Our Approach

Self-Determination Theory

Self-Determination Theory (SDT) is a theory of motivation that has been applied in many life domains such as health, sport, education and work. Health is an intrinsic goal for us all that is strongly influenced by our habits and lifestyle choices. Motivation—energy directed at a goal—plays a big role in our lifestyle choices and in our ability to make sustained changes as needed to maintain our health.

According to SDT, all of us have three key psychological needs as depicted graphically below. When our social environments, including the places where we receive health care, are more supportive of these psychological needs, the quality of our motivation is more autonomous. Alternatively, when our psychological needs are not well met or even thwarted through our social interactions, the quality of our motivation is more controlled. Researchers have found through many studies that when people are more autonomously motivated, they are more likely to achieve their health goals over time.

Read on to learn more about the science behind Self-Determination Theory. 

Motivation

Early ideas of motivation simply suggested that you either have it (you are motivated) or you don’t (you are not motivated, or unmotivated). However, more than 40 years of research has shown that motivation is much more complex than this. The quality of motivation (autonomous or controlled) is key to both satisfaction and sustained success in achieving one’s goals.

Motivated behavior can be driven by rewards, punishments and internalized pressures from others. It can also be fueled by deeply held values or interest and enjoyment of the behavior itself. In simple terms, people can feel more pressured or controlled to behave in a certain way or they can feel they have a choice in how to behave. For example, people can be driven by:

• Reward: People might try to lose weight because their employer will pay them to lose weight.
• Punishment: People might try to lose weight because their insurance company will raise the cost of their health insurance if they don’t lose weight.
• Internal Pressure: People might try to lose weight because others have told them they should lose weight or they will be upset with them.
• Value: People might try to lose weight because they want to be healthier and be a positive role model for their kids.
• Interest/Enjoyment: People might try to lose weight because they really like exercising and eating in a healthy way.

When people are mainly motivated by rewards, punishments, and internal pressure, they have a harder time initiating and maintaining their behaviors over the long term. However, when people are more autonomous—that is, when people are motivated more by their value for the behavior, or by their interest and enjoyment of the behavior—they tend to be more persistent in their behavior, feel more satisfied, and have higher well-being overall.

Psychological Needs

Self-determination theory suggests that all humans have three basic psychological needs—autonomy, competence, and relatedness—that underlie growth and development.

• Autonomy refers to feeling one has choice and is willingly endorsing one’s behavior. The opposite experience is feeling compelled or controlled in one’s behavior.
• Competence refers to the experience of mastery and being effective in one’s activity.
• Finally, relatedness refers to the need to feel connected and a sense of belongingness with others.

The social environment (e.g., family, friends, co-workers, health care professionals, culture, etc.) can promote or get in the way of people’s strivings by the extent to which they support a person’s basic psychological needs.

• Autonomy is supported by attempting to grasp and acknowledge the person's wishes, preferences and perspectives, conveying understanding of their point of view, providing a rationale for engaging in a behavior, and providing choice in how to behave. Supporting someone’s autonomy also means refraining from trying to control or pressure them to act in a certain way.
• Competence is supported by providing the person with optimal challenges and opportunities (specific goals that are challenging enough, but not overwhelming), encouraging their sense of initiation (try it out!), providing structure (for example, evidence-based health recommendations) to mobilize and organize behavior and providing relevant feedback.
• Finally, relatedness is supported when others are involved and show interest in the person’s activities, are empathic in responding to their feelings and convey that the person is significant, cared for, and loved.

When these needs are optimally supported, evidence suggests that people are more autonomous in their behaviors, are more likely to persist at their behaviors, and feel better overall.

Here at the Center for Community Health & Prevention, our approach is focused on providing you with evidence-based information and supporting your psychological needs so that we can help you discover what works for you on your journey to making healthy changes in your life.

This material is based on the following references:

• LaGuardia, J. 2017. Self-determination theory in practice: how to create an optimally supportive health care environment. Middletown, DE. Independently published 2017.
• Ntoumanis N, Ng JYY, Prestwich A, Quested E, Hancox JE, Thøgersen-Ntoumani C, Deci EL, Ryan RM, Lonsdale C, Williams GC. A meta-analysis of self-determination theory-informed intervention studies in the health domain: effects on motivation, health behavior, physical, and psychological health. Health Psychol Rev. 2021 Jun;15(2):214-244. doi: 10.1080/17437199.2020.1718529. Epub 2020 Feb 3. PMID: 31983293.
• Ryan, R. M., & Deci, E. L. Self-determination theory: basic psychological needs in motivation, development, and wellness. 2017. NY: The Guilford Press.

Relevant Team Publications

• Mayo NL, Russell HA, Holt K, Williams GC. Implementation of a self-determination based clinical program to reduce cardiovascular disease risk. Journal of Health Psychology. January 2022. doi:10.1177/13591053211068124