Dental hygienists' biopsychosocial beliefs and giving autonomy support in treatment of patients: A self-determination theory perspective.

OBJECTIVES: Self-determination theory posits that managers' autonomy-supportive behaviour and employees' autonomy causality orientation are motivation constructs to explain internalization of values, functioning and wellness at work. Hypothesis 1 tested whether profiles comprising perceived dental clinic managers' autonomy-supportive, as opposed to their controlling interpersonal style, and dental hygienists' autonomy, as opposed to their control and impersonal, causality orientations at baseline, would be positively related to dental hygienists' biopsychosocial (BPS) beliefs and giving autonomy support in treatment of patients after 18 months. Hypothesis 2 tested whether dental hygienists' BPS beliefs in treatment of patients will be positively associated with their autonomy-supportive behaviour given to patients after 18 months. MATERIAL AND METHODS: A prospective cohort design with 299 (Mage  = 42.71; SDage  = 12.62) dental hygienists completed an online survey at baseline and after 18 months. RESULTS: Latent profile and correlational analyses supported the hypotheses. Effect sizes were moderate to large. CONCLUSIONS: Both perceived managerial styles and dental hygienists' causality orientations are important for dental hygienists' BPS beliefs and autonomy-supportive behaviours when working with dental patients.

How self-determined choice facilitates performance: a key role of the ventromedial prefrontal cortex.

Recent studies have documented that self-determined choice does indeed enhance performance. However, the precise neural mechanisms underlying this effect are not well understood. We examined the neural correlates of the facilitative effects of self-determined choice using functional magnetic resonance imaging (fMRI). Participants played a game-like task involving a stopwatch with either a stopwatch they selected (self-determined-choice condition) or one they were assigned without choice (forced-choice condition). Our results showed that self-determined choice enhanced performance on the stopwatch task, despite the fact that the choices were clearly irrelevant to task difficulty. Neuroimaging results showed that failure feedback, compared with success feedback, elicited a drop in the vmPFC activation in the forced-choice condition, but not in the self-determined-choice condition, indicating that negative reward value associated with the failure feedback vanished in the self-determined-choice condition. Moreover, the vmPFC resilience to failure in the self-determined-choice condition was significantly correlated with the increased performance. Striatal responses to failure and success feedback were not modulated by the choice condition, indicating the dissociation between the vmPFC and striatal activation pattern. These findings suggest that the vmPFC plays a unique and critical role in the facilitative effects of self-determined choice on performance.

Outcomes of the Smoker's Health Project: a pragmatic comparative effectiveness trial of tobacco-dependence interventions based on self-determination theory.

A pragmatic comparative effectiveness trial examined whether extending the duration of a cost-effective, intensive tobacco-dependence intervention designed to support autonomy will facilitate long-term tobacco abstinence. Participants were randomly assigned to one of three tobacco-dependence interventions based on self-determination theory, namely, Intensive Treatment (IT; six contacts over 6 months), Extended Need Support (ENS; eight contacts over 12 months) and Harm Reduction (HR; eight contacts over 12 months with medication use if willing to reduce cigarette use by half). Among participants who completed the interventions, analyses revealed beneficial effects of ENS (15.7 versus 3.8%; χ 2(1) = 6.92, P < 0.01) and HR (13.6 versus 3.8%; χ 2(1) = 5.26, P < 0.05), relative to IT, on 12-month prolonged abstinence from tobacco. Also, analyses revealed beneficial effects of ENS (77.7 versus 43.0%; χ 2(1) = 24.90, P < 0.001) and HR (84.0 versus 43.0%; χ 2(1) = 37.41, P < 0.001), relative to IT, on use of first-line medications for smoking cessation. Hence, two new interventions were found to be efficacious particularly among participants who completed the interventions. Smokers who stay in treatment for an additional 6 months may benefit from an additional two contacts with practitioners, and thus it seems reasonable for policy makers to offer additional contacts given the health benefits associated with prolonged tobacco abstinence.

Diminished neural responses predict enhanced intrinsic motivation and sensitivity to external incentive.

The duration and quality of human performance depend on both intrinsic motivation and external incentives. However, little is known about the neuroscientific basis of this interplay between internal and external motivators. Here, we used functional magnetic resonance imaging to examine the neural substrates of intrinsic motivation, operationalized as the free-choice time spent on a task when this was not required, and tested the neural and behavioral effects of external reward on intrinsic motivation. We found that increased duration of free-choice time was predicted by generally diminished neural responses in regions associated with cognitive and affective regulation. By comparison, the possibility of additional reward improved task accuracy, and specifically increased neural and behavioral responses following errors. Those individuals with the smallest neural responses associated with intrinsic motivation exhibited the greatest error-related neural enhancement under the external contingency of possible reward. Together, these data suggest that human performance is guided by a "tonic" and "phasic" relationship between the neural substrates of intrinsic motivation (tonic) and the impact of external incentives (phasic).

Show them the money? The role of pay, managerial need support, and justice in a self-determination theory model of intrinsic work motivation.

The link between money and motivation has been a debated topic for decades, especially in work organizations. However, field studies investigating the amount of pay in relation to employee motivation is lacking and there have been calls for empirical studies addressing compensation systems and motivation in the work domain. The purpose of this study was to examine outcomes associated with the amount of pay, and perceived distributive and procedural justice regarding pay in relation to those for perceived managerial need support. Participants were 166 bank employees who also reported on their basic psychological need satisfaction and intrinsic work motivation. SEM-analyses tested a self-determination theory (SDT) model, with satisfaction of the competence and autonomy needs as an intervening variable. The primary findings were that amount of pay and employees' perceived distributive justice regarding their pay were unrelated to employees' need satisfaction and intrinsic work motivation, but procedural justice regarding pay did affect these variables. However, managerial need support was the most important factor for promoting need satisfaction and intrinsic work motivation both directly, indirectly, and as a moderator in the model. Hence, the results of the present organizational field study support earlier laboratory experiments within the SDT framework showing that monetary rewards did not enhance intrinsic motivation. This seems to have profound implications for organizations concerned about motivating their employees.

Self-determination theory in health care and its relations to motivational interviewing: a few comments.

The papers of this special issue have the dual focus of reviewing research, especially clinical trials, testing self-determination theory (SDT) and of discussing the relations between SDT and motivational interviewing (MI). Notably, trials are reviewed that examined interventions either for behaviors such as physical activity and smoking cessation, or for outcomes such as weight loss. Although interventions were based on and intended to test the SDT health-behavior-change model, authors also pointed out that they drew techniques from MI in developing the interventions. The current paper refers to these studies and also clarifies the meaning of autonomy, which is central to SDT and has been shown to be important for effective change. We clarify that the dimension of autonomy versus control is conceptually orthogonal to the dimension of independence versus dependence, and we emphasize that autonomy or volition, not independence, is the important antecedent of effective change. Finally, we point out that SDT and MI have had much in common for each has emphasized autonomy. However, a recent MI article seems to have changed MI's emphasis from autonomy to change talk as the key ingredient for change. We suggest that change talk is likely to be an element of effective change only to the degree that the change talk is autonomously enacted and that practitioners facilitate change talk in an autonomy supportive way.

How environmental and psychological factors interact with travel participation after spinal cord injury.

PURPOSE/OBJECTIVE: Spinal cord injury (SCI) usually causes neurological impairment, which can make traveling to places challenging. The ability to travel is nevertheless essential for societal participation, and full participation of persons in society after SCI is a key indicator of successful rehabilitation. Research has widely documented lowered level of participation of people living with SCI. To offer insights for effective intervention, the study aims to examine how psychological and environmental factors influence participation in travel related activities after SCI. Based on the self-determination theory (SDT) and the literature in participation research, the study proposed a model depicting the interrelationships among travel barriers, travel need satisfaction, travel motivation and participation of people with SCI in travel-related activities. RESEARCH METHOD/DESIGN: Cross-sectional quantitative data were collected from 250 individuals enrolled in a SCI model system. RESULTS: Path analysis reveals significant negative effect of travel barriers on respondents' need satisfaction for autonomy, which in turn affects controlled motivation (introjected and external) and amotivation. Only external motivation leads to participation in travel while amotivation negatively influences travel participation. Travel barriers were found to indirectly influence travel participation through need satisfaction for autonomy, external motivation and amotivation. CONCLUSIONS/IMPLICATIONS: Although people have high intrinsic motivation for travel, they do not travel for fun as much as for external motivations after SCI. Travel barriers can lower people's need satisfaction for autonomy, which results more travel for external motivation. The study provides preliminary evidence supporting an SDT-based travel participation model after SCI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A meta-analysis of self-determination theory-informed intervention studies in the health domain: effects on motivation, health behavior, physical, and psychological health.

There are no literature reviews that have examined the impact of health-domain interventions, informed by self-determination theory (SDT), on SDT constructs and health indices. Our aim was to meta-analyse such interventions in the health promotion and disease management literatures. Studies were eligible if they used an experimental design, tested an intervention that was based on SDT, measured at least one SDT-based motivational construct, and at least one indicator of health behaviour, physical health, or psychological health. Seventy-three studies met these criteria and provided sufficient data for the purposes of the review. A random-effects meta-analytic model showed that SDT-based interventions produced small-to-medium changes in most SDT constructs at the end of the intervention period, and in health behaviours at the end of the intervention period and at the follow-up. Small positive changes in physical and psychological health outcomes were also observed at the end of the interventions. Increases in need support and autonomous motivation (but not controlled motivation or amotivation) were associated with positive changes in health behaviour. In conclusion, SDT-informed interventions positively affect indices of health; these effects are modest, heterogeneous, and partly due to increases in self-determined motivation and support from social agents.

The Roles of Patients' Authenticity and Accepting External Influence, and Clinicians' Treatment Styles in Predicting Patients' Dental Anxiety and Avoidance of Dental Appointments.

A substantial proportion of adults suffer from high dental anxiety, which is related to poor oral health and functioning. Using authenticity theory and self-determination theory, we applied a model testing two moderated mediation hypotheses: (i) the negative indirect association between authenticity and avoiding dental appointments through dental anxiety would be more evident when clinicians provides higher levels of autonomy support; and (ii) the indirect positive association between accepting external influence and avoiding dental appointments through dental anxiety would be more evident when clinicians provides higher levels of controllingness. Participants (N = 208) responded to a survey with validated questionnaires. The model with hypotheses were tested using Structural Equation Modeling (SEM) in LISREL and Conditional Process Modeling (moderated mediation). The results supported our hypotheses. The SEM model tested was found to fit the data well. Patient's personality and dental clinic treatment environments predicted 38% of the variance in dental anxiety, which explained 38% of avoidance of treatment.

The importance of supporting autonomy and perceived competence in facilitating long-term tobacco abstinence.

BACKGROUND: The Public Health Service (PHS) Guideline for Treating Tobacco Use and Dependence (Fiore et al. 2000) recommends supporting autonomy and perceived competence to facilitate tobacco abstinence. PURPOSE: The aim of the study was to evaluate the effectiveness of an intensive tobacco-dependence intervention based on self-determination theory (SDT) and intended to support autonomy and perceived competence in facilitating long-term tobacco abstinence. METHODS: One thousand and six adult smokers were recruited into a randomized cessation-induction trial. Community care participants received cessation pamphlets and information on local treatment programs. Intervention participants received the same materials and were asked to meet four times with counselors over 6 months to discuss their health in a manner intended to support autonomy and perceived competence. The primary outcome was 24-month prolonged abstinence from tobacco. The secondary outcome was 7-day point prevalence tobacco abstinence at 24 months postintervention. RESULTS: Smokers in the intervention were more likely to attain both tobacco abstinence outcomes and these effects were partially mediated by change in both autonomous self-regulation and perceived competence from baseline to 6 months. Structural equation modeling confirmed the SDT model of health-behavior change in facilitating long-term tobacco abstinence. CONCLUSIONS: An intervention based on SDT and consistent with the PHS Guideline, which was intended to support autonomy and perceived competence, facilitated long-term tobacco abstinence.

The emotional and academic consequences of parental conditional regard: comparing conditional positive regard, conditional negative regard, and autonomy support as parenting practices.

The authors conducted 2 studies of 9th-grade Israeli adolescents (169 in Study 1, 156 in Study 2) to compare the parenting practices of conditional positive regard, conditional negative regard, and autonomy support using data from multiple reporters. Two socialization domains were studied: emotion control and academics. Results were consistent with the self-determination theory model of internalization, which posits that (a) conditional negative regard predicts feelings of resentment toward parents, which then predict dysregulation of negative emotions and academic disengagement; (b) conditional positive regard predicts feelings of internal compulsion, which then predict suppressive regulation of negative emotions and grade-focused academic engagement; and (c) autonomy support predicts sense of choice, which then predicts integrated regulation of negative emotions and interest-focused academic engagement. These findings suggest that even parents' use of conditional positive regard as a socialization practice has adverse emotional and academic consequences, relative to autonomy support.

Aspiring to physical health: the role of aspirations for physical health in facilitating long-term tobacco abstinence.

OBJECTIVE: To assess aspirations for physical health over 18 months. To examine whether maintained importance of aspirations for physical health mediated and/or moderated the effect of an intensive intervention on long-term tobacco abstinence. METHODS: Participants were randomly assigned to an intervention based on self-determination theory or to community care, and provided data at baseline and at 18 and 30 months post-randomization. RESULTS: Aspirations for physical health were better maintained over 18 months among participants in the intervention (mean change=.05), relative to community care (mean change=-.13), t=2.66, p<.01. Maintained importance of aspirations for physical health partially mediated the treatment condition effects on seven-day point prevalence tobacco abstinence (z'=1.68, p<.01) and the longest number of days not smoking (z'=2.16, p<.01), and interacted with treatment condition to facilitate the longest number of days not smoking (beta=.08, p<.05). CONCLUSION: Maintained importance of aspirations for physical health facilitated tobacco abstinence. PRACTICE IMPLICATIONS: Smokers may benefit from discussing aspirations for physical health within autonomy-supportive interventions. Patients may benefit from discussing aspirations during counseling about therapeutic lifestyle change and medication use.

Autonomy-supportive dental treatment, oral health-related eudaimonic well-being and oral health: a randomized clinical trial.

Objective: We tested the hypotheses that a dental intervention designed to promote oral care competence in an autonomy-supportive way, relative to standard care, would positively predict patients' perceived autonomy support from oral health-care professionals, increases in eudaimonic well-being (i.e. both personal growth and purposeful behaviour goals) and improved oral health (i.e. reduced dental bacterial plaque on tooth surface and reduced gingivitis) over 5.5 months. We also tested a self-determination theory model with the intervention positively predicting perceived autonomy support, which in turn would predict increases in eudemonic well-being, leading to improved oral health.Design: A randomised two-group experiment was conducted at a dental clinic with 138 patients (Mage = 23.31 yr, SD = 3.5). Variables were measured before and right after the intervention and 5.5 months later.Results: Overall, the experiment and hypothesised process models received strong support. The effect sizes were large for perceived autonomy support, change in personal growth, change in dental plaque and change in gingivitis, whereas the effect size for purposeful behaviour was moderate. The measurement and structural equation models for the SDT process model received good fit.Conclusions: The current field experiment extends previous knowledge by showing that promoting patient oral care competence in an autonomy-supportive way improves oral health through patients' eudaimonic well-being.

Solitude as an Approach to Affective Self-Regulation.

In this research, we showed that solitude generally has a deactivation effect on people's affective experiences, decreasing both positive and negative high-arousal affects. In Study 1, we found that the deactivation effect occurred when people were alone, but not when they were with another person. Study 2 showed that this deactivation effect did not depend on whether or not the person was engaged in an activity such as reading when alone. In Study 3, high-arousal positive affect did not drop in a solitude condition in which participants specifically engaged in positive thinking or when they actively chose what to think about. Finally, in Study 4, we found that solitude could lead to relaxation and reduced stress when individuals actively chose to be alone. This research thus shed light on solitude effects in the past literature, and on people's experiences when alone and the different factors that moderate these effects.

Predicting dental attendance from dental hygienists' autonomy support and patients' autonomous motivation: A randomised clinical trial.

OBJECTIVE: To test the hypothesis that a Self-Determination Theory (SDT) intervention designed to promote oral health care competence in an autonomy-supportive way would predict change in caries competence relative to standard care. Further, to test the SDT process path-model hypotheses with: (1) the intervention and individual differences in relative autonomous locus of causality (RALOC) predicting increases in caries competence, which in turn would positively predict dental attendance; (2) RALOC negatively predicting dental anxiety, which would negatively predict dental attendance; (3) RALOC and caries disease referred to the dentist after an autonomy-supportive clinical exam directly positively predicting dental attendance; and (4) the intervention moderating the link between RALOC and dental attendance. DESIGN: A randomised two-group experiment was conducted at a dental clinic with 138 patients (Mage = 23.31 yr., SD = 3.5), with pre- and post-measures in a period of 5.5 months. RESULTS: The experimental model was supported. The SDT path model fit the data well and supported the hypotheses explaining 63% of the variance in dental attendance. CONCLUSIONS: Patients personality (RALOC) and hygienists promoting oral health care competence in an autonomy-supportive way, performance of autonomy-supportive clinical exams and reductions of anxiety for dental treatment have important practical implications for patients' dental attendance.

Changes in return to work among patients in vocational rehabilitation: a self-determination theory perspective.

PURPOSE: The aim of the current study was to examine whether patient perceptions of autonomy support from the treatment team in a vocational rehabilitation program will be associated with change (increase) in need satisfaction, autonomous motivation, perceived competence, well-being, physical activity, and return to work (RTW), and whether the self-determination theory (SDT) Model of Health Behavior will provide adequate fit to the data. METHOD: A total of 90 participants were enrolled in a longitudinal study and completed measures at four time points over 15 months. RESULTS: Participants reported increases in all variables, and in general these changes were maintained at six weeks post-rehabilitation and at 15 months post-baseline. As well, the SDT Model of Health Behavior provided adequate fit to the data. CONCLUSIONS: These results underscore the importance of health care practitioners' providing support for their patients' autonomy, competence, and relatedness to improve well-being, physical activity, and RTW in the context of vocational rehabilitation. Implications for Rehabilitation Vocational rehabilitation that emphasizes physical activity is associated with increases in patients' well-being, physical activity, and return to work (RTW). It is important for health care practitioners to provide support for their patients' autonomy, competence, and relatedness in the context of vocational rehabilitation, as doing so is associated with increases in patients' autonomous motivation, perceived competence, and psychosocial outcomes.

A self-determination multiple risk intervention trial to improve smokers' health.

BACKGROUND: Little is known about how interventions motivate individuals to change multiple health risk behaviors. Self-determination theory (SDT) proposes that patient autonomy is an essential factor for motivating change. OBJECTIVE: An SDT-based intervention to enhance autonomous motivation for tobacco abstinence and improving cholesterol was tested. DESIGN: The Smokers' Health Study is a randomized multiple risk behavior change intervention trial. SETTING: Smokers were recruited to a tobacco treatment center. PATIENTS: A total of 1.006 adult smokers were recruited between 1999 and 2002 from physician offices and by newspaper advertisements. INTERVENTIONS: A 6-month clinical intervention (4 contacts) to facilitate internalization of autonomy and perceived competence for tobacco abstinence and reduced percent calories from fat was compared with community care. Clinicians elicited patient perspectives and life strivings, provided absolute coronary artery disease risk estimates,enumerated effective treatment options, supported patient initiatives,minimized clinician control, assessed motivation for change, and developed a plan for change. OUTCOME MEASURES: Twelve-month prolonged tobacco abstinence, and change in percent calories from fat and low-density lipoprotein-cholesterol (LDL-C) from baseline to 18 months. RESULTS- Intention to treat analyses revealed that the intervention significantly increased 12-month prolonged tobacco abstinence (6.2% vs 2.4%; odds ratio [OR]=2.7, P=.01, number needed to treat [NNT] =26), and reduced LDL-C (-8.9 vs -4.1 mg/dL; P=.05). There was no effect on percent calories from fat. CONCLUSIONS: An intervention focused on supporting smokers'autonomy was effective in increasing prolonged tobacco abstinence and lowering LDL-C. Clinical interventions for behavior change may be improved by increasing patient autonomy and perceived competence.

Testing a self-determination theory intervention for motivating tobacco cessation: supporting autonomy and competence in a clinical trial.

A longitudinal randomized trial tested the self-determination theory (SDT) intervention and process model of health behavior change for tobacco cessation (N = 1006). Adult smokers were recruited for a study of smokers' health and were assigned to intensive treatment or community care. Participants were relatively poor and undereducated. Intervention patients perceived greater autonomy support and reported greater autonomous and competence motivations than did control patients. They also reported greater medication use and significantly greater abstinence. Structural equation modeling analyses confirmed the SDT process model in which perceived autonomy support led to increases in autonomous and competence motivations, which in turn led to greater cessation. The causal role of autonomy support in the internalization of autonomous motivation, perceived competence, and smoking cessation was supported.

Choice and ego-depletion: the moderating role of autonomy.

The self-regulatory strength model maintains that all acts of self-regulation, self-control, and choice result in a state of fatigue called ego-depletion. Self-determination theory differentiates between autonomous regulation and controlled regulation. Because making decisions represents one instance of self-regulation, the authors also differentiate between autonomous choice and controlled choice. Three experiments support the hypothesis that whereas conditions representing controlled choice would be egodepleting, conditions that represented autonomous choice would not. In Experiment 3, the authors found significant mediation by perceived self-determination of the relation between the choice condition (autonomous vs. controlled) and ego-depletion as measured by performance.

On the benefits of giving as well as receiving autonomy support: mutuality in close friendships.

Two studies examined autonomy support within close friendships. The first showed that receiving autonomy support from a friend predicted the recipient's need satisfaction within the relationship and relationship quality as indexed by emotional reliance, security of attachment, dyadic adjustment, and inclusion of friend in self and that there was significant mutuality of receiving autonomy support and of each other variable. The relations of perceived autonomy support to need satisfaction and relationship quality held for both female-female and male-male pairs across the two studies. The second study replicated and extended the first, showing that receiving autonomy support also predicted psychological health. Furthermore, giving autonomy support to a friend predicted the givers' experience of relationship quality over and above the effects of receiving autonomy support from the friend. When both receiving and giving autonomy support competed for variance in predicting well-being, giving, rather than receiving, autonomy support was the stronger predictor.