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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 bifurcatesome 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 pursuitpersistence,
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

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 emotionalmotivational 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 ones behavior),
and
maintenance (i.e., changing ones 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


persons perception of the problem and readiness
to change it.
These factors may help us to determine the
timing and content of treatment, or whether selfhelp 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 and


Motivation 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 selfhelp 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 patients 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 Structure
Questionnaire

Personal
Concerns Inventory

Motivational Treatment
Approaches

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 averageeffect 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 patients 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
patients 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 patients 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 patients self-efficacy, or confidence that he
or she can change, can help bridge the gap between a
patients 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 patients
current behavior and the target behavior
5. involves eliciting self-motivational statements from the
patient, such as recognition of the problem and concern
for ones own welfare
. The MI therapist emphasizes the patients 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 39month 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 therapists task is to create a set of
conditions that will enhance the patients 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 patients scores are then compared with the


scores of a reference group of patients or other
groups of American adults
Helps increase the patients 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 patients commitment to change by using MI
techniques that are appropriate for the patients 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