appears to integrate emotion-related signals from the limbic system with signals from various cortical areas, including some that are necessary for planning and volition

• patients with ventromedial prefrontal damage were unable to learn to avoid risky or nonoptimal strategies

Motivational States versus Motivational Traits

Motivation and Volition

• German psychological tradition restrict the term motivation to the processes and factors that determine which goals an individual will pursue

• Volition the factors that regulate how the individual carries out the pursuit—persistence, vigor, and efficiency

• American tradition the term motivation includes volition; volitional processes are simply a subset of motivation

• The advantage of the German approach is that there is a separate term (motivation) for those factors that determine choice of goals, just as there is a term (volition) for how the goal is pursued

• The advantage of the broader usage of the term motivation in American tradition is that it provides a single term to refer to all goal-related processes

Intrinsic versus Extrinsic Motivation

• Motivation is said to be intrinsic when an individual pursues a goal for its own sake.

• reaching the goal is not just a step in attaining some further goal.

• Motivation is said to be extrinsic when a goal is a stepping-stone to some further goal

• Acts that are purely extrinsically motivated yield only one kind of satisfaction: the satisfaction of moving closer to attaining some other source of satisfaction.

• extrinsically motivated act is part of a chain of acts and subgoals that ultimately lead to an intrinsically motivated goal.

• the intrinsically motivated goal at the end of the chain can be appetitive or aversive

• People with more aversive goals are generally less satisfied with life and work than those with fewer aversive goals

Theories

• Motivation for change v motivation for compliance

Drive theory

• Push theory• Behaviour is pushed towards the goal by driving state within

the individual• When an internal driving state is aroused , the individual is

pushed to engage in behavior that will lead to to agoal that reduces the intensity of the driving state

• Reaching the goal that reduces the driving state is pleasurable or satisfying

• Consists of• A driving state• The goal directed behavior initiated by the driving state• Attainment of the appropriate goal• The reduction of the driving state and subjective satisfaction

and relief

• After a time the driving state builds up again to push behavior towards another goal

• Motivational cycle• Can be inborn or learned drives

Driving state

Goal directed bahavioGoal

Incentive theory

• States that the stimulus characteristic of the goal can sometimes start a train of motivated behavior

• Pull theory• The goal objects that motivate the behavior are called

incentives• Believe that individuals expect pleasure from the attainment

of what are called as positive incentives and from the avoidance of what are known as negative incentives

Opponent process theory

• Also known as theory of emotions• States that many emotional-motivating states are followed by

opposing, or opposite , states• The peak point of emotional-motivational state occurs soon

after the emotion provoking situation is encountered.• With the emotion provoking situation still present, the

intensity of emotional-motivational state adapts and declines to a steady state

• When the emotion provoking situation terminates, an after reaction occurs in which the emotional-motivational state is in the opposite direction

Optimal level theory

• Just right theory• The individual is motivated to behave in such a way as to

maintain the optimal level of arousal

ALCOHOL USE FROM A MOTIVATIONAL PERSPECTIVE

• Involves incentive value, expected affective change, goal, and current concern.

• an incentive acquires value to the extent that the person expects to derive either positive or negative changes in affect from it.

• Drinking alcohol is a positive incentive when people expect that drinking will bring about desirable changes in their affect

• a negative incentive when they expect undesirable changes;• both positive and negative incentive value simultaneously.

Stages of motivation

• stages—• precontemplation (i.e., not yet considering change), • contemplation (i.e., considering change but not taking action), • Preparation (i.e., planning to change), • action (i.e., making changes in one’s behavior), and• maintenance (i.e., changing one’s lifestyle to maintain new

behavior)

• People in the precontemplation stage of the change model are not aware of the problem or, if they are, have no interest in change.

• Precontemplators are those who often are said to be in “denial.”

• It appears that progression in the change cycle requires acknowledgment of the problem and its negative consequences, and an accurate evaluation of change possibilities and how they might occur

• Contemplators vacillate between the pros and cons of their problem behaviour and between the pros and cons of making changes in it.

• People in the preparation stage are on the edge of taking action to change and may have made a try in the recent past

• To progress further , a commitment to take action and to set goals is needed

• Individuals in the action stage already are engaged in explicit activities to change.

• Maintenance stage, involves the continued use of behavior-change activities for as long as three years after the action stage began.

• People are thought to progress through each of these stages in the process of change.

• the stage of change helps us to identify a person’s perception of the problem and readiness to change it.

• These factors may help us to determine the timing and content of treatment, or whether self-help groups or professional treatment is needed

• the stage may tell us what needs to be done to move the change process forward

Motivation To Change andMotivation for Treatment

• Motivation appears to be a critical dimension in influencing patients to seek, comply with, and complete treatment as well as to make successful long-term changes in their drinking

• Motivation for changing problem behaviors like drinking, however, is not synonymous with motivation for participating in treatment.

• Most substance abuse treatment programs and self-help initiatives are designed to assist patients who are ready to take action and address their problems

• However patients are admitted prematurely

• traditional approaches to treating unmotivated patients with alcohol problems often use aggressive and confrontational strategies in response to the patients’ denial.

• Recent evidence indicates, however, that confrontation can foster denial and resistance in the drinker

• clinicians who work with unmotivated patients must implement less confrontational and more motivation-generating treatment approaches

Sources of Motivation• intrinsic sources of motivation (e.g., feeling a sense of

accomplishment) • extrinsic sources (e.g., financial incentives)• internal motivation is associated with greater long-term change

than is external motivation• among people who received outpatient alcohol treatment,

internal motivation was related positively to both treatment involvement and retention

• outpatients with high levels of both internal and external motivation had the highest treatment retention and treatment attendance outcomes.

• Irrespective of their level of external motivation, outpatients with low internal motivation had the worst treatment outcomes

• The severity of the patient’s alcohol problems enhances internal motivation, presumably because the problem severity increases distress and thus influences decision making

• Sobell et al. (1993) reported that most of the people brought about change after weighing the benefits and costs of continuing their current alcohol-use pattern.

Assesment

• Motivational measurement in historical perspective

• Thematic Apperception Test

Motivational StructureQuestionnaire

PersonalConcerns Inventory

Motivational TreatmentApproaches

Brief Motivational Intervention

• Brief (i.e., single-session) motivational intervention uses straightforward advice and information on the negative consequences of alcohol abuse to motivate patients to reduce or stop drinking

• Treatment approach has generally been viewed as more relevant for problem drinkers who are not yet alcohol dependent than for alcohol-dependent drinkers

• Brief interventions vary in duration from one to four sessions, with each session lasting from 10 to 60 minutes

• The goal of brief intervention is often reduced drinking rather than abstinence

• Physicians or other treatment providers advise patients on the need to reduce their alcohol consumption and offer feedback on the effects of the patients’ drinking

• The feedback is designed to increase patient motivation to reduce or stop drinking.

• This technique does not involve overtly confrontational tactics but rather consists of a respected professional giving the patient advice and providing personally motivating information

• Researchers generally have found brief intervention to be effective

• In a meta analysis, found that brief interventions effectively reduced drinking and yielded high average-effect sizes.

• Wilk and colleagues (1997) conducted a meta-analysis to explore the effectiveness of brief interventions with heavy drinkers

• heavy drinkers who received brief interventions were nearly twice as likely to successfully reduce their alcohol consumption within the following year compared with heavy drinkers who did not receive brief interventions

• Heavy drinking men may benefit more from brief intervention than from screening for alcohol problems

• The patient’s level of motivation also may contribute to the effectiveness of brief interventions

• brief motivational interventions to be superior to skill-based approaches for patients with initially low motivation to change

• However this has a high attrition rates

Motivational Interviewing

• Based on motivational psychology and the stages-of-change model,

• focuses on enhancing and facilitating the patient’s internal motivation to change

• This approach assumes that the patient is responsible for changing his or her addictive behavior and recognizes ambivalence as a natural part of the process.

• MI is designed to assist patients in working through their ambivalence and in moving toward positive behavioral change

• The MI therapist uses various techniques to help increase the patient’s motivation to change his or her behavior

1. Reflective listening -A form of paraphrasing that enables patients to more fully tell their stories and to feel that they are being heard by the empathetic MI therapist

2. involves exploring the pros and cons of change, which may help patients realistically evaluate their behavior and current situation

• supports the patient’s self-efficacy, or confidence that he or she can change, can help bridge the gap between a patient’s desire to change and concrete behavioral change

4. uses interview and assessment data to provide patients with personalized feedback regarding the problem behavior as a means of increasing self-awareness and of highlighting the discrepancy between the patient’s current behavior and the target behavior

5. involves eliciting self-motivational statements from the patient, such as recognition of the problem and concern for one’s own welfare

• The MI therapist emphasizes the patient’s personal choice regarding change, deemphasizes diagnostic labels, and avoids arguing with and confronting the patient

Motivational Enhancement Therapy

• The MET approach was specifically developed for Project MATCH, an 8-year, national, multisite, clinical trial initiated in 1989 that compared three alcoholism treatment methods and included a 39-month follow up period

• Systemic intervention technique for evoking change• Based on principles of motivational psychology and is

designed to produce rapid, internally motivated changes• Employs motivational strategies to mobilize the patients own

change resources

Principles and rationale

• The MET approach begins with the assumption that the responsibility and capability for change lie within the patient

• The therapist’s task is to create a set of conditions that will enhance the patient’s own motivation for and commitment to change.

• MET seeks to support intrinsic motivation for change, which will lead the patient to initiate, persist in, and comply with behavior change efforts

• Miller and Rollnick (1991) have described five basic motivational principles underlying such an approach:

• Express empathy • Develop discrepancy • Avoid argumentation • Roll with resistance • Support self-efficacy

• MET consists of four treatment sessions over 12 weeks preceded by an extensive assessment.

• In the first session the therapist provides the patient with clear, structured, personalized feedback concerning his or her

drinking frequency (number of drinking days per month), drinking intensity (number of drinks per drinking occasion), typical level of intoxication, risk for negative consequences of alcohol use, results of liver function and neurological tests, Risk factors for alcohol problems

• The patient’s scores are then compared with the scores of a reference group of patients or other groups of American adults

• Helps increase the patient’s awareness of the extent to which alcohol has affected his or her life and to motivate the patient to change his or her drinking behavior.

• session 2, the therapist concentrates on strengthening the patient’s commitment to change by using MI techniques that are appropriate for the patient’s stage in the change process and on helping the patient develop a specific plan for change

• During sessions 3 and 4, the therapist focuses on reviewing patient progress and renewing motivation and commitment by exploring remaining ambivalent feelings that the patient might have about changing the targeted behavior.

• Termination of the treatment and future plans are also discussed at the end of session 4

Project MATCH

• Project MATCH consisted of two parallel but independent studies

• one study was with patients who had received only outpatient treatment and

• the other study was with patients who had participated in either an inpatient or a day hospital treatment program and were currently receiving aftercare

• The study was designed to test the effectiveness matching patients to one of three conceptually different treatments based on various patient characteristics

• cognitive behavioral therapy (CBT), in which patients learned coping skills to reduce alcohol use

• 12-step facilitation (TSF), which is based on the principles of Alcoholics Anonymous (AA) and

• MET.

• All modalities are effective but no single treatment was substantially more effective than another

• Project MATCH results• Motivation or readiness to change at the start of treatment

was the most potent predictor of drinking outcomes throughout the post-treatment period for outpatients

• During the final month of the 12-month followup period, less motivated outpatient clients in the MET group had a higher percentage of days in which they were abstinent from alcohol compared with less motivated clients in the CBT group.

• patients with different levels of anger had different treatment outcomes depending on the treatment they received.

• Outpatient clients who reported a higher baseline level of anger fared better after MET than after CBT and TSF treatments

• The researchers found that patients who had greater motivation at baseline were more likely to have a strong client-therapist alliance and better posttreatment drinking outcomes across treatments.

• Baseline motivation levels were significant predictors of drinking outcomes for the entire year after treatment and at the 3-year followup for outpatient clients

• Patients’ readiness to change at the start of treatment had a significant impact on their success in quitting and reducing drinking throughout the 3 years after treatment