Motivation and Initiation - Fact Sheet

Following an acquired or traumatic brain injury, some individuals may experience a reduction in drive or motivation. Motivation is important for quality of life and for functioning in day-to-day activities, without it we may not pursue the things we normally would enjoy and need.

Generally, motivation can be defined as an internal state of a person that drives them to action for the purpose of reaching a target goal [1]. Motivation results from the interaction of many factors including the level of need (how much they want something), the ability to initiate the first action, the availability of appropriate responses i.e. does the person know the sequence of steps he/she needs to take to achieve the goal and also the presence of conflicting motives. [1]

Problems with motivation and its related behaviours can be the outcome of disruption to parts of the brain [2]. The frontal lobe is involved in our ability to start an action with a clear goal in mind and persist with it until the goal is achieved. Damage to the frontal lobe is closely associated with deficits in forward planning and initiation. Damage to the brain-stem has also been closely linked to such disorders [3].

Disorders of motivation include apathy, abulia and akinetic mutism and are all characterised by a reduction in motivation [2]. The three disorders lie on a continuum with akinetic mutism being the most severe, to apathy being the least severe:

Problems with Initiation

A component of motivation is initation or drive. Individuals with impaired drive may not be able to initiate behaviours on their own. For this reason external prompts are often needed for meaningful actions to occur. There is often not only a verbal reminder needed to start a task, but further reminders required throughout the task. It is easy to see how family members can get frustrated in these situations unless they fully understand the impact of loss of drive.

People not aware of certain effects of brain injury may describe the individual as being ‘lazy’ and ‘as not wanting to do anything’ when the individual may have a desire for the final goal or result, but has lost the ability to push themselves to action. Sometimes external devises may be used to prompt the person into action such as a pocket watch or alarm, which may also assist the transition into new activities.

Other Explanations for Appearance of Reduced Motivation

It is important not to mistake a disorder of drive or initiation that is due to brain injury with a psychological reaction to the changes a acquired or traumatic brain injury can bring to a persons life [3]. Reduced motivation can occur following long periods of hard work and effort dedicated to rehabilitation programs. Some individuals may see little improvement and become aware they are not going to return to their pre-injury state. This may lead to feelings of helplessness and reduce motivation. A person’s emotional state is closely connected to motivation. Personal counselling can be helpful in coping with this natural reaction.

Fatigue can be commonly mistaken for difficulties with motivation and drive. Individuals with an acquired or traumatic brain injury are susceptible to fatigue from the day’s activities. Fatigue can interfere with functioning by leaving individuals drained of all energy after which they need to sleep to regain lost energy.

Frontal lobe injuries may result in damage to Executive Function. Difficulties with Executive Functioning result in a reduced ability to plan, initiate and maintain goal-oriented behaviour. This may mean an individual will struggle with knowing how to start and maintain goal-directed activities.

The Impact of Reduced Motivation and Drive on Daily Life

Difficulties with motivation can impact on many areas of life. Areas impacted may include rehabilitation, use of coping skills, social functioning and work life. Social isolation is common among those who experience reduced motivation and drive. Individuals may not make the effort to keep in contact with friends or family, leading to isolation and further reduction in stimulating activities.

For family members, apathy can be difficult to cope with, as the lively person they once new may now appear disinterested in the tasks and people that once excited them. It may also be frustrating to see the individual not making the best of their rehabilitation program. Negative comments by family or friends can make the situation worse so it is important to avoid making the individual feel bad or guilty for not showing the reactions and behaviors family or friends wish to see.

Approaches to Managing Reduced Motivation and Drive

Improving General Health- Before attempting to treat or manage difficulties with motivation a person’s health should be at its most optimal [2]. For a person with a brain injury this means having seizures appropriately managed and having physical or cognitive rehabilitation for cognitive and sensorimotor loss. This also means having appropriate aids for any hearing or vision loss [2].

Task Analysis- Task analysis is one possible strategy to combat problems with motivation. Tasks are broken into individual sequenced steps and formed into a checklist. Each step is then ticked as it is completed. This way beginning, completing and following through on a task is less overwhelming and increases chances of success in undertaking daily activities. Successful experiences have the ability to generate further motivation, as the individual feels that sense of enjoyment a success brings. Task analysis can also help re-establish the routine in activities of daily living, with plenty of practice and support.

Make things interesting and increase stimulation - It is important to use different stimulating perceptual experiences to increase motivation. This may include visiting different places, diverse social and cognitive activities. Also using different activities during rehabilitation and in the home to encourage different ways of managing memory difficulties or problem solving.

Reinforcing the positive - Any desired activities or behaviours displayed by the individual should be reinforced with a reward, such as praise and attention. This may be part of a behaviour management plan. Goals and tasks should be discussed with the person first to increase collaboration and sense of control and success and to make sure they are doing things they enjoy.

Counselling – As motivation is closely associated with mood, appropriate treatment should be provided for depression or any other psychological problems. One-on-one counselling may assist in helping the individual work through difficult and distressing emotions that impact on motivation.

Social Contact – It is important for social contact to be maintained. This means maintaining social ties and outside interests. Joining a support group or participation in appropriate recreational activities can be of invaluable assistance.

Care for the Carer

Providing care and assistance to a person with impaired motivation can be difficult for a carer. At times a carer may feel fed up trying to assist and stimulate the individual to undertake daily tasks. All efforts may seem futile and the carer may begin to feel apathetic themselves. It is important to take breaks from the caring role and have some time to do outside activities. These breaks can be crucial to well-being and may allow you to provide a better quality of care upon return.

Reference

[1] Reber, A. S. (1995). The Penguin Dictionary of Psychology (Second Edition). London: Penguin Books.

[2] Marin, R. S & Chakravorty, S. (2005). Disorders of Diminished Motivation. In J. M. Silver, T. W. McAllister, & S. C. Yudofsky (Eds.), Textbook of Traumatic Brain Injury ( pp. 337-349). Washington, DC: American Psychiatric Publishing.

[3] Wood, R. Ll., & McMillan. (2001). Neurobehavioural Disability and Social Handicap Following Traumatic Brain Injury. East Sussex, England: Psychology Press.

[4] Rees, R. (2005). Interrupted Lives: Rehabilitation and learning following brain injury. Melbourne, VIC: IP Communications. (IN BIAQ LIBRARY)