MOTIVATIONAL ENHANCEMENT THERAPYxyz.pptx

Psychiatry

1. MOTIVATIONAL ENHANCEMENT THERAPY Dr.Chinnu Mary Chacko PG Resident Dept of Psychiatry

2. OVERVIEW 1 .INTRODUCTION 2.DEFINITIONS 3.ACTIVATING FORCES OF MOTIVATION 4.MOTIVATIONAL INTERVIEWING 5.MOTIVATIONAL ENHANCEMENT THERAPY 6.CONCLUSION 8.REFERENCES

3. MOTIVATION Something which prompts, compels and energizes an individual to act or behave in a particular fashion at particular time for attaining some specific goal or purpose. Motivation refers to a state within a person or animal that drives behavior towards some goals-(Morgan and King)

4. ACTIVATING FORCES OF MOTIVATION Needs Drives Motives NEEDS: General want or desires. BIOLOGICAL NEEDS: Most fundamental needs to survival and existence. Ex:Water , oxygen , food and sleep. SOCIO PSYCHOLOGICAL NEEDS: Associated with socio cultural environment freedom, security, love and affection.

5. DRIVES Need gives rise to drive. An aroused reaction tendency or a state of heightened tension that sets up activities in an individual and sustains them for increasing his general activity. Primary drives : Hunger ,thirst ,sex Secondary drives : anxiety ,aggression ,dependence.

6. MOTIVES: Inner state of Mind ,generated through basic needs or drives, which compel an individual to respond till attainment of goal. Ex:hunger motives ,thirst ,sex motives ,maternal motives ,achievement motives

7. MOTIVATIONAL TREATMENT APPROACHES Designed to enhance patients intrinsic motivation. Brief Motivational Intervention(BMI) Motivational Interviewing (MI) Motivational Enhancement Therapy (MET)

8. BRIEF MOTIVATIONAL INTERVENTION Vary in duration from 1-4 sessions (10-60 mins). Straightforward advise and information based on consequences of alcohol abuse. Relevant for problem drinkers who are not yet alcohol dependent. Goal: Reduce drinking rather than abstinence.

9. 2 .MOTIVATIONAL INTERVIEWING “Client –Centered ,directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. Miller and Rollnick elaborated on this fundamental concepts & approaches in 1991.

10. BASIS OF MOTIVATIONAL INTERVIEWING (PACE MODEL) P artner ship (avoid the “expert” role) A cceptance (Respecting Persons autonomy, perspective etc ) C ompassion E vocation (best ideas come from the Patient)

11. CORE SKILLS REQUIRED Open Ended Questions Affirmations :Positive statements that create a sense of self confidence Reflections :Understanding what patient is thinking and feeling saying it back to the person to convey empathy and understanding . Summaries : basically collection of more than a reflection .

12. PROCESS OF MOTIVATIONAL INTERVIEWING E ngaging F ocusing E voking P lanning E ngaging is process of establishing trusting and mutually respectful relationship(Therapeutic relationship). F ocusing is ongoing process of seeking and maintaining direction. E voking is eliciting patients own motivation for change ,while evoking hope and confidence. P lanning involves client making commitment to change and together with counselor developing a specific plan of action. P lan should be smart, specific ,measurable and achievable.

13. MOTIVATIONAL INTERVIEWING Miller and Sanchez (in press) described six elements which they believed to be active ingredients of the relatively brief interventions that have been shown by research to induce change in problem drinkers, summarized by the acronym FRAMES : ■ FEEDBACK of personal risk or impairment ■ Emphasis on personal RESPONSIBILITY for change ■ Clear ADVICE to change ■ A MENU of alternative change options ■ Therapist EMPATHY ■ Facilitation of client SELF-EFFICACY or optimism

14. MOTIVATIONAL ENHANCEMENT THERAPY HISTORY: Project MATCH began in 1989 in the United States and was sponsored by the National Institute On Alcohol Abuse and Alcoholism(NIAAA). The project was 8 year ,multisite investigation that studied which type of alcoholics respond best to which forms of treatment. Motivational Enhancement Therapy (MET) is a systematic intervention approach for evoking change in problem drinkers. It is based on principles of motivational psychology and is designed to produce rapid, internally motivated change

15. STAGES OF CHANGE : Prochaska and DiClemente (1982, 1984, 1985, 1986) have described a transtheoretical model of how people change addictive behaviors, with or without formal treatment.

16. STAGES OF CHANGE -CONTD People who are not considering change in their problem behavior are described as Precontemplators . 2. Contemplation Stage includes individuals beginning to consider both that they have a problem and feasibility and costs of changing that behavior. 3. Determination Stage : Decision is made to take action and change. 4. Once individuals begin to modify the problem behavior, they enter action stage which normally continues for 3-6 months. 5. After successfully negotiating the action stage ,individuals move to maintenance or sustained change 6. If this efforts fails RELAPSE occurs and individual begins another cycle.

17. BASIC PRINCIPLES OF MET( Ee -Dd-Aa-Rr-Ss ) E xpress E mpathy D evelop D iscrepancy(between what they are told and what they want to be) A void A rgumentation R olling With R esistance S upport S elf Efficacy (Belief that one can accomplish a particular task.Clients must be persuaded that it is possible to change their own drinking and reduce related problems)

18. MET PHASES : PHASE 1 : Building Motivation for change. PHASE 2 :Strenghthening Commitment to change . PHASE 3 :Follow through strategies.

19. PHASE 1:HOW TO BUILD MOTIVATION? By asking open ended questions elicit self motivational statements. In general best opening strategy for eliciting self motivational statement is to ask for them : “Tell me what concerns you about your drinking ?” “Tell me why you think you might need to make a change ?” Once this process is rolling you can simply keep it on going by reflective listening and asking “what else?” Elicited information is then responded to with empathic reflection, affirmation or reframing.

20. AFFIRMATION : Also seek opportunities to affirm , compliment and reinforce patient sincerely. “I Think its great that you are strong enough to recognize risk here and that you want to do something before it gets more serious.” “You really have some ideas for how you might change .”

21. REFRAMING It is a strategy where by therapists invite patients to examine their perceptions in new light or recognized form. For example if person drinks after work saying that “You may need to reward yourself for successfully handling stressful and difficult job.” Implying that there are alternative ways to reward oneself without going on a binge .

22. Summarizing It is useful to summarize periodically during a session ,particularly at the end of sessions. Elements of reluctance and resistance may be included in the summary to prevent negating reaction from patient .

23. PHASE 2:HOW TO STRENGTHEN COMMITMENT? Second major process is to consolidate patient’s commitment to change once sufficient motivation is obtained. By recognizing change readiness. How do you recognize change readiness? Patient stops resisting and raising objections . Patient asks few questions and remains more settled ,resolved unburdened or peaceful. Patient makes self motivational statements indicating decision to change .( ex:I guess I need to do something about my drinking) Patient begins to imagine how life would be after change.

24. DISCUSSING A PLAN: The key shift for the therapist is from focusing on reasons for change to negotiate a plan for change . The therapist may signal this shift by asking a transitional question such as “What do you make of all this .What are you thinking you will do about it?” Useful strategy is to ask the Patient to anticipate the result if patient continues drinking as before. What would be likely consequences. Change Plan Worksheet (CPW) is to be used in Phase 2 to help in specifying the clients action plan.

25. PHASE 3:FOLLOW THROUGH STRATEGIES Begin a follow through session with review of what has happened in last session. Phase 1 process can be used again to review motivation for change. Phase 2 can also be continued during follow through. This can be simply reaffirmation of commitment made earlier.

26. MET SESSIONS Consist of 3-4 Sessions. The 3 Phases are done in each session. If certain phase is not completed in session can be carried over in next session. Each session is concluded with a summary and summary is recapped in next session.

27. Termination Formal termination should be acknowledged and discussed at the end of fourth session. Finally summary includes these elements: Review most important factors and reconfirm these self motivational themes. Summarize the commitments and changes that have been made thus far. Affirm and reinforce client for commitments and changes that have been made . Explore additional areas of change that client wants to accomplish in future . Remind the client of continuing followup sessions that can be helpful in maintaining change .

28. THE “5AS” The 5 Major steps in intervention are Ask about substance use Advise to quit Assess commitment and barriers to change Assist Patients committed to change Arrange follow up to monitor progress

29. The “5RS” 1. Relevance :What is the personal relevance of quitting substance for the patient? 2. Risk : What are the negative consequences of using the substance for patient? 3. Rewards :What are potential benefits of stopping the substance for patient? 4. Roadblocks :What are the barriers in quitting the substance and elements in treatment that may help in handling the barrier. 5. Repitition: Motivational intervention should be repeated every time the unmotivated patient meets you.

30. TAKE HOME MESSAGE: Motivational enhancement therapy (MET)  is a directive, person-centered approach to therapy that focuses on improving an individual's motivation to change. Motivational interviewing(MI) is designed to assist patients in working through their ambivalence and in moving towards positive behavioral change. MET combines MI with brevity of less intensive intervention MET is conducted in 4 sessions in a duration of 12 weeks.

31. REFERENCES Miller WR. Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. US Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Alcohol Abuse and Alcoholism; 1992. Benegal V, Bajpai A, Basu D, Bohra N, Chatterji S, Galgali RB, Goel DS, Isaac MK, Jhanwar V, Lenin R, Madhavan PM. Proposal to the Indian Psychiatric Society for adopting a specialty section on addiction medicine (alcohol and other substance abuse). Indian journal of psychiatry. 2007 Oct;49(4):277. Kumar S, Srivastava M, Srivastava M, Yadav JS, Prakash S. Effect of Motivational Enhancement Therapy (MET) on the self efficacy of Individuals of Alcohol dependence. Journal of Family Medicine and Primary Care. 2021 Jan;10(1):367.

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