Therapist's Autonomy Support and Patient's Self-Criticism Predict Motivation during Brief Treatments for Depression

Abstract

Zuroff et al. (2007) showed that autonomous motivation, defined as the extent to which patients experience participation in treatment as a personally meaningful choice, predicted outcome in a study of 95 depressed outpatients who were randomly assigned to one of three 16-week manualized treatments. Further analyses were undertaken to test hypotheses derived from Self-Determination Theory (SDT; Ryan & Deci, 2008a, 2008b). Autonomous motivation, controlled motivation, perceived therapist autonomy support, and depressive severity were assessed at Sessions 3, 8, 13, and posttreatment. Autonomous and controlled motivation displayed both trait and contextual influences and were only moderately correlated with one another. Multilevel modeling was used to separate the predictive influences of within-person and between-person differences. Better treatment response (i.e., lower depressive severity) was predicted positively by between-person and within-person differences in autonomous motivation and inversely by between-person differences in controlled motivation. Higher perceived autonomy support from the therapist predicted higher autonomous motivation both between-person and within-person. Controlled motivation was unrelated to autonomy support, but instead was predicted by trait Self-Criticism. The results did not differ across treatment conditions, supporting the suggestion that SDT can be used to identify novel common factors in psychotherapy.