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Silje S Lie,1 Bjørg Karlsen,1 Christopher P Niemiec,2 Marit Graue,3 Bjørg Oftedal1 1Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; 2Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, USA; 3Center for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway Background: Individuals with type 2 diabetes mellitus (T2DM) are responsible for the daily decisions and actions necessary to manage their disease, which makes self-management the cornerstone of diabetes care. Many patients do not reach recommended treatment goals, and thus it is important to develop and evaluate innovative interventions that facilitate optimal motivation for adequate self-management of T2DM. Objective: The aim of the current study was to explore how adults with T2DM experience using reflection sheets to stimulate written reflection in the context of the Guided Self-Determination (GSD) eHealth intervention and how written reflection might affect their motivation for self-management of T2DM. Methods: We used a qualitative design in which data were collected through individual interviews. The sample consisted of 10 patients who completed the GSD eHealth intervention, and data were analyzed using qualitative content analysis. Results: The qualitative content analysis yielded 2 main themes. We labeled the first theme as “Written reflection affects awareness and commitment in diabetes self-management”, which reflects 2 subthemes, namely, “Writing creates space and time for autonomous reflection” and “Writing influences individuals’ focus in diabetes self-management”. We labeled the second theme as “Written reflection is perceived as inapplicable in diabetes self-management”, which reflects 2 subthemes, namely, “Responding in writing is difficult” and “The timing of the writing is inappropriate”. Conclusion: Our findings indicate that written reflection in the context of the GSD eHealth intervention may be conducive to motivation for diabetes self-management for some patients. However, it seems that in-person consultation with the diabetes nurse may be necessary to achieve the full potential benefit of the GSD as an eHealth intervention. We advocate further development and examination of the GSD as a “blended” approach, especially for those who consider written reflection to be difficult or unfamiliar. Keywords: eHealth, guided self-determination, self-determination theory, self-management, type 2 diabetes mellitus, written reflection

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. [ABSTRACT FROM AUTHOR]

Using self-determination theory, two studies found that holding an extrinsic, relative to an intrinsic, work value orientation was associated with less positive outcomes (i.e. less satisfaction with, dedication to and vitality while on the job) and more negative outcomes (i.e. higher emotional exhaustion, short-lived satisfaction after successful goal-attainment, and turn-over intention). These relations were not limited to job outcomes, but also emerged using indicators of employees' general mental health. Moreover, income level did not moderate these relations. Study 2 found that holding an extrinsic, relative to an intrinsic, work value orientation was detrimental to employees' job outcomes because these orientations thwarted the satisfaction of the basic psychological needs for autonomy, competence and relatedness at work. [ABSTRACT FROM AUTHOR]

Goal pursuit is rife with obstacles triggering negative emotions. To persist in goal pursuit, individuals need to regulate these emotions using adaptive emotion regulation strategies. Reappraisal and emotional integration are two such strategies. Reappraisal involves people's attempts to reframe how they are thinking about an emotional situation, whereas emotional integration involves taking an interest in emotions as they arise. In three studies, we examined the distinct effects of these two strategies on goal pursuit at the within-person and the between-person levels. Study 1 ( N = 264) was a three-wave, short-term longitudinal study. At the within-person level, emotional integration predicted goal progress and goal effort but also predicted negative affect, while reappraisal predicted goal progress and positive affect. At the between-person level, emotional integration was positively related to optimal goal pursuit outcomes, whereas reappraisal was negatively related. Study 2 ( N = 154) and Study 3 ( N = 366) used daily methodologies and followed participants across 10 days. At the daily within-person level, reappraisal was a stronger predictor of goal progress, goal effort, and positive affect than emotional integration. Emotional integration predicted daily negative affect. In contrast, at the between-person level, emotional integration better predicted these outcomes than reappraisal. Collectively, these studies provide a nuanced understanding of how adaptive emotion regulation strategies relate to goal pursuit. The results show that within-participants reappraisal is more strongly related to increased goal progress, effort, and positive affect than emotional integration. However, habitual emotional integration aligns with greater overall goal effort and progress than habitual reappraisal. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objectives: To examine the motivational predictors of the smoking cessation process at the between-persons and within-persons levels., Methods: Mediation analyses were conducted on self-report data (N = 236) that were collected using interval contingent sampling over a 39-day study period., Results: There was a high rate of attrition, as nearly 50% of participants were lost to follow-up. There were credible indirect effects of autonomous self-regulation on smoking behavior on the next day and seven-day abstinence through perceived competence and medication use. At the between-persons level, these models explained 17% of the variance in smoking behavior on the next day and 31% of the variance in seven-day abstinence; at the within-persons level, these estimates were 39% and 57%, respectively., Conclusions: Day-to-day changes in autonomous self-regulation, perceived competence, and medication use are important initiators of the smoking cessation process., Practice Implications: Smokers might be more likely to make a quit attempt if practitioners "tune into" the day-to-day fluctuations of their patients' motivation for stopping smoking, perhaps using an electronic platform to assess and compare smokers' current reports to their previous experiences. Such "motivational attunement" can afford practitioners an opportunity to provide need support when patients are willing and able to initiate a quit attempt., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Given the centrality of sleep and work in most individuals' lives, it is interesting to note that an empirical understanding of the association between what happens in the workplace and how well people sleep is in an early stage of development, at least relative to other topics that are of interest in the literature on stress and health. Using self-determination theory, the current study examined how maladaptive motivational processes at work relate to sleep disturbance and mental ill health. In line with hypotheses, the results of a cross-sectional analysis and analyses using data from two time points over 15 months revealed that employees are more likely to report sleep disturbance, anxiety, and depressive symptoms when they experience frustration of the basic psychological needs for autonomy, competence, and relatedness in the workplace. Additional results revealed an indirect effect of change in basic psychological need frustration on change in anxiety-but not on change in depressive symptoms-through change in sleep disturbance. Taken together, these findings add to the burgeoning literature on the maladaptive motivational origins of ill health and dysfunction in the workplace., (© 2022 John Wiley & Sons Ltd.)

Healthy Life Centers (HLCs) have been established throughout Norway to support lifestyle changes and promote physical and mental health. We conducted a 12-month observational study among participants in an HLC that aimed to improve physical activity (PA) and dietary behaviors, and this study examined predictors of completion, and changes in psychological variables, lifestyle behaviors, and physical health indicators. The participants (N = 120, 71% female, mean age = 44 years) reported symptoms of psychological distress (77%) and were obese (77%). No baseline characteristics were found to be consistent predictors of completion (42%). Completers had significant improvements in autonomous motivation for PA ( d = 0.89), perceived competence for PA ( d = 1.64) and diet ( d = 0.66), psychological distress ( d = 0.71), fruit intake ( d = 0.64), vegetable intake ( d = 0.38), BMI among all participants ( d = 0.21) and obese participants ( d = 0.34), body fat percentage among all participants ( d = 0.22) and obese participants ( d = 0.33), and lower body strength ( d = 0.91). Fat-free mass and all forms of PA remained unchanged from baseline to 12 months. Hence, there were indications of improvement among completers on psychological variables, lifestyle behaviors, and physical health indicators. The low rate of completion was a concern, and the unchanged levels of PA reflect an important area of focus for future interventions in the context of HLCs.

Background: Since the early 2000s, Healthy Life Centres have been established in Norway to promote physical and mental health. Yet to date, little is known about the efficacy of Healthy Life Centres in promoting health behaviour change and maintenance or the factors that underlie these processes. Accordingly, the aim of the current study was to examine the factors that participants in a Healthy Life Centre perceive as relevant for the initiation and maintenance of lifestyle changes toward more physical activity and consumption of a healthier diet., Method: Participants were purposely recruited from among adherers in a 12-month multi-method research project at a Healthy Life Centre. Individual, semi-structured interviews were conducted with 8 women and 6 men who were between the ages of 20 and 61 years old. Data were analysed using Systematic Text Condensation., Results: Three main themes were derived from this analysis. The first theme focused on the motives behind initiation and maintenance of lifestyle changes along with the importance of a relationally supportive environment to promote perceived competence in pursuing a healthy lifestyle. The second theme focused on strategies for coping with the challenges and potential pitfalls that were associated with various unpleasant experiences and life events. The third theme focused on several specific skills that were helpful to the initiation and maintenance of lifestyle changes., Conclusion: The current study enhanced an understanding of the initiation and maintenance of lifestyle changes, although these processes were not disentangled in participants' experiences. In line with self-determination theory, the results suggested that lifestyle change is more likely to be initiated and maintained when goals are not only achievable but also regulated with autonomous motivation and of intrinsic value. Conversely, lifestyle change is difficult to maintain when motives are external to the self. Further, cognitive and behavioural skills were valuable and necessary in coping with unpleasant emotions. Finally, the critical function of self-regulation skills for making realistic plans and prioritizations in order to balance healthy lifestyle behaviours with the routines of "daily life" while monitoring outcomes was readily apparent. Healthy Life Centres can contribute to these processes in meaningful ways.

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.

There is a lack of research on the use of electronic tools that guide patients toward reducing their cardiovascular disease risk. We conducted a 9-month clinical trial in which participants who were at low (n = 100) and moderate (n = 23) cardiovascular disease risk-based on the National Cholesterol Education Program III's 10-year risk estimator-were randomized to usual care or to usual care plus use of an Interactive Cholesterol Advisory Tool during the first 8 weeks of the study. In the moderate-risk category, an interaction between treatment condition and Framingham risk estimate on low-density lipoprotein and non-high-density lipoprotein cholesterol was observed, such that participants in the virtual clinician treatment condition had a larger reduction in low-density lipoprotein and non-high-density lipoprotein cholesterol as their Framingham risk estimate increased. Perceptions of the Interactive Cholesterol Advisory Tool were positive. Evidence-based information about cardiovascular disease risk and its management was accessible to participants without major technical challenges., Competing Interests: Declaration of Conflicting Interest: Geoffrey C. Williams and C. Scott Rigby are shareholders in Self-Determined Health, Inc., the company to which the SBIR grant was awarded. Drs. Williams and Rigby were involved in the development of the virtual clinician and contributed only to the introduction and methods sections of this report. Dr. Williams managed subjects in both of the moderate risk groups, and those subjects were informed (via the study consent form) of Dr. Williams’ interest in the company. Drs. Williams and Rigby did not have access to the data or contribute to the interpretation of the results., (© The Author(s) 2015.)

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., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The potential benefits of children's engagement in sport for their psychological, social, and physical health are well established. Yet children may also experience psychological and social impairments due, in part, to a variety of detrimental coach behaviors. In the current study, we proposed and tested a conditional process model of children's self-reported behavioral engagement and behavioral disaffection in sport based on self-determination theory. Results from a sample of 245 youth soccer players suggested that structure from coaches related positively to behavioral engagement and negatively to behavioral disaffection, and that these relations were mediated by athletes' basic psychological need satisfaction. Importantly, and in line with our hypotheses, these indirect effects were moderated by autonomy support from coaches, such that the mediation was evident only among those who reported higher levels of autonomy support. These findings underscore the importance of coaches' providing guidance, expectations, and feedback (i.e., structure) in a way that respects athletes' volition (i.e., autonomy support).

Objectives: To evaluate cost-effectiveness of a tobacco dependence intervention based on self-determination theory (SDT) and consistent with the Public Health Service (PHS)-sponsored Clinical Practice Guideline for Treating Tobacco Use and Dependence., Study Design: Adult smokers were recruited into a randomized cessation-induction trial of an intensive intervention versus community care. Seven-day point prevalence (7dPP) tobacco abstinence and cost-effectiveness of the intervention were examined using 737 participants with health insurance., Methods: Community care (CC) participants received smoking-cessation pamphlets and information on local treatment programs. Intervention participants received those materials and were asked to meet 4 times over 6 months with study counselors to discuss their health in a manner that supported autonomy and perceived competence. The third-party payer's perspective was used for this analysis, and the primary outcome was cost-effectiveness using self-reported 7dPP tobacco abstinence at 6 months. Sensitivity analyses were performed using costs of generic medications, biochemically validated tobacco abstinence, actual rates of tobacco abstinence, life-years saved (not adjusted for quality of life), and costs in 2011 US dollars. A subgroup analysis was conducted using smokers who did not want to stop within 30 days., Results: Smokers in the intervention, relative to CC, were more likely to attain 7dPP tobacco abstinence at 6 months. The overall incremental cost-effectiveness ratio was $1258 per quality-adjusted life-year saved, in US dollars. The sensitivity and subgroup analyses yielded similar results., Conclusions: An intervention based on SDT and consistent with the PHS Guideline facilitated tobacco abstinence among insured smokers and was cost-effective compared with other tobacco dependence and medical interventions.

A previous randomized clinical trial based on self-determination theory (SDT) and consistent with the Public Health Service (PHS) Guideline for Treating Tobacco Use and Dependence demonstrated that an intensive intervention could change autonomous self-regulation and perceived competence, which in part facilitated long-term tobacco abstinence. The current article describes a pragmatic comparative effectiveness trial of three SDT-based intensive tobacco-dependence interventions. Eligible participants are randomized to one of the three treatment conditions designed to facilitate long-term maintenance of tobacco abstinence, namely, Community Care (CC), which includes the 6 month SDT-based intervention previously shown to promote autonomous self-regulation, perceived competence, medication use, and tobacco abstinence; Extended Need Support (ENS), which extends the 6 month SDT-based intervention to 12 months and trains an important other to provide support for smokers' basic psychological needs; and Harm Reduction (HR), which provides extended need support and recommends medication use for participants who do not want to stop smoking completely within 30 days but who are willing to reduce their cigarette use by half. The primary outcome is 12 month prolonged abstinence from tobacco, which is assessed one year following termination of treatment (two years post-randomization). Secondary outcomes include 7- and 30 day point prevalence tobacco abstinence, number of days using smoking-cessation medication, change in autonomous self-regulation and perceived competence, and perceived need support from important others., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Terror management theory posits that people tend to respond defensively to reminders of death, including worldview defense, self-esteem striving, and suppression of death thoughts. Seven experiments examined whether trait mindfulness-a disposition characterized by receptive attention to present experience-reduced defensive responses to mortality salience (MS). Under MS, less mindful individuals showed higher worldview defense (Studies 1-3) and self-esteem striving (Study 5), yet more mindful individuals did not defend a constellation of values theoretically associated with mindfulness (Study 4). To explain these findings through proximal defense processes, Study 6 showed that more mindful individuals wrote about their death for a longer period of time, which partially mediated the inverse association between trait mindfulness and worldview defense. Study 7 demonstrated that trait mindfulness predicted less suppression of death thoughts immediately following MS. The discussion highlights the relevance of mindfulness to theories that emphasize the nature of conscious processing in understanding responses to threat.

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.

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.

Life goals, or aspirations, organize and direct behavior over extended periods of time. The present study, guided by self-determination theory, examined the consequences of pursuing and attaining aspirations over a one-year period in a post-college sample. Results indicated that placing importance on either intrinsic or extrinsic aspirations related positively to attainment of those goals. Yet, whereas attainment of intrinsic aspirations related positively to psychological health, attainment of extrinsic aspirations did not; indeed, attainment of extrinsic aspirations related positively to indicators of ill-being. Also as predicted, the association between change in attainment of intrinsic aspirations and change in psychological health was mediated by change in the satisfaction of the basic psychological needs for autonomy, competence, and relatedness. Discussion focuses on the idea that not all goal attainment is beneficial; rather, attainment of aspirations with different contents relates differentially to psychological health.

Purpose: The purpose of this study is to apply the self-determination theory (SDT) model of health behavior to predict medication adherence, quality of life, and physiological outcomes among patients with diabetes., Methods: Patients with diabetes (N = 2973) receiving care from an integrated health care delivery system in 2003 and 2004 were identified from automated databases and invited to participate in this study. In 2005, patients responded to a mixed telephone-and-mail survey assessing perceived autonomy support from health care providers, autonomous self-regulation for medication use, perceived competence for diabetes self-management, medication adherence, and quality of life. In 2006, pharmacy claims data were used to indicate medication adherence, and patients' non-high-density lipoprotein (HDL) cholesterol, A1C, and glucose levels were assessed., Results: The SDT model of health behavior provided adequate fit to the data. As hypothesized, perceived autonomy support from health care providers related positively to autonomous self-regulation for medication use, which in turn related positively to perceived competence for diabetes self-management. Perceived competence then related positively to quality of life and medication adherence, and the latter construct related negatively to non-HDL cholesterol, A1C, and glucose levels., Conclusions: Health care providers' support for patients' autonomy and competence around medication use and diabetes self-management related positively to medication adherence, quality of life, and physiological outcomes among patients with diabetes.

Using self-determination theory, two studies investigated the relations among perceived need support from parents, their adolescents' autonomous self-regulation for academics, and the adolescents' well-being. Study 1 indicated that perceived need support from parents independently predicted adolescents' well-being, although when mothers' and fathers' data were examined separately, the relation was stronger for mothers than for fathers. In Study 2, autonomous self-regulation for planning to attend college was a significant partial mediator of the relation of adolescents' perceived need support to well-being. Thus, perceived need support from parents does seem important for the development of adolescents' autonomous self-regulation and well-being.

The basic psychological needs for autonomy, competence, and relatedness have been found to have unique additive effects on psychological well-being (see E. L. Deci & R. M. Ryan, 2000). In the present study, the authors extended these findings by examining whether the balance in the satisfaction of these 3 needs is also important. The results of 4 studies showed that people who experienced balanced need satisfaction reported higher well-being than those with the same sum score who reported greater variability in need satisfaction. This finding emerged for multiple measures of needs and adjustment and was independent of neuroticism. Moreover, results were obtained consistently across concurrent, prospective, daily diary, and observer-report study designs. Discussion focuses on the psychological meaning and functional implications of balanced need satisfaction.