Motivational enhancement therapy

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Motivational enhancement therapy (MET) is a time-limited, four-session adaptation used in Project MATCH, a US-government-funded study of treatment for alcohol problems, and the "Drinkers' Check-up", which provides normative-based feedback and explores client motivation to change in light of the feedback. It is a development of motivational interviewing and motivational therapy. It focuses on the treatment of alcohol and other substance use disorders. The goal of the therapy is not to guide the patient through the recovery process, but to invoke inwardly motivated change. The method has two elements: initial assessment battery session, and two to four individual therapeutic sessions with a therapist. During the first session, the specialist stimulates discussion on the patient's experiences with substance use disorder and elicits self-motivational statements by providing feedback to the initial assessment. The principles of MET are utilized to increase motivation and develop a plan for further change; coping strategies are also presented and talked over with the patient. Changes in the patients behavior are monitored and cessation strategies used are reviewed by the therapist in the subsequent sessions, where patients are encouraged to sustain abstinence and progress. [1]

Contents

Motivational enhancement therapy is effective in helping adolescents because it focuses on the relationship of the counselor and the counselee. The most effective way to integrate this form of therapy is by light guidance directed to the intrinsic desire of the individual to change. Most adolescents will not trust their counselors which is why it is important to develop this relationship. By providing an environment that is receptive to change, a counselee can find this intrinsic motivation. A unique aspect of motivational enhancement therapy is that it is uniquely tailored to support adolescents that struggle with substance abuse by matching their attributes and readiness/willingness to change.

Affective change is  how someone who is experiencing an insight of a solution. These moments can build confidence and have a positive affect on the person. Affective deals with changes in epistemic emotions. In order to invoke  a change we need to have some sort of satisfaction in doing the change. Change can affect us emotionally And physically.

Motivational change can have a change in beliefs and attitudes, thus if you set your mind to it you can change the behavior. Satisfaction of a change is to have a renewed factory of oneself. Using statistical modeling we can improve our motivation to change our lives. Self-regulation explains the quality of progress towards a goal.  Making small steps towards a goal will have a self of achievement as the progress is being made. This effort being made can have a positive feeling towards that goal.

Problem finding moments usually leads to moments that are able to find a solution. This is included because as we try to change our behavior there will be moments that are problematic and when we find a solution to that problem. We will learn about how to get to that certain goal with a different way of looking at how to reach a goal. [2]

Process

Motivational enhancement therapy is a strategy of therapy that involves a variation of motivational interviewing to analyze feedback gained from client sessions. Motivational Interviewing was originated by William Miller and Stephen Rollnick based on their experiences treating problem drinkers. [3] The idea of Motivational Interviewing is based on engaging the client to pursue a behavior change. The method revolves around goal making, with assistance from the counselor to help guide the client to that specific set goal. [4] This concept of motivational interviewing later developed into motivational enhancement therapy. The goal of this therapy is to help lead the client to achieve the goals they have set for themselves. Its aim is to provide the client with the opportunity to develop a focus in their life, other than their addiction.

The MET approach is grounded on the trans-theoretical perspective that "individuals move through a series of stages of change as they progress in modifying problem behaviors". [5] In understanding change, this concept of stages is notable. Every stage has certain processes used and specific tasks to be accomplished in order to achieve change. MET focuses on motivational strategies using the client's own resources rather than training them through recovery step by step. This approach is very personal to each individual client it is used with, centered around the main goal of evoking change. Oftentimes individuals who undergo motivational transformation can subjectively experience a sudden realization or understanding of a formerly perplexing situation. Like a light bulb illuminating a dark room, an otherwise dark and bewildering issue can be made clear within an individual's internal self-concept. This is termed as an "aha moment", and can aid individuals in their newfound sense of focus in life. [2]

Reality therapy is a closely related form of therapeutical work that works specifically with the present state of life. It stresses improving relationships through our choices. It asserts that even though we cannot control how we feel we do have control over our thoughts and actions. Through this, a client will be able to achieve control over their life and work toward improving the aspects they are dissatisfied with.

Therapists use change talk. This will help with reinforcement that they think it’s impossible to change. Thinking they can do it they will succeed in achieving their goal. Our minds are powerful and can change the way we think about something. This helps because they change their minds about using drugs. They will start to hate the idea about taking substances to fulfill a need that they need.

Patients/Clients

Addicts are one of the primary populations motivational enhancement therapy lends an aid to. The therapist works closely with the client to help create an inner willingness to fight their addiction. Unlike other therapy or counseling programs that offer a step-by-step process, MET focuses on creating an internally motivated change. A typical therapy session consists of an initial assessment, and two to four treatment sessions with the therapist. In the initial session, the therapist conducts a discussion about the client's substance use. They encourage the use of self-motivational statements through Motivational Interviewing. It is in this first session where a plan for change is established between the therapist and client. The following sessions are based around achieving that plan. Early research studies have indicated that psychedelics paired with MET can result in increased levels of abstinence, and the decrease of relapse and heavy drinking days. Further experimentation with the combining of psychedelics and MET could provide additional support for individuals struggling with alcoholism. [6]

MET has become increasingly effective. As it is rooted in the idea of self-motivation, those who seek help genuinely want it. It is also known by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to be one of the most cost-effective methods available.

Key components

There are 5 key components to motivational enhancement therapy:

Related Research Articles

<span class="mw-page-title-main">Alcohol abuse</span> Substance abuse of alcoholic beverages

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Communal reinforcement is a social phenomenon in which a concept or idea is repeatedly asserted in a community, regardless of whether sufficient empirical evidence has been presented to support it. Over time, the concept or idea is reinforced to become a strong belief in many people's minds, and may be regarded by the members of the community as fact. Often, the concept or idea may be further reinforced by publications in the mass media, books, or other means of communication. The phrase "millions of people can't all be wrong" is indicative of the common tendency to accept a communally reinforced idea without question, which often aids in the widespread acceptance of factoids. A very similar term to this term is community-reinforcement, which is a behavioral method to stop drug addiction.

Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

Psychedelic therapy refers to the proposed use of psychedelic drugs, such as psilocybin, MDMA, LSD, and ayahuasca, to treat mental disorders. As of 2021, psychedelic drugs are controlled substances in most countries and psychedelic therapy is not legally available outside clinical trials, with some exceptions.

Motivational interviewing (MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. It is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, it is more focused and goal-directed, and departs from traditional Rogerian client-centered therapy through this use of direction, in which therapists attempt to influence clients to consider making changes, rather than engaging in non-directive therapeutic exploration. The examination and resolution of ambivalence is a central purpose, and the counselor is intentionally directive in pursuing this goal. MI is most centrally defined not by technique but by its spirit as a facilitative style for interpersonal relationship.

Motivational therapy is a combination of humanistic treatment and enhanced cognitive-behavioral strategies, designed to treat substance use disorders. It is similar to motivational interviewing and motivational enhancement therapy.

William Richard Miller is an American clinical psychologist, an emeritus distinguished professor of psychology and psychiatry at the University of New Mexico in Albuquerque. Miller and Stephen Rollnick are the co-founders of motivational interviewing.

Psychological resistance, also known as psychological resistance to change, is the phenomenon often encountered in clinical practice in which patients either directly or indirectly exhibit paradoxical opposing behaviors in presumably a clinically initiated push and pull of a change process. In other words, the concept of psychological resistance is that patients are likely to resist physician suggestions to change behavior or accept certain treatments regardless of whether that change will improve their condition. It impedes the development of authentic, reciprocally nurturing experiences in a clinical setting. Psychological resistance can manifest in various ways, such as denying the existence or severity of a problem, rationalizing or minimizing one's responsibility for it, rejecting or distrusting the therapist's or consultant's suggestions, withholding or distorting information, or sabotaging the treatment process. It is established that the common source of resistances and defenses is shame. This and similar negative attitudes may be the result of social stigmatization of a particular condition, such as psychological resistance towards insulin treatment of diabetes.

Attack therapy was one of several pseudo-therapeutic methods described in the book Crazy Therapies. It involves highly confrontational interaction between the patient and a "therapist" or between the patient and fellow patients during group therapy, in which the patient may be verbally abused, denounced, or humiliated by the therapist or other members of the group.

SMART Recovery is an international community of peer support groups that help people recover from addictive and problematic behaviors, using a self-empowering and evidence-informed program. SMART stands for Self-Management and Recovery Training. The SMART approach is secular and research-based. SMART has a global reach, with a presence established in more than 30 countries. SMART Recovery is effective with a range of addictive and problematic behaviors

Project MATCH began in 1989 in the United States and was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). MATCH is an initialism for Matching Alcoholism Treatments to Client Heterogeneity. The project was an 8-year, multi site, $27-million investigation that studied which types of alcoholics respond best to which forms of treatment. MATCH studied whether treatment should be uniform or assigned to patients based on specific needs and characteristics. The programs were administered by psychotherapists and, although twelve-step methods were incorporated into the therapy, actual Alcoholics Anonymous meetings were not included. Three types of treatment were investigated:

Behavioral health outcome management (BHOM) involves the use of behavioral health outcome measurement data to help guide and inform the treatment of each individual patient. Like blood pressure, cholesterol and other routine lab work that helps to guide and inform general medical practice, the use of routine measurement in behavioral health is proving to be invaluable in assisting therapists to deliver better quality care.

Relapse prevention (RP) is a cognitive-behavioral approach to relapse with the goal of identifying and preventing high-risk situations such as unhealthy substance use, obsessive-compulsive behavior, sexual offending, obesity, and depression. It is an important component in the treatment process for alcohol use disorder, or alcohol dependence. This model founding is attributed to Terence Gorski's 1986 book Staying Sober.

Community reinforcement approach and family training (CRAFT) is a behavior therapy approach in psychotherapy for treating addiction developed by Robert J. Meyers in the late 1970s. Meyers worked with Nathan Azrin in the early 1970s whilst he was developing his own community reinforcement approach (CRA) which uses operant conditioning techniques to help people learn to reduce the power of their addictions and enjoy healthy living. Meyers adapted CRA to create CRAFT, which he described as CRA that "works through family members." CRAFT combines CRA with family training to equip concerned significant others (CSOs) of addicts with supportive techniques to encourage their loved ones to begin and continue treatment and provides them with defences against addiction's damaging effects on themselves.

Psychotherapy discontinuation, also known as unilateral termination, patient dropout, and premature termination, is a patient's decision to stop mental health treatment before they have received an adequate number of sessions. In the United States, the prevalence of patient dropout is estimated to be between 40–60% over the course of treatment however, the overwhelming majority of patients will drop after two sessions. An exhaustive meta-analysis of 146 studies in Western countries showed that the mean dropout rate is 34.8% with a wide range of 10.3% to 81.0%. The studies from the US (n = 85) had a dropout rate of 37.9% (range: 33.0% to 43.0%).

Substance use disorders (SUD) can have a significant effect on one's function in all areas of occupation. Physical and psychosocial issues due to SUD can impact occupational performance. Unfulfilled life roles and disruption in meaningful activity can result from lack of structure or routine, poor motivation, limited skills, and poor social networks. These deficits may also contribute to stress, affecting the ability to cope with challenges. While SUD can affect a client's participation in therapy and ability to follow recommendations, occupational therapists are trained to facilitate occupational participation and performance.

Linda Carter Sobell, Ph.D., ABPP, is the President's Distinguished Professor at Nova Southeastern University (NSU) in Fort Lauderdale, Florida. She is a professor of clinical psychology, addiction specialist, co-director of NSU's Guided Self-Change clinic, a Motivational Interviewing Trainer, and is board-certified in cognitive and behavioral psychology.

Guided self-change (GSC) treatment has been accepted by American Psychological Association Division 12, Society of Clinical Psychology, as an empirically supported treatment.

Screening, Brief Intervention and Referral to Treatment (SBIRT) is a model that encourages mental health and substance use screenings as a routine preventive service in healthcare.

References

  1. "Motivational Enhancement Therapy (Alcohol, Marijuana, Nicotine)". drugabuse.gov.
  2. 1 2 Taku, Kanako; Shackelford, Todd (2024). THE ROUTLEDGE INTERNATIONAL HANDBOOK OF CHANGES IN HUMAN PERCEPTIONS AND BEHAVIORS. 605 Third Avenue, New York, NY 10158: Taylor & Francis. pp. 187–204. doi:10.4324/9781003316602. ISBN   9781032327655.{{cite book}}: CS1 maint: date and year (link) CS1 maint: location (link)
  3. Miller, William R. (1982). "Motivational Interviewing with Problem Drinkers". Behavioural and Cognitive Psychotherapy. 11 (2): 147–172. doi:10.1017/S0141347300006583. ISSN   2051-199X via CambridgeCore.
  4. "Project MATCH Monograph Series | National Institute on Alcohol Abuse and Alcoholism (NIAAA)". www.niaaa.nih.gov. Retrieved 2023-05-04.
  5. 1 2 3 4 5 6 Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence. U.S. Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Alcohol Abuse and Alcoholism. 1992. ISBN   978-0-16-038187-4.
  6. Dakwar, Elias; Levin, Frances; Hart, Carl L.; Basaraba, Cale; Choi, Jean; Pavlicova, Martina; Nunes, Edward V. (2019-12-09). "A Single Ketamine Infusion Combined With Motivational Enhancement Therapy for Alcohol Use Disorder: A Randomized Midazolam-Controlled Pilot Trial". American Journal of Psychiatry. 177 (2): 125–133. doi:10.1176/appi.ajp.2019.19070684. ISSN   0002-953X.

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