13.6: Self-Determination Theory

Another theory that emerged in the 1970s and 80s was the self-determination theory, developed by psychologists Edward Deci and Richard Ryan. This model focuses on what motivates a person to perform a task or work towards a goal, whether it is an academic, occupational, or health-related goal. Instead of assuming that people will or will not perform a behavior based on the reward or punishment they might receive afterward, this model describes a person’s motivation based on how much autonomy they feel they have (O’Hara, 2017). Motivation is described as “psychological energy directed at a particular goal” (Patrick & Williams, 2012). Traditional concepts of motivation include extrinsic or external motivation (as when someone is motivated by an external reward), vs. intrinsic or internal motivation (as when someone enjoys the behavior itself). Intrinsic motivation is considered the most powerful and long lasting type of motivation, and is therefore valued much more than extrinsic motivation. But Deci and Ryan proposed that there are still powerful types of extrinsic motivation, particularly for behaviors that people may not ever enjoy doing - and must therefore find a “why” that keeps them going.

Figure \(\PageIndex{1}\): The Extrinsic Motivation Continuum

Self-determination theory expands on extrinsic motivation and includes the “internalization” of external forces; people can internalize social pressures and even be self-motivated for external benefits of a behavior (Patrick & Williams, 2012). Thus extrinsic motivation becomes a continuum including the following types of self-regulation:

• External regulation (in pursuit of a reward, or avoiding a negative impact),
• Introjected regulation (feeling guilty or obligated to others, or trying to prove something to themselves or others)
• Identified regulation (the behavior is important to them)
• Integrated regulation (the behavior aligns with their personal goals and values)(Patrick & Williams, 2012) (See Figure 13.4 above).

Intrinsic motivation is still identified as doing something simply for the sake of doing it, because the person enjoys the behavior itself. But the expansion of extrinsic motivation into a continuum also recognizes that with health behaviors in particular, someone can value a behavior and be strongly motivated without actually enjoying the behavior itself. Some behaviors may always have an extrinsic level of motivation, like “eating your vegetables”. A person can also have several types of motivations for their health behaviors, and can move between these levels of extrinsic motivation over time (Patrick & Williams, 2012). The first two, external and introjected regulation, are considered “controlled motivation” because they are largely based on external pressures. Identified and integrated regulation are considered “autonomous motivation” because the reasons for changing are derived from the person themselves, rather than pressures from others (Sheeran et al., 2020). The more autonomous types of motivation are considered stronger and more persistent over time. See Figure 13.4 above for a diagram of the extrinsic motivation continuum.

The SDT is further built on the concept that humans have 3 basic psychological needs that influence their motivation: autonomy, relatedness, and competence. Autonomy is the sense that someone has that they are in control of their life and making their own decisions. Relatedness refers to the social connections that the person has with others, particularly supportive relationships. Competence describes the person’s perceptions of their own capabilities relative to achieving their goal - essentially their self-efficacy. In order for a person to develop longer-lasting and powerful types of extrinsic motivation, they need to have these three needs met (Patrick & Williams, 2012). See Fig. (\PageIndex{2}\) for a diagram of the SDT needs.

Figure \(\PageIndex{2}\): Diagram of Self-Determination Theory - motivational needs.

Physicians, therapists, and coaches can use several strategies that support an individual’s perceived autonomy, competence, and relatedness. For example, instead of simply telling a patient with obesity that they must diet and exercise to lose weight, a practitioner might ask the patient about their prior experiences with attempting to lose weight, validate their feelings of apprehension about trying again, explore why losing weight is important to them. They might ask the patient about how this weight loss aligns with their health goals and values, and provide some information on evidence-based weight-loss methods. This supports the patient’s autonomy in making their own decisions about their weight management. Practitioners can help patients build self-efficacy and competence by reviewing past experiences, and reframing “failures” as short successes - even leveraging memories of success in other areas of life. They can help the patient set small, achievable goals that will add up to the larger goal - giving them small “wins” to reinforce their competence. Finally, supporting the patient in setting their own goals, outlining a plan, and strategizing for potential challenges can allow for the patient to feel more autonomy - and more competence when they are successful. It is especially important that the practitioner provides their support (relatedness) in a non-judgmental way, putting the patient in the “driver’s seat” rather than taking control themselves. Several interventions have shown that SDT can be successful in helping people to quit smoking, lose weight, take their medications, and even practice better oral hygiene (like flossing and brushing techniques) (Patrick & Williams, 2012).