Motivational Enhancement Strategies Research Articles

Tryptophan and Substance Abuse: Mechanisms and Impact.

Addiction, the continuous misuse of addictive material, causes long-term dysfunction in the neurological system. It substantially affects the control strength of reward, memory, and motivation. Addictive substances (alcohol, marijuana, caffeine, heroin, methamphetamine (METH), and nicotine) are highly active central nervous stimulants. Addiction leads to severe health issues, including cardiovascular diseases, serious infections, and pulmonary/dental diseases. Drug dependence may result in unfavorable cognitive impairments that can continue during abstinence and negatively influence recovery performance. Although addiction is a critical global health challenge with numerous consequences and complications, currently, there are no efficient options for treating drug addiction, particularly METH. Currently, novel treatment approaches such as psychological contingency management, cognitive behavioral therapy, and motivational enhancement strategies are of great interest. Herein, we evaluate the devastating impacts of different addictive substances/drugs on users' mental health and the role of tryptophan in alleviating unfavorable side effects. The tryptophan metabolites in the mammalian brain and their potential to treat compulsive abuse of addictive substances are investigated by assessing the functional effects of addictive substances on tryptophan. Future perspectives on developing promising modalities to treat addiction and the role of tryptophan and its metabolites to alleviate drug dependency are discussed.

Implementation of a brief motivational intervention for alcohol and other drug using Latinx college students.

Alcohol and other drug (AOD) use problems among college students continue to represent a public health epidemic. In 2019, historically high rates of binge-drinking and marijuana use were reported among college-age adults, and the detrimental effects of excessive AOD use in college, such as poorer academic performance, sexual assault, injury or overdoses, and a range of other negative consequences, have been well-documented. Thus, there is a continued need for effective implementation of evidence-based, cost-effective interventions aimed at reducing risks associated with collegiate AOD use. Guided Self Change (GSC) is a brief intervention involving motivational enhancement and cognitive-behavioral strategies and has demonstrated effectiveness in reducing AOD use problems. Its brevity, client-driven style, and concrete here-and-now focus are appealing to individuals struggling with mild to moderate AOD use problems. In order to successfully intervene with collegians with AOD use problems attending minority-serving institutions, GSC requires developmental and cultural tailoring. The current report describes the developmental and cultural tailoring of GSC for emerging adult Latinx collegians, as well as our consumer-driven addition of mindfulness content. Key components of our GSC program are documented through qualitative feedback, quantitative results, and case vignettes.

Effectiveness of multimodal psychotherapeutic intervention for internet gaming disorder

BackgroundLarge number of studies on Internet gaming disorder (IGD) have primarily focused on ascertaining its psychological correlates. Few studies have focused on developing and assessing effectiveness of multimodal psychotherapeutic intervention programs. This intervention focused on minimizing salience, pre-occupation, conflict related to gaming and enhancing the overall quality of life, inclusive of psychological health, physical health, and environmental problems in individuals with IGD. At present, there appear to be no such studies in the Indian context. MethodsIn this study, we developed and assessed the effectiveness of an intervention manual for IGD. The intervention program consisted of ten 60-minutes sessions with one therapist administering sessions once in each week. The interventions included motivational enhancement strategies, cognitive restructuring, behavioral strategies and relapse prevention. The outcomes from intervention were measured in terms of improvement in IGD, IAT, and overall quality of life. Our assessments, both at baseline and post-intervention consisted of Internet Addiction Test (IAT), Internet Gaming Disorder Test (IGD-20) and the Whoqol-Bref. A total sample of 40 was selected out of which 33 individuals completed the 10 sessions of multimodal psychotherapy program and post assessments. ResultsA total of 40 participants (age: M = 20.25, SD = 5.39) enrolled, out of which 33 completed the entire intervention program of 10 sessions and showed significant improvements. The IAT and IGD-20 showed significant difference in the scores for before treatment (M = 52.88, SD = 16.25) and after treatment (M = 42.87, SD = 11.31; t (32) = 5.10, p = 0.000) conditions; and right before treatment (M = 56.88, SD = 19.25) and after treatment (M = 47.87, SD = 15.31; t (32) = 6.94, p = 0.000) conditions respectively. The internet addiction and internet gaming disorder scores showed a similar degree of severity reductions on the IAT and IGD-20 respectively at the end of week 8. In addition, the participants showed significant improvements in the quality of life inclusive of physical and psychological health post the completion of intervention program. LimitationsThe sample size of the study was small and assessments for evaluation of other psychological symptoms like depression, anxiety could have been conducted. ConclusionThe intervention program indicated a substantial change in the IGD scores at post- assessment. A study on a larger sample to assess the validity of the manualized multimodal psychotherapy program for IGD needs to be conducted. In addition, this manualized intervention program can be useful for administering structured intervention for IGD by mental health professionals working in the area of internet gaming disorder.

Supporting students’ transition into higher education: Motivation enhancement strategies

In this article, we explore first-year students’ transition into higher education (HE), focusing on the motivational factors that enhance their engagement. We argue that Student Support Professionals (SSPs) can play a pivotal role in heightening student motivation, given the broad range of academic, administrative, and pastoral responsibilities that this role entails. Against this background, we ask two questions: Firstly, how should we understand student motivation with specific regard to its antecedents, manifestations, and consequences? Secondly, what motivation-enhancement strategies can SSPs integrate into their practice to build a productive relationship with students? Drawing on self-determination theory (SDT) insights, we provide a taxonomy of student motivation, arguing that: Motivation exists in a continuum of self-regulation, motivation is contextual, motivation is multidimensional, and motivation is causally significant. Building on this taxonomy we offer practical guidance to SSPs who are looking to catalyse students’ intrinsic motivation, identifying three specific motivational enhancement strategies, namely: Fostering competence by establishing realistic expectations between oneself and students; fostering relatedness by providing resources for holistic student engagement; and fostering autonomy by empowering students in their decision-making. We argue that central to SSPs’ ability to foster engagement is possessing a conceptual and experiential understanding of student motivation, which can heighten their ability to respond to students’ needs. SSPs should approach this process of motivation enhancement as collaborative—working with students to discover both motivational impediments and motivation-enhancing resources to better engage with their HE experience.

Illness management and recovery in community practice.

To examine provider competence in providing Illness Management and Recovery (IMR), an evidence-based self-management program for people with severe mental illness, and the association between implementation supports and IMR competence. IMR session recordings, provided by 43 providers/provider pairs, were analyzed for IMR competence using the IMR Treatment Integrity Scale. Providers also reported on receipt of commonly available implementation supports (e.g., training, consultation). Average IMR competence scores were in the "needs improvement" range. Clinicians demonstrated low competence in several IMR elements: significant other involvement, weekly action planning, action plan follow-up, cognitive-behavioral techniques, and behavioral tailoring for medication management. These elements were commonly absent from IMR sessions. Competence in motivational enhancement strategies and cognitive-behavioral techniques differed based on the module topic covered in a session. Generally, receipt of implementation supports was not associated with increased competence; however, motivational interviewing training was associated with increased competence in action planning and review. IMR, as implemented in the community, may lack adequate competence and commonly available implementation supports do not appear to be adequate. Additional implementation supports that target clinician growth areas are needed. (PsycINFO Database Record

Hombres violentos contra la pareja: ¿tienen un trastorno mental y requieren tratamiento psicológico?

Hay muchas razones por las que los hombres maltratadores contra la pareja deben recibir tratamiento psicologico. En este articulo se analizan los transtornos mas relevantes, tales como el abuso de alcohol/drogas, los celos patologicos y los transtornos de personalidad (antisocial, limite, narcisista y paranoide), asi como los deficits psicologicos de estas personas, tales como el descontrol de la ira, las dificultades emocionales, las distorsiones cognitivas, la baja autoestima y los deficits de comunicacion y de solucion de problemas. Se describen las tipologias de hombres maltratadores mas relevantes y se senala su importancia para la planificacion del tratamiento individualizado. La inclusion de medidas penales y de tratamiento psicologico es posible. Se analiza la motivacion para el tratamiento y se senalan las principales vias de intervencion terapeutica, asi como los resultados obtenidos. Por ultimo, se comentan las lineas de investigacion mas urgentes para el futuro.

Readiness to change is a predictor of reduced substance use involvement: findings from a randomized controlled trial of patients attending South African emergency departments

BackgroundThis study examines whether readiness to change is a predictor of substance use outcomes and explores factors associated with RTC substance use among patients at South African emergency departments.MethodsWe use data from participants enrolled into a randomized controlled trial of a brief substance use intervention conducted in three emergency departments in Cape Town, South Africa.ResultsIn adjusted analyses, the SOCRATES “Recognition” (B = 11.6; 95 % CI = 6.2–17.0) and “Taking Steps” score (B = -9.5; 95 % CI = -15.5- -3.5) as well as alcohol problems (B = 4.4; 95 % CI = 0.9–7.9) predicted change in substance use involvement at 3 month follow-up. Severity of depression (B = 0.2; 95 % CI = 0.1–0.3), methamphetamine use (B = 3.4; 95 % CI = 0.5- 6.3) and substance-related injury (B = 1.9; 95 % CI = 0.6–3.2) were associated with greater recognition of the need for change. Depression (B = 0.1; 95 % CI = 0.04 -0.1) and methamphetamine use (B = 2.3; 95 % CI = 0.1 -4.2) were also associated with more ambivalence about whether to change. Participants who presented with an injury that was preceded by substance use were less likely to be taking steps to reduce their substance use compared to individuals who did not (B = -1.7; 95 % CI = -5.0- -0.6).ConclusionFindings suggest that brief interventions for this population should include a strong focus on building readiness to change substance use through motivational enhancement strategies. Findings also suggest that providing additional support to individuals with depression may enhance intervention outcomes.Trial registrationThis trial registered with the Pan African Clinical Trial Registry (PACTR201308000591418) on 14/07/2013.

Can we improve cognitive–behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy.

This study evaluated whether tailored cognitive-behavioral therapy (TCBT) that incorporated preferences for learning specific cognitive and/or behavioral skills and used motivational enhancement strategies would improve treatment engagement and participation compared with standard CBT (SCBT). We hypothesized that participants receiving TCBT would show a lower dropout rate, attend more sessions, and report more frequent intersession pain coping skill practice than those receiving SCBT. We also hypothesized that indices of engagement and adherence would correlate with pre- to posttreatment changes in outcome factors. One hundred twenty-eight of 161 consenting persons with chronic back pain who completed baseline measures were allocated to either TCBT or SCBT using a modified randomization procedure. Participants completed daily ratings of pain coping skill practice and goal accomplishment during treatment, as well as measures of pain severity, disability, and other key outcomes at the end of treatment. No significant differences between treatment groups were noted on measures of treatment engagement or adherence. However, these factors were significantly related to some pre- to posttreatment improvements in outcomes, regardless of treatment condition. Participants in this study evidenced a high degree of participation and adherence, but treatment tailored to take into account participant preferences, and that employed motivational enhancement strategies, failed to increase treatment participation over and above SCBT for chronic back pain. Evidence that participation and adherence were associated with positive outcomes supports continued clinical and research efforts focusing on these therapeutic processes.

Adherencia al tratamiento en hombres maltratadores contra la pareja en un entorno comunitario: Realidad actual y retos de futuro

This paper addresses the difficulties inherent in providing mental health treatment for men who commit acts of violence against their intimate partners. The effectiveness of available treatment programs for men who batter, both in the international literature and in Spain, is analyzed. In all studies the dropout rates in the treatment of men involved in intimate partner violence are very high. Different studies have pointed to multiple psychological and social causes to explain the poor adherence to treatment in men who batter. The main predictors of poor adherence to therapy are described. Therefore, motivational enhancement strategies are being developed to strengthen subjects' commitment to change by helping them to identify their goals for recovery and to determine ways to reach these goals. Finally, some suggestions are discussed about how to successfully deal with these issues. It is necessary to implement strategies to improve motivation for treatment. Implications of this study for clinical practice, policy decisions, and future research in this field are commented upon.

Psychosocial Issues in Diabetes Self-Management: Strategies for Healthcare Providers

Education and training for diabetes mellitus self-management is widely available and an essential part of many diabetes centres. Nonetheless, the majority of individuals with diabetes do not adhere to optimal self-management recommendations. It is believed that psychosocial issues play an important role in individuals' ability to undertake the extensive behavioural demands involved in managing diabetes. The goal of the present article is to provide an overview of psychosocial issues and suggest strategies for healthcare providers in supporting patients with the challenges of diabetes self-management. First, motivational enhancement strategies have the potential to augment patients' own motivation to engage in health behaviours. Second, behavior modification principles can increase patients' self-efficacy and their experiences of success. Third, managing distressing emotions, including anxiety, depression, distress specifically related to diabetes care, and fear of hypoglycemia, can facilitate motivation and ability to undertake diabetes self-management efforts. Recognizing and addressing psychosocial challenges allows healthcare providers to better support their patients in the demanding tasks of diabetes self- management.

P-108 - The effectiveness of two smoking cessation interventions targeted for residents of disadvantaged neighborhoods and smokers with other addictions and co-morbidities

Smoking cessation has been less effective among low SES smokers and those with other addictions/co-morbidities. There are few studies assessing different service delivery models through rigorous scientific methods while engaging the community. To assess the utilization and effectiveness of smoking cessation group versus individual counseling interventions among economically disadvantaged clients through a Randomized Controlled Trial (RCT). A Community-Based Participatory Research (CBPR) approach in conjunction with RCT methodology were used to compare the effectiveness of a behavior change communication intervention and pharmacotherapy through group vs. individual counseling models. Participants were recruited from a low-income urban setting in mid Atlantic area (n = 348), and randomized to either an individual or group-based intervention. Participants received training according to the Fresh Start curriculum on their 12 weekly sessions and followed for nine months after the termination of the program. After the intervention, the overall cessation rate was 10% with no significant difference between the two arms. The Cessation rate among participants who attended 6 to 12 sessions was significantly higher (p < 0.001) compared to those who attended 1 to 5 sessions (27.8% vs. 7.0%). Those with more positive perception of being “ready to quit” had higher odds of actual quitting (OR = 5.8). Although individual and group counseling cessation appear to be equally effective, the group counseling is more cost-effective and feasible approach for low SES smokers and those with other co-morbidities. The effectiveness of the intervention can significantly improve with better retention and motivational enhancement strategies. NCMHD 5-R24-MD002803.

Methamphetamine Addiction: A Review of the Literature

Methamphetamine, a synthetically produced central nervous system stimulant, is the second most illicit drug world- wide after cannabis. This drug has an annual global prevalence estimated at 0.4%, and its use is important in North America, Asia, and Oceania. Literature review was conducted from 1989 to 2011, using PubMed, Google Scholar, EMBASE, and PsycInfo, using the following key words alone or in combination: methamphetamine, addiction, dependence, complications, and pharmacotherapy. Methamphetamine addiction is a serious public health problem with many consequences and complications. Significant morbidity, including cardiovascular, infectious, pulmonary, dental diseases and other systems complications are associated with methamphetamine acute or chronic use. Methamphetamine dependence also causes serious cognitive impairments that can persist during abstinence and negatively affect recovery outcomes. There are no approved medications for the treatment of methamphetamine dependence. Efficient treatments include behavioural and psychological approaches of contingency management, cognitive-behavioural therapy, and motivational enhancement strategies.

Refer2Quit: Impact of Web-Based Skills Training on Tobacco Interventions and Quitline Referrals

Tobacco quitlines (QLs) provide effective evidence-based tobacco cessation counseling, yet they remain underutilized. Barriers to utilization include the lack of referrals by health care providers who typically have little knowledge about QLs and low self-efficacy for providing tobacco interventions. In order to educate providers about QLs, referral methods and tobacco interventions, a case-based online CME/CE program, Refer2Quit (R2Q), was developed. R2Q includes QL education and intervention and referral skills training tailored to provider type (eg, physician, nurse, dental provider, pharmacist) and work setting (eg, emergency, outpatient, inpatient). A module teaching motivational enhancement strategies was also included. Four health care organizations in Washington State participated in a study examining the effects of R2Q training on fax referral rates in an interrupted times series. Attitudes and self-efficacy toward delivering tobacco interventions was also assessed. Participants were a mix of provider types, including prescribers (20.1%), RNs (46.7%), and others (33.2%). Health care sites that participated in the study increased the fax referral rates (odds ratio [OR] 2.86, confidence interval [CI] 1.52-6.00) as well as rates of referrals that converted to actual quitline registrations (OR 2.73, CI 1.0-7.4). Providers who completed the training expressed significantly more positive attitudes and improved self-efficacy for delivering tobacco services. At follow-up most providers reported increased delivery of tobacco interventions and QL referrals, although only 17% reported increased rates of fax referral. Our study suggests that online education builds skills, improves knowledge, and thus increases the number and quality of fax referrals made to QLs by health care providers. Providers nonetheless reported ongoing barriers to providing tobacco services and referral, including lack of reimbursement and patient unwillingness to accept a referral.

Web-Based Intervention for Returning Veterans with Symptoms of Posttraumatic Stress Disorder and Risky Alcohol Use.

A substantial number of military personnel who have served in Iraq (Operation Iraqi Freedom; OIF) and Afghanistan (Operating Enduring Freedom; OEF) develop symptoms of posttraumatic stress disorder (PTSD) in response to their military experiences and many of these same individuals will drink in a risky or problematic manner following deployment. If left untreated, PTSD symptoms and alcohol problems can become chronic and have a significant, negative impact on the lives of veterans, their families and communities. Further, OIF and OEF service members are often reluctant to seek treatment for mental health symptoms or alcohol problems secondary to stigma. In order to reach this population it is essential that new strategies and venues for delivering evidence-based care are explored. Web-based interventions are uniquely suited to this cohort of veterans in that they have the potential to reach a significant number of veterans who commonly use the Web and who might not otherwise receive care. This article will review the prevalence of PTSD and alcohol problems among OIF and OEF veterans, common barriers they experience with accessing care in traditional mental health settings, and what is known about the effectiveness of Web-based approaches for PTSD and alcohol problems. It also describes the components of a new Web-based intervention, developed by the authors, that uses motivational enhancement and cognitive-behavioral strategies to intervene with returning veterans who report PTSD symptoms and problem drinking. Recommendations for future directions in working with returning veterans with PTSD and alcohol problems will be offered.

Randomized Controlled Trial of Internet Cognitive Behavioural Treatment for Social Phobia with and Without Motivational Enhancement Strategies

The present study (Shyness 7) has two aims: Firstly, to replicate an earlier trial showing that a self-guided Internet treatment for social phobia is efficacious, and secondly, to examine whether the addition of self-guided motivational enhancement strategies improves completion rates and clinical outcomes. Randomized controlled trial (RCT) of self-guided Internet-based cognitive behavioural treatment (iCBT), or iCBT plus self-guided motivational enhancement strategies (iCBT+MS), was conducted. An intention-to-treat and last observation carried forward model was used for data analyses. The participants consisted of 108 volunteers with social phobia. The iCBT intervention consisted of two online lessons about symptoms and treatment of anxiety disorders and six lessons about management of social phobia (the Shyness programme) with complex automated reminders. The motivational intervention was based on traditional techniques including understanding and exploring ambivalence about change using a cost–benefit analysis, developing and resolving discrepancy between values and symptoms, and enhancing self-efficacy for change. The main outcome measures were the Social Interaction Anxiety Scale and Social Phobia Scale. More iCBT+MS group participants completed the eight lessons than iCBT group participants (75% versus 56%, respectively), but there were no between-group differences in outcome measures at post-treatment or at 3 month follow up. Large mean within-groups effect sizes (Cohen's d) for the two social phobia measures were found for both the iCBT and iCBT+ MS groups (1.1 and 0.95, respectively), which were sustained at 3 month follow up (1.06 and 1.07, respectively). Both iCBT and iCBT+MS group participants reported that the procedures were highly acceptable. Both self-guided versions of the Shyness programme were reliably efficacious, confirming that people with social phobia may significantly benefit from a highly structured self-guided intervention. The addition of motivational techniques increased completion rates but did not improve clinical outcomes or acceptability.

The use of motivational enhancement strategies for the maintenance of weight loss among obese individuals: a preliminary investigation

To investigate the efficacy of motivational enhancement strategies integrated within a standard lifestyle modification program for the maintenance of weight loss and improved psychosocial functioning of obese adults. Twenty-two obese adults completed 20 sessions of a motivationally informed cognitive behavioural treatment for weight loss and maintenance. Treatment outcome measures included anthropometrics, obesity-specific quality of life, impulsive eating tendencies, body dissatisfaction, mood disturbance and maladaptive cognitions. At post-treatment, there was a significant decrease in body weight (123.04 +/- 22.06 vs. 116.84 +/- 23.53, p < 0.001) with no significant change by the 12-month follow-up. Patients also reported significant improvements in obesity-related quality of life, impulsive eating tendencies, body dissatisfaction and maladaptive cognitions at post-treatment that were maintained at the 1-year follow-up. The implementation of motivational enhancement strategies within a cognitive behavioural program results in sustained weight loss that compares favourably to previous lifestyle modification programs.

Pediatric Obesity: Parallels with Addiction and Treatment Recommendations

Rates of pediatric obesity have increased dramatically over the past decade. This trend is especially alarming because obesity is associated with significant medical and psychosocial consequences. It may contribute to cardiovascular, metabolic, and hepatic complications, as well as to psychiatric difficulties. The development of obesity appears to be influenced by a complex array of genetic, metabolic, and neural frameworks, along with behavior, eating habits, and physical activity. Numerous parallels exist between obesity and addictive behaviors, including genetic predisposition, personality, environmental risk factors, and common neurobiological pathways in the brain. Typical treatments for pediatric obesity include behavioral interventions targeting diet or exercise. These treatments have yielded mixed results and typically have been examined in specialty clinic populations, limiting their generalizability. There are limited medication options for overweight children and adolescents, and no approved medical intervention in children younger than 16 years old. Bariatric surgery may be an option for some adolescents, but due to the risks of surgery, it is often seen as a last resort. The parallels between addiction and obesity aid in developing novel interventions for pediatric obesity. Motivational enhancement and cognitive-behavioral strategies used in addiction treatment may prove to be beneficial.

Predicting the Completion of an Integrative and Intensive Outpatient Chronic Pain Treatment With the Personality Assessment Inventory

The effects of intensive, integrative treatments for chronic pain are affected by patient compliance, and in many cases, selecting noncompliant individuals adversely impacts the cost-effectiveness of such programs. The pretreatment identification of individuals who are at risk for dropout could assist clinicians in augmenting treatments with motivational enhancement strategies for high-risk patients or using such information to select individuals who are most likely to complete a given intervention program. In this study, we tested the ability of indicators from the Personality Assessment Inventory (PAI; Morey, 1991), administered prior to treatment, to identify individuals who dropped out of a 20-day chronic pain program. Results replicate findings from outpatient psychotherapy research in finding that PAI Mean Clinical Elevation and Treatment Process Index significantly differentiated dropouts from graduates, particularly when the Treatment Rejection scale suggested patients were motivated for treatment. We discuss these results and offer recommendations for the prediction of treatment dropout in pain settings.

Screening for College Student Problem Drinkers: The Role of the Student Affairs Professional

Heavy drinking continues to be a nationally recognized problem on college campuses. This article describes how student affairs professionals play a pivotal role in identifying and referring these students for relevant services. A five-step model for alcohol screening, advising, and referral is described using motivational enhancement strategies.

Efficacy of the Team Solutions Program for Educating Patients About Illness Management and Treatment

Despite the demonstrated efficacy of psychosocial approaches to schizophrenia treatment that include a psychoeducational component, such as illness management, the implementation of these approaches into routine mental health treatment has been slow. The authors sought to examine the efficacy of a comprehensive, modularized, psychoeducational program called Team Solutions, which was designed to educate patients with major mental illnesses about their illness and how to manage it. Team Solutions was chosen for study because it is available over the Internet and other venues at no cost and is used by mental health agencies across the United States and Canada. Seventy-one persons with schizophrenia or schizoaffective disorder from three day treatment settings participated in this randomized, single-blind study. Participants were randomly assigned to attend one of two interventions: the Team Solutions intervention, which consisted of participating in a 24-week psychoeducational group focused on illness management, or treatment as usual. For participants who attended the experimental group, significant improvement was observed in knowledge about schizophrenia. In addition, client satisfaction was high. However, no changes were observed in symptoms or functioning. Results indicated that participation in the Team Solutions psychoeducational group improved participants' knowledge. However, participation in the program did not demonstrate superiority over treatment as usual with respect to secondary and tertiary outcomes, such as symptom severity, treatment adherence, and global functioning.