Transdiagnostic Motivational Enhancement Therapy to Reduce Treatment Attrition: Use in Emerging Adults

Abstract

Improving outcomes of youth with mental health (MH) needs as they transition into adulthood is of critical public health significance. Effective psychotherapy MH treatment is available, but can be effective only if the emerging adult (EA) attends long enough to benefit. Unfortunately, completion of psychotherapy among EAs is lower than for more mature adults (Edlund et al., 2002; Olfson, Marcus, Druss, & Pincus, 2002). To target the high attrition of EAs in MH treatment, investigators adapted a developmentally appropriate brief intervention aimed at reducing treatment attrition (TA) in psychotherapy and conducted a feasibility study of implementation. The intervention employs motivational interviewing strategies aimed at engaging and retaining EAs in outpatient MH treatment. Motivational enhancement therapy for treatment attrition, or MET-TA, takes only a few sessions at the outset of treatment as an adjunct to usual treatment. Importantly, it can be used for TA with psychotherapy for any MH condition; in other words, it is transdiagnostic. This article presents the first description of MET-TA, along with a case example that demonstrates important characteristics of the approach, and then briefly describes implementation feasibility based on a small pilot randomized controlled trial.

Challenges in Emerging Adulthood Related to the Impact of Childhood Bullying Victimization

“…During emerging adulthood there is a peak in mental health problems (Arnett et al, 2014; Henin & Berman, 2016; Public Health Agency of Sweden, 2020) and the onset of psychiatric disorders, possibly as a ‘spillover’ function of untreated psychological problems in childhood and adolescence (Tanner, 2015). These increases coincide with heightened problems with attrition and adherence to treatment (Arnett et al, 2014; Henin & Berman, 2016), possibly due to a distrust of authority figures as part of the developmental process (Mistler et al, 2016). Consequently, the work of clinical psychologists and counsellors might benefit from addressing emerging adults’ mental health problems in relation to the specific challenges of this developmental stage (Arnett et al, 2014; Tanner, 2015).…”

An Exploratory Study of a Training Team-Coordinated Approach to Implementation

“…The specific implementation supports provided by PLL trainers appeared to practically address many discrete factors found empirically to impact implementation success. For example, attempting to increase motivation of potential clients to engage in an intervention through motivational enhancement strategies has been found to be an effective adjunctive strategy for increasing enrollment and ongoing participation in psychosocial treatment (Karam et al 2017;Mistler et al 2016;Randall and McNeils 2017;Sterrett-Hong et al 2017). PLL trainer support to referral sources by training them in motivational enhancement skills perhaps helped to ensure therapists were seeing enough clients to capitalize on the training and practice their skills, as well as to meet the benchmarks for therapist competence in the intervention.…”

Principles of Care for Young Adults With Co-Occurring Psychiatric and Substance Use Disorders

“…Use of evidence-based and developmentally informed strategies that promote motivational enhancement and build therapeutic alliance is imperative for the challenge of engaging young adults in care and treatment planning for co-occurring conditions. 85 Providers and systems should also work to address barriers to accurate assessment of young adults who may have co-occurring conditions, which include separating symptoms of an existing or emerging psychiatric disorder from sequelae of intoxication or withdrawal; lack of access to expert evaluation because of scarcity of specialists or high cost; and lack of patient motivation for evaluation (eg, due to the perception that evaluation is unnecessary, or to self and social stigma). 86 Evidence Ambivalence regarding behavior change and treatment is expected, 87 and young adults face multiple unique barriers to engagement in care.…”