Christopher Masciari

Masciari (2025) examines the “motivational barriers” which can compromise patient adherence to treatment decisions. On this foundation, they consider interventions that may alleviate such barriers. In this commentary, I begin with a brief clarification of Masciari’s use of evolutionary adaptation. With the original argument’s empirical boundaries more transparently outlined, I then discuss how paternalistic objections against motivational interventions can be further settled by establishing why and how motivational interventions, not simply medical treatment, should be decided by the patient.

In this commentary, I will elaborate on the connection between motivational barriers to care, their possible remedies, and particular mental health conditions. In his paper, Masciari argues that health care providers ought to use certain methods of encouragement drawn from the extensive literature on the science of decision making. The discussion in his paper is limited to treatment plans in a cancer context because, of course, such treatments are particularly aversive and the outcomes can be particularly bad if patients do not follow through with their plans. I will argue that his suggestions are particularly relevant to many mental health contexts. Though Masciari does comment on mental health in his paper, there is much more to be said. As such, in my commentary, I will do three things. 1) I will expand the discussion of Generalized Anxiety Disorder and Major Depressive Disorder, 2) I will extend the encouragement techniques to ADHD, and 3) I will raise a potential limitation to the view on offer, with the case of Borderline Personality Disorder. The use and success of the provided encouragement techniques in these contexts is plausible given the similarities between them and certain therapeutic techniques. However, successful deployment of this methodology in these contexts will not come without a distinct set of challenges.