DESCRIBE PRINCIPLES OF MOTIVATION ASSESSMENT THERAPY ? 5 MARKS
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A ) DEFINITION
1 Motivation is a theoretical construct used to explain behaviour.
2 It gives the reason for people’s actions, desires, and needs.
3 Motivation can also be defined as one’s direction to behavior, or what causes a person to want to repeat a behavior and vice versa.
4 A motive is what prompts the person to act in a certain way, or at least develop an inclination for specific behavior.
5 According to Maehr and Meyer, “Motivation is a word that is part of the popular culture as few other psychological concepts are.”
CLASSIFICATION
A ) Motivation theories can be classified on a number of bases -"
1 Natural vs. Rational: based on whether the underlying theory of human cognition is based on natural forces (drives, needs, desires) or some kind of rationality (instrumentality, meaningfulness, self-identity).
2 Content vs. Process: based on whether the focus is on the content (“what”) motivates vs process (“how”) motivation takes place.
B ) Incentive theories: intrinsic and extrinsic motivation
1 Motivation can be divided into two different theories known as intrinsic (internal or inherent) motivation and extrinsic (external) motivation.
A ) Intrinsic motivation
1 Intrinsic motivation has been studied since the early 1970s.
2 Intrinsic motivation is the self-desire to seek out new things and new challenges, to analyze one’s capacity, to observe and to gain knowledge
3 It is driven by an interest or enjoyment in the task itself, and exists within the individual rather than relying on external pressures or a desire for consideration.
4 The phenomenon of intrinsic motivation was first acknowledged within experimental studies of animal behavior.
5 In these studies, it was evident that the organisms would engage in playful and curiosity driven behaviors in the absence of reward.
6 Intrinsic motivation is a natural motivational tendency and is a critical element in cognitive, social, and physical development.
7 Students who are intrinsically motivated are more likely to engage in the task willingly as well as work to improve their skills, which will increase their capabilities.
8 Students are likely to be intrinsically motivated if they:
A ) attribute their educational results to factors under their own control, also known as autonomy or locus of control
B ) believe they have the skills to be effective agents in reaching their desired goals, also known as self-efficacy beliefs
C ) are interested in mastering a topic, not just in
D ) achieving good grades
E ) An example of intrinsic motivation is when an employee becomes an IT professional because he or she wants to learn about how computer users interact with computer networks. The employee has the intrinsic motivation to gain more knowledge.
F ) Art for art’s sake is an example of intrinsic motivation in the domain of art.
G ) Traditionally, researchers thought of motivations to use computer systems to be primarily driven by extrinsic purposes; however, many modern systems have their use driven primarily by intrinsic motivations.
H ) Examples of such systems used primarily to fulfil users’ intrinsic motivations, include on-line gaming, virtual worlds, online shopping, learning/education, online dating, digital music repositories, social networking, online pornography, gamified systems, and general gamification.
Advantages:
1 Intrinsic motivation can be long-lasting and self-sustaining.
2 Efforts to build this kind of motivation are also typically efforts at promoting student learning.
3 Such efforts often focus on the subject rather than rewards or punishments.
Disadvantages:
1 Efforts at fostering intrinsic motivation can be slow to affect behavior and can require special and lengthy preparation.
2 Students are individuals, so a variety of approaches may be needed to motivate different students.
3 It is often helpful to know what interests one’s students in order to connect these interests with the subject matter. This requires getting to know one’s students. Also, it helps if the instructor is interested in the subject.
B ) Extrinsic motivation
1 Extrinsic motivation refers to the performance of an activity in order to attain a desired outcome and it is the opposite of intrinsic motivation.
2 Extrinsic motivation comes from influences outside of the individual.
3 In extrinsic motivation, the harder question to answer is where do people get the motivation to carry out and continue to push with persistence.
4 Usually extrinsic motivation is used to attain outcomes that a person wouldn’t get from intrinsic motivation.
5 Common extrinsic motivations are rewards (for example money or grades) for showing the desired behavior, and the threat of punishment following misbehavior.
6 Competition is an extrinsic motivator because it encourages the performer to win and to beat others, not simply to enjoy the intrinsic rewards of the activity.
7 A cheering crowd and the desire to win a trophy are also extrinsic incentives
8 Social psychological research has indicated that extrinsic rewards can lead to overjustification and a subsequent reduction in intrinsic motivation.
9 In one study demonstrating this effect, children who expected to be (and were) rewarded with a ribbon and a gold star for drawing pictures spent less time playing with the drawing materials in subsequent observations than children who were assigned to an unexpected reward condition.
10 However, another study showed that third graders who were rewarded with a book showed more reading behavior in the future, implying that some rewards do not undermine intrinsic motivation.
11 While the provision of extrinsic rewards might reduce the desirability of an activity, the use of extrinsic constraints, such as the threat of punishment, against performing an activity has actually been found to increase one’s intrinsic interest in that activity.
12 In one study, when children were given mild threats against playing with an attractive toy, it was found that the threat actually served to increase the child’s interest in the toy, which was previously undesirable to the child in the absence of threat.
NEUROPHYSIOLOGY OR MECHANISM
A ) Motivation as a desire to perform an action is usually defined as having two parts, directional such as directed towards a positive stimulus or away from a negative one, as well as the activated “seeking phase” and consummatory “liking phase”.
1 This type of motivation has neurobiological roots in the basal ganglia, and mesolimbic dopaminergic pathways.
2 Activated “seeking” behavior, such as locomotor activity is influenced by dopaminergic drugs, and in micro dialysis reveals dopamine release during anticipation of a reward.
3 The “wanting behavior” associated with a rewarding stimulus can be increased by microinjections of dopamine and dopaminergic drugs in the dorsorostral nucleus accumbens and posterior ventral palladium.
4 Opioid injections in this area produce pleasure, however outside of these hedonic hotspots they create an increased desire.
5 Furthermore, depletion or inhibition of DA in neurons of the nucleus accumbens decreases appetitive but not consummatory behavior.
6 Dopamine is further implicated in motivation as administration of amphetamine increased the break point in a progressive ratio self-reinforcement schedule.
7 That is, subjects were willing to go to greater lengths (e.g. press a level more times) to obtain a reward.
B ) ASSESSMENT
1 Motivation is multidimensional, not a single domain that can be easily measured with one instrument or scale.
2 For measuring the scale should have foll characteristics -
A ) Self-efficacy
B ) Readiness to change
C ) Decisional balancing
D ) Motivations for using substances
E ) Goals and values
3 Foll tests should be used -
A ) Situational Confidence Questionnaire -
1 The Situational Confidence Questionnaire (SCQ) has been used specifically with those who drink heavily.
A ) The instrument consists of 100 items that ask clients to identify their level of confidence in resisting drinking as a response to the following eight types of situations (Marlatt and Gordon, 1985) -
A ) Unpleasant emotions
B ) Physical discomfort
C ) Testing personal control over substance use
D ) Urges and temptations to drink
E ) Pleasant times with others
F ) Conflicts with others
G ) Pleasant emotions
H ) Social pressure to drink
1 Rating is done on a 6-point scale, ranging from not at all confident (a rating of 0) to totally confident (a rating of 6) that they can resist the urge to drink heavily in that situation.
2 The SCQ generally takes about 20 minutes to complete, using either pencil and paper or computer software that automatically scores answers and generates a profile of the client’s alcohol use.
3 The SCQ is accompanied by an Inventory of Drinking Situations that assesses the frequency of heavy drinking in different situations.
B ) The Brief Situational Confidence Questionnaire (BSCQ) was developed as an alternative to the SCQ because some treatment programs found the length and scoring and graphing systems of the original instrument to be too time-consuming in clinical practice (Sobell, 1996).
C ) Alcohol Abstinence self efficacy Scale -
1 The AASE consists of 20 items and can be used to assess both the temptation to drink and the confidence to abstain .
2 Clients rate their temptation to drink and their confidence that they would not drink in each situation on separate 5-point Likert scales that range from 1 (not at all likely) to 5 (extremely likely).
3 Scores are calculated separately for temptation and self-efficacy (DiClemente et al., 1994).
D ) University of Rhode Island Change Assessment Scale
1 Was developed to measure client change in terms of four stages of change - precontemplation, contemplation, action, and maintenance.
2 The scale has 32 items, with eight items for each of the four stage-specific subscales
3 Respondents rate items on a five-point Likert scale from 1 (strong disagreement) to 5 (strong agreement).
4 Scores for each of the four stages are obtained.
5 The instrument is designed for a broad range of concerns and asks clients general questions about their “problem.”
E ) Alcohol and Drug Consequences Questionnaire
1 The Alcohol and Drug Consequences Questionnaire (ADCQ) is a relatively new instrument for assessing the costs and benefits of changing a substance problem (Cunningham et al., 1997).
2 The 29 items included on the questionnaire were derived from information reported by clients participating in a brief cognitive behavioural intervention for guided self change at an outpatient basis
3 Respondents are asked the importance of each item if they were to stop or cut down their use of substances (0 = not applicable, 1 = not important, 3 = moderately important, 4 = very important, 5 = extremely important
C ) PRINCIPLES OF MOTIVATION ASSESSMENT THERAPY
INTRODUCTION
1 Motivational Enhancement Therapy (MET) is a counseling approach that helps individuals resolve their ambivalence about engaging in treatment and stopping their drug use.
2 This approach aims to evoke rapid and internally motivated change, rather than guide the patient stepwise through the recovery process.
3 This therapy consists of an initial assessment battery session, followed by two to four individual treatment sessions with a therapist.
4 In the first treatment session, the therapist provides feedback to the initial assessment, stimulating discussion about personal substance use and eliciting self-motivational statements.
5 Motivational interviewing principles are used to strengthen motivation and build a plan for change.
6 Coping strategies for high-risk situations are suggested and discussed with the patient.
7 In subsequent sessions, the therapist monitors change, reviews cessation strategies being used, and continues to encourage commitment to change or sustained abstinence.
8 Patients sometimes are encouraged to bring a significant other to sessions.
9 Research on MET suggests that its effects depend on the type of drug used by participants and on the goal of the intervention.
A ) This approach has been used successfully with people addicted to alcohol to both improve their engagement in treatment and reduce their problem drinking.
B ) MET has also been used successfully with marijuana-dependent adults when combined with cognitive-behavioral therapy, constituting a more comprehensive treatment approach.
C ) The results of MET are mixed for people abusing other drugs (e.g., heroin, cocaine, nicotine) and for adolescents who tend to use multiple drugs.
D ) In general, MET seems to be more effective for engaging drug abusers in treatment than for producing changes in drug use.
10 MET was one of three interventions tested in Project MATCH, a 1993 clinical trial of treatment options for those experiencing alcohol addiction, and an initiative of the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
11 MET is based on the principles of motivational psychology and employs techniques associated with Motivational Interviewing, a counseling style developed by William R. Miller and Stephen Rollnick.
12 In MET, the style and techniques of Motivational Interviewing are incorporated into a structured therapeutic approach which involves a comprehensive assessment of an individual’s behaviors, as well as systematic feedback based on the findings.
13 MET may be useful in enhancing the treatment of other conditions, such as anxiety, eating disorders, and problem gambling. This type of therapy may even be of help to persons who are at risk of developing these conditions.
IN DETAIL
Is based on five motivational principles that are designed to guide the therapist’s work with an individual in therapy:
A ) Express empathy: Therapists create a supportive environment in order to help an individual feel accepted and respected, and they engage in reflective listening rather than direct confrontation. The therapist will listen to what an individual is saying and then reflect it back, with slight but deliberate modifications. The modifications both let the individual know that the therapist has heard and understood and encourage the individual to elaborate.
B ) Develop discrepancy: In MET, the therapist directs attention toward the discrepancy between an individual’s desired state of being and that individual’s actual state of being. This discrepancy may help aid in recognizing the ways that current behaviors hinder one from achieving goals, and it can also provide a strong incentive for behavior change.
C ) Avoid argumentation: A therapist will avoid attacking an individual or an individual’s behavior, as this is thought to result in defensiveness and resistance. Other, gentler methods are used to raise awareness of any problems, and any statements regarding a need for change should come from the individual, not the therapist.
D ) Roll with resistance: Instead of directly confronting any resistance on the part of the individual, the therapist tries to defuse it, often through reflective listening or by simply going along with what an individual is saying.
1 This approach may seem counterintuitive, but it decreases the odds of further defensiveness and may make it more likely that an individual will remain in therapy and benefit from other aspects of the intervention.
E ) Support self-efficacy: One’s motivation to change typically depends not only on the reasons for modifying behavior but also on the belief that one is able to perform the tasks required for change. One aspect of a therapist’s role is to help individuals become aware of their ability to successfully undertake the actions needed for change.