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PubMed2004

Managing resistance in cognitive behavioural therapy: the application of motivational interviewing in mixed anxiety and depression.

While cognitive behavioural therapy is highly effective in the treatment of anxiety and depression, a substantive number of individuals either refuse treatment, fail to respond to treatment or respond only partially. Arguably, ambivalence about change or about engaging in treatment tasks may in part be related to incomplete recovery rates in cognitive behavioural therapy. Motivational interviewing is a client-centred, directive treatment originally developed in the addictions domain whose goal is to enhance motivation for change by understanding and resolving ambivalence. This method has consistently received support for enhancing outcomes in the addictions domain, particularly when used as an adjunct to further treatment. As yet, motivational methods have not been generalized to the treatment of prevalent mental health problems, such as anxiety and depression. The present paper presents the application of a treatment targeting motivation (motivational interviewing adapted for anxiety and depression) to the management of resistance in cognitive behavioural therapy for 3 clients with mixed anxiety and depression. Motivational interviewing is conceived as an adjunct to highly effective traditional cognitive behavioural therapy methods, which is indicated for use with clients resistant to and significantly ambivalent about change-based techniques for managing anxiety or alleviating depression.

Adult↗
PubMedDate not supplied

How does childbearing affect fertility motivations and desires?

In this study we assume that fertility decisions are made one birth at a time and use longitudinal data collected from 401 married couples over a two-year period to explore how having a child affects two types of fertility motivation and three types of fertility desires. Using a series of five constrained multiple regression analyses, we tested the effects of two childbearing variables on these five types of motivation and desires in the context of a large set of control variables also hypothesized to affect fertility motivation and desires. The results demonstrate that the childbearing variables have a substantial effect in all five regression models. Specific findings indicate that childbearing stimulates greater positive motivation for childbearing and an increase in the number of children desired. Although this situation would appear to create a positive feedback loop in which each child born further increases the motivation and desire for children, the findings also suggest three different mechanisms whereby childbearing causes a counterbalancing regulation of that loop. These mechanisms include a negative motivation mechanism, a satiation mechanism, and a delay mechanism. The effect of these mechanisms on the termination of childbearing is considered in conjunction with a fourth mechanism, the achievement of desired family size.

Adult↗
PubMed2003

Relationships between personality and preferred substance and motivations for use among adolescent substance abusers.

This study examined the utility of Cloninger's tridimensional personality theory (1986, 1987a) in predicting preferred substance of abuse and self-reported motivations for use among a sample of 200 adolescent substance abusers and 200 matched community control adolescents. Two primary hypotheses were tested: (1) Cloninger's type II profile is more strongly associated with stimulant use, and his type I profile is more strongly associated with substances having sedative-hypnotic effects; and 2) type II individuals will report motivations for use that focus primarily on obtaining positive rewards, whereas type I individuals will report motivations primarily concerning negative reinforcement or the avoidance of problems and negative life experiences. Our results did not show strong associations between Cloninger's Harm Avoidance and Reward Dependence dimensions and preferred substance or motivations for use. However, in partial support of the hypotheses examined here, we did find that individuals low in novelty seeking (NS) tended to prefer alcohol and marijuana, whereas those high in NS endorsed a wider range of preferred substances. High NS was associated with significantly greater stimulant use and motivations focused on obtaining positive rewards, whereas low NS was associated with greater sedative use and motivations related to avoiding negative emotions or negative life experiences.

Adolescent↗
PubMed2004

Effectiveness of vocational problem-solving skills on motivation and job-seeking action steps.

Most research on employment interventions focuses on job acquisition as the sole outcome measure, despite the fact that there are many intermediate steps to obtaining work. This article examines the impact of a vocational problem solving skills (VPSS) intervention to increase motivation and action step activities that lead to employment. Over a 1-year period between 1995 and 1996, a sample of 109 methadone maintained treatment clients were randomly assigned to either a 10-session vocational problem solving intervention (N= 62) or a time and attention control condition (N=47). The Addiction Severity Index (ASI) and a Vocational Motivational Assessment Checklist (VMAC) were administered upon enrollment in the study and at 6 months postbaseline. The VMAC was completed on a biweekly basis over the 12-week intervention period. The VMAC measures both the behavioral actions to obtain employment (e.g., reading want ads, completing job applications) and client perceived motivation to obtain a job. There were no differences by condition in the level of motivation to secure employment and the number of job seeking activities during the intervention period. However, motivation to work and number of action steps did predict obtaining employment for the sample as a whole at the 6-month follow-up. Although the intervention did not increase motivation and job seeking activities, information regarding reasonable outcomes for this population of chronically unemployed persons was identified. Also, practical and methodological implications are discussed.

Adult↗
PubMed2005

Drinking and motivations to drink among adolescent children of parents with alcohol problems.

AIMS: To study the influences of parental alcohol problems on adolescents' alcohol consumption and motivations to drink alcohol. METHODS: A community sample of 1744 adolescents from schools in South Wales completed the 6-item Children of Alcoholics Screening Test, Drinking Motives Questionnaire, and survey measures of alcohol consumption. RESULTS: Children of parents with alcohol problems constituted almost one-fifth of the sample group and were found to drink more frequently, more heavily, and more often alone than children of parents without alcohol problems. Parental alcohol problems were also related to internal motives to drink (e.g. coping) in their adolescent children. Across the entire sample, internal motives to drink interacted with parental alcohol problems in predicting alcohol consumption and drinking frequency. CONCLUSION: Parental alcohol problems appeared to co-exist with an asocial pattern of alcohol consumption in adolescents that involves drinking alone and drinking to feel intoxicated or to forget about problems. In addition to the external, social motives to drink, which are shared by most adolescents, nearly one in five of the adolescents studied reported salient internal motives to drink that tended to coexist with alcohol problems in their parents.

Adolescent↗
PubMed2006

Development and validation of the Amsterdam Motives for Drinking Scale (AMDS): an attempt to distinguish relief and reward drinkers.

UNLABELLED: Determination of alcoholic subtypes is a promising strategy for patient treatment matching with anti-craving interventions. The aim of this study is to develop and validate a questionnaire on drinking motives that can distinguish relief and reward drinkers. METHODS: A 103-item self-report questionnaire was developed: the Amsterdam Motives for Drinking Scale (AMDS). The AMDS was tested in two samples of alcoholics (Sample A: n = 251; Sample B: n = 197). The psychometric properties were examined in Sample A and cross-validated in B. RESULTS: The AMDS consists of a relief scale and a reward scale, both containing distinct subscales. All (sub)scales had good internal consistency. However, the relief and reward scales were highly correlated (Sample A: r = 0.84, P < 0.01; Sample B: r = 0.76, P < 0.01), and convergent and divergent validity was only partly confirmed. The lowest correlations were found between the relief subscale 'stress and vulnerability' and the reward subscale 'stimulation seeking' (Sample A: r = 0.33, P < 0.01; Sample B: r = 0.13, P > 0.01). CONCLUSIONS: The AMDS reliably measures two types of motives. However, the relief and reward scales are highly correlated. Lower correlations were found only at the subscale level. It is concluded that most treatment-seeking alcoholics have both relief and reward motives. More research is needed on the relationship between motives for drinking and other phenotypic, endophenotypic and genetic indicators of relief and reward drinking, and appropriate cut-off points. Only than we can draw firm conclusions regarding the potential of drinking motives for patient treatment matching.

Adult↗
PubMed1998

GPs' motives for referrals to general hospitals: does access to GP hospital beds make any difference?

OBJECTIVES: We aimed to explore the relative impact of medical and other situational motives on GP's decisions to refer patients to specialist care in a general hospital, and to assess whether having access to a GP hospital influences the decisions. METHODS: We carried out a prospective study of consecutive doctor-patient contacts during one week. The effects of main motives, medical, social/nursing, general hospital advice, distance from the nearest general hospital and access to GP hospitals on referral decisions were explored by logistic regression. The motives for different referral decisions were also explored through frequency analyses. The study was set in general practices in the county of Finnmark in North Norway, which included 40 GPs from rural practices with access to a GP hospital and eight GPs working closer to a general hospital without access to GP hospital. We studied 2496 doctor-patient contacts, which resulted in 411 patients being considered for any kind of referral, of which 205 were referred to the general hospital. RESULTS: Medical needs were recorded as the only referral motive of major importance in about half of the cases considered for referral, while additional motives were recorded in the other half. The rationale for admissions to general hospitals and GP hospitals (in-patient care) was compatible in terms of the relative importance of the medical arguments. The GP hospital option was mainly chosen because of the long distance from the general hospital, nursing needs and the preferences of the patient and the family, and resulted in a lower proportion of patients being referred to general hospitals from GPs with access to a GP hospital. CONCLUSION: Medical motives dominate the decision to refer patients to general hospitals, but access to a GP hospital, in cases where nursing needs and long distances to the general hospital are supplementary considerations, reduces the proportion of patients being referred to general hospitals.

Adolescent↗
PubMed2002

A new method for describing smokers' consulting behaviours which indicate their motivation to stop smoking: an exploration of validity and reliability.

BACKGROUND: Smokers vary in their readiness to try stopping smoking, but there currently are no objective tools for identifying smokers' consulting behaviours which indicate their level of motivation to try stopping smoking. OBJECTIVE: The aim of this study was to investigate the construct validity and inter-observer reliability of the Smokers' Motivation Code (SMC). METHODS: General practice consultations between 29 different Leicestershire GPs and their patients were video-recorded. In 47 consultations, regular or occasional smokers discussed smoking with their GPs and their consulting behaviour was coded using the SMC. The reliability of three different observers' codings was investigated. Construct validity was also investigated by comparing smokers' consulting behaviours coded using the SMC with measures of motivation to stop smoking recorded on pre-consultation questionnaires. RESULTS: Two pairs of observers achieved good reliability when using the SMC to code smokers' consulting behaviours during a subset of 11 video-recorded consultations. For readiness behaviours (indicating motivation to stop smoking), kappas were 0.82 and 0.65, and for resistance behaviours (indicating little motivation to stop smoking), kappas were 0.74 and 1.0. For the 37 consultations attended by regular smokers, complete pre-consultation questionnaires were obtained. Smokers displaying readiness behaviours were significantly more likely than others to report having tried to stop in the past year, thinking about or trying to stop and to agree that their health would improve if they stopped smoking. Smokers displaying resistant behaviours were significantly less likely to report thinking about stopping/trying to stop smoking. CONCLUSION: We have provided some evidence to support the construct validity and inter-observer reliability of the SMC and have identified some consulting behaviours which might indicate smokers' motivation to stop smoking. Further work is needed to determine whether smokers' consulting behaviour can be used to predict future quit attempts.

Adult↗
PubMed2003

A cross-cultural analysis of 'motivation for eating' as a potential factor in the emergence of global obesity: Japan and the United States.

This exploratory study compared motivation for eating between individuals from two different cultures that have moved through the nutrition transition at different rates and to different degrees. The analysis was based on a convenience sample of 1218 participants aged >or=18 years attending colleges in the US and Japan. The Motivation for Eating Scale (MFES) was used to evaluate different motivations for eating by nation and gender. The MFES consists of 12 items classified into three subscales: emotional, physical and environmental eating. The questionnaire used in the study also included responses about participants' motivation to lose weight, frequency of dieting, presence of previous or existing eating disorders, and frequency of exercise. Results showed no significant differences in the three MFES subscales for men in the US and Japan. For women, however, significant differences were seen for all three subscales. Women in the US were more likely to initiate eating for emotional reasons, while women in Japan were more likely to eat for physical or environmental reasons. Women and men in the US were more likely than the Japanese respondents to eat in response to watching TV or movies. These results suggest that there are national differences in the cultural environment that may impact individual motivations for eating. As such, various cultural perceptions of food should be considered in attempts to understand more fully the mechanics of the nutrition transition as it operates within a given country. By extension, public health policies and health promotion initiatives that are designed to limit the negative impacts of the nutrition transition may benefit from a greater understanding of the larger role that cultural perceptions of food may play in influencing individual motivations for eating.

Adolescent↗
PubMed1999

A brief motivational intervention to improve dietary adherence in adolescents. The Dietary Intervention Study in Children (DISC) Research Group.

Motivational interviewing offers health care professionals a potentially effective strategy for increasing a patient's readiness to change health behaviors. Recently, elements of motivational interviewing and the stages of change model have been simplified and adapted for use with patients in brief clinical encounters. This paper describes in detail a brief motivational intervention model to improve and renew dietary adherence with adolescents in the Dietary Intervention Study in Children (DISC). DISC is a randomized, multi-center clinical trial assessing the efficacy and safety of lowering dietary fat to decrease low-density lipoprotein cholesterol in high-risk children. In the first 3 years of follow-up covering ages 8-13, intervention participants (n = 334) were exposed to a family-based group intervention approach to change dietary choices. To address adherence and retention obstacles as participants moved into adolescence (age 13-17), an individual-level motivational intervention was implemented. The DISC motivational intervention integrates several intervention models: stages of change, motivational interviewing, brief negotiation and behavioral self-management. A preliminary test of the intervention model suggests that it was acceptable to the participants, popular with interventionists and appeared to be an age-appropriate shift from a family-based intervention model.

Adolescent↗
PubMed2003

Demographic and clinical correlates of client motivation among substance abusers.

Understanding the role of motivation in substance abusers' acceptance of treatment is critically important to improving treatment outcomes. To examine this phenomenon a cohort of substance abuse treatment clients was recruited from two treatment programs whose services are funded by a state managed care system. Motivation at treatment entry was examined. Better motivation was consistently associated with severity of substance use. Neither the coercion that accompanies legal system involvement nor self-referral was significantly related to measured levels of motivation. Motivation was not related to alcohol and drug use severity six months later. The severity associated with motivation at treatment entry was, for the most part, not related to clients' success six months later. Implications for social work practice with substance abusers are discussed.

Adult↗
PubMedDate not supplied

Disorders of diminished motivation.

Disorders of diminished motivation occur frequently in individuals with traumatic brain injury. Motivation is an ever-present, essential determinant of behavior and adaptation. The major syndromes of diminished motivation are apathy, abulia, and akinetic mutism. Depending on their etiology, disorders of diminished motivation may be a primary clinical disturbance, a symptom of another disorder, or a coexisting second disorder. This article presents a biopsychosocial approach to the assessment and management of motivational impairments in patients with traumatic brain injury. The recognition and differential diagnosis of disorders of diminished motivation, as well as the mechanism and clinical pathogenesis, are discussed.

Adaptation, Psychological↗
PubMed1981

A multivariate analysis of motivational attributes among spinal cord injured rehabilitation clients.

Based on the assumption that understanding client motivation is central to the rehabilitation process but that motivation is complex, configural, and not a bipolar construct, this study sought to describe the motivational patterns of 110 spinal cord injured persons receiving vocational rehabilitation services. Self-report inventories purporting to measure four motivational concepts--arousal level, expectations, incentive conditions and need fulfillment--were used as descriptors. A cluster analysis procedure was used to form homogeneous subgroups of spinal cord injured persons according to motivational variable scores. Results indicated that the cluster analysis technique was reliable and that 80% of the sample was correctly classified into one or another of four subgroups on the basis of five motivational variables: personal goal choice and perceived importance of that goal, current life satisfaction, family need satisfaction, age, and arousal level. The clearest discriminator in forming the subgroups was type of goal chosen and perceived importance of that goal. Other demographic and psychological information was provided to sharpen intragroup similarities and intergroup differences. Implications for rehabilitation practice and future research were discussed.

Adaptation, Psychological↗
PubMed2001

Managing motivation and developing job satisfaction in the health care work environment.

Motivation relies on internal/intrinsic and external factors to stimulate work-related behavior. This article presents an overview of Herzberg's motivation-hygiene theory and reports on the results of a study of 99 health service midmanagers. The participants completed a survey asking whether they believe in motivational factors and if they use them. Several of Herzberg's motivational factors were included (achievement, recognition, work itself, responsibility, advancement) plus several other motivational factors including money/pay, self-interest, seek a higher standard of living. Negative factors included guilt, threats, power, and control. This article presents motivation factors, such as achievement, recognition, work itself, responsibility, advancement, growth, self-interest, pay, and belief in successful outcome, that were presented to 99 mid-level health services administrators.

Attitude of Health Personnel↗
PubMed2005

Reinforcing mood effects of alcohol in coping and enhancement motivated drinkers.

BACKGROUND: People may be motivated to drink because of differential sensitivities to the rewarding outcomes of alcohol consumption. Previous research has demonstrated that alcohol may produce both potentially positive reinforcing effects (i.e., increased elation; Conrad et al., 2001) and potentially negative reinforcing effects (i.e., anxiolytic effects; Levenson st al., 1980). It was desired to test the effects of alcohol on mood in a sample of two groups of drinkers that report different motivations for alcohol use. It was hypothesized that both potentially positive and negative reinforcing mood effects would be observed and that these effects would be moderated by drinking motive. METHODS: Twenty-four drinkers with Coping Motives (CMs) and 24 drinkers with Enhancement Motives (EMs) were randomly assigned to either an alcohol condition (target blood alcohol level of 0.08%) or a placebo condition. Participants used the Profile of Mood States-Bipolar (Lorr, 1983) to report their mood at (1) sober baseline, (2) after beverage consumption, and (3) during anticipation of a self-disclosing speech (a stressor). RESULTS: As hypothesized, after drinking, those in the alcohol group reported increased feelings of elation and energy relative to sober baseline. Those receiving alcohol also reported feeling more confused and anxious after beverage consumption. Also as hypothesized, participants receiving alcohol reported feeling increased sedation during anticipation of the stressor, whereas those receiving placebo reported increased energy during this period. Contrary to the hypothesis, none of these effects were moderated by drinking motive. CONCLUSIONS: Although potentially positive and negative reinforcing mood effects of alcohol were observed, CM and EM drinkers were not differentially sensitive to these effects. However, it is possible that EM drinkers may highly value the baseline stimulating effects of alcohol, whereas CM drinkers may highly value the anxiolytic effects that were observed during anticipation of the stressor.

Adaptation, Psychological↗
PubMed2006

Psychosocial factors predicting the motivation to undergo cosmetic surgery.

BACKGROUND: The present study investigates psychological factors expected to predict the motivation to undergo cosmetic surgery. It is hypothesized that body image, self-esteem, teasing history, acceptance of cosmetic surgery in the individual's environment, and self-monitoring relate to motivation to have cosmetic surgery. METHODS: Questionnaire data were obtained from 907 participants who responded to a survey distributed to a representative sample of Norwegian women aged 22 to 55 years. A second sample of 195 female prospective cosmetic surgery patients was recruited from a plastic surgery clinic. Measures of the hypothesized predictor variables were obtained from both samples. Surgery motivation was operationalized in two different ways. First, the women in the first sample were asked to indicate whether they wished to undergo cosmetic surgery, such that women who wished to have surgery could be compared with those who did not. Second, prospective patients were compared with women from the first sample who indicated that they did not wish to have cosmetic surgery. RESULTS: Analyses revealed all predictor variables but self-esteem to be related to either the wish or the decision to undergo surgery, or to both. Social acceptance of cosmetic surgery and body image were the strongest predictors of cosmetic surgery motivation. CONCLUSIONS: The study gives new insights into psychological factors predicting cosmetic surgery motivation. Furthermore, the influence of social factors on cosmetic surgery motivation is emphasized, and it is suggested that these factors be included in future research designs.

Adult↗
PubMed2002

Implicit and self-attributed achievement motives: concordance and predictive validity.

As a complement to the literature on the discriminant validity of implicit and self-attributed motives, this study explored two issues that point to convergences: moderation of concordance between implicit and self-attributed achievement motives, and the role of the two types of motive as antecedents of achievement goals. Significant positive correlations were found between implicit and self-attributed need for achievement and between implicit and self-attributed fear of failure. Individuals higher in self-determination were more concordant in implicit and self-attributed need for achievement. Implicit and self-attributed achievement motives predicted achievement goals in a similar manner, and structural equation modeling yielded good fit for a conceptually parsimonious latent motive model. It is suggested that implicit and self-attributed motives converge in some respects (yet diverge in others), and implications for theory are discussed.

Achievement↗
PubMed1989

The experience of opioid abstinence: the relevance of motivation and history.

Questionnaire measures relating to a recent episode of unmodified heroin withdrawal (the target episode) were obtained from 70 subjects. The duration of the target episode, but not reported distress during the episode, correlated with the amount of heroin consumed in the previous 3 months. Data from scales measuring motivation during the target episode were factor analysed and two factors emerged, one relating to motivation concerning private affairs and the other relating to motivation derived from public sources. High scores for private affairs motivation were correlated with success in the target episode whilst there was a trend for public affairs based motivation to be associated with failure. Private affairs motivation was negatively correlated with length of heroin use but positively correlated with the number of coping strategies employed in withdrawal. The implications of these findings for the treatment of heroin users are discussed.

Adaptation, Psychological↗