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❶Scandinavian Journal of Primary Health Care.

Earlier studies showed contradictory or inconclusive findings regarding decrease in performance on a task following an external reward. The third experiment was based on findings of developmental learning theorists and looked at whether a different type of reward enhances intrinsic motivation to participate in an activity.

This experiment tested the hypothesis that if an individual is intrinsically motivated to perform an activity, introduction of an extrinsic reward decreases the degree of intrinsic motivation to perform the task. Each group participated in three sessions conducted on three different days. During the sessions, participants were engaged in working on a Soma cube puzzle—which the experimenters assumed was an activity college students would be intrinsically motivated to do.

The puzzle could be put together to form numerous different configurations. In each session, the participants were shown four different configurations drawn on a piece of paper and were asked to use the puzzle to reproduce the configurations while they were being timed. The first and third session of the experimental condition were identical to control, but in the second session the participants in the experimental condition were given a dollar for completing each puzzle within time.

During the middle of each session, the experimenter left the room for eight minutes and the participants were told that they were free to do whatever they wanted during that time, while the experimenter observed during that period. The amount of time spent working on the puzzle during the free choice period was used to measure motivation.

As Deci expected, when external reward was introduced during session two, the participants spent more time working on the puzzles during the free choice period in comparison to session 1 and when the external reward was removed in the third session, the time spent working on the puzzle dropped lower than the first session. All subjects reported finding the task interesting and enjoyable at the end of each session, providing evidence for the experimenter's assumption that the task was intrinsically motivating for the college students.

The study showed some support of the experimenter's hypothesis and a trend towards decrease in intrinsic motivation was seen after money was provided to the participants as external reward.

The second experiment was a field experiment, similar to laboratory Experiment I, but was conducted in a natural setting. Eight student workers were observed at a college biweekly newspaper. Four of the students served as a control group and worked on Friday. The experimental group worked on Tuesdays. The control and experimental group students were not aware that they were being observed.

The week observation was divided into three time periods. The task in this study required the students to write headlines for the newspaper. During "Time 2", the students in the experimental group were given 50 cents for each headline they wrote. At the end of Time 2, they were told that in the future the newspaper cannot pay them 50 cent for each headline anymore as the newspaper ran out of the money allocated for that and they were not paid for the headlines during Time 3.

The speed of task completion headlines was used as a measure of motivation in this experiment. Absences were used as a measure of attitudes. To assess the stability of the observed effect, the experimenter observed the students again Time 4 for two weeks. There was a gap of five weeks between Time 3 and Time 4. Due to absences and change in assignment etc.

The results of this experiment were similar to Experiment I and monetary reward was found to decrease the intrinsic motivation of the students, supporting Deci's hypothesis. Experiment III was also conducted in the laboratory and was identical to Experiment I in all respects except for the kind of external reward provided to the students in experimental condition during Session 2.

The experimenter hypothesized that a different type of reward—i. The results of the experiment III confirmed the hypothesis and the students' performance increased significantly during the third session in comparison to session one, showing that verbal praise and positive feedback enhances performance in tasks that a person is initially intrinsically motivated to perform.

This provides evidence that verbal praise as external reward increases intrinsic motivation. The author explained differences between the two types of external rewards as having different effects on intrinsic motivation. When a person is intrinsically motivated to perform a task and money is introduced to work on the task, the individual cognitively re-evaluates the importance of the task and the intrinsic motivation to perform the task because the individual finds it interesting shifts to extrinsic motivation and the primary focus changes from enjoying the task to gaining financial reward.

However, when verbal praise is provided in a similar situation increases intrinsic motivation as it is not evaluated to be controlled by external factors and the person sees the task as an enjoyable task that is performed autonomously.

The increase in intrinsic motivation is explained by positive reinforcement and an increase in perceived locus of control to perform the task. Pritchard, Campbell and Campbell [33] conducted a similar study to evaluate Deci's hypothesis regarding the role of extrinsic rewards on decreasing intrinsic motivation.

Participants were randomly assigned to two groups. A chess-problem task was used in this study. Data was collected in two sessions. Participants were asked to complete a background questionnaire that included questions on the amount of time the participant played chess during the week, the number of years that the participant has been playing chess for, amount of enjoyment the participant gets from playing the game, etc.

The participants in both groups were then told that the experimenter needed to enter the information in the computer and for the next 10 minutes the participant were free to do whatever they liked. The experimenter left the room for 10 minutes. The room had similar chess-problem tasks on the table, some magazines as well as coffee was made available for the participants if they chose to have it.

The time spent on the chess-problem task was observed through a one way mirror by the experimenter during the 10 minutes break and was used as a measure of intrinsic motivation. After the experimenter returned, the experimental group was told that there was a monetary reward for the participant who could work on the most chess problems in the given time and that the reward is for this session only and would not be offered during the next session.

The control group was not offered a monetary reward. After a filler task, the experimenter left the room for 10 minutes and the time participants spent on the chess-problem task was observed.

The experimental group was reminded that there was no reward for the task this time. After both sessions the participants were required to respond to questionnaires evaluating the task, i. Both groups reported that they found the task interesting.

The results of the study showed that the experimental group showed a significant decrease in time spent on the chess-problem task during the minute free time from session 1 to session 2 in comparison to the group that was not paid, thus confirming the hypothesis presented by Deci that contingent monetary reward for an activity decreases the intrinsic motivation to perform that activity.

Other studies were conducted around this time focusing on other types of rewards as well as other external factors that play a role in decreasing intrinsic motivation. Principles of SDT have been applied in many domains of life, e. Murcia, Roman, Galindo, Alonso and Gonzalez-Cutre [41] looked at the influence of peers on enjoyment in exercise. Specifically, the researchers looked at the effect of motivational climate generated by peers on exercisers by analyzing data collected through questionnaires and rating scales.

The assessment included evaluation of motivational climate, basic psychological needs satisfaction, levels of self-determination and self-regulation amotivation, external, introjected, identified and intrinsic regulation and also the assessment of the level of satisfaction and enjoyment in exercising.

Data analysis revealed that when peers are supportive and there is an emphasis on cooperation, effort, and personal improvement, the climate influences variables like basic psychological needs, motivation and enjoyment. The task climate positively predicted the three basic psychological needs competence, autonomy and relatedness and so positively predicted self-determined motivation. Task climate and the resulting self-determination were also found to positively influence level of enjoyment the exercisers experienced during the activity.

Awareness has always been associated with autonomous functioning; however, it was only recently that the SDT researchers incorporated the idea of mindfulness and its relationship with autonomous functioning and emotional wellbeing in their research. Brown and Ryan [42] conducted a series of five experiments to study mindfulness: They defined mindfulness as open, undivided attention to what is happening within as well as around oneself.

From their experiments, the authors concluded that when individuals act mindfully, their actions are consistent with their values and interest. Also, there is a possibility that being autonomous and performing an action because it is enjoyable to oneself increases mindful attention to one's actions. Another area of interest for SDT researchers is the relationship between subjective vitality and self-regulation. Ryan and Deci [43] define vitality as energy available to the self, either directly or indirectly, from basic psychological needs.

This energy allows individuals to act autonomously. Many theorists have posited that self-regulation depletes energy but SDT researchers have proposed and demonstrated that only controlled regulation depletes energy, autonomous regulation can actually be vitalizing.

A recent study by Hyungshim Jang [45] in which the capacity of two different theoretical models of motivation were used to explain why an externally provided rationale for doing a particular assignment often helps in a student's motivation, engagement, and learning during relatively uninteresting learning activities.

Students who received the rationale showed greater interest, work ethic, and determination. Structural equation modeling was used to test three alternative explanatory models to understand why the rationale produced such benefits:. The data fit all three models; but only the model based on self-determination theory helped students to engage and learn.

Findings show the role that externally provided rationales can play in helping students generate the motivation they need to engage in and learn from uninteresting, but personally important, material. The importance of these findings to those in the field of education is that when teachers try to find ways to promote student's motivation during relatively uninteresting learning activities, they can successfully do so by promoting the value of the task.

One way teachers can help students value what they may deem "uninteresting" is by providing a rationale that identifies the lesson's otherwise hidden value, helps students understand why the lesson is genuinely worth their effort, and communicates why the lesson can be expected to be useful to them. An example of SDT and education are Sudbury Model schools where people decide for themselves how to spend their days.

In these schools, students of all ages determine what they do, as well as when, how, and where they do it. This freedom is at the heart of the school; it belongs to the students as their right, not to be violated. The fundamental premises of the school are simple: In practice this means that students initiate all their own activities and create their own environments.

The physical plant, the staff, and the equipment are there for the students to use as the need arises. The school provides a setting in which students are independent, are trusted, and are treated as responsible people; and a community in which students are exposed to the complexities of life in the framework of a participatory democracy.

Sudbury schools do not perform and do not offer evaluations, assessments, or recommendations, asserting that they do not rate people, and that school is not a judge; comparing students to each other, or to some standard that has been set is for them a violation of the student's right to privacy and to self-determination. Students decide for themselves how to measure their progress as self-starting learners as a process of self-evaluation: According to self-determination theory, [47] individuals who attribute their actions to external circumstances rather than internal mechanisms are far more likely to succumb to peer pressure.

In contrast, individuals who consider themselves autonomous tend to be initiators of actions rather than followers. Research examining the relationship between self-determination theory and alcohol use among college students has indicated that individuals with the former criteria for decision making are associated with greater alcohol consumption and drinking as a function of social pressure.

For instance, in a study conducted by Knee and Neighbors, [48] external factors in the individuals who claim to not be motivated by internal factors were found to be associated with drinking for extrinsic reasons, and with stronger perceptions of peer pressure, which in turn was related to heavier alcohol use. Given the evidence suggesting a positive association between an outward motivation and drinking, and the potential role of perceived social influence in this association, understanding the precise nature of this relationship seems important.

Further, it may be hypothesized that the relationship between self-determination and drinking may be mediated to some extent by the perceived approval of others.

Motivational interviewing MI is a popular approach to positive behavioral change. It is a client-centered method that doesn't persuade or coerce patients to change and instead attempts to explore and resolve their ambivalent feelings, which allows them to choose themselves whether to change or not.

They believe that MI provides an autonomy-supportive atmosphere, which allows clients to find their own source of motivation and achieve their own success in terms of overcoming addiction. Patients randomly assigned to an MI treatment group found the setting to be more autonomy-supportive than those in a regular support group.

Several studies explored the link between self-determination theory and environmental behaviors to determine the role of intrinsic motivation for environmental behavior performance and to account for the lack of success of current intervention strategies. Environmental attitudes and knowledge are not good predictors of behavior. Self-determination theory suggests that motivation can predict behavior performance.

Each item is scored on a Likert scale. The Amotivation toward the Environment Scale measures the four reasons for amotivation by answering a question 'Why are you not doing things for the environment? The participants rank 16 total statements four in each category of amotivation on a Likert scale.

Intervention strategies have to be effective in bridging the gap between attitudes and behaviors. Monetary incentives, persuasive communication, and convenience are often successful in the short term, but when the intervention is removed, behavior is discontinued. In the long run, such intervention strategies are therefore expensive and difficult to maintain. Self-determination theory explains that environmental behavior that is not motivated intrinsically is not persistent.

On the other hand, when self-determination is high, behavior is more likely to occur repeatedly. The importance of intrinsic motivation is particularly apparent with more difficult behaviors. While they are less likely to be performed in general, people with high internal motivation are more likely to perform them more frequently than people with low intrinsic motivation.

According to Osbaldiston and Sheldon , autonomy perceived by an individual leads to an increased frequency of environmental behavior performance. In their study, university students chose an environmental goal and performed it for a week. Perceived autonomy, success in performing chosen behavior, and their future intention to continue were measured. The results suggested that people with higher degree of self-perceived autonomy successfully perform behaviors and are more likely to do so in the long term.

Based on the connection between self-determination theory and environmental behaviors, Pelletier et al. From Wikipedia, the free encyclopedia. This article is about the psychology theory. For the self-determination in politics, see Self-determination.

Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist , 55, Motivation, personality, and development within embedded social contexts: An overview of self-determination theory.

Basic psychological needs in motivation, development, and wellness. Undermining children's intrinsic interest with extrinsic reward: A test of the "overjustification" hypothesis.

Journal of Personality and Social Psychology , 28 , — Effects of externally mediated rewards on intrinsic motivation. Journal of Personality and Social Psychology , 18 , — A motivational approach to self: Perspectives on motivation pp.

University of Nebraska Press. The basis for true self-esteem. Here we describe a few of these interventions. Others are discussed elsewhere in this issue. Some of the earliest developments of SDT-based interventions involved tobacco cessation. In one study, patients who smoked were recruited to have a discussion with their physician about their smoking behavior [ 21 ]. Physicians were randomly assigned to work with each patient in either a need-supportive or need- thwarting manner i. The need-supportive condition was characterized by eliciting and acknowledging the patient's perspective, providing a rationale for advice given, and minimizing control, while avoiding judgment.

The need-thwarting condition was characterized by the physician dominating the conversation, minimizing patient choice, and instructing the patient on what he or she should do, with no rationale or reflection. Patient involvement in the discussion was assessed by independent raters, based on audio tapes of the doctor-patient interaction.

Patient smoking status was assessed at 6 months, 12 months, and 30 months post-discussion. Results revealed that observed physician interaction style indirectly predicted patient smoking status through its direct influence on patient involvement-a hallmark of autonomous self-regulation. This intervention is particularly important because it speaks directly to the practical utility of SDT as it was conducted in the real-world setting of a community-based physician group with physicians and their patients, with whom they had had ongoing relationships.

In the Smokers' Health Study, participants were 1, smokers who smoked at least five cigarettes per day and had smoked at least cigarettes in their lifetime. Slightly more than half of the participants did not want to try to stop smoking at the time they enrolled in the study.

Participants were randomly assigned to either an intensive treatment or community care control. Intensive treatment consisted of four contacts over six months. Practitioners were trained to interact with participants based on the Public Health Service Guideline intensive tobacco dependence treatment [ 48 ] in an SDT-consistent manner, which included: The community care condition consisted of provision of current pamphlets on stopping smoking and encouragement to discuss smoking with one's physician and was consistent with what was typically prescribed for tobacco cessation in the community at the time [ 49 ].

Results demonstrated support for the SDT process model whereby greater perceived need support from one's health care providers including study practitioners predicted greater increases in autonomous self-regulation and perceived competence for stopping smoking from baseline to the end of the intervention.

Greater increases in autonomous self-regulation and perceived competence for stopping smoking predicted better tobacco abstinence 12 months after the end of the intervention, both in terms of 7-day point prevalence and prolonged abstinence. It is worth noting that autonomous self-regulation influenced tobacco abstinence indirectly through its impact on use of smoking cessation medications.

This model was invariant across the intervention and community care groups, suggesting that internalization is at least, in part, a naturally-occurring process. However, it is important to note that those in the intervention group, compared to those in community care, evidenced greater perceived need support, greater changes in autonomous self-regulation and perceived competence for stopping smoking, greater medication usage, and higher abstinence rates. Thus, although the process of internalization appears to be a process that occurs naturally in the course of behavior change, this study demonstrated that the process can be accelerated through a need-supportive, SDT-based intervention [ 12 ].

Importantly, tobacco abstinence was maintained 24 months post-intervention more so for those in the intervention group compared to community care [ 50 ]. Thus, there is some initial evidence that SDT- based interventions not only facilitate health behavior change, but, importantly its maintenance.

Further, change in autonomous self-regulation during treatment directly predicted 7-day abstinence 24 months post-intervention and indirectly predicted change in prolonged abstinence 24 months post- intervention. This suggests that the change in autonomy during treatment continued to motivate new efforts at abstinence well after the intervention was over. SDT-based interventions have also been developed for dental behaviors and oral health [ 10 ].

Participants were 86 individuals in a dental clinic randomly assigned to either the SDT intervention or a usual care control group. All participants completed baseline questionnaires to assess autonomous self- regulation and perceived competence for dental care and were provided with a routine dental cleaning.

One month following the dental cleaning, participants in the intervention group participated in a minute informational session about dental health conducted by a dental hygienist. The informational session was designed to be consistent with the principles of SDT including acknowledging patient perspectives and feelings about dental health concerns, providing a rationale for dental prophylaxis, and providing choices and options for preventive behaviors that patients could choose to adopt.

The dental hygienist also provided competence-support for intervention participants by demonstrating proper brushing and flossing techniques, allowing participants to practice these dental health behaviors, and conveying confidence in participants' ability to maintain these behaviors over time. Six months after the routine dental cleaning, all participants returned for an assessment of their oral health plaque and gingivitis and to complete follow-up questionnaires assessing autonomous self-regulation and perceived competence for dental care, self-reported dental behaviors, and attitudes and affect toward dental care.

Compared to those in the usual care control, those in the SDT intervention group evidenced greater increases in autonomous self-regulation and perceived competence for dental care, decreases in plaque and gingivitis, better self-reported dental behaviors, and more positive attitudes and affect toward dental care.

Importantly, further support for the SDT process model of health behavior change was provided by this study on dental health. Perceived need support of dental health providers predicted greater increases in autonomous self-regulation and perceived competence for dental care, which in turn predicted better dental health behaviors and outcomes i. In addition to these interventions developed for tobacco cessation and oral health, there has been a flurry of recent research activities involving SDT-based interventions for weight loss, physical activity, and dietary change.

Although previous research has examined SDT variables in the context of traditional medical weight loss interventions [ 22 ], this recent research activity has used the tenets of SDT to inform the development of interventions for weight loss, physical activity, and diet.

For example, in a study of patients in a community-based primary care practice, participants who worked with an SDT-trained physical activity counselor experienced greater need support in the health care climate which predicted greater increases in autonomous self-regulation for physical activity and, in turn, increases in perceived competence for physical activity. Both autonomous self-regulation and perceived competence for physical activity predicted greater increases in physical activity behavior [ 9 ].

In a one- year, SDT-based intensive behavioral intervention for weight loss among overweight and obese women, weight loss was greater for women in the intervention compared to the control at the end of the intervention and at 1 year post-intervention [ 11 , 51 ].

The intervention explicitly targeted increasing exercise autonomous self-regulation and intrinsic motivation, namely enjoyment of physical activity. The effect of the intervention on autonomous self-regulation was notable because it was large, it was sustained over one year, and it mediated the effect of the intervention on physical activity at 1 and 2 years [ 52 ].

Further evidence from this study has suggested a "motivational spill-over" whereby autonomous self-regulation for exercise predicted later autonomous self-regulation for healthy eating over one year [ 53 ]. Thus, facilitating autonomous self-regulation in one health domain may increase autonomous self-regulation in other, related domains. Additional details on each of these studies-and other related studies-are provided elsewhere in this issue.

Considered together, these randomized controlled trials demonstrate that SDT based interventions effect change in several health behaviors that are maintained after a free choice period tobacco abstinence, physical activity, dental health, and weight loss. These tests of SDT interventions demonstrate mediation by key SDT constructs, thus linking SDT with these interventions' effect on important health behaviors through change in autonomous self-regulation and perceived competence.

These studies conducted by several investigators in different countries all western cultures support a causal role of change in autonomous self-regulation, and perceived competence in the process of health behavior change.

While SDT and MI have developed independently and have been utilized by relatively independent sets of researchers, recent attention has been given to the complementarity of these perspectives [e. Thus, it is possible indeed, likely!

We hope that the points outlined below will facilitate further discussion, debate, and, perhaps most importantly, empirical investigation about how these two perspectives may complement and enhance each other and the science of health behavior more broadly.

Miller [ 54 ] has described MI as being based on concepts such as causal attributions, cognitive dissonance, and self-efficacy-all of which are grounded in social psychological theories and various social cognitive approaches.

However, MI has been criticized for being largely atheoretical [ 55 ]. This lack of an organizing theoretical framework precludes explanations for how and why MI can be effective [ 56 - 58 ], although recent efforts have been made toward the development of an emergent theory of MI [ 13 ]. SDT is a theory, while MI is a set of techniques for further discussion of this distinction, see [ 8 ].

And although an advantage to SDT is that it offers a theoretical basis from which to understand the mechanisms through which SDT-based interventions are efficacious, a challenge to SDT researchers has been to translate theoretical concepts of need-supportive contexts into clinical techniques used in interventions. One of the areas in which much debate has ensued between SDT and MI researchers is around the area of directiveness. Although Miller and Rollnick [ 61 ] define MI as both client-centered and directive, MI is also very clear that attempts to directly persuade a client are ineffective in dealing with the client's ambivalence because such persuasive attempts inherently "take sides" in the ambivalence.

In contrast, SDT has maintained, in the practice of healthcare interventions, that patient autonomy may be supported, in part, by making explicit recommendations about health and well-being cf 12, Further, in medical contexts in particular, explicit recommendations are often an expected component of interactions between practitioners and patients, and a practitioners' refusal to provide such direction-in addition to its potential for being unethical-does not support the patient's psychological needs.

To illustrate, if a patient asks for a recommendation about treatment for a heart attack, the patient would likely feel a high level of control e. Within SDT, recommendations must be given after eliciting and acknowledging client perspectives, non-coercively and in an autonomy-supportive way. When provided in this manner, the recommendation is more likely to be experienced by the patient as being informational, as opposed to coercive, and thus supports the patient in making the decision himself or herself e.

The choice is ultimately yours, and I am here to support you in whatever decision you make. More recent formulations of MI have allowed for medical practitioners to make recommendations when patients specifically ask for advice and have encouraged directiveness in the case of provoking change talk [ 13 ].

It is also possible that, as with the case of intrinsic motivation described below , these two perspectives have defined "directive" in somewhat different ways. However, SDT and other motivational theories [e. Given this definition, it seems likely that, rather than enhancing intrinsic motivation, MI techniques facilitate the process of internalization of extrinsic motivations see [ 6 ] for a more detailed discussion of this point.

This issue is largely one of semantics and may be one area in which SDT may serve to refine and enhance MI. Despite these differences, there is actually a good deal of conceptual overlap and similarity between SDT and MI. That humans are naturally oriented toward growth, health and well-being.

Additionally, both identify and work with-rather than attempt to combat-patient's ambivalence toward change. Although traditionally, SDT has spoken primarily to the issue of autonomy support, the way in which perceptions of autonomy support have traditionally been measured i. Indeed, perceived competence is facilitated by autonomous self-regulation, which arises out of need-supportive contexts [e. Once individuals have a high willingness to act, they are more likely to learn new knowledge and apply new strategies that result in greater perceived competence.

SDT predicts that perceived competence alone is not sufficient to motivate behavior; it must be accompanied by autonomy. This is in contradistinction to Social Cognitive Theory [ 64 ] which places nearly exclusive emphasis on self-efficacy. These SDT-based interventions are discussed in greater detail elsewhere in this issue [cf 64]. MI originally identified four key principles consistent with the practice of MI techniques: More recent conceptualizations of MI applications to health care contexts have used somewhat different terminology, though the spirit of MI remains much the same [ 66 ].

We also discuss how these elements of MI are consistent with the support of psychological needs identified by SDT and thus, may support the process of internalization more broadly.

MI recognizes the natural tendency for those in the helping professions-particularly those in health care settings-to want to try to "fix" whatever is wrong with their patients or clients.

However, MI also notes that resistance can arise when patients feel that their practitioner is trying to convince them of a particular course of action. This may be particularly pronounced in situations in which the individual feels ambivalent about change. Thus, it is critical that practitioners resist the righting reflex and instead allow clients to explore both sides of their ambivalence so that, in the end, the client is the one giving voice to reasons for change [ 66 ].

This guiding principle is similar to what SDT describes as minimizing control and remaining nonjudgmental. This may support clients' needs for both autonomy and relatedness by allowing patients the freedom to explore reasons for or against change autonomy in a non-judgmental context relatedness.

Like SDT, from the perspective of MI, it is critical for patients to experience themselves as the originators of their actions toward behavior change. Thus, practitioners need to understand and explore the patient's motivations. This includes exploring how the patient views their current behavior and situation, concerns about change, and other goals and values [ 66 ]. This guiding principle of MI is consistent with SDT autonomy support, particularly eliciting and acknowledging client perspectives and emotions, supporting client initiative, and assessing values.

One of the defining features of MI is its emphasis on listening to the patient empathically. Thus, MI places importance on listening over informing on the part of practitioners, and an empathic interpersonal style, including an authentic interest in understanding the client [ 61 , 65 , 66 ]. According to MI, the client must feel personally accepted and valued before behavior change is possible. Listening to a patient empathically likely supports the client's need for relatedness and reflects that both MI and SDT emerged from the Rogerian school of thought, which promotes unconditional positive regard and patient centeredness as paramount to the therapeutic relationship [ 60 ].

Finally, the fourth guiding principle of MI- empower the patient - involves supporting self-efficacy for change. This technique likely primarily supports clients' need for competence by enhancing their confidence in being able to make progress toward positive change and to cope with challenges and barriers as they arise.

In addition to these four guiding principles, MI researchers have also articulated three core communication skills that provide practical utility to these principles. These communication skills include asking, listening, and informing. The purpose of asking is to elicit the client's perspective so that the practitioner understands where the patient is coming from and how the patient approaches the possibility of behavior change.

Listening is an active process whereby the practitioner "checks in" with the client to ensure that he or she has an accurate understanding of client's perspective, motivations, and struggles through the process of behavior change. Finally, informing is the primary means by which practitioners convey knowledge to a client about their health condition, the behavior changes necessary to monitor or improve the health condition, and treatment options that may be available.

Although SDT and MI originally began on two distinct paths, it seems clear from this special issue, the meeting in Sintra, and previous publications elsewhere [e.

However, it is important that this endeavor not stagnate with discussion and debate. Indeed, the next steps in this process of bringing together this theory and these clinical techniques must be borne out empirically.

SDT has not yet identified the critical components for supporting psychological needs and facilitating autonomous self-regulation and perceived competence in health behavior interventions. MI techniques and their assessments may be useful additions to current SDT interventions in informing this empirical avenue. However, to date, results on whether MI interventions facilitate change in autonomous self-regulation, in particular, have been somewhat mixed, though some research has found that autonomous self-regulation mediates the association between MI intervention and treatment outcome [ 71 ].

Additional research is needed to identify which principles of MI operate on need support and the process of internalization. Further, current measures from SDT may need to be refined to better capture all three dimensions of perceived need support and to more accurately assess fluctuations in autonomous self-regulation and perceived competence in the initial stages of behavior change as well as behavior maintenance. In addition, assessment techniques, advanced analytic methods growth curve analysis and latent trajectory modeling and the use of internet technology and mobile devices in ecological momentary sampling may also improve researchers' ability to detect changes in motivation in response to provision of specific components of need support.

Finally, future research in which MI and SDT-based interventions are directly compared are needed to 1 more clearly elucidate the extent to which SDT can explain how and why MI interventions effect behavior, 2 identify aspects of SDT-based interventions that are similar to and distinct from MI e.

These empirical endeavors require not only a bridging of ideas but, perhaps more importantly, the convergence of a multi-conceptual team with representation from both SDT and MI camps to refine MI techniques, to improve SDT applications to health behavior, and to further expand our understanding of these approaches and how they serve to facilitate the initiation and maintenance of health behavior change.

Miller and Rose [ 13 ] recently published a statement on a theory for MI. From the SDT perspective, change talk is a reflection of the client or patient shifting from a voice of external locus of causality to internal -literally reflecting "real time" internalization. However, it is not clear that this is precisely how MI views change talk. Miller and Rose [ 13 ] and others have placed strong emphasis on practitioners actively promoting and eliciting change talk. This may be somewhat inconsistent with SDT.

The aggressive push toward change talk may reflect an underlying assumption that the person is better off changing when in fact this may not be their goal. Pushing change talk may be experienced as coercive and judgmental, and thus is not need-supportive. Self-determination theorists will also need to carefully consider whether MI's statement of theory is consistent with SDT. Particularly important for SDT theorists and researchers will be the resolution of issues such as MI's conceptualization of intrinsic motivation, the role of directiveness, and the issue of development of discrepancy.

Though the latter is not explicitly listed in current conceptualizations of MI's guiding principles, the extent to which development of discrepancy is key to the execution of MI interventions may be important particularly with respect to whether this aspect of MI supports or thwarts need satisfaction.

By bringing together the strengths of both approaches, we may be better equipped to develop efficacious interventions that yield positive results for health, health behavior, and well-being not only amongst the highly motivated participant pool willing to enroll in clinical trials but also among more general patient populations with whom practitioners interact on a daily basis. Only by facilitating the development of practical interventions with long-lasting effects will we succeed in improving length and quality of life through lifestyle change.

Collaborative efforts between complementary approaches will foster the development of a rigorous science of health behavior change that is equipped to tackle these issues in the real world of health care practice. HP and GWC discussed the format and scope of the manuscript.

HP wrote the initial draft of the manuscript, and GWC contributed to the writing of the manuscript. All authors read and approved the final manuscript. National Center for Biotechnology Information , U. Published online Mar 2. Heather Patrick 1 and Geoffrey C Williams 2. Received Jul 14; Accepted Mar 2.

This article has been cited by other articles in PMC. Abstract Mounting evidence implicates health behaviors e. Its Application to Health Behavior and Complementarity with Motivational Interviewing An impressive body of research has provided convincing evidence for the pivotal role of behavior in well-being, and morbidity and mortality, as well as health care costs [ 1 ]. Self-Determination Theory Self-determination theory SDT [ 14 , 15 ] is a general theory of human motivation that emphasizes the extent to which behaviors are relatively autonomous i.

The Motivation Continuum Traditionally, theories of motivation have made a distinction between intrinsic and extrinsic motivations. Open in a separate window. Aspirations As described above, SDT has focused on the role of personality-level i.

From Basic Science to Application: Overlap and Distinctions While SDT and MI have developed independently and have been utilized by relatively independent sets of researchers, recent attention has been given to the complementarity of these perspectives [e.

Directions for the Future Although SDT and MI originally began on two distinct paths, it seems clear from this special issue, the meeting in Sintra, and previous publications elsewhere [e. Conclusions By bringing together the strengths of both approaches, we may be better equipped to develop efficacious interventions that yield positive results for health, health behavior, and well-being not only amongst the highly motivated participant pool willing to enroll in clinical trials but also among more general patient populations with whom practitioners interact on a daily basis.

Competing interests The authors declare that they have no competing interests. We can do better-Improving the health of the American people.

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Transforming health care to dispense knowledge for decision making. Informed decision making in outpatient practice: Time to get back to basics.

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Self-Determination Theory (SDT) is a theory of motivation. It is concerned with supporting our natural or intrinsic tendencies to behave in effective and healthy ways. It is concerned with supporting our natural or intrinsic tendencies to behave in effective and healthy ways.

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Self-Determination Theory (SDT), developed by Deci and Ryan, identifies autonomy, relatedness, and competence as crucial elements of human motivation.

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Self-determination theory focuses on internal sources of motivation including the need for personal growth and fulfillment. Learn how this process works. Summary: Self-Determination Theory is a theory of motivation and personality that addresses three universal, innate and psychological needs: competence, autonomy, and psychological relatedness.

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Mar 02,  · Self-Determination Theory: Its Application to Health Behavior and Complementarity with Motivational Interviewing. An impressive body of research has provided convincing evidence for the pivotal role of behavior in well-being, and morbidity and mortality, as well as health care costs [].Indeed, some estimates indicate that nearly 3/4 of all health care costs are attributable to chronic diseases. Join Karl Kapp for an in-depth discussion in this video, Self-determination theory, part of Gamification of Learning.