Motivation, Theories, and Interventions in Occupational Therapy

What is motivation in the context of occupational therapy?

the source of energy that drives individuals to explore and engage in meaningful occupations independently and with others, sustaining participation over time.

Operant conditioning

An approach in which behavior is conditioned by either rewards or punishment

why is operant conditioning not consistent with contemporary OT values?

it hinders intrinsic motivation and self-determination

How can extrinsic motivation approaches affect intrinsic motivation?

Extrinsic motivation approaches, like operant conditioning, can hinder intrinsic motivation

intrinsic motivation

the personal drive to explore oneself and the environment and feel competent and satisfied with what one achieves with their own actions

What are the key theories of motivation relevant to occupational therapy?

- Maslow's Hierarchy of Needs

- Self-Determination Theory (SDT)

- Flow Theory

- Self-Efficacy Theory

- Transtheoretical Model of Change

What does Maslow's Hierarchy of Needs represent?

It is a psychological theory that categorizes human needs into a hierarchy, where basic needs must be met before higher-level needs can be addressed.

biological/physiological includes:

Maslow's hierarchy of needs

food, water, sleep

An OTR is treating a 72-year-old client post-hip fracture who refuses to participate in therapy because they are in pain, exhausted, and report they have not eaten since breakfast. Which step of Maslow’s hierarchy of needs is most impacting this client’s motivation?

Biological

3 multiple choice options

safety/safety and security includes:

Maslow's hierarchy of needs

health, financial security, crime-free neighborhood

A 45-year-old client with a traumatic brain injury is preparing for discharge but expresses fear about returning home because their apartment requires climbing steep stairs, and they live alone. Which step of Maslow’s hierarchy is the client primarily concerned with?

Safety

3 multiple choice options

affiliation/love and belonging includes:

Maslow's hierarchy of needs

friends, family, belonging to groups and organizations

A 60-year-old client recovering from a stroke becomes discouraged and says they feel lonely because they cannot attend church or socialize with their family as before. Which step in Maslow’s hierarchy is being impacted?

Affiliation

3 multiple choice options

esteem includes:

Maslow's hierarchy of needs

self-efficacy and confidence

A 30-year-old client with a spinal cord injury expresses frustration, saying, “I feel useless because I can’t do anything for myself anymore.”This statement reflects a challenge with which step of Maslow’s hierarchy?

Esteem

3 multiple choice options

Self-actualization includes:

Maslow's hierarchy of needs

meaning, purpose, and acceptance of self

A 50-year-old client who has recovered independence after a heart attack tells their OTR they want to mentor others in making lifestyle changes to prevent future cardiac events. Which step of Maslow’s hierarchy of needs is being expressed here?

Self-actualization

3 multiple choice options

t/v Maslows Hierarchy of Needs involves individualism and priority of needs as 2 key themes

true

1 multiple choice option

What are the three psychological needs identified by Self-Determination Theory (SDT)?

autonomy, competence, and connection or relatedness

what is autonomy according to SDT?

- the need to be able to take direct action that will result in real change

- intrinsic need to do well and will do actions for wellness

what is competence according to SDT?

the need to gain mastery of tasks and feel self-efficacy

t/f the more autonomy you have over your actions the more you will competence (SDT)

true

1 multiple choice option

what is connection or relatedness according to SDT?

the need to experience a sense of belonging and connectedness to other people

t/f social and cultural conditions in the environment do not promote self-determined behavior (SDT)

false

1 multiple choice option

what is the main focus of the self-determination theory (SDT)?

- human beings actively seek psychological growth and well-being

- specific supports from one's social environment are necessary to achieve personal growth, integrity, and well-being

what is the main focus of Flow Theory?

- the experience of participation in an activity that is so intrinsically rewarding that the person "loses" themself in the process

- optimal personal experience that occurs while participating in any intrinsically motivating activity

What characterizes Flow Theory?

- intense and focused concentration on activity

- merging action and awareness

- self-regulation of motivation

- loss of self-consciousness

- deep sense of control

- distortion of time

-absence of anxiety

- activity is intrinsically motivating

During an OT session, a 12-year-old with ADHD becomes fully absorbed in a computer-based fine motor game. The child does not get distracted by noises in the therapy gym and maintains engagement for 30 minutes straight. Which Flow Theory characteristic is most demonstrated here?

Intense and focused concentration on activity

3 multiple choice options

An OTR observes a client with a traumatic brain injury during painting therapy. The client’s brush strokes flow naturally, and they report feeling “like my hands just know what to do.” Which Flow Theory characteristic is demonstrated?

Merging action and awareness

3 multiple choice options

A young adult recovering from depression chooses to work on woodworking projects between therapy sessions, even without external encouragement. The client explains, “I don’t need anyone to tell me to do it—it makes me feel better when I’m working.” Which Flow Theory characteristic does this represent?

Self-regulation of motivation

3 multiple choice options

A 70-year-old client practicing adaptive gardening becomes so absorbed in planting that they stop worrying about how others perceive their physical limitations. They later say, “I didn’t even think about my disability while I was gardening.” Which Flow Theory characteristic is this?

Loss of self-consciousness

3 multiple choice options

During a cooking activity, a client with multiple sclerosis feels confident using adaptive utensils. The client states, “I know I can manage this task on my own.” Which Flow Theory characteristic is shown?

Deep sense of control

3 multiple choice options

A college student with a hand injury is practicing typing during OT. At the end of the session, they are surprised when told that an hour has passed because they felt like only 15 minutes had gone by. Which Flow Theory characteristic is most present?

Distortion of time

3 multiple choice options

A veteran with PTSD participates in a woodworking group. During the activity, they remain calm, engaged, and free of intrusive thoughts. They report, “When I’m working on this project, my worries disappear.” Which Flow Theory characteristic is most demonstrated?

Absence of anxiety

3 multiple choice options

A high school student with autism engages in drawing daily, without being asked by parents or teachers. When asked why, they respond, “I just love doing it.” Which Flow Theory characteristic does this best illustrate?

Activity is intrinsically motivating

3 multiple choice options

What are the four sources of self-efficacy?

The four sources are mastery experiences, modeling, social persuasion, and somatic/emotional states.

According to Flow Theory, what level of difficulty should an activity present in order for an individual to experience intrinsic motivation and enter a state of flow?

The activity should provide the right challenge according to the person's subjective perception of their own capacity and what they think is challenging

What is Self-efficacy?

belief in one's own capabilities

if you have high self-efficacy, you may have increased:

goal-setting, persistence regardless of obstacles, resilience

what are the 4 sources of self-efficacy?

- mastery

- modeling

- social persuation

- somatic/emotional states

what is mastery according to the Self-Efficacy Theory?

- the strongest and most enduring source of self-efficacy

- experiencing success leads to a positive belief about one's skills and abilities

what is modeling according to the Self-Efficacy Theory?

people are motivated by those who are seen as similar to them (peers)

Individuals with intellectual disabilities may have low self-efficacy due to multiple difficulties, such as taking a longer time to complete activities or master skills. What part of the Self-Efficacy Theory would be beneficial for these individuals?

modeling

3 multiple choice options

what is social persuasion according to the Self-Efficacy Theory?

verbal encouragement that can positively influence one's belief in one's skills

t/f positive feedback is considered part of social persuasion in the Self-Efficacy Theory

true

good feedback can increase self-efficacy, whereas negative feedback can diminish a person's belief in their capability

what is somatic/emotional states according to the Self-Efficacy Theory?

the physical and emotional response to activity that can either encourage or dishearten an individual

What does the Model of Human Occupation (MOHO) focus on?

- participation in occupation is a central aspect of the human experience that has a unique personal, historical, and social meaning

- individuals and their environments are inseparable and interdependent

- addresses the motivation for occupation, providing assessment and intervention processes

what are the subsystems in the Dynamic Systems Theory of MOHO?

- performance capacity

- habituation

- volitional

what is performance capacity according to MOHO?

the extent to which underlying abilities from the internal mind-body systems facilitate or inhibit occupational performance and participation

According to MOHO, through continued participation in an occupation, individuals develop which of the following outcomes?

Occupational identity, occupational competence, and occupational adaptation

3 multiple choice options

occupational identity

one's own perception of who they are and who they wish to become

occupational competence

the extent to which individuals maintain a meaningful and satisfactory lifestyle

occupational adaptation

achieved when one has a clear occupational identity and a lifestyle that represents it

what is habituation according to MOHO?

the internalized patterns (habits, roles, and routines) or ways people do things and organize their participation

According to MOHO, repeating activities in similar situations, individuals develop performance patterns that help them interact semiautomatically in daily life. This process is called:

Habituation

2 multiple choice options

what is volition according to MOHO?

- motivation for participating in an occupation

- the thoughts and feelings individuals hold about themselves as participants in their daily lives, which evolve as they experience, interpret, anticipate, and choose what they do

what are the 3 parts of volition in MOHO?

interests, values, and personal causation

what is personal causation according to MOHO?

one's own sense of competence or efficacy

what are the 3 parts of personal causation according to MOHO?

- sense of capacity

- self-efficacy

- self-appraisal

What are the components of the Transtheoretical Model of Change?

- Precontemplation

- Contemplation

- Preparation (planning)

- Action

- Maintenance

What happens during the Precontemplation stage of the Transtheoretical Model?

the individual is not considering or intending to make a change in the near future.

What is a key characteristic of the Contemplation stage?

The individual starts to think about the problem, weighing the pros and cons of making a change.

t/f total reluctance towards change is a primary characteristic of the contemplation stage of the transtheoretical model

false

individual may be highly ambivalent while thinking about change

What occurs during the Preparation stage of the Transtheoretical Model?

- the individual recognizes that the pros outweigh the cons and begins planning for change.

- the person is weighing the options but not necessarily committing to the plan

What is the Action stage in the Transtheoretical Model?

the individual actively makes the change, but this phase is fragile and relapse is likely.

how many months should the individual actively make changes while in the action stage of the transtheoretical model?

6 months

What defines the Maintenance stage of the Transtheoretical Model?

the individual has maintained the behavioral change for at least six months, with a lower likelihood of relapse.

t/f relapse can occur during the maintenance stage of the transtheoretical model?

true

A 55-year-old client with type 2 diabetes consistently skips his exercise program and states, "I don't see the point of working out. I feel fine the way I am." He avoids conversations about lifestyle change.

What stage of change is the client in?

Precontemplation

3 multiple choice options

A 30-year-old client with chronic back pain says, "I know I should probably try therapy exercises, but I'm not sure if it will really help me." She appears ambivalent and often lists both pros and cons of trying OT. Which stage of change is she in?

Contemplation

3 multiple choice options

A 42-year-old client recovering from a stroke expresses, "I want to be more independent in dressing. I know it will be hard, but I'm ready to try and make some changes." What stage of change is this client in?

Preparation

3 multiple choice options

A 28-year-old client recently diagnosed with depression has started following a structured morning routine with OT support. She says, "I feel good about sticking to this plan—it's making a difference." Which stage of change best describes this client?

Action

3 multiple choice options

A client with generalized anxiety disorder has been successfully practicing relaxation strategies for six months. He states, "I feel much more in control now, but I sometimes worry I could fall back into old habits." What stage of change is he in?

Maintenance

3 multiple choice options

An OT is working with a 55-year-old client with high cholesterol who refuses to follow a heart-healthy diet. The client says, “I don’t need to change what I eat—this is just how I’ve always lived.” He avoids further discussion when the OT brings up lifestyle changes. The client is in the Precontemplation stage of change.All of the following OT strategies are appropriate, EXCEPT:

A) Provide gentle encouragement

B) Avoid lecturing

C) Express belief in ability to change

D) Support new behavior already in place

Support new behavior already in place

3 multiple choice options

A 30-year-old client recovering from a wrist injury is hesitant about adaptive kitchen tools. She says, “I know they might help, but I don’t want to feel dependent. Maybe I’ll just keep trying without.” She is in the Contemplation stage.

All of the following OT strategies are appropriate, EXCEPT:

A) Weigh pros and cons

B) Provide feedback on ambivalence

C) Encourage reasons for change

D) Create a detailed action plan

Create a detailed action plan

3 multiple choice options

An OT is seeing a 42-year-old client who wants to begin exercising after a stroke. She says, “I’m ready to make changes, but I’m not sure where to start.” The client is in the Preparation stage.

All of the following OT strategies are appropriate, EXCEPT:

A) Offer options for routines

B) Assess possible barriers

C) Brainstorm effective plans

D) Emphasize long-term maintenance

Emphasize long-term maintenance

3 multiple choice options

A 28-year-old client with depression has started using a daily planner but says, “When I get stressed, I stop writing things down.” The client is in the Action stage.

All of the following OT strategies are appropriate, EXCEPT:

A) Provide support

B) Affirm progress

C) Adjust plan as needed

D) Give only vague encouragement

Give only vague encouragement

3 multiple choice options

A 60-year-old client with anxiety has practiced relaxation strategies for a year. He says, “It’s helping, but I worry I’ll slip back into old habits when stressed.” The client is in the Maintenance stage.

All of the following OT strategies are appropriate, EXCEPT:

A) Continue support

B) Reinforce long-term change

C) Plan for relapse prevention

D) Avoid information-sharing

D) Avoid information-sharing

3 multiple choice options

What is the relationship between motivation and mental illness?

Mental illnesses like schizophrenia and mood disorders can lead to issues such as avolition and anhedonia, affecting motivation.

What role does occupational therapy play in coping and adaptation?

Occupational therapy explores stress and personal coping strategies, assessing their impact on quality of life and occupational performance.

What are some factors that contribute to successful coping?

Factors include mastery, self-acceptance, a drive for personal growth, and positive relationships.

What is resilience in the context of coping?

Resilience is a dynamic process involving the development of adaptive coping skills, self-efficacy, cognitive flexibility, emotional regulation, and mindfulness.

What is the purpose of motivational interviewing in occupational therapy?

Motivational interviewing is a collaborative conversation designed to strengthen a person's motivation for and commitment to change.

What are some assessment tools used in occupational therapy for coping?

Assessment tools include the Volitional Questionnaire, OCAIRS, Modified Interest Checklist, and Family Stress and Coping Interview.

What types of interventions are used in occupational therapy for stress and coping?

Interventions include psychodynamic approaches, creative expression, occupation-based approaches, cognitive behavioral interventions, and education.

How does cognitive behavioral intervention help in coping?

Cognitive behavioral intervention identifies maladaptive behaviors and thought patterns, restructuring them with adaptive thoughts and actions.