Using Motivation to Understand Treatment and Decision-Making

Abstract

Background: Mental health challenges continue to impact Canadians, with major depression, bipolar disorder and substance use among the leading causes of disability. Depressive disorders are often associated with diminished motivation. In contrast, substance use has been described as a “motivated behaviour”, where use of drugs is associated with specific goals; motivation may therefore help explain health behaviours like vaping. This thesis studies motivation and mental illness, by assessing treatments for patients who lack motivation, and characterizing motives for behaviour.

Methods: A pilot trial (RCT) was conducted to determine the feasibility of a trial to test the effects of behavioural activation (BA) in patients with major depressive disorder (MDD) (n=20). The full RCT was conducted to test the effectiveness of BA (n=169). Next, a protocol for a systematic review is described which explores outcomes used in trials for bipolar disorder type 1. Finally, a mixed-methods study was undertaken to identify vaping perceptions in patients with opioid use disorder (OUD) who vape (n=41).

Results: The pilot RCT demonstrated the feasibility for a full trial. The full RCT revealed that behavioural approaches may produce improvements in depression and quality of life (QoL) for patients with diminished motivation. Finally, the mixed-methods study identified 14 themes, revealing that vaping is convenient, common among youth, and a tool for smoking cessation.

Discussion: The pilot and full RCT trials reveal that BA has positive effects on depression and QoL in patients with depression, specifically showing significant improvements compared to waitlist. The mixed-methods study of vaping provides a lens through which vaping behaviours in the OUD population can be understood, generating evidence which can inform cessation efforts.

Conclusions: These works highlight how motivation can be intervened upon through treatment, and harnessed to better understand health decisions, with the overall objective of improving care within psychiatric populations.