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PubMed2005

Course of mental fatigue and motivation in breast cancer patients receiving adjuvant chemotherapy.

BACKGROUND: The purpose of this study is to determine the course of fatigue referring to cognitive symptoms (scale 'mental fatigue') as well as the motivation to start any activity (scale 'reduced motivation'), as a function of chemotherapy, in breast cancer patients undergoing adjuvant chemotherapy. PATIENTS AND METHODS: In a prospective cohort study a sample of 157 patients with breast cancer was interviewed at the first, third and fifth cycle of adjuvant chemotherapy as well as 4 and 12 weeks after completion of adjuvant chemotherapy. Patients were treated with standard adjuvant chemotherapy, either a doxorubicin containing schedule or CMF (cyclophosphamide, methotrexate and fluorouracil). The psychological dimensions of fatigue were measured by the Multidimensional Fatigue Inventory. A linear multilevel model was used for analysing the courses. RESULTS: The course of mental fatigue and motivation were not affected by the type of chemotherapy. The course of mental fatigue and motivation varied, but seemed to be stable during the treatment of chemotherapy. After the completion of chemotherapy, a weak improvement was seen. Relatively many patients experienced depressive symptoms during the study. These symptoms were correlated with both dimensions of fatigue. At all measurements mental fatigue was influenced by type of operation where women with a mastectomy were significantly more mentally fatigued than women that had undergone a lumpectomy, but nevertheless they were significantly more motivated to start any activity. Age, marital status, number of treatments and the interval between the operation and the first treatment of chemotherapy also seemed to be important determinants. CONCLUSIONS: An unequivocal pattern of mental fatigue and reduced motivation during as well as after adjuvant chemotherapy was not found. Depressive symptoms were definitely related to these variables. Type of operation had a significant impact on mental fatigue and motivation to start any activity. Health care providers should be aware of the high rate of patients who experience depressive symptoms during and after the treatment of chemotherapy. Further research should include the trajectory preceding adjuvant chemotherapy and a longer study period afterwards. Moreover, the exact influence of the variables 'age', 'marital status', 'number of treatments' and 'the interval between the operation and the first treatment of chemotherapy' on fatigue is unclear and needs further study.

Adult↗
PubMed2004

Motives for becoming a living kidney donor.

BACKGROUND: Recruitment of living donors represents a medical and moral responsibility. Their motives are often complex. Categories of motives and factors causing concern were identified from a previous in-depth interview study and from the literature. The aim of the present study was to evaluate these motives. METHODS: A questionnaire was sent to 207 potential kidney donors undergoing evaluation for donation in Norway and Sweden. They were asked to mark on a visual analogue scale, 0-10, the importance given to each of nine motives and five factors of concern. Questions were also asked about who took the initiative and the source of information. RESULTS: The response rate was 74%; 154 questionnaires were returned. The strongest motives to become a donor were a wish to help (median 9.3), self-benefit from the recipient's improved health (median 9.2) and identification with the recipient (median 9.1). In contrast, a sense of guilt regarding past relationships (median 0.9), pressure from others (median 0.8), a religious motive (median 0.8) and increased self-esteem (median 0.7) were rare or weak incentives for donation. There were large individual variations in the mix, particularly regarding moral duty (5.6, range 0.1-10.0). Most potential donors (64%) had taken the initiative for the assessment themselves, but in 22% it was the recipient's physician. Physicians were the dominant source of information. The potential donors expressed much more concern for the recipient than for themselves. CONCLUSIONS: Living kidney donor assessment includes an exploration of the individuals' mixed feelings. An analysis of the motive enables individualized treatment and support for non-donors.

Adolescent↗
PubMed2004

Psychotic motivation and the paradox of current research on serious mental illness and rates of violence.

Persuasive empirical support exists for a positive association between serious mental illness (SMI) and rates of violence; a great deal of support is also present for the clinical impression that psychotic symptoms sometimes motivate "symptom-consistent" violence. We propose that the issue of the motivation for violence in the SMI population can be considered independently of the issue of the association between SMI and violence rates. We review much of the current literature on the association between SMI and violence in a framework that emphasizes motivational influences unique to the SMI population. We conclude that the contribution of psychotic motivation to rates of violence in the SMI population is a major research issue. Furthermore, we believe that recognition of the independence of motivational influences and violence rates, and consideration of the impact of treatment on violence, may help explain the paradox of current research: Delusions and hallucinations may motivate violent behavior, but this psychotic motivation may not be reflected in the actual rate of violence.

Delusions↗
PubMed1995

Expectations and motives for substance use in schizophrenia.

This study examined the internal reliability of standardized measures of substance use expectancies and motives in a schizophrenia population (n = 70) and the relationship of these expectancies and motives to alcohol and drug use disorders. Internal reliabilities were uniformly high for the subscales of the expectancy and motive measures. Analyses of the relationship between substance use disorders and expectancies revealed strong substance-specific expectations. Alcohol expectancies were related to alcohol disorders but not to drug disorders; cocaine expectancies were related to drug but not to alcohol disorders; and marijuana expectancies were more strongly related to drug than to alcohol use disorders. In contrast, motives were related to substance use disorders, and self-reported substance use problems were related to expectancies and motives in a non-specific manner. These results suggest that expectancy and motive questionnaires developed for the primary substance abuse population may be valid for psychiatric populations. Research on motives and expectancies may help to clarify the functions of substance abuse in persons with schizophrenia.

Adult↗
PubMed2005

The relationships among cognition, motivation, and emotion in schizophrenia: how much and how little we know.

This article summarizes a workshop discussion focused on the current state of our understanding of the ways in which cognitive dysfunction in schizophrenia is related to, influenced by, or even leads to disturbances in areas such as emotion, motivation, and stress, as well as areas in need of further research. A major emphasis in the workshop discussion was the critical importance of motivation and its potential influence on cognitive function and learning in schizophrenia. As such, the members of the workshop suggested a number of questions regarding motivation that need further research, including (1) the definition and measurement of different components of motivation; (2) the relationship between intrinsic motivation and incentive drive and hedonic processing; (3) the integrity of motivational processes, incentive drive, and hedonic processing in schizophrenia; (4) the influence of cognitive deficits on motivational disturbances in schizophrenia; (5) the influence of antipsychotic medication on incentive drive and hedonic processing in schizophrenia; and (6) the relationships among cognitive function, stress, and the processing of aversive stimuli.

Antipsychotic Agents↗
PubMed1999

Motivation in medical education: how theory can inform our practice.

Medical educators seek to understand and facilitate learners' motivations to acquire the skills, knowledge, values, and attitudes that will prepare them for life-times of learning and providing care to their patients and communities. Yet faculty are often challenged by experiences with learners who appear unmotivated, or who seem to value goals other than those the faculty espouse. Understanding what motivates learners may help educators appreciate the complex environment in which motivations are formed, and the sometimes-hidden influences upon motivation that may explain learners' attitudes and behaviors. In this brief essay, the author discusses some of the current theories about motivation and describes how they might relate to the education of physicians. She also explores the too-frequent disparities between medical schools' stated goals for learners and what is actually taught or rewarded by faculty. Although motivation is multifaceted, involving learners and the entire learning environment, there are strategies that may be used to strengthen students' motivations to achieve important goals.

Curriculum↗
PubMed1999

Motivational interviewing and treatment adherence among psychiatric and dually diagnosed patients.

The effect of motivational interviewing on outpatient treatment adherence among psychiatric and dually diagnosed inpatients was investigated. Subjects were 121 psychiatric inpatients, 93 (77%) of whom had concomitant substance abuse/dependence disorders, who were randomly assigned to: a) standard treatment (ST), including pharmacotherapy, individual and group psychotherapy, activities therapy, milieu treatment, and discharge planning; or b) ST plus motivational interviewing (ST+MI), which involved 15 minutes of feedback on the results of a motivational assessment early in the hospitalization, and a 1-hour motivational interview just before discharge. Interviewers utilized motivational techniques described in Miller and Rollnick (1991), such as reflective listening, discussion of treatment obstacles, and elicitation of motivational statements. Results indicated that the proportion of patients who attended their first outpatient appointment was significantly higher for the ST+MI group (47%) than for the ST group (21%; chi2 = 8.87, df = 1, p<.01) overall, and for dually diagnosed patients (42% for ST+MI vs. 16% for ST only; chi2 = 7.68, df = 1, p<.01). Therefore, brief motivational interventions show promise in improving outpatient treatment adherence among psychiatric and dually diagnosed patients.

Adult↗
PubMed2005

Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain.

STUDY DESIGN: A prospective clinical randomized controlled trial. OBJECTIVES: To determine the long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic and recurrent low back pain (LBP). SUMMARY OF BACKGROUND DATA: There is agreement on the importance of exercise during the course of chronic LBP. However, it is well known that long-term adherence with exercises is particularly low. METHODS: A total of 93 patients with LBP were randomly assigned to the control group (standard exercise program) or the motivational group (combined exercise and motivational program). Follow-up assessments were performed at 3.5 weeks, 4 months, 12 months, and 5 years. Main outcome measures were disability scores, pain intensity, and working ability. In addition to classic statistics, the sophisticated linear partial credit model was used to test the effects of treatment on disability scores. RESULTS: In both groups, significant improvements in the disability scores were found at all points of follow-up assessment, however, the cumulative effect of the treatment in the motivational group was more than twice as much as in the control group. This result is in accordance with the increasing divergence in pain intensity between groups between 12 months and 5 years after intervention. A significant, positive long-term effect at the 5-year reassessment in working ability was only seen in the motivational group. All statistically significant results were confirmed by intention-to-treat analyses. CONCLUSIONS: Regarding long-term efficacy, the combined exercise and motivation program was superior to the standard exercise program. Five years after the supervised combined exercise and motivational program, patients had significant improvements in disability, pain intensity, and working ability.

Chronic Disease↗
PubMed1991

Self-reinforcement in mildly mentally retarded adults: effects of motivational orientation and instructional demand.

The effects of external (environmental) and internal (cognitive) self-influences of self-regulatory behaviour were investigated in 60 mildly mentally retarded adults. External conditions were three demand conditions (stringent, variable, and lenient). The 'internal' variable was an individual differences one, motivational orientation: one-half of the subjects were relatively intrinsically motivated and the other half were relatively extrinsically motivated. Both external and internal self-influences affected performance on a motor/attention task. Subjects in the stringent-demand condition worked harder, set higher performance standards and arranged leaner schedules of self-reinforcement than did subjects in the lenient demand condition. Intrinsically motivated subjects worked harder, set higher performance standards, and arranged leaner schedules of self-reinforcement than did extrinsically motivated subjects over all demand conditions. Furthermore, intrinsically motivated subjects chose higher performance standards than had been demonstrated to them in the lenient-demand condition, and also arranged leaner schedules of self reinforcement over all demand conditions than had been demonstrated to them, compared to extrinsically motivated subjects. Internal self-system characteristics appear to interact reciprocally with external demand characteristics to reveal substantial individual differences in patterns of self-reward behaviour.

Activities of Daily Living↗
PubMed2005

Motivation, recruitment and retention of voluntary non-remunerated blood donors: a survey-based questionnaire study.

BACKGROUND AND OBJECTIVES: The aim of this study was to establish which motivational and socio-demographic factors are important for the development of a long-term commitment as a voluntary, non-remunerated blood donor. STUDY DESIGN AND METHODS: A cross-sectional sample survey of active blood donors in Oslo, Norway, was conducted. Donors filled in a self-administered questionnaire during donation. Data on motivation were analysed using factor analysis. RESULTS: The blood donors' socio-demographic characteristics were found to be similar to those of the population as a whole. The single, most important, recruitment channel was the influence of active blood donors. Five dimensions of blood-donor motivation were identified with factor analysis. These were: altruism and empathy; social reasons (such as the influence of friends and family); strengthening of one's self-esteem; positive experiences associated with donation; and a moral obligation to donate. Support for statements on altruistic motives for donation was strong and similar in long-time and short-time donors. In contrast, short-time donors were more likely to be motivated by factors related to self-esteem than were long-term donors. CONCLUSION: The 'good habit' of continued blood donation seems not to be exclusively linked to a high degree of reported other-regarding ('altruistic') reasons, but also to a combination of motives, including some modestly self-regarding motives.

Altruism↗
PubMed1987

Social motives and susceptibility to disease: stalking individual differences in health risks.

This article reviews studies on the relation between social motives and susceptibility to physical illness. The motives examined in the studies include power motivation and affiliation motivation and their related syndromes such as inhibited power and relaxed affiliation. The subject populations include college students as well as adults. Blood pressure, self-reports of illnesses, catecholamines, and parameters of immunologic functioning are among the indices of health outcomes investigated. Taken together, these studies suggest that social motives may be importantly related to susceptibility to illness, that the power motive may be related to heightened susceptibility to illness, particularly when the person is under stress, whereas the affiliation motive may be related to diminished susceptibility to illness.

Humans↗
PubMed1987

Intimacy motivation and subjective mental health in a nationwide sample.

Over 1,200 adults in a representative nationwide sample were administered the Thematic Apperception Test (TAT) and an unstructured interview which produced 25 measures of subjective mental health and ultimately six factor scores: unhappiness, lack of gratification, strain, feelings of vulnerability, lack of self-confidence, and uncertainty. The TATs were scored for intimacy motivation (McAdams, 1980)--a recurrent preference or readiness for experiences of warm, close, and communicative interaction with others. Controlling for age, education, and their interaction, high intimacy motivation in women was associated with greater happiness and gratification, whereas in men it was associated with lack of strain and lack of uncertainty. Women high in intimacy motivation who were living alone reported lower levels of gratification and more uncertainty in their lives than other women. Intimacy motivation also declined significantly over the life span for women, but not for men. Finally, demographic effects on intimacy motivation were examined. Controlling for age, education, and their interaction, professional men (e.g., doctors, lawyers, and teachers) scored higher on intimacy motivation than did men in other occupational categories, while among women the occupational groups with highest intimacy motivation were service workers and craftspersons.

Adaptation, Psychological↗
PubMed2005

[Treatment-oriented attitudes and treatment motivation of patients from two clinics for complementary medicine].

BACKGROUND: The increasing demand for complementary medicine indicates a change in attitudes regarding treatment understanding. OBJECTIVES: To investigate the role of attitudes in treatment motivation. (1) Can the study sample be subdivided into homogenous groups as regards attitudes toward complementary treatment? (2) How do these groups relate to motivational variables? PATIENTS AND METHODS: Four questionnaires on motivation and attitudes were administered to 203 patients of two clinics for complementary medicine. Results were interpreted following Petry's motivational process model that distinguishes treatment disposition, preparedness for treatment and treatment activity. RESULTS: According to a cluster analysis, 3 patient groups could be identified: 'Not-convinced' patients (cluster 1,n = 24) demonstrated little conviction regarding any aspect of complementary treatment. 'Convinced' patients (cluster 2,n = 103) showed a high degree of agreement on all three scales,being highest on 'Role of patient'. 'Partially-convinced' patients(cluster 3, n = 70) also evaluated 'Role of patient' highest, but aspects of the 'Physician-patient relationship' and the 'Treatment method' were only partly regarded as important. In all clusters, the pragmatic motive of treatment acceptance was central for the treatment choice, but was highest in cluster 2. As compared to cluster 1, a complementary treatment understanding was higher in patients of clusters 2 and 3 (highest in cluster 2). DISCUSSION: Even if the pragmatic treatment motivation was high in all groups, the central role of treatment attitudes in the motivational process could be verified. Despite differing attitude structures, a majority of patients displayed a complementary treatment comprehension.

Adult↗
PubMed1996

Motivation for brief dynamic psychotherapy.

BACKGROUND: Preliminary research indicates that motivation may be a key predictor of success in brief dynamic psychotherapy, but different aspects of motivation have not been studied as predictors. METHODS: In this study 48 out-patients were clinically evaluated before therapy with regard to different aspects of motivation. Seven motivation items modified after Sifneos were rated by several experienced judges. Forty-three patients were treated and followed up 2 and 4 years after brief dynamic psychotherapy. The predictive validity of each of the motivation items was tested by their direct correlations with long-term outcome, and their collective predictive validity was tested by use of multiple regression analyses. RESULTS: The interrater reliability was problematic for single items, but when the average scores of 4 judges were used, adequate reliabilities on 4 items were achieved. Two items, Motivation for change and Realistic expectations, showed the best predictive validity of long-term outcome. CONCLUSIONS: An Active engagement aspect of motivation may predict both successful and unsuccessful cases. Our data indicate that patients should be instructed about the principles and procedures of dynamic psychotherapy and they should be told why it is important for them to actively test alternative problem-solving strategies during and after therapy.

Adult↗
PubMed2007

Is decreased prefrontal cortical sensitivity to monetary reward associated with impaired motivation and self-control in cocaine addiction?

OBJECTIVE: This study attempted to examine the brain's sensitivity to monetary rewards of different magnitudes in cocaine abusers and to study its association with motivation and self-control. METHOD: Sixteen cocaine abusers and 13 matched healthy comparison subjects performed a forced-choice task under three monetary value conditions while brain activation was measured with functional magnetic resonance imaging. Objective measures of state motivation were assessed by reaction time and accuracy, and subjective measures were assessed by self-reports of task engagement. Measures of trait motivation and self-control were assessed with the Multidimensional Personality Questionnaire. RESULTS: The cocaine abusers demonstrated an overall reduced regional brain responsivity to differences between the monetary value conditions. Also, in comparison subjects but not in cocaine abusers, reward-induced improvements in performance were associated with self-reports of task engagement, and money-induced activations in the lateral prefrontal cortex were associated with parallel activations in the orbitofrontal cortex. For cocaine abusers, prefrontal cortex sensitivity to money was instead associated with motivation and self-control. CONCLUSIONS: These findings suggest that in cocaine addiction 1) activation of the corticolimbic reward circuit to gradations of money is altered; 2) the lack of a correlation between objective and subjective measures of state motivation may be indicative of disrupted perception of motivational drive, which could contribute to impairments in self-control; and 3) the lateral prefrontal cortex modulates trait motivation and deficits in self-control, and a possible underlying mechanism may encompass a breakdown in prefrontal-orbitofrontal cortical communication.

Adult↗
PubMed2006

The attractions of medicine: the generic motivations of medical school applicants in relation to demography, personality and achievement.

BACKGROUND: The motivational and other factors used by medical students in making their career choices for specific medical specialities have been looked at in a number of studies in the literature. There are however few studies that assess the generic factors which make medicine itself of interest to medical students and to potential medical students. This study describes a novel questionnaire that assesses the interests and attractions of different aspects of medical practice in a varied range of medical scenarios, and relates them to demographic, academic, personality and learning style measures in a large group of individuals considering applying to medical school. METHODS: A questionnaire study was conducted among those attending Medlink, a two-day conference for individuals considering applying to medical school for a career in medicine. The main outcome measure was the Medical Situations Questionnaire, in which individuals ranked the attraction of three different aspects of medical practise in each of nine detailed, realistic medical scenarios in a wide range of medical specialities. As well as requiring clear choices, the questionnaire was also designed so that all of the possible answers were attractive and positive, thereby helping to eliminate social demand characteristics. Factor analysis of the responses found four generic motivational dimensions, which we labelled Indispensability, Helping People, Respect and Science. Background factors assessed included sex, ethnicity, class, medical parents, GCSE academic achievement, the 'Big Five' personality factors, empathy, learning styles, and a social desirability scale. RESULTS: 2867 individuals, broadly representative of applicants to medical schools, completed the questionnaire. The four generic motivational factors correlated with a range of background factors. These correlations were explored by multiple regression, and by path analysis, using LISREL to assess direct and indirect effects upon the factors. Helping People was particularly related to agreeableness; Indispensability to a strategic approach to learning; Respect to a surface approach to learning; and Science to openness to experience. Sex had many indirect influences upon generic motivations. Ethnic origin also had indirect influences via neuroticism and surface learning, and social class only had indirect influences via lower academic achievement. Coming from a medical family had no influence upon generic motivations. CONCLUSION: Generic motivations for medicine as a career can be assessed using the Medical Situations Questionnaire, without undue response bias due to demand characteristics. The validity of the motivational factors is suggested by the meaningful and interpretable correlations with background factors such as demographics, personality, and learning styles. Further development of the questionnaire is needed if it is to be used at an individual level, either for counselling or for student selection.

Adolescent↗
PubMed2003

Cancer patients seeking a second surgical opinion: results of a study on motives, needs, and expectations.

PURPOSE: To explore the sociodemographic and clinical characteristics of cancer patients seeking a second-opinion consultation and to analyze their second opinion-related motives, needs, and expectations. PATIENTS AND METHODS: In 212 consecutive patients seeking a second opinion at the Surgical Oncology Outpatient Clinic, satisfaction with the first specialist, motivation for the second opinion, need for information, preference for decision participation, and hope for and expectation of a different second opinion were assessed with a questionnaire. RESULTS: The mean age was 53 years. Most patients were women (82%), of whom 76% were diagnosed with breast cancer. Half of the patients (51%) had a low educational level. The majority of patients (62%) only had internal motives for second-opinion seeking associated with the need for reassurance and more certainty, whereas a substantial minority of patients (38%) also had external motives related to negative experiences or unfulfilled needs. The externally motivated patients had a higher anxiety disposition, were less satisfied with their first specialist, preferred a more active role in medical decision making, and more often hoped for and expected a different second opinion. CONCLUSION: Motives for second-opinion consultations differ greatly. Understanding the difference between internal and external motivation is necessary to develop strategies to prevent unnecessary second-opinion seeking. Additional studies are warranted to evaluate the objective and subjective outcomes of second-opinion consultations.

Adult↗
PubMed2006

The thematic apperception test: toward a standard measure of the big three motives.

The application of the Thematic Apperception Test to the assessment of motives has been heralded as an important milestone in personality psychology. However, although this approach is well established, there is at present no standard battery of cues for measuring the Big Three motives (achievement, affiliation, power). Furthermore, the extent to which scoring subcategories contribute to overall motive scores has been neglected. Our research with students and managers examined the effectiveness of picture cues in eliciting motive imagery and the prevalence of scoring subcategories within each motive scoring system. Results from 2 data sets comprising 547 men and women suggested that there were 3 cues that should be retained for future research and that motive scoring systems could be refined through removal of redundant subcategories. Further research is needed to systematically investigate the effectiveness of a standard battery of cues and the validity of revised motive scoring systems.

Achievement↗