Motivational Enhancement Therapy And Cognitive ...
cMET/CBT/CM is a computer-delivered intervention for cannabis use disorders, incorporating features of three evidence-based treatments: cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), and contingency management (CM).
Motivational Enhancement Therapy and Cognitive ...
Summary: In this randomized controlled trial, the effectiveness of cMET/ICBT/CM was compared to two therapist delivered treatments for cannabis use disorders. Adults with cannabis use disorders were recruited (n=75) and randomly assigned to: 1)cMET/ICBT/CM; 2) Nine sessions of a therapy incorporating MET, CBT, and CM delivered in-person with a therapist (THERAPIST); or 3) Two motivational interviewing sessions, in-person with a therapist (BRIEF). Cannabis use was assessed pre-treatment, post-treatment, and at 3- and 9-month post-treatment follow-ups. Post-treatment, participants in the cMET/ICBT/CM and THERAPIST conditions had significantly longer durations of continuous abstinence from cannabis than the BRIEF group. Participants in the THERAPIST and cMET/ICBT/CM conditions were also significantly more likely to be abstinent from cannabis at the end of treatment. While 47% and 45% of the cMET/ICBT/CM and THERAPIST groups, respectively, were abstinent, only 13% of the BRIEF group was abstinent from cannabis post-treatment. There were no post-treatment differences in cannabis use between the cMET/ICBT/CM and THERAPIST conditions. At the 3- and 9-month follow-ups, the rates of participants abstaining from cannabis use were similar across all three treatment conditions. Participants in the THERAPIST group, however, used cannabis on a greater percentage of days at 9-months, compared to the cMET/ICBT/CM group.
Self-help interventions for gambling include self-guided activities and information workbooks designed to reduce or eliminate gambling. Sometimes these approaches can be accompanied by planned support from a helpline specialist, clergy, a community health specialist, a therapist, or some other treatment provider. More specifically, guided self-help approaches that have been tested include workbooks accompanied by a brief explanatory or informational phone call related to the intervention, motivational interviewing, and/or motivational enhancement. These studies generally show that individuals who engage in guided self-help tend to do better over time than others who do not engage in self-help, such as those who are in a wait list control group. However, some studies do not fully support this outcome; for example, one study reported that workbooks can help people progress toward abstinence, but did not find any benefit for the addition of an explanatory or informational phone call to workbook self-help. Another study also found limited benefit to guided self-help itself.
Brief treatment can take a number of different forms, including limited motivational enhancement therapy, as we mentioned previously. Brief treatment does not necessarily need to include motivational enhancement, however. These interventions might include a 10 minute conversation or a few counseling sessions of cognitive behavioral therapy, for example, but not protracted clinical involvement. A brief treatment might include a gambling disorder screen, information about harmful consequences of excessive gambling, or simply advice for reducing gambling-related harm. Studies of brief advice suggest that it is associated with clinically significant changes in gambling behavior. Documented benefits of brief advice are apparent as early as six weeks following an intervention and as long as nine months later. Additional studies of brief advice from other sources will help confirm brief advice as an important treatment approach for gambling.
Behavioral therapy seeks to undo learned associations between a particular stimulus, such as gambling triggers, and an unwanted response, such as feeling an urge to gamble when in the presence of a trigger. One example, exposure therapy seeks to help people eliminate the experience of gambling-related urges in response to actual gambling experiences. Similarly, imaginal desensitization intentionally provokes gambling-related urges using imagery and immediately provides assistance with cognitive restructuring and the presence of incompatible responses (e.g., relaxation). One way of doing this is through the use of audiotaped recordings of gambling scenarios. Despite the popularity of this treatment type, most studies of behavioral therapy for gambling disorder rely upon weak experimental designs that make drawing causal attributions about treatment efficacy difficult. One trial, however, shows that, in combination with relapse prevention, imaginal desensitization can reduce key gambling-related urges effectively.
Motivational enhancement therapy differs from motivational interviewing (MI), another client-centered therapy aimed at changing behavior. MI takes a broader approach to behavior change, while MET focuses on the evaluation, feedback, and action steps.
Anyone engaging in a behavior that may be having a negative impact on their life may consider MET. Specifically, individuals struggling with substance use or gambling issues may benefit. Motivational enhancement therapy can be an effective way of helping them identify the benefits of making a change.
It's important to keep in mind that MET is not a standalone treatment but a short intervention that can be applied to and integrated with other therapies, like cognitive behavioral therapy. Additionally, success with MET varies based on the substances someone is using and the extent of their addiction.
Motivational enhancement therapy can be influential in empowering people to change their lives. Research shows that MET can help people decrease substance use issues, reduce drinking and smoking, strengthen medication adherence, and implement healthy lifestyle changes.
Motivational enhancement therapy is an intervention focusing on assessment, feedback, and plans for making change. It can be applied in just a few sessions to engage individuals, resolve ambivalence, and draw out their intrinsic motivation. Motivational interviewing is a communication style that strengthens a person's language around change. A healthcare provider may use MI techniques to enhance their MET interventions.
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. J Family Med Prim Care. 2021;10(1):367-372. doi:10.4103/jfmpc.jfmpc_1578_20
Lenz, A. Stephen, Lorena Rosenbaum, and Donna Sheperis. Meta-analysis of randomized controlled trials of motivational enhancement therapy for reducing substance use. Journal of Addictions & Offender Counseling. 2016;37(2):66-86. doi:10.1002/jaoc.12017
Murphy CM, Ting LA, Jordan LC, et al. A randomized clinical trial of motivational enhancement therapy for alcohol problems in partner violent men. J Subst Abuse Treat. 2018;89:11-19. doi:10.1016/j.jsat.2018.03.004
Motivational enhancement therapy (MET) is an intervention and counseling approach specifically designed to evoke internally motivated change. MET is often combined with other forms of counseling for those struggling with a substance use disorder (SUD) , such as the 12-Step treatment method.
A recent review of four meta-analyses examining the effectiveness of Motivational Interviewing found strong support for the benefits of MI compared to control groups (e.g., no treatment) and compared to other treatments (e.g., cognitive-behavioral therapy; CBT) (Lundahl & Burke, 2009). These authors concluded that MI consistently results in positive treatment outcomes, although the magnitude of benefit varies based on factors such as the disorder treated (e.g., alcohol use, anxiety) and the comparison group (Lundahl & Burke, 2009). Empirical studies also have shown MI to be effective with anxiety disorders, including social anxiety disorder, as a pre-treatment additive to traditional approaches, such as CBT, especially for those who are highly distressed (Westra, Arkowitz, & Dozois, 2009; Westra & Dozois, 2006). Additionally, recent research using MET among individuals with SAD has shown promising effects for increasing treatment seeking among these individuals (Buckner & Schmidt, 2009).
Buckner, J. D., & Schmidt, N. B. (2009). A randomized pilot study of motivation enhancement therapy to increase utilization of cognitive-behavioral therapy for social anxiety. Behaviour Research and Therapy, 47(8), 710-715.
Westra, H. A., Arkowitz, H., & Dozois, D. J. A. (2009). Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: A preminary randomized controlled trial. Journal of Anxiety Disorders, 23, 1106-1117.
Westra, H. A., & Dozois, D. J. A. (2006). Preparing clients for cognitive behavioral therapy: A randomized pilot study of motivational interviewing for anxiety. Cognitive Therapy and Research, 30, 481-498.
Carla Marienfeld, MD, is a board-certified addiction psychiatrist and Clinical Professor at the University of California, San Diego who supports recovery in an evidence based, harm-reduction approach through therapy, motivational interviewing, and medication treatment. Her research involves analysis of electronic medical record data for individuals with substance use disorders. She has authored or co-authored over 35 peer reviewed articles, book chapters, practice guidelines, and invited commentaries, and she edited two books: Motivational Interviewing for Clinical Practice and Absolute Addiction Psychiatry Review: An essential board exam study guide. She has been highly involved in education of colleagues and trainees about addiction psychiatry and effective interventions including buprenorphine treatment and motivational interviewing, and she is the fellowship director for the UCSD Addiction Psychiatry Fellowship. Dr. Marienfeld completed a fellowship in addiction psychiatry and residency training in psychiatry at Yale. During her residency, she was chief resident of psychiatry and founded (and later led) the Yale Global Mental Health Program. She earned a medical degree with honors from Baylor College of Medicine in Houston. 041b061a72