Self-determination theory is a theory of human motivation that describes two distinct types of motivation: autonomous (regulated through natural and internal processes such as inherent enjoyment or satisfaction) and controlled (regulated through externally held demands and social expectations). Autonomous motivation can be elicited and sustained through social–environmental factors including high autonomy, competence, and relatedness and may contribute to long-term maintenance of a behavior change.
Self-determination theory (SDT) is a theory of human motivation that describes motivation in two distinct types: autonomous and controlled (Deci and Ryan 2008). Autonomous motivation, which includes intrinsic and well-internalized extrinsic motivation, is regulated through natural and internal processes such as inherent satisfaction and can be thought of as an individual’s innate desire to engage in healthy behaviors independent of external influences. Autonomous motivation can be elicited and sustained through social contextual conditions including social support from significant others that facilitates intrinsic motivation (e.g., autonomy, competence, and relatedness) in contrast to conditions that undermine one’s innate propensity for it such as authoritarian or highly controlled interpersonal interactions (Ryan and Deci 2000). An intrinsically motivated individual may engage in healthy eating because it aligns with his/her self-concept and is enjoyable. Controlled (extrinsic) motivation is regulated through externally held demands and expectations that are contingent on rewards or punishments. An extrinsically motivated individual may engage in healthy eating for approval from peers or to avoid health consequences rather than inherent enjoyment or self-satisfaction. While both types of motivation represent an individual’s intention to act, health behavior outcomes resulting from autonomous versus controlled motivation may be qualitatively different. A growing evidence base shows that autonomous motivation may more likely contribute to the maintenance of health behaviors compared to controlled motivation (Ng et al. 2012).
SDT provides a framework for understanding motivational influences on health behaviors, such as healthy diet, physical activity, safe sex practices, and substance use. The conceptualization of motivation on a continuum allows for distinctions to be made in the type and quality of motivation that may contribute to different outcomes. SDT makes distinctions between autonomous and controlled motivation with autonomous motivation being more inherently enjoyable, long-lasting, and internally regulated, while controlled motivation consists of motivation that is primarily driven by externally held demands, social pressures, and reinforcers (Deci and Ryan 2008). For example, controlled motivation based on social pressures has been shown to be negatively related to fruit and vegetable intake compared to autonomous motivation which positively predicted this health behavior (McSpadden et al. 2016).
SDT originally conceptualized the motivation continuum as ranging from amotivation to extrinsic to intrinsic motivation. Amotivation is conceptualized as having no intention to act and has been associated with a lack of outcome value, as well as a lack of beliefs about the link between behavior and desired outcome, or competence in performing the behavior. On the one end of the continuum, motivation is hypothesized to be regulated extrinsically and controlled by rewards and punishments or other externally regulated processes. Extrinsic motivation may be broken down into subcategories based on increasing levels of intrinsic regulation: extrinsic, introjected (i.e., somewhat external regulation or internal rewards and/or punishments), and identified (somewhat internal regulation and holds personal importance; Deci and Ryan 1985; Ryan and Deci 2000). At the other end of the continuum, intrinsic motivation is regulated or controlled by an individual’s inherent satisfaction, novelty, and drive. Previous research has supported beneficial effects of intrinsic motivation compared to extrinsic motivation in substance abuse treatment outcomes (Zeldman et al. 2004) and in predicting mental health and job outcomes in the workplace (Vansteenkiste et al. 2007). However, some researchers have combined extrinsic and introjected into controlled-type motivation and combined identified and intrinsic into autonomous-type motivation (Deci and Ryan 2008). This has resulted in a shift of the primary motivation differentiation moving toward autonomous and controlled in conceptualizing intrinsic and extrinsic in a more dynamic fashion.
SDT emphasizes the role of social context in understanding health behavior motivation and suggests its influence on behavior is through affecting social contextual conditions that may help to elicit and sustain intrinsic motivation. These conditions are described as psychological needs that are inherent to being human and consist of the needs for competence, autonomy, and relatedness. Social relationships (e.g., social support), environmental characteristics (e.g., built environment, resources), and cultural practices and norms (e.g., gender roles) can influence these psychological needs and in turn facilitate or undermine one’s sense of intrinsic motivation for engaging in healthy behaviors (Deci and Ryan 1985, 2008; Ryan and Deci 2000). An intervention to increase physical activity, the Active by Choice Today trial, focused on increasing social support (relatedness), teaching behavioral skills (competence), and encouraging choice (autonomy) to provide conditions that facilitate the development of autonomous motivation to be physically active for a lifetime (Wilson et al. 2008). This trial showed a significant intervention effect on increasing accelerometry estimates of physical activity in youth during the afterschool program as compared to a general health education program (Wilson et al. 2011). Similarly, researchers and clinicians interested in reducing substance use have utilized autonomy-supportive strategies for resisting peer pressure (competence) for substance use while preserving positive peer relationships (relatedness) and increasing their choices for alternative activities (autonomy; Williams et al. 2000).
Application of SDT to interventions with other behavioral change theories, such as Social Cognitive Theory (SCT) or Family Systems Theory (FST), has also been implemented in recent trials. For example, the Families Improving Together for Weight Loss trial combined essential elements from SCT including self-monitoring and goal setting and FST including family communication skills and social support with SDT strategies that promoted parental autonomy-supportive communication to enhance motivation for health behavior change in overweight African American adolescents (Wilson et al. 2015). Integrating evidenced-based theoretical frameworks will allow researchers to design comprehensive interventions that are relevant and effective in improving long-term health behaviors.
There is growing evidence that interventions that address cognitive and social factors related to health behavior change may also have ripple effects, such as impacting additional physical, mental, and social health outcomes that were not the intended targeted outcomes (Wilson 2015). This suggests that these health behavior interventions may have far-reaching benefits and impact population health more broadly. Mata et al. (2009) found that increased motivation for exercise behavior also had positive effects on eating self-regulation in a weight control intervention, suggesting that utilizing SDT in health behavior interventions may support multiple health behavior change. Further, a recent meta-analysis of studies utilizing SDT in health interventions showed positive relationships between supportive health climates that emphasized autonomous motivation and mental and physical health, suggesting that positive health climate-based interventions may be a cost-effective strategy to improve a variety of health outcomes (Ng et al. 2012). In addition, a recent study found that applying SDT to financial incentives was a cost-effective strategy for increasing adherence to existing treatments (Kullgren et al. 2016). However, it is important to utilize theories of motivation, such as SDT, in behavioral economics studies to better understand which types of incentive structures may yield consistent positive changes across different settings (Haff et al. 2015).
In conclusion, SDT has been shown to be a promising theory for individual health behavior change that emphasizes the importance of a positive social context in fostering motivation over time and across health behaviors. Applications of SDT, especially when coupled with other evidenced-based theoretical frameworks of behavior change, show strong promise for future interventions that could be important for improving population level health outcomes.
References and Further Reading
- Haff, N., Patel, M. S., Lim, R., Zhu, J., Troxel, A. B., Asch, D. A., & Volpp, K. G. (2015). The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: A meta-analysis. American Journal of Health Promotion, 29(5), 314–323.CrossRefGoogle Scholar
- Mata, J., Silva, M. N., Vieira, P. N., Carraça, E. V., Andrade, A. M., Coutinho, S. R., …, & Teixeira, P. J. (2009). Motivational “spill-over” during weight control: Increased self-determination and exercise intrinsic motivation predict eating self-regulation. Health Psychology, 28(6), 709.CrossRefGoogle Scholar
- Vansteenkiste, M., Neyrinck, B., Niemiec, C. P., Soenens, B., Witte, H., & Broeck, A. (2007). On the relations among work value orientations, psychological need satisfaction and job outcomes: A self-determination theory approach. Journal of Occupational and Organizational Psychology, 80(2), 251–277.CrossRefGoogle Scholar
- Wilson, D. K., Van Horn, M. L., Kitzman-Ulrich, H., Saunders, R., Pate, R., Lawman, H. G. …, & Mansard, L. (2011). Results of the “Active by Choice Today” (ACT) randomized trial for increasing physical activity in low-income and minority adolescents. Health Psychology, 30(4), 463–471.CrossRefGoogle Scholar
- Wilson, D. K., Kitzman-Ulrich, H., Resnicow, K., Van Horn, M. L., George, S. M. S., Siceloff, E. R., …, & Coulon, S. (2015). An overview of the Families Improving Together (FIT) for weight loss randomized controlled trial in African American families. Contemporary Clinical Trials, 42, 145–157.CrossRefGoogle Scholar