Frequently Asked Questions about Motivation

Q: Why is motivation important?

A: When you need to take action to solve a behavioral health problem, motivation is needed to take the necessary steps. People often fail to make behavioral changes when they lack motivation.¹  Therefore, being willing to change is a necessary and important first step when facing a difficult challenge, such as quitting smoking, increasing exercise, or targeting a psychiatric disorder like depression or anxiety. Being motivated to make a change also makes it easier to ask others, including a professional, for help.

Q: Is lack of motivation a mental disorder?

A: Lack of motivation is not a mental disorder. However, people experiencing psychiatric problems may lack motivation to change or seek help for their problems. Also, symptoms of particular psychiatric disorders may mimic signs of poor motivation. For example, people who are depressed suffer from anhedonia (the inability to experience pleasure from normally enjoyable experiences) and often feel hopeless, indecisive, and physically slowed down. Because of these symptoms individuals may seem like they do not want to improve their lives. It is important to keep in mind that most people want to improve the quality of their lives, but may have a difficult time doing so. It takes practice using new tools and incorporating new behaviors to improve and/or increase motivation.

Q: How do you make a change?

A: Some researchers believe that change is a gradual process. For instance, the transitional model of change suggests that people change over the course of five stages: ²

• Precontemplation: Either unaware or under-aware that a problem exists.
• Contemplation: Aware that a problem exists. Considering taking action, but no commitment to change.
• Preparation:  Intention has been set to take action and preparations are being made.
• Action: Steps are taken to overcome a problem.
• Maintenance: Effort is made to maintain the gains.

Many people cycle through these stages several times before achieving their change goals.³ More

Q: What factors have an affect on the ability to change?

A: Most people want to make changes to better themselves. People making life changes often face a number of actual or perceived barriers that interfere with success:

• Poor understanding about how to change
• Lack of skills needed to change
• Poor self-efficacy (belief in one's capabilities)
• Ambivalence (mixed feelings) about changing
• Cost of change seems to outweigh the benefits
• Lack of resources to make changes—finances, transportation, child care
• Fear of change—sometimes things get worse before they get better. For example, sometimes substance abusers lose relationships with drinking or drug buddies when they get sober
• Concern about what others will think

A 2004 study published in the New England Journal of Medicine found that service members report unique factors for resistance to seeking mental health services:²

• Access to mental health treatment
• Stigma associated with seeking mental health treatment—concern about how they will be perceived by leadership and peers
• Confidence in mental health treatment

Although some of these concerns are valid, many perceived barriers are fueled by misinformation about mental health treatment. More

Q: How does someone get motivated?

A: There are a number of steps people can take to improve motivation.

• Since misconceptions about the change process and/or behavioral health treatment can impact motivation, receiving accurate information may be helpful.
• People can take steps on their own to enhance motivation. Check out self-help tools offered on this site.
• Providers can help enhance willingness to change through motivational interviewing (MI).⁵ MI is a brief psychosocial intervention that is designed to highlight discrepancies between a person's current values and goals and actual living circumstances.¹ MI is a successful technique that was initially developed to enhance an individual's motivation to reduce problem drinking, however it has been successfully applied to a number of other behavioral health issues.¹More

Q: Is motivational interviewing a covered TRICARE benefit?

A: Motivational interviewing is typically used in addition to treatment to help people see where they are, and the steps they will need to make in order to realize significant behavioral changes. When a primary behavioral health problem is a diagnosed mental disorder, e.g., depression or an anxiety disorder, treatment in support of the diagnosed mental disorder may be covered.  Motivational interviewing is not a covered TRICARE benefit when that is the primary focus of treatment.  TRICARE beneficiaries are eligible for eight behavioral health care visits per year without a referral or pre-authorization for covered behavioral health services. Active duty military personnel always need a referral for care outside a military treatment facility. More

References:

¹Levensky, E. R. (2003). Motivational interviewing. In W. O'Donohue, J. E. Fisher, & S. C. Hayes (Eds.). Cognitive Behavior Therapy: Applying Empirically Supported Techniques in Your Practice, pp. 252-260. Hoboken, New Jersey: Wiley & Sons, Inc.

²Prochaska J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change. American Psychologist, 47, 1102-1104.

³Zimmerman, G. L., Olsen, C. G., & Bosworth, M. F. (2000). A 'Stages of Change' Approach to Helping Patients Change Behavior. American Family Physician, 61, 1409-16.

⁴Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I., & Koffman, R.L. (2004). Combat duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care. The New England Journal of Medicine, 351, 13-22.

⁵Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people for change. New York: Guilford Press.

TRICARE policy for reimbursement requires that services must be medically necessary for a diagnosed psychological disorder. The disorder must be one referenced in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and must be of a severity not only to cause the patient distress but also to interfere with the patient's usual activities.