Different Perspectives of Clinicians and Patients with Severe Mental Illness on Motivation for Treatment (original) (raw)
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Social Psychiatry
Lack of motivation for treatment makes a subgroup of patients with severe mental illness (SMI) difficult to engage in psychiatric treatment. Such difficult-to-engage patients may also be the most in need of treatment. We hypothesized that the level of psychosocial problems would be inversely related to motivation for treatment. Cross-sectional study in two independent samples. The first sample (n = 294) included SMI patients who participated in a randomized controlled trial and were assessed using the Health of the Nation Outcome Scales (HoNOS) and self-rated and clinician-rated motivation-for-treatment scales. The second sample (n = 1,170) included SMI patients who were treated in Assertive Outreach Teams and were routinely assessed with the HoNOS and a motivation-for-treatment scale. In both samples, patients also self-rated their quality of life. In both samples, patients with HoNOS scores of 16 and higher had lower motivation scores on all motivation scales than patients with lo...
A Critical Analysis of the Utility and Compatibility of Motivation Theories in Psychiatric Treatment
Current Psychiatry Reviews, 2011
The TransTheoretical Model (TTM), Self-Determination Theory (SDT), and the Integral Model of Treatment Motivation (IM) provide distinct but not incompatible conceptualisations of motivation. We discuss the utility of these theories as a basis for the improvement of psychiatric treatment engagement and treatment outcomes in patients with severe mental illness. It appears that all three theories have gained support for their predictions of outcomes in patients with severe mental illness, but important questions remain unanswered, such as which of these theories provides the best prediction of treatment engagement and treatment outcomes. We explain how these three theories could complete each other, based on their strong and unique assets. It is imperative that the theories are empirically tested and compared to confirm their utility, and to this end we propose several important research questions that should be addressed in future research. Theory comparisons can advance what is currently known about intrapersonal changes and interpersonal differences in treatment engagement and outcomes in severely mentally ill patients.
Assessment, 2014
Self-determination theory is potentially useful for understanding reasons why individuals with mental illness do or do not engage in psychiatric treatment. The current study examined the psychometric properties of three questionnaires based on self-determination theory-The Treatment Entry Questionnaire (TEQ), Health Care Climate Questionnaire (HCCQ), and the Short Motivation Feedback List (SMFL)-in a sample of 348 Dutch adult outpatients with primary diagnoses of mood, anxiety, psychotic, and personality disorders. Structural equation modeling showed that the empirical factor structures of the TEQ and SMFL were adequately represented by a model with three intercorrelated factors. These were interpreted as identified, introjected, and external motivation. The reliabilities of the Dutch TEQ, HCCQ, and SMFL were found to be acceptable but can be improved on; congeneric estimates ranged from 0.66 to 0.94 depending on the measure and patient subsample. Preliminary support for the construct validities of the questionnaires was found in the form of theoretically expected associations with other scales, including therapist-rated motivation and treatment engagement and with legally mandated treatment. Additionally, the study provides insights into the relations between measures of motivation based on self-determination theory, the transtheoretical model and the integral model of treatment motivation in psychiatric outpatients with severe mental illness.
Relation between stages of change and motivation in the treatment of psychiatric patients1
Psihologija, 2007
Results have shown that stages of changes are significantly related to inspected motivational variables. Patients in higher stages of readiness express specific motivational profile characterized by the proactive optimism, which means that they rely on their own resources and expect positive outcome of the treatment. Patients in lower stages of readiness express motivational profile characterized by passive resignation receptiveness, by inclination towards demoralization and low trust in their own strength. Results of this research are in conformity with the basic hypothesis of transtheoretical model of change.
Neuropsychiatric Disease and Treatment, 2015
Objective: To evaluate the effectiveness of providing clinicians with regular feedback on the patient's motivation for treatment in increasing treatment engagement in patients with severe mental illness. Methods: Design: cluster randomized controlled trial (Dutch Trials Registry NTR2968). Participants: adult outpatients with a primary diagnosis of a psychotic disorder or a personality disorder and their clinicians, treated in 12 community mental health teams (the clusters) of two mental health institutions in the Netherlands. Interventions: monthly motivation feedback (MF) generated by clinicians additional to treatment as usual (TAU) and TAU by the community mental health teams. Primary outcome: treatment engagement at patient level, assessed at 12 months by clinicians. Randomization: teams were allocated to MF or TAU by a computerized randomization program that randomized each team to a single treatment by blocks of varying size. All participants within these teams received similar treatment. Clinicians and patients were not blind to treatment allocation at the 12-month assessment. Results: The 294 randomized patients (148 MF, 146 TAU) and 57 clinicians (29 MF, 28 TAU) of 12 teams (6 MF, 6 TAU) were analyzed according to the intention-to-treat principle. No statistically significant differences between treatment groups on treatment engagement were found (adjusted mean difference =0.1, 95% confidence interval =-2.2 to 2.3, P=0.96, d=0). Preplanned ancillary analyses showed statistically significant interaction effects between treatment group and primary diagnosis on treatment motivation and quality of life (secondary outcomes), which were beneficial for patients with a primary diagnosis of a personality disorder but not for those with a psychotic disorder. There were no reports of adverse events. Conclusion: The current findings imply that monitoring and discussing the patient's motivation is insufficient to improve motivation and treatment engagement, and suggests that more elaborate interventions for severe mental illness patients are needed.
Motivation for Treatment in Patients With Personality Disorders
Journal of Personality Disorders, 2008
The primary objective of the present study is to investigate the association between DSM-IV personality disorders and motivation for treatment in a large sample of patients admitting for a variety of psychotherapeutic programs (n = 1083). Second, we examine whether and to what extent this association is accounted for by other relevant patient variables (i.e., demographics, subjective distress, and treatment history). We developed a brief questionnaire to measure the motivation for treatment: the Motivation for Treatment Questionnaire (MTQ-8). The MTQ-8 consists of two subscales, i.e., Need for help and Readiness to change. The results show that patients with various personality disorders were significantly more motivated for treatment than those without. No differences across specific personality disorders were apparent. The association between personality disorders and motivation for treatment appeared to be partly accounted for by the level of symptom distress. It is concluded that, among treatment-seeking patients, personality disorders are associated with motivation for treatment and this association can best be understood by the higher symptom distress in patients with personality disorders as compared to those without personality disorders.
Pakistan journal of humanities and social sciences, 2024
Positive motivations toward treatment are an important factor that plays a significant role in the treatment outcomes and patients' recovery process. The present study investigates the impact of patients' motivation toward treatment and its impact on patients positive, negative, and general psychopathological symptoms among patients with psychosis. A total of 200 participants diagnosed with psychotic disorders were approached from different hospitals and clinics in Faisalabad and Karachi. 11 out of 200 participants were excluded due to comorbid conditions and unclarity in diagnostic symptoms. 189 participants met the inclusion and exclusion criteria of the study. Both male 112(59.26%) and females 77(40.74%). patients were included in this study. Participants were taken from all socioeconomic statuses. Participants' age range was between 20 to 45 years with M±SD=34.53±2.57. Findings show that patients a significant difference was estimated in positive, negative and general psychopathological symptoms between patients with low motivation and high motivation. Furthermore, results indicate that a significant difference was estimated in positive, negative and general psychopathological symptoms between patients with schizophrenia disorder and other psychotic disorders among patients with psychotic disorders. It is concluded that low motivation toward treatment is suspected a lower chance of engagement in treatment as compared to those who have high motivation. Patients with schizophrenia disorder perceived relevantly high symptom severity on positive, negative, and general psychopathological symptoms as compared to other psychotic disorders.
BMC Psychiatry, 2012
Background: Treatment disengagement and non-completion poses a major problem for the successful treatment of patients with severe mental illness. Motivation for treatment has long been proposed as a major determinant of treatment engagement, but exact mechanisms remain unclear. This current study serves three purposes: 1) to determine whether a feedback intervention based on the patients' motivation for treatment is effective at improving treatment engagement (TE) of severe mentally ill patients in outpatient psychiatric treatment, 2) to gather insight into motivational processes and possible mechanisms regarding treatment motivation (TM) and TE in this patient population and 3) to determine which of three theories of motivation is most plausible for the dynamics of TM and TE in this population.
Social Psychiatry and Psychiatric Epidemiology, 2014
Purpose To investigate the pattern of associations between changes in unmet needs and treatment motivation in elderly patients with severe mental illness. Methods Observational longitudinal study in 70 patients treated by an assertive community treatment team for the elderly. Unmet needs and motivation for treatment were measured using the Camberwell assessment of needs for the elderly and the stages-of-change (SoC) scale, respectively, at baseline, after 9 and 18 months. SoC scores were dichotomized into two categories: motivated and unmotivated. Multinomial logistic regression analyses were conducted to determine whether changes in motivation were parallel to or preceded changes in unmet needs.
Psychosis, 2018
Addressing motives determining behaviour and experiences of people in treatment for psychosis could improve the therapeutic relationship. This pilot study explored the association between the concordance of clients and clinicians ratings of clients' motivational goals and the therapeutic relationship in the treatment of psychosis. Twenty in-and outpatients with a psychotic disorder in a general psychiatric setting answered measures addressing motivational goals and the therapeutic relationship. Fifteen clinicians rated their clients' motivational goals and psychopathology. The concordance between clients' and clinicians' ratings of approach goals was not associated with clients' ratings of the therapeutic relationship. However, a higher concordance in avoidance goals ratings was significantly correlated with less satisfaction with the therapeutic relationship. This finding might be understood in light of explicit (i.e., conscious) and implicit (i.e., non-conscious) avoidance goals: The more difficulties clinicians had in recognizing their clients' implicit goals, the more they may have only rated and considered the clients' explicit goals. This could have resulted in both a higher concordance rating between clients and clinicians, and less clients' satisfaction with the therapeutic relationship (because of unintended threats for implicit avoidance goals). Future studies with larger samples are needed that separately examine explicit and implicit motivational goals of people in treatment for psychosis.