Autonomous motivation for therapy: A new common factor in brief treatments for depression

Abstract The authors propose a new common treatment factor, autonomous motivation (Deci & Ryan, 2000), defined as the extent to which patients experience participation in treatment as a freely made choice emanating from themselves. Ninety-five depressed outpatients were randomly assigned to receive 16 sessions of manualized interpersonal therapy, cognitive–behavior therapy, or pharmacotherapy with clinical management. Self-report and interviewer-based measures of depressive severity were collected at pretreatment and posttreatment. Autonomous motivation, therapeutic alliance, and perceived therapist autonomy support were assessed at Session 3. Autonomous motivation was a stronger predictor of outcome than therapeutic alliance, predicting higher probability of achieving remission and lower posttreatment depression severity across all three treatments. Patients who perceived their therapists as more autonomy supportive reported higher autonomous motivation.

[1]  Janet B W Williams.  Standardizing the Hamilton Depression Rating Scale: past, present, and future , 2009, European Archives of Psychiatry and Clinical Neuroscience.

[2]  W. Carroll,et al.  The 1981 socioeconomic index for occupations in Canada , 2008 .

[3]  C. Pourgourides.  Dilemmas in the treatment of asylum seekers , 2007 .

[4]  Z. Shahrivar,et al.  Structured Clinical Interview for DSM-IV (SCID): Persian Translation and Cultural Adaptation , 2007 .

[5]  R. Bagby,et al.  Attachment as moderator of treatment outcome in major depression: a randomized control trial of interpersonal psychotherapy versus cognitive behavior therapy. , 2006, Journal of consulting and clinical psychology.

[6]  Kennon M. Sheldon,et al.  Reconciling Humanistic Ideals and Scientific Clinical Practice , 2006 .

[7]  Kennon M. Sheldon,et al.  There's nothing more practical than a good theory: integrating motivational interviewing and self-determination theory. , 2006, The British journal of clinical psychology.

[8]  D. Zuroff,et al.  The therapeutic relationship in the brief treatment of depression: contributions to clinical improvement and enhanced adaptive capacities. , 2006, Journal of consulting and clinical psychology.

[9]  Richard M. Ryan,et al.  Motivational Interviewing and Self–Determination Theory , 2005 .

[10]  R. Bagby,et al.  The Hamilton Depression Rating Scale: has the gold standard become a lead weight? , 2004, The American journal of psychiatry.

[11]  R. Ryan,et al.  MOTIVATION, AUTONOMY SUPPORT, AND ENTITY BELIEFS: THEIR ROLE IN METHADONE MAINTENANCE TREATMENT , 2004 .

[12]  J. Michalak,et al.  Personal goals of psychotherapy patients: The intensity and the “why” of goal-motivated behavior and their implications for the therapeutic process , 2004 .

[13]  C. O’Donovan.  Achieving and sustaining remission in depression and anxiety disorders: introduction. , 2004, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[14]  R. Styra,et al.  The Internet's Impact on the Practice of Psychiatry , 2004, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[15]  J. Markowitz,et al.  Therapeutic alliance in depression treatment: controlling for prior change and patient characteristics. , 2003, Journal of consulting and clinical psychology.

[16]  I. Weiner.  Psychotherapy Relationships That Work: Therapist Contributions and Responsiveness to Patients , 2003, Psychotherapy research : journal of the Society for Psychotherapy Research.

[17]  Michael J. Lambert,et al.  Bergin and Garfield's Handbook of Psychotherapy and Behavior Change , 2003 .

[18]  K. Dobson,et al.  Cognitive therapy of depression: pretreatment patient predictors of outcome. , 2002, Clinical psychology review.

[19]  A. Horvath.  The Great Psychotherapy Debate: Models Methods and Findings , 2002 .

[20]  J. Markowitz,et al.  Comprehensive Guide to Interpersonal Psychotherapy , 2002 .

[21]  Marylène Gagné,et al.  Facilitating autonomous motivation for smoking cessation. , 2002, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[22]  E. Deci,et al.  The "What" and "Why" of Goal Pursuits: Human Needs and the Self-Determination of Behavior , 2000 .

[23]  J. Garske,et al.  Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. , 2000, Journal of consulting and clinical psychology.

[24]  Alliance predicts patients' outcome beyond in-treatment change in symptoms. , 2000, Journal of consulting and clinical psychology.

[25]  E. Deci,et al.  Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. , 2000, The American psychologist.

[26]  J. Reeve,et al.  Autonomy-Supportive Teachers: How They Teach and Motivate Students , 1999 .

[27]  E. Deci,et al.  Supporting Autonomy to Motivate Patients With Diabetes for Glucose Control , 1998, Diabetes Care.

[28]  M Weiss,et al.  The role of the alliance in the pharmacologic treatment of depression. , 1997, The Journal of clinical psychiatry.

[29]  L. Pelletier,et al.  Client Motivation for Therapy Scale: a measure of intrinsic motivation, extrinsic motivation, and amotivation for therapy. , 1997, Journal of personality assessment.

[30]  M. First,et al.  Structured clinical interview for DSM-IV axis I disorders : SCID-I : clinical version : scoresheet , 1997 .

[31]  E. Deci,et al.  Motivational predictors of weight loss and weight-loss maintenance. , 1996, Journal of personality and social psychology.

[32]  R. Ryan,et al.  Psychological needs and the facilitation of integrative processes. , 1995, Journal of personality.

[33]  R. Ryan,et al.  Initial motivations for alcohol treatment: relations with patient characteristics, treatment involvement, and dropout. , 1995, Addictive behaviors.

[34]  C. Marmar,et al.  The California Psychotherapy Alliance Scales. , 1994 .

[35]  I. Elkin.  The NIMH Treatment of Depression Collaborative Research Program: Where we began and where we are. , 1994 .

[36]  A. Horvath,et al.  Relation between Working Alliance and Outcome in Psychotherapy: A Meta-Analysis. , 1991 .

[37]  L. Gaston,et al.  The concept of the alliance and its role in psychotherapy: Theoretical and empirical considerations. , 1990 .

[38]  S D Imber,et al.  National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. , 1989, Archives of general psychiatry.

[39]  M. Shea,et al.  NIMH Treatment of Depression Collaboration Research Program: I. General effectiveness of treatments , 1989 .

[40]  J. Fawcett,et al.  Clinical management--imipramine/placebo administration manual. NIMH Treatment of Depression Collaborative Research Program. , 1987, Psychopharmacology bulletin.

[41]  N. Sartorius,et al.  Assessment of Depression , 1986, Springer Berlin Heidelberg.

[42]  I. Elkin,et al.  NIMH Treatment of Depression Collaborative Research Program. Background and research plan. , 1985, Archives of general psychiatry.

[43]  Edward L. Deci,et al.  Intrinsic Motivation and Self-Determination in Human Behavior , 1975, Perspectives in Social Psychology.

[44]  M. Kovács.  Cognitive therapy in depression. , 1980, The Journal of the American Academy of Psychoanalysis.

[45]  E. Bordin.  The generalizability of the psychoanalytic concept of the working alliance. , 1979 .

[46]  G. Price,et al.  An Evaluation of the Sex Stereotyping Effect as Related to Counselor Perceptions of Courses Appropriate for High School Students. , 1977 .

[47]  M. Hamilton,et al.  Development of a rating scale for primary depressive illness. , 1967, The British journal of social and clinical psychology.

[48]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.