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Motivational enhancement therapy (MET): definition, use, addiction treatment, and benefits

Reading time: 12 mins
Motivational enhancement therapy (MET): definition, use, addiction treatment, and benefits

Motivational enhancement therapy (MET) is a type of psychotherapy aimed at enhancing a patient’s motivation to change harmful behaviors, like alcoholism and substance abuse. Individuals engaging in self-destructive behaviors often feel ambivalent or lack motivation to change, despite recognizing the negative impacts on their health and life. Motivational enhancement therapy incorporates motivational interviewing techniques into a structured approach, using comprehensive behavioral assessments and feedback to build commitment and facilitate behavioral change.

Uses of motivational enhancement therapy include treatment of substance use disorders, alcohol addiction, cannabis cravings, anxiety, eating disorders, obsessive-compulsive disorder (OCD), bipolar disorder, post-traumatic stress disorder (PTSD), and gambling issues.

Addiction treatment with motivational enhancement therapy effectively addresses ambivalence and internal struggles. It fosters intrinsic motivation, tackling negative views and hesitation, paving the way for successful addiction recovery.

Benefits of motivational enhancement therapy include its brief duration, focus on empowerment, readiness to change, improved treatment engagement, and building confidence. It reduces substance use severity and supports lasting abstinence by empowering individuals to find their own reasons for change.

What is motivational enhancement therapy (MET)?

A woman in MET session

Motivational enhancement therapy (MET) is a structured intervention approach aimed at encouraging change in a patient’s motivation, particularly in relation to self-destructive behaviors such as substance use. MET is grounded in the principles of motivational psychology and aims to foster swift, self-motivated change. This therapy recognizes that individuals feel ambivalent or lack the motivation to change their harmful behaviors, even when they are aware of the negative impacts on their health, family life, and social functioning.

MET integrates techniques from motivational interviewing (MI) and the transtheoretical model (TTM) of change. Through MET, individuals gain a clearer understanding of how their behavior affects them, and their confidence in overcoming addiction grows.

The research guide titled “MOTIVATIONAL ENHANCEMENT THERAPY MANUAL: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence,” authored by William R. Miller et al. and published by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reprinted in 1999, highlights the success of MET in aftercare settings. MET effectively supports patients post-inpatient treatment, reinforcing their progress and helping them develop a robust plan for maintaining sobriety. The MET approach helps individuals comprehend the impact of their behavior and increase their confidence in their ability to recover from addiction.

Who created motivational enhancement therapy (MET)?

Motivational enhancement therapy (MET) was created by William R. Miller and Stephen Rollnick, drawing on the principles of motivational interviewing (MI). In 1993, it was developed as a part of project MATCH, a clinical trial funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). This large-scale study compared three different treatments for alcohol dependence: twelve-step facilitation therapy, cognitive-behavioral coping skills therapy, and MET. Each treatment lasted 12 weeks and followed a strict manual. MET is distinguished by its unique approach, incorporating the stages of change concept to help individuals with addiction visualize their path to a healthier lifestyle. Tailored specifically for substance abuse, this targeted approach empowers individuals and significantly increases their chances of overcoming addiction.

MET is grounded in the Transtheoretical Model (TTM), developed by Prochaska and DiClemente. Wayne W. LaMorte’s article, “The Transtheoretical Model (Stages of Change)” last modified on November 3, 2022, and published by Boston University School of Public Health, elaborates on TTM’s concept that behavior change occurs in stages, emphasizing the dynamic nature of the change process.

Building on the core principles of MI, MET adapts techniques such as expressing empathy, developing discrepancy, avoiding argumentation, rolling with resistance, and supporting self-efficacy for individuals struggling with substance abuse. This tailored approach empowers individuals, enhancing their likelihood of overcoming addiction.

Where is motivational enhancement therapy (MET) used?

Three women in a MET session.

Motivational enhancement therapy (MET) is used in treating substance use disorders. A study titled “Meta-Analysis of Randomized Controlled Trials of Motivational Enhancement Therapy for Reducing Substance Use” by A. Stephen Lenz et al., published in the Journal of Addictions & Offender Counseling in 2016, suggests that MET is effective compared to no treatment and alternative treatments, highlighting the potential benefits of integrating MET into treatment strategies for individuals with diverse substance use addiction conditions.

Another research study, titled “A qualitative interview study of patient experiences of receiving motivational enhancement therapy in a Swedish addiction specialist treatment setting,” authored by Stina Ingesson Hammarberg et al. and published in the journal Addiction Science and Clinical Practice in 2023, highlights the efficacy of MET in treating alcohol addiction and alcohol use disorder (AUD). The study demonstrates that MET effectively reduces alcohol consumption and its related consequences.

The article titled “The effectiveness of mobile-based ecological momentary motivational enhancement therapy in reducing craving and severity of cannabis use disorder: Study protocol for a randomized controlled trial,” authored by Mohammad Darharaj et al., and published in the journal of Internet Interventions in 2023, addresses the effectiveness of MET to control high cravings with cannabis use disorder (CUD). It further emphasizes the need to extend treatment beyond traditional face-to-face sessions into patients’ daily lives to address the momentary nature of cravings effectively.

MET has proven effective in enhancing the treatment of conditions such as anxiety, eating disorders, obsessive-compulsive disorders (OCD), bipolar disorder, post-traumatic stress disorder (PTSD), and gambling problems, and benefits those at risk of developing these conditions. The article “Healthy choices: motivational enhancement therapy for health risk behaviors in HIV-positive youth” authored by Sylvie Naar-King et al., published in the journal of AIDS Education and Prevention in 2006, highlights that MET promotes positive changes in health-risk behaviors among youth living with HIV.

According to Korte, K. J., & Schmidt, N. B. in their article “Motivational Enhancement Therapy Reduces Anxiety Sensitivity,” published in the journal Cognitive Therapy and Research in 2013, MET has been shown to be particularly effective in the treatment of anxiety disorders.

Is motivational enhancement therapy (MET) effective in treating addiction?

Yes, motivational enhancement therapy (MET) is effective in treating addiction as evidenced in 2023 research article titled “The effectiveness of motivational enhancement therapy for addiction treatment and attitudinal ambivalence towards addiction” by Farzin Bagheri Sheykhangafshe et al. published in the Journal of Research in Psychopathology in 2023, highlighting the effectiveness of MET in addressing the challenges of addiction treatment.

Additionally, the article discusses how MET addresses negative perceptions and reluctance towards treatment by enhancing intrinsic motivation. The study indicates that obstacles to treatment arise from internal conflicts and a lack of motivation, which MET effectively tackles. By encouraging a desire for change and addressing uncertainties, MET facilitates successful addiction treatment.

How does motivational enhancement therapy (MET) work in treating addiction?

Motivational enhancement therapy (MET) works in treating addiction by focusing on intrinsic motivation. MET empowers individuals to discover their own reasons for wanting to change. MET draws upon the principles of motivational psychology, particularly techniques derived from motivational interviewing (MI). Before starting MET, individuals go through a thorough assessment process that typically takes 7-8 hours. To ensure everyone’s safety and focus during therapy sessions, participants take a breathalyzer test beforehand. If the test detects alcohol, the session gets rescheduled.

A research titled “MOTIVATIONAL ENHANCEMENT THERAPY MANUAL: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence,” by William R. Miller et al., and published by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reprinted in 1999, outlines a structured approach to MET with four personalized sessions. Whenever possible, the patient’s spouse or another close confidante is included in the first two sessions to provide additional support. The ideal progression through the stages of change is direct until maintenance is achieved. However, most individuals with serious drinking problems experience several slips or relapses, which are part of the learning process. The positive aspect is that many patient’s who relapse re-enter the cycle, moving back into contemplation and continuing the change process. The MET approach supports patients’ in navigating these stages.

These sessions are designed to guide individuals through the early stages of change. The first session (week 1) focuses on two key areas. First, therapists provide structured feedback based on the initial assessment. This feedback delves into the patient’s drinking problems, including the level of consumption, associated symptoms, and any decision-making struggles they are facing. Additionally, therapists work on building the patient’s motivation to initiate or continue their journey towards change.

The second session (week 2) builds upon the momentum from the first session. Here, the focus is on solidifying the patient’s commitment to change. This is achieved by further exploring their motivations and developing a clear plan for moving forward.

The remaining two sessions, held at weeks 6 and 12, act as follow-up support. During these sessions, therapists monitor the patient’s progress, address any challenges that arise, and offer continued encouragement. The entire MET program takes place within a 90-day timeframe, providing focused support during a crucial period of change.

At the end of the fourth MET session, formal termination is discussed with a recap of the patient’s progress. This summary reviews key motivational factors, commitments, and changes made while affirming and reinforcing the patient’s efforts. It explores future goals, elicits self-motivational statements for maintaining change, supports the patient’s self-efficacy, addresses any special issues, and reminds the patient of the importance of follow-up sessions for sustained change.

What is the main goal of motivational enhancement therapy (MET) in addiction treatment?

The main goal of motivational enhancement therapy (MET) in addiction treatment is to help individuals overcome their ambivalence or resistance to behavior change. MET focuses on increasing intrinsic motivation by raising awareness of a problem, adjusting self-defeating thoughts regarding the problem, and boosting confidence in one’s ability to change. Rather than identifying a problem and instructing a person in therapy on what to do, the therapist encourages the individual to make self-motivating statements that reflect a clear understanding of the problem and a commitment to change.

Although MET is often employed alongside other forms of therapy, it serves as a pre-treatment to enhance a person’s motivation to begin a more specific therapy, such as cognitive-behavioral therapy. MET is used concurrently with another therapy to reinforce the individual’s motivation to change. In essence, MET aims to prepare people for change rather than pushing them to change immediately.

The ultimate objective of MET is to support intrinsic motivation for change, leading patients to initiate, persist in, and comply with behavior change efforts. By fostering self-motivation, MET helps individuals navigate their journey toward a healthier lifestyle.

What are the techniques used in motivational enhancement therapy (MET) when treating addiction?

A young African American woman in MET.

The techniques used in motivational enhancement therapy (MET) when treating addiction are listed below.

  • Expressing empathy: This approach focuses on helping people understand how their behavior impacts others and motivating them to change. In MET, therapists show respect for patients, avoiding any sense of superiority. They act as supportive guides, respecting patients’ autonomy and their right to make their own decisions. MET emphasizes building patients up with compliments and focusing on listening rather than instructing. Persuasion is gentle and subtle, always reinforcing that the decision to change is up to the patient. Reflective listening, a key skill in MET, involves showing genuine understanding and compassion for the patient’s experiences and feelings. This creates a supportive, non-judgmental environment that helps patients feel accepted and supported in their journey toward change.
  • Developing discrepancy: In MET, therapists help patients see the gap between their current behaviors and their broader life goals or values. Recognizing this discrepancy motivates patients to change their behavior to better align with their values and goals. The MET approach aims to enhance patients’ awareness of how their behaviors, such as drinking, conflict with their personal aspirations. For patients, it is necessary to first raise awareness of the negative consequences of their actions. This realization creates a sense of urgency and motivates them to consider change. When patients understand the disparity between where they are and where they want to be, they are more likely to engage in discussions about change options to bridge the gap and achieve their desired state. This process is often quicker and easier if the patient is already contemplating change, as they are more prepared to move toward making a decision to change.
  • Avoiding argumentation: Rather than confronting or challenging the patient directly, MET therapists avoid arguments and guide patients to explore their ambivalence and reasons for change at their own pace. MET therapists avoid arguing with individuals about their behavior or substance use because argumentation often triggers defensiveness and resistance to change. Instead, they gently and optimistically help patients become more aware, allowing the motivation to change to come from within rather than from external pressure. If ambivalence and discrepancy are handled poorly, patients develop defensive coping strategies that reduce discomfort without addressing the underlying issue. Unrealistic attacks on drinking behavior evoke defensiveness and opposition, suggesting the therapist doesn’t understand the patient’s perspective. MET therapists don’t try to force patients to accept a diagnostic label or prove their point through argument. Instead, they use other strategies to help patients see the consequences of their drinking and start to devalue alcohol’s perceived benefits.
  • Rolling with resistance: Therapists accept patient resistance without pushing back, using it as an opportunity to explore the patient’s views and gently guide them towards considering change. In the MET approach, how the therapist handles patient resistance is crucial. Instead of confronting resistance directly, therapists “roll with” it, aiming to shift the patient’s perceptions in the process. New ways of thinking about problems are suggested but not imposed, and ambivalence is seen as normal rather than pathological. Solutions are typically drawn out from the patient rather than provided by the therapist. This method encourages patients to develop their own insights and motivations for change, making the process more effective and personalized.
  • Enhancing self-efficacy: MET helps individuals develop a sense of self-efficacy by emphasizing their past successes and encouraging them to set achievable goals. A study titled “Effect of Motivational Enhancement Therapy (MET) on the self-efficacy of Individuals with Alcohol Dependence,” conducted by Saurav Kumar et al. and published in the Journal of Family Medicine and Primary Care in 2021, demonstrates that MET effectively enhances self-efficacy in individuals with alcohol dependence.

What are the stages of motivational enhancement therapy (MET) in addiction treatment?

A woman in yellow top smiling.

The stages of motivational enhancement therapy (MET) in addiction treatment are listed below.

  • Precontemplation: In the pre-contemplation stage, individuals do not plan to change their behavior within the next six months. They often do not recognize that their behavior is problematic or harmful. They tend to overlook the benefits of change and emphasize the drawbacks. As a result, they feel comfortable with their current habits and do not view their substance addiction as an issue. These individuals are referred to as precontemplators.
  • Contemplation: In the contemplation stage, individuals recognize their behavior as problematic and contemplate changing it. They think about the feasibility and costs of change. This stage involves intending to start healthy behavior within the next six months. People in this stage carefully weigh the pros and cons of changing, feeling ambivalent about it despite this recognition.
  • Determination: As individuals progress, they move to the determination stage, where they decide to take action and change. People in this stage are ready to act within the next 30 days, taking small steps towards behavior change and believing it will lead to a healthier life. In the preparation stage, patients start making small changes to facilitate a drastic change, committing to change after understanding the problematic nature of their behavior. They even have a roadmap or set targets to achieve within a period.
  • Action: The action stage of recovery is when the individual actively modifies their behavior to incorporate change, lasting for 6 months from the start of these changes. This period assumes the individual is still in a state of change.
  • Maintenance: After successfully navigating the action stage, individuals progress to maintenance, characterized by sustained behavior change for more than 6 months with a focus on preventing relapse. This stage involves actively taking measures to avoid previous problematic behaviors and addictions while adopting a lifestyle that supports the new way of life.
  • Relapse: In MET, if efforts to change fail, a relapse occurs, leading the individual to begin another cycle of therapy. This stage is seen as an opportunity for further growth and self-reflection, allowing the individual to reassess their motivations and strategies, and to develop a renewed commitment to change. MET supports individuals through these cycles, helping them to learn from setbacks and build resilience in their journey towards sustained change.

What are the benefits of motivational enhancement therapy (MET) in addiction treatment?

The benefits of motivational enhancement therapy (MET) in addiction treatment are listed below.

  • Brief duration: MET is designed to be brief, usually involving just four sessions, and occasionally extending to six. Even with the maximum number of sessions, a round of MET typically takes only a few weeks to complete. This doesn’t mean MET is simple; it requires commitment and active participation in each session. However, the substantial impact it has on treatment success, coupled with its short duration, makes MET a highly efficient and effective method.
  • Focus on empowerment: MET stresses a collaborative relationship between therapist and patient. While the therapist contributes expertise, the approach centers on empowering patients to become more self-aware and contemplate the choices available to them.
  • Readiness to change: MET benefits readiness to change by helping individuals explore and resolve their ambivalence towards change. It does this by enhancing their intrinsic motivation to change. A research titled “Effects of motivational enhancement therapy on readiness to change MDMA and methamphetamine use behaviors in Taiwanese adolescents” authored by Ya-Shune Huang et al., published in the journal of Substance use & misuse in 2011, MET effectively boosts willingness to change methamphetamine (MAMP) and 3,4-methylenedioxymethamphetamine (MDMA) use behaviors in adolescents participating in short-term treatment programs.
  • Improved treatment engagement: MET helps improve treatment engagement by using techniques to understand ambivalence, creating a safe space for open communication. MET focuses on building the person’s own desire for change, fostering a sense of ownership over recovery.
  • Builds confidence: MET builds confidence by highlighting past successes, making treatment feel more achievable. By openly exploring the pros and cons of change, individuals feel more invested in pursuing a healthier future.

What is the difference between motivational enhancement therapy (MET) and motivational interviewing (MI)?

difference between MET and MI

The difference between motivational enhancement therapy (MET) and motivational interviewing (MI) is evident in their definitions, structures, focuses, and methodologies. MI is a broad therapeutic approach that helps patients resolve ambivalence and build motivation for change. It is adaptable to various settings and behaviors, allowing therapists to respond flexibly to patient needs over time. On the other hand, MET is a specific adaptation of MI, created for research on substance use disorders. MET is more structured, typically involving a set number of sessions with a defined protocol.

The focus and application of MI and MET set them apart. MI is versatile, used to address a wide range of behaviors and issues beyond substance use. It emphasizes exploring and resolving ambivalence, enhancing intrinsic motivation, and fostering commitment to change across different areas of a person’s life. In contrast, MET is tailored specifically for substance use disorders, concentrating on providing feedback to motivate change in substance use behaviors. MET sessions incorporate structured assessments to offer personalized feedback, helping patients understand the impact of their substance use and encouraging them to consider change.

Both MI and MET are rooted in patient-centered counseling and the transtheoretical model of change, but their methodologies differ. MI emphasizes empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy in a conversational and exploratory manner. While MI includes feedback as part of the process, it does not rely on formal assessments. Conversely, MET integrates MI principles with a more structured, assessment-based approach. Personalized feedback is a central component of MET, which uses this information to motivate patients by highlighting the consequences of their substance use and encouraging positive change.

MET is an intervention that emphasizes assessment, feedback, and developing plans for change. It is designed to be effective within a few sessions, engaging individuals, addressing ambivalence, and fostering intrinsic motivation. MI, on the other hand, is a communication style that reinforces a person’s language around change. Healthcare providers often use MI techniques to enhance their MET interventions.