What is the Twelve-Step Programme?

Introduction

Twelve-step programmes are international mutual aid programs supporting recovery from substance addictions, behavioural addictions and compulsions. Developed in the 1930s, the first twelve-step programme, Alcoholics Anonymous (AA), founded by Bill Wilson and Bob Smith, aided its membership to overcome alcoholism. Since that time dozens of other organisations have been derived from AA’s approach to address problems as varied as drug addiction, compulsive gambling, sex, and overeating. All twelve-step programmes utilise a version of AA’s suggested twelve steps first published in the 1939 book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism.

As summarised by the American Psychological Association (APA), the process involves the following:

  • Admitting that one cannot control one’s alcoholism, addiction, or compulsion;
  • Coming to believe in a Higher Power that can give strength;
  • Examining past errors with the help of a sponsor (experienced member);
  • Making amends for these errors;
  • Learning to live a new life with a new code of behaviour; and
  • Helping others who suffer from the same alcoholism, addictions, or compulsions.

Overview

Twelve-step methods have been adapted to address a wide range of alcoholism, substance abuse, and dependency problems. Over 200 mutual aid organisations – often known as fellowships—with a worldwide membership of millions have adopted and adapted AA’s 12 Steps and 12 Traditions for recovery. Narcotics Anonymous was formed by addicts who did not relate to the specifics of alcohol dependency.

Demographic preferences related to the addicts’ drug of choice has led to the creation of Cocaine Anonymous, Crystal Meth Anonymous and Marijuana Anonymous. Behavioural issues such as compulsion for or addiction to gambling, crime, food, sex, hoarding, getting into debt and work are addressed in fellowships such as Gamblers Anonymous, Overeaters Anonymous, Sexaholics Anonymous and Debtors Anonymous.

Auxiliary groups such as Al-Anon and Nar-Anon, for friends and family members of alcoholics and addicts, respectively, are part of a response to treating addiction as a disease that is enabled by family systems. Adult Children of Alcoholics (ACA or ACOA) addresses the effects of growing up in an alcoholic or otherwise dysfunctional family. Co-Dependents Anonymous (CoDA) addresses compulsions related to relationships, referred to as co-dependency.

Brief History

Alcoholics Anonymous (AA), the first twelve-step fellowship, was founded in 1935 by Bill Wilson and Dr. Robert Holbrook Smith, known to AA members as “Bill W.” and “Dr. Bob”, in Akron, Ohio. In 1946 they formally established the twelve traditions to help deal with the issues of how various groups could relate and function as membership grew. The practice of remaining anonymous (using only one’s first names) when interacting with the general public was published in the first edition of the AA Big Book.

As AA chapters were increasing in number during the 1930s and 1940s, the guiding principles were gradually defined as the Twelve Traditions. A singleness of purpose emerged as Tradition Five: “Each group has but one primary purpose—to carry its message to the alcoholic who still suffers”. Consequently, drug addicts who do not suffer from the specifics of alcoholism involved in AA hoping for recovery technically are not welcome in “closed” meetings unless they have a desire to stop drinking alcohol.

The principles of AA have been used to form numerous other fellowships specifically designed for those recovering from various pathologies; each emphasizes recovery from the specific malady which brought the sufferer into the fellowship.

The Twelve Steps

The following are the original twelve steps as published by Alcoholics Anonymous:[11]

  1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
  2. Came to believe that a power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed, and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take personal inventory, and when we were wrong, promptly admitted it.
  11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
  12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

Where other twelve-step groups have adapted the AA steps as guiding principles, step one is generally updated to reflect the focus of recovery. For example, in Overeaters Anonymous, the first step reads, “We admitted we were powerless over compulsive overeating—that our lives had become unmanageable.” The third step is also sometimes altered to remove gender-specific pronouns.

The Twelve Traditions

The Twelve Traditions accompany the Twelve Steps. The Traditions provide guidelines for group governance. They were developed in AA in order to help resolve conflicts in the areas of publicity, politics, religion, and finances. Alcoholics Anonymous’ Twelve Traditions are:

  1. Our common welfare should come first; personal recovery depends upon AA unity.
  2. For our group purpose there is but one ultimate authority—a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.
  3. The only requirement for AA membership is a desire to stop drinking.
  4. Each group should be autonomous except in matters affecting other groups or AA as a whole.
  5. Each group has but one primary purpose—to carry its message to the alcoholic who still suffers.
  6. An AA group ought never endorse, finance, or lend the AA name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.
  7. Every AA group ought to be fully self-supporting, declining outside contributions.
  8. Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.
  9. AA, as such, ought never be organised; but we may create service boards or committees directly responsible to those they serve.
  10. Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.
  11. Our public relations policy is based on attraction rather than promotion; we need always to maintain personal anonymity at the level of press, radio, and films.
  12. Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.

The Process

In the twelve-step programme, the human structure is symbolically represented in three dimensions: physical, mental, and spiritual. The problems the groups deal with are understood to manifest themselves in each dimension. For addicts and alcoholics, the physical dimension is best described by the allergy-like bodily reaction resulting in the compulsion to continue using substances even when it’s harmful or wanting to quit. The statement in the First Step that the individual is “powerless” over the substance-abuse related behaviour at issue refers to the lack of control over this compulsion, which persists despite any negative consequences that may be endured as a result.

The mental obsession is described as the cognitive processes that cause the individual to repeat the compulsive behaviour after some period of abstinence, either knowing that the result will be an inability to stop or operating under the delusion that the result will be different. The description in the First Step of the life of the alcoholic or addict as “unmanageable” refers to the lack of choice that the mind of the addict or alcoholic affords concerning whether to drink or use again. The illness of the spiritual dimension, or “spiritual malady,” is considered in all twelve-step groups to be self-centeredness. The process of working the steps is intended to replace self-centeredness with a growing moral consciousness and a willingness for self-sacrifice and unselfish constructive action. In twelve-step groups, this is known as a “spiritual awakening.” This should not be confused with abreaction, which produces dramatic, but temporary, changes. As a rule, in twelve-step fellowships, spiritual awakening occurs slowly over a period of time, although there are exceptions where members experience a sudden spiritual awakening.

In accordance with the First Step, twelve-step groups emphasize self-admission by members of the problem they are recovering from. It is in this spirit that members often identify themselves along with an admission of their problem, often as “Hi, I’m [first name only], and I’m an alcoholic”.

Sponsorship

A sponsor is a more experienced person in recovery who guides the less-experienced aspirant (“sponsee”) through the program’s twelve steps. New members in twelve-step programmes are encouraged to secure a relationship with at least one sponsor who both has a sponsor and has taken the twelve steps themselves. Publications from twelve-step fellowships emphasize that sponsorship is a “one on one” non-hierarchical relationship of shared experiences focused on working the Twelve Steps. According to Narcotics Anonymous:

Sponsors share their experience, strength, and hope with their sponsees… A sponsor’s role is not that of a legal adviser, a banker, a parent, a marriage counsellor, or a social worker. Nor is a sponsor a therapist offering some sort of professional advice. A sponsor is simply another addict in recovery who is willing to share his or her journey through the Twelve Steps.

Sponsors and sponsees participate in activities that lead to spiritual growth. Experiences in the programme are often shared by outgoing members with incoming members. This rotation of experience is often considered to have a great spiritual reward. These may include practices such as literature discussion and study, meditation, and writing. Completing the programme usually implies competency to guide newcomers which is often encouraged. Sponsees typically do their Fifth Step, review their moral inventory written as part of the Fourth Step, with their sponsor. The Fifth Step, as well as the Ninth Step, have been compared to confession and penitence. Michel Foucault, a French philosopher, noted such practices produce intrinsic modifications in the person—exonerating, redeeming and purifying them; relieves them of their burden of wrong, liberating them and promising salvation.

The personal nature of the behavioural issues that lead to seeking help in twelve-step fellowships results in a strong relationship between sponsee and sponsor. As the relationship is based on spiritual principles, it is unique and not generally characterised as “friendship”. Fundamentally, the sponsor has the single purpose of helping the sponsee recover from the behavioural problem that brought the sufferer into twelve-step work, which reflexively helps the sponsor recover.

A study of sponsorship as practiced in Alcoholics Anonymous and Narcotics Anonymous found that providing direction and support to other alcoholics and addicts is associated with sustained abstinence for the sponsor, but suggested that there were few short-term benefits for the sponsee’s one-year sustained abstinence rate.

Effectiveness

Alcoholics Anonymous is the largest of all of the twelve-step programmes (from which all other twelve-step programmes are derived), followed by Narcotics Anonymous; the majority of twelve-step members are recovering from addiction to alcohol or other drugs. The majority of twelve-step programmes, however, address illnesses other than substance addiction. For example, the third-largest twelve-step programme, Al-Anon, assists family members and friends of people who have alcoholism and other addictions. About twenty percent of twelve-step programmes are for substance addiction recovery, the other eighty percent address a variety of problems from debt to depression. It would be an error to assume the effectiveness of twelve-step methods at treating problems in one domain translates to all or to another domain.

A 2020 Cochrane review of Alcoholics Anonymous showed that participation in AA resulted in more alcoholics being abstinent from alcohol and for longer periods of time than cognitive behavioural therapy and motivational enhancement therapy, and as effective as these in other measures. The 2020 review did not compare twelve step programmes to the use of disulfiram or naltrexone, though some patients did receive these medications. These medications are considered the standard of care in alcohol use disorder treatment among medical experts and have demonstrated efficacy in randomised controlled trials in promoting alcohol abstinence. A systematic review published in 2017 found that twelve-step programmes for reducing illicit drug use are neither better nor worse than other interventions.

Criticism

In the past, some medical professionals have criticised 12-step programmes as “a cult that relies on God as the mechanism of action” and as lacking any experimental evidence in favour of its efficacy. Ethical and operational issues had prevented robust randomised controlled trials from being conducted comparing 12-step programmes directly to other approaches. More recent studies employing non-randomised and quasi-experimental studies have shown 12-step programmes provide similar benefit compared to motivational enhancement therapy (MET) and cognitive behavioural therapy (CBT), and were more effective in producing continuous abstinence and remission compared to these approaches.

Confidentiality

The Twelve Traditions encourage members to practice the spiritual principle of anonymity in the public media and members are also asked to respect each other’s confidentiality. This is a group norm, however, and not legally mandated; there are no legal consequences to discourage those attending twelve-step groups from revealing information disclosed during meetings. Statutes on group therapy do not encompass those associations that lack a professional therapist or clergyman to whom confidentiality and privilege might apply. Professionals and paraprofessionals who refer patients to these groups, to avoid both civil liability and licensure problems, have been advised that they should alert their patients that, at any time, their statements made in meetings may be disclosed.

Cultural Identity

One review warned of detrimental iatrogenic effects of twelve-step philosophy and labelled the organisations as cults, while another review asserts that these programs bore little semblance to religious cults and that the techniques used appeared beneficial to some. Another study found that a twelve-step program’s focus on self-admission of having a problem increases deviant stigma and strips members of their previous cultural identity, replacing it with the deviant identity. Another study asserts that the prior cultural identity may not be replaced entirely, but rather members found adapted a bicultural identity.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Twelve-step_program >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Self-Determination Theory?

Introduction

Self-determination theory (SDT) is a macro theory of human motivation and personality that concerns people’s innate growth tendencies and innate psychological needs. It pertains to the motivation behind people’s choices in the absence of external influences and distractions. SDT focuses on the degree to which human behaviour is self-motivated and self-determined.

In the 1970s, research on SDT evolved from studies comparing intrinsic and extrinsic motives, and from growing understanding of the dominant role that intrinsic motivation played in individual behaviour. It was not until the mid-1980s, when Edward L. Deci and Richard Ryan wrote a book titled Intrinsic Motivation and Self-Determination in Human Behaviour, that SDT was formally introduced and accepted as a sound empirical theory. Since the 2000s, research into practical applications of SDT has increased significantly.

The key research that led to the emergence of SDT included research on intrinsic motivation. Intrinsic motivation refers to initiating an activity because it is interesting and satisfying in itself to do so, as opposed to doing an activity for the purpose of obtaining an external goal (extrinsic motivation). A taxonomy of motivations has been described based on the degree to which they are internalised. Internalisation refers to the active attempt to transform an extrinsic motive into personally endorsed values and thus assimilate behavioural regulations that were originally external.

Edward Deci and Richard Ryan later expanded on the early work differentiating between intrinsic and extrinsic motivation and proposed three main intrinsic needs involved in self-determination. According to Deci and Ryan, three basic psychological needs motivate self-initiated behaviour and specify essential nutrients for individual psychological health and well-being. These needs are said to be the universal and innate need for autonomy, competence, and relatedness.

Self-Determination Theory

Humanistic psychology has been influential in the creation of SDT. Humanistic psychology is interested in looking at a person’s psyche and personal achievement for self-efficacy and self-actualisation. Whether or not an individual’s self-efficacy and self-actualisation are fulfilled can affect their motivation.

To this day, it may be difficult for a parent, coach, mentor, and teacher to motivate and help others complete specific tasks and goals. SDT acknowledges the importance of the interconnection of intrinsic and extrinsic motivations as a means of motivation to achieve a goal. With the acknowledgment of interconnection of motivations, SDT forms the belief that extrinsic motivations and the motivations of others, such as a therapist, may be beneficial. However, it is more important for people to find the “why” behind the desired goal within themselves. According to Sheldon et al., “Therapists who fully endorse self-determination principles acknowledge the limits of their responsibilities because they fully acknowledge that ultimately people must make their own choices” (2003, p.125). One needs to determine their reasons for being motivated and reaching their goal.

SDT comprises The Organismic Dialectic approach, which is a meta-theory, and a formal theory containing mini-theories focusing on the connection between extrinsic and intrinsic motivations within society and an individual. SDT is continually being developed as individuals incorporate the findings of more recent research. As SDT has developed, more mini-theories have been added to what was originally proposed by Deci and Ryan in 1985. Generally, SDT is described as having either five or six mini-theories. The main five mini-theories are cognitive evaluation theory, organismic integration theory, causality orientations theory, basic needs theory, and goal contents theory. The sixth mini-theory that some sources include in SDT is called Relational Motivation Theory.

SDT centres around the belief that human nature shows persistent positive features, with people repeatedly showing effort, agency, and commitment in their lives that the theory calls inherent growth tendencies. “Self-determination also has a more personal and psychology-relevant meaning today: the ability or process of making one’s own choices and controlling one’s own life.” The use of one’s personal agency to determine behaviour and mindset will help an individual’s choices.

Summary of SDT Mini-Theories

Mini-TheoryOutline
Cognitive Evaluation Theory (CET)1. This explains the relationship between internal motivation and external rewards.
2. According to CET, when external rewards are controlling, when they pressure individuals to act a certain way, they diminish internal motivation.
3. On the other hand, when external motivations are informational and provide feedback about behaviours, they increase internal motivation.
Organismic Integration Theory (OIT)1. This suggests different types of extrinsic motivations and how they contribute to the socialization of the individual.
2. This mini-theory suggests that people willingly participate in activities and behaviours that they do not find interesting or enjoyable because they are influenced by external motivators.
3. The four types of extrinsic motivations proposed in this theory are external regulation, introjected regulation, identified regulation, and integrated regulation.
Causality Orientations Theory (COT)1. This explores individual differences in the way people motivate themselves in regards to their personality.
2. COT suggests three orientations toward decision making which are determined by identifying the motivational forces behind an individual’s decisions.
3. Individuals can have an autonomy orientation and make choices according to their own interests and values, they may have a control orientation and make decisions based on the different pressures that they experience from internal and external demands, or they may have an impersonal orientation where they are overcome with feelings of helplessness which are accompanied by a belief that their decisions will not make a difference on the outcome of their lives.
Basic Needs Theory (BNT)1. This considers three psychological needs that are related to intrinsic motivation, effective functioning, high quality engagement, and psychological well-being.
2. The first psychological need is autonomy or the belief that one can choose their own behaviours and actions.
3. The second psychological need is competence.
4. In this sense, competence is when one is able to work effectively as they master their capacity to interact with the environment.
5. The third psychological need proposed in basic needs theory is relatedness, or the need to form strong relationships or bonds with people who are around an individual.
Goal Contents Theory (GCT)1. This compares the benefits of intrinsic goals to the negative outcomes of external goals in terms of psychological well-being.
2. Key to this mini-theory is understanding what reasoning lies behind an individual’s goals.
3. Individuals who pursue goals as a way to satisfy their needs have intrinsic goals and over time experience need satisfaction while those who pursue goals in search of validation have external goals and do not experience need satisfaction.
Relationship Motivation Theory (RMT)1. This examines the importance of relationships.
2. This theory posits that high quality relationships satisfy all three psychological needs described in BNT.
3. Of the three needs, relatedness is impacted the most by high quality relationships but autonomy and competence are satisfied as well.
4. This is because high quality relationships are able to provide individuals with a bond to another person while simultaneously reinforcing their needs for autonomy and competence.

The Organismic Dialectical Perspective

The organismic dialectical perspective sees all humans as active organisms interacting with their environment. People are actively growing, striving to overcome challenges, and creating new experiences. While endeavouring to become unified from within, individuals also become part of social structures. SDT also suggests that people have innate psychological needs that are the basis for self-motivation and personality integration. Through further explanation, people search for fulfilment in their ‘meaning of life’. Discovering the meaning of life constitutes a distinctive desire someone has to find purpose and aim in their lives, which enhances their perception of themselves and their surroundings. Not only does SDT tend to focus on innate psychological needs, it also focuses on the pursuit of goals, the effects of the success in their goals, and the outcome of goals.

Basic Psychological Needs

One mini-theory of SDT includes basic psychological needs theory which proposes three basic psychological needs that must be satisfied to foster well-being and health. These three psychological needs of autonomy, competence, and relatedness are generally universal (i.e. apply across individuals and situations). However, some needs may be more salient than others at certain times and be expressed differently based on time, culture, or experience. SDT identifies three innate needs that, if satisfied, allow optimal function and growth:

  • Autonomy;
  • Competence; and
  • Relatedness.

Autonomy

Desire to be causal agents of one’s own life and act in harmony with one’s integrated self; however, note this does not mean to be independent of others, but rather constitutes a feeling of overall psychological liberty and freedom of internal will. When a person is autonomously motivated their performance, wellness, and engagement is heightened rather than if a person is told what to do (a.k.a. control motivation).

Deci found that offering people extrinsic rewards for behaviour that is intrinsically motivated undermined the intrinsic motivation as they grow less interested in it. Initially intrinsically motivated behaviour becomes controlled by external rewards, which undermines their autonomy. In further research by Amabile, DeJong and Lepper, other external factors also appear to cause a decline in such motivation. For example, it is shown that deadlines restrict and control an individual which decreases their intrinsic motivation in the process.

Situations that give autonomy as opposed to taking it away also have a similar link to motivation. Studies looking at choice have found that increasing a participant’s options and choices increases their intrinsic motivation. Direct evidence for the innate need comes from Lübbecke and Schnedler who find that people are willing to pay money to have caused an outcome themselves. Additionally, satisfaction or frustration of autonomy impacts not only an individual’s motivation, but also their growth. This satisfaction or frustration further affects behaviour, leading to optimal well-being, or unfortunate ill-being.

Competence

Seek to control the outcome and experience mastery.

Deci found that giving people unexpected positive feedback on a task increases their intrinsic motivation to do it, meaning that this was because positive feedback fulfilled people’s need for competence. Additionally, SDT influences the fulfilment of meaning-making, well-being, and finding value within internal growth and motivation. Giving positive feedback on a task served only to increase people’s intrinsic motivation and decreased extrinsic motivation for the task.

Vallerand and Reid found negative feedback has the opposite effect (i.e. decreasing intrinsic motivation by taking away from people’s need for competence). In a study conducted by Felnhofer et al., the level of competence and view of attributing competence is judged in regards to the scope of age differences, gender, and attitude variances of an individual within a given society. The effect of the different variances between individuals subsidise the negative influence that may lead to decreasing intrinsic motivation.

Relatedness

Will to interact with, be connected to, and experience caring for others.

During a study on the relationship between infants’ attachment styles, their exhibition of mastery-oriented behaviour, and their affect during play, Frodi, Bridges and Grolnick failed to find significant effects: “Perhaps somewhat surprising was the finding that the quality of attachment assessed at 12 months failed to significantly predict either mastery motivation, competence, or affect 8 months later, when other investigators have demonstrated an association between similar constructs …” Yet they note that larger sample sizes could be able to uncover such effects: “A comparison of the secure/stable and the insecure/stable groups, however, did suggest that the secure/stable group was superior to the insecure/stable groups on all mastery-related measures. Obviously, replications of all the attachment-motivation relations are needed with different and larger samples.”

Deci and Ryan claim that there are three essential elements of the theory:

  • Humans are inherently proactive with their potential and mastery of their inner forces (such as drives and emotions);
  • Humans have an inherent tendency toward growth development and integrated functioning; and
  • Optimal development and actions are inherent in humans but they do not happen automatically.

In an additional study focusing on the relatedness of adolescents, connection to other individuals’ predisposed behaviours from relatedness satisfaction or frustration. The fulfilment or dissatisfaction of relatedness either promotes necessary psychological functioning or undermines developmental growth through deprivation. Across both study examples, the essential need for nurturing from a social environment goes beyond obvious and simple interactions for adolescents and promotes the actualisation of inherent potential.

If this happens, there are positive consequences (e.g. well-being and growth) but if not, there are negative consequences (e.g. dissatisfaction and deprivation). SDT emphasizes humans’ natural growth toward positive motivation, development, and personal fulfilment. However, this prevents the SDT’s purpose if the basic needs go unfulfilled. Although thwarting of an individual’s basic needs might occur, recent studies argue that such prevention has its own influence on well-being.

Self-determination theory

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Self-determination theory (SDT) is a macro theory of human motivation and personality that concerns people’s innate growth tendencies and innate psychological needs. It pertains to the motivation behind people’s choices in the absence of external influences and distractions. SDT focuses on the degree to which human behavior is self-motivated and self-determined.[1][2][3]

In the 1970s, research on SDT evolved from studies comparing intrinsic and extrinsic motives,[4] and from growing understanding of the dominant role that intrinsic motivation played in individual behavior.[5] It was not until the mid-1980s, when Edward L. Deci and Richard Ryan wrote a book titled Intrinsic Motivation and Self-Determination in Human Behavior,[6] that SDT was formally introduced and accepted as a sound empirical theory. Since the 2000s, research into practical applications of SDT has increased significantly.[7]

The key research that led to the emergence of SDT included research on intrinsic motivation.[8] Intrinsic motivation refers to initiating an activity because it is interesting and satisfying in itself to do so, as opposed to doing an activity for the purpose of obtaining an external goal (extrinsic motivation). A taxonomy of motivations has been described based on the degree to which they are internalized. Internalization refers to the active attempt to transform an extrinsic motive into personally endorsed values and thus assimilate behavioral regulations that were originally external.[9]

Edward Deci and Richard Ryan later expanded on the early work differentiating between intrinsic and extrinsic motivation and proposed three main intrinsic needs involved in self-determination.[10][11] According to Deci and Ryan, three basic psychological needs motivate self-initiated behavior and specify essential nutrients for individual psychological health and well-being. These needs are said to be the universal and innate need for autonomy, competence, and relatedness.[1]

Self-determination theory
Humanistic psychology has been influential in the creation of SDT.[12] Humanistic psychology is interested in looking at a person’s psyche and personal achievement for self-efficacy[13] and self-actualization. Whether or not an individual’s self-efficacy and self-actualization are fulfilled can affect their motivation.[14]

To this day, it may be difficult for a parent, coach, mentor, and teacher to motivate and help others complete specific tasks and goals. SDT acknowledges the importance of the interconnection of intrinsic and extrinsic motivations as a means of motivation to achieve a goal. With the acknowledgment of interconnection of motivations, SDT forms the belief that extrinsic motivations and the motivations of others, such as a therapist, may be beneficial. However, it is more important for people to find the “why” behind the desired goal within themselves.[15] According to Sheldon et al., “Therapists who fully endorse self-determination principles acknowledge the limits of their responsibilities because they fully acknowledge that ultimately people must make their own choices” (2003, p. 125).[15] One needs to determine their reasons for being motivated and reaching their goal.

SDT comprises The Organismic Dialectic approach, which is a meta-theory, and a formal theory containing mini-theories focusing on the connection between extrinsic and intrinsic motivations within society and an individual.[16] SDT is continually being developed as individuals incorporate the findings of more recent research. As SDT has developed, more mini-theories have been added to what was originally proposed by Deci and Ryan in 1985. Generally, SDT is described as having either five or six mini-theories. The main five mini-theories are cognitive evaluation theory, organismic integration theory, causality orientations theory, basic needs theory, and goal contents theory.[17][18] The sixth mini-theory that some sources include in SDT is called Relational Motivation Theory.[16]

SDT centers around the belief that human nature shows persistent positive features, with people repeatedly showing effort, agency, and commitment in their lives that the theory calls inherent growth tendencies.[12] “Self-determination also has a more personal and psychology-relevant meaning today: the ability or process of making one’s own choices and controlling one’s own life.”[19] The use of one’s personal agency to determine behavior and mindset will help an individual’s choices.

Summary of the SDT mini-theories
Cognitive evaluation theory (CET): explains the relationship between internal motivation and external rewards. According to CET, when external rewards are controlling, when they pressure individuals to act a certain way, they diminish internal motivation. On the other hand, when external motivations are informational and provide feedback about behaviors, they increase internal motivation.[18]
Organismic integration theory (OIT): suggests different types of extrinsic motivations and how they contribute to the socialization of the individual. This mini-theory suggests that people willingly participate in activities and behaviors that they do not find interesting or enjoyable because they are influenced by external motivators.[17] The four types of extrinsic motivations proposed in this theory are external regulation, introjected regulation, identified regulation, and integrated regulation.[18]
Causality orientations theory (COT): explores individual differences in the way people motivate themselves in regards to their personality.[18] COT suggests three orientations toward decision making which are determined by identifying the motivational forces behind an individual’s decisions. Individuals can have an autonomy orientation and make choices according to their own interests and values, they may have a control orientation and make decisions based on the different pressures that they experience from internal and external demands, or they may have an impersonal orientation where they are overcome with feelings of helplessness which are accompanied by a belief that their decisions will not make a difference on the outcome of their lives.[17]
Basic needs theory (BNT): considers three psychological needs that are related to intrinsic motivation, effective functioning, high quality engagement, and psychological well-being. The first psychological need is autonomy or the belief that one can choose their own behaviors and actions. The second psychological need is competence. In this sense, competence is when one is able to work effectively as they master their capacity to interact with the environment. The third psychological need proposed in basic needs theory is relatedness, or the need to form strong relationships or bonds with people who are around an individual.[18]
Goal contents theory (GCT): compares the benefits of intrinsic goals to the negative outcomes of external goals in terms of psychological well-being.[18] Key to this mini-theory is understanding what reasoning lies behind an individual’s goals. Individuals who pursue goals as a way to satisfy their needs have intrinsic goals and over time experience need satisfaction while those who pursue goals in search of validation have external goals and do not experience need satisfaction.[17]
Relationship motivation theory (RMT): examines the importance of relationships. This theory posits that high quality relationships satisfy all three psychological needs described in BNT. Of the three needs, relatedness is impacted the most by high quality relationships but autonomy and competence are satisfied as well. This is because high quality relationships are able to provide individuals with a bond to another person while simultaneously reinforcing their needs for autonomy and competence.[16]
The organismic dialectical perspective
The organismic dialectical perspective sees all humans as active organisms interacting with their environment. People are actively growing, striving to overcome challenges, and creating new experiences. While endeavoring to become unified from within, individuals also become part of social structures.[20][21] SDT also suggests that people have innate psychological needs that are the basis for self-motivation and personality integration. Through further explanation, people search for fulfillment in their ‘meaning of life’. Discovering the meaning of life constitutes a distinctive desire someone has to find purpose and aim in their lives, which enhances their perception of themselves and their surroundings.[22] Not only does SDT tend to focus on innate psychological needs, it also focuses on the pursuit of goals, the effects of the success in their goals, and the outcome of goals.[20]

Basic psychological needs
One mini-theory of SDT includes basic psychological needs theory which proposes three basic psychological needs that must be satisfied to foster well-being and health.[23] These three psychological needs of autonomy, competence, and relatedness are generally universal (i.e., apply across individuals and situations). However, some needs may be more salient than others at certain times and be expressed differently based on time, culture, or experience. SDT identifies three innate needs that, if satisfied, allow optimal function and growth:

Autonomy[24][25]
Desire to be causal agents of one’s own life and act in harmony with one’s integrated self; however, note this does not mean to be independent of others, but rather constitutes a feeling of overall psychological liberty and freedom of internal will. When a person is autonomously motivated their performance, wellness, and engagement is heightened rather than if a person is told what to do (a.k.a. control motivation).[26][27]
Deci[28] found that offering people extrinsic rewards for behavior that is intrinsically motivated undermined the intrinsic motivation as they grow less interested in it. Initially intrinsically motivated behavior becomes controlled by external rewards, which undermines their autonomy. In further research by Amabile, DeJong and Lepper,[29] other external factors also appear to cause a decline in such motivation. For example, it is shown that deadlines restrict and control an individual which decreases their intrinsic motivation in the process.

Situations that give autonomy as opposed to taking it away also have a similar link to motivation. Studies looking at choice have found that increasing a participant’s options and choices increases their intrinsic motivation.[30] Direct evidence for the innate need comes from Lübbecke and Schnedler[31] who find that people are willing to pay money to have caused an outcome themselves. Additionally, satisfaction or frustration of autonomy impacts not only an individual’s motivation, but also their growth. This satisfaction or frustration further affects behavior, leading to optimal well-being, or unfortunate ill-being.[27]

Competence[32][33]
Seek to control the outcome and experience mastery.[34]
Deci[28] found that giving people unexpected positive feedback on a task increases their intrinsic motivation to do it, meaning that this was because positive feedback fulfilled people’s need for competence. Additionally, SDT influences the fulfillment of meaning-making, well-being, and finding value within internal growth and motivation.[35] Giving positive feedback on a task served only to increase people’s intrinsic motivation and decreased extrinsic motivation for the task.

Vallerand and Reid[36] found negative feedback has the opposite effect (i.e., decreasing intrinsic motivation by taking away from people’s need for competence). In a study conducted by Felnhofer et al., the level of competence and view of attributing competence is judged in regards to the scope of age differences, gender, and attitude variances of an individual within a given society. The effect of the different variances between individuals subsidize the negative influence that may lead to decreasing intrinsic motivation.[37]

Relatedness
Will to interact with, be connected to, and experience caring for others.[38]
See also: Belongingness
During a study on the relationship between infants’ attachment styles, their exhibition of mastery-oriented behaviour, and their affect during play, Frodi, Bridges and Grolnick[39] failed to find significant effects: “Perhaps somewhat surprising was the finding that the quality of attachment assessed at 12 months failed to significantly predict either mastery motivation, competence, or affect 8 months later, when other investigators have demonstrated an association between similar constructs …” Yet they note that larger sample sizes could be able to uncover such effects: “A comparison of the secure/stable and the insecure/stable groups, however, did suggest that the secure/stable group was superior to the insecure/stable groups on all mastery-related measures. Obviously, replications of all the attachment-motivation relations are needed with different and larger samples.”

Deci and Ryan claim that there are three essential elements of the theory:[26]

Humans are inherently proactive with their potential and mastery of their inner forces (such as drives and emotions)
Humans have an inherent tendency toward growth development and integrated functioning
Optimal development and actions are inherent in humans but they do not happen automatically
In an additional study focusing on the relatedness of adolescents, connection to other individuals’ predisposed behaviors from relatedness satisfaction or frustration. The fulfillment or dissatisfaction of relatedness either promotes necessary psychological functioning or undermines developmental growth through deprivation. Across both study examples, the essential need for nurturing from a social environment goes beyond obvious and simple interactions for adolescents and promotes the actualization of inherent potential.[40][26]

If this happens, there are positive consequences (e.g. well-being and growth) but if not, there are negative consequences (e.g. dissatisfaction and deprivation). SDT emphasizes humans’ natural growth toward positive motivation, development, and personal fulfillment.[41][42] However, this prevents the SDT’s purpose if the basic needs go unfulfilled. Although thwarting of an individual’s basic needs might occur, recent studies argue that such prevention has its own influence on well-being.[41]

Motivations

SDT claims to offer a different approach to motivation, considering what motivates a person at any given time, rather than viewing motivation as a single concept. SDT makes distinctions between different types of motivation and what results from them. White and deCharms proposed that the need for competence and autonomy is the basis of intrinsic motivation and behaviour. This idea is a link between people’s basic needs and their motivations.

Intrinsic Motivation

Intrinsic motivation is the natural, inherent drive to seek out challenges and new possibilities that SDT associates with cognitive and social development.

Cognitive evaluation theory (CET) is a sub-theory of SDT that specifies factors explaining intrinsic motivation and variability with it and looks at how social and environmental factors help or hinder intrinsic motivations. CET focuses on the needs of competence and autonomy. CET is offered as an explanation of the phenomenon known as motivational “crowding out”.

Claiming social context events like feedback on work or rewards lead to feelings of competence and so enhance intrinsic motivations. Deci found positive feedback enhanced intrinsic motivations and negative feedback diminished it. Vallerand and Reid went further and found that these effects were being mediated by perceived control.

Autonomy, however, must accompany competence for people to see their behaviours as self determined by intrinsic motivation. There must be immediate contextual support for both needs or inner resources based on prior development for this to happen.

CET and intrinsic motivation are also linked to relatedness through the hypothesis that intrinsic motivation flourishes if linked with a sense of security and relatedness. Grolnick and Ryan found lower intrinsic motivation in children who believed their teachers to be uncaring or cold and so not fulfilling their relatedness needs.

There is an interesting correlation between intrinsic motivation and educational performance according to Augustyniak, et al. They studied intrinsic motivation in second year medical students and discovered that students with lower intrinsic motivation had lower test scores and overall grades. They also noted these students lacked interest and enjoyment in their studies. They suggest that it may be beneficial to find out if a student lacks intrinsic motivation when they are younger and it may be possible to develop as they grow up.

Extrinsic Motivation

Extrinsic motivation comes from external sources. Deci and Ryan developed organismic integration theory (OIT) as a sub-theory of SDT to explain the different ways extrinsically motivated behaviour is regulated.

OIT details the different forms of extrinsic motivation and the contexts in which they come about. The context of such motivation concerns the SDT theory as these contexts affect whether the motivations are internalised and so integrated into the sense of self.

OIT describes four different types of extrinsic motivations that often vary in terms of their relative autonomy:

Extrinsic MotivatorOutline
Externally Regulated Behaviour1. Is the least autonomous, it is performed because of external demand or possible reward.
2. Such actions can be seen to have an externally perceived locus of control.
Introjected Regulation of Behaviour1. This describes taking on regulations to behaviour but not fully accepting said regulations as your own.
2. Deci and Ryan claim such behaviour normally represents regulation by contingent self-esteem, citing ego involvement as a classic form of introjections.
3. This is the kind of behaviour where people feel motivated to demonstrate ability to maintain self-worth.
4. While this is internally driven, introjected behavior has an external perceived locus of causality or not coming from one’s self.
5. Since the causality of the behavior is perceived as external, the behavior is considered non-self-determined.
Regulation through Identification1. This a more autonomously driven form of extrinsic motivation.
2. It involves consciously valuing a goal or regulation so that said action is accepted as personally important.
Integrated Regulation1. Is the most autonomous kind of extrinsic motivation.
2. Occurring when regulations are fully assimilated with self so they are included in a person’s self-evaluations and beliefs on personal needs.
3. Because of this, integrated motivations share qualities with intrinsic motivation but are still classified as extrinsic because the goals that are trying to be achieved are for reasons extrinsic to the self, rather than the inherent enjoyment or interest in the task.

Extrinsically motivated behaviours can be integrated into self. OIT proposes that internalisation is more likely to occur when there is a sense of relatedness.

Ryan, Stiller and Lynch found that children internalize school’s extrinsic regulations when they feel secure and cared for by parents and teachers.

Internalisation of extrinsic motivation is also linked to competence. OIT suggests that feelings of competence in activities should facilitate internalisation of said actions.

Autonomy is particularly important when trying to integrate its regulations into a person’s sense of self. If an external context allows a person to integrate regulation—they must feel competent, related and autonomous. They must also understand the regulation in terms of their other goals to facilitate a sense of autonomy. This was supported by Deci, Eghrari, Patrick and Leone who found in laboratory settings if a person was given a meaningful reason for uninteresting behaviour along with support for their sense of autonomy and relatedness they internalised and integrated their behaviour.

Individual Differences

SDT argues that needs are innate but can be developed in a social context or learned from various life experiences and outside influences. Some people develop stronger needs than others, creating individual differences in the needs of people, whether it be autonomy, relatedness, or competence. However, individual differences within the theory focus on concepts resulting from the degree to which needs have been satisfied or not satisfied. This has the potential to lead to either need satisfaction or need frustration. Depending on which is reached, there can either be positive or negative outcomes, which vary between individual to individual and what their needs may be.

Within SDT there are two general individual difference concepts, causality orientations and life goals, which will be discussed in further detail below.

Causality Orientations

Causality orientations are motivational orientations that refer to the way people interact and adapt to an environment and regulate their behaviour in response to these adaptations; in other words, this is the extent to which people experience feelings related to self-determination across many settings. SDT created three orientations: autonomous, controlled and impersonal. This orientation helps to explain the consequences of these interactions with the environment. The orientation an individual holds dictates how that person will adapt.

Autonomous orientations refer to the results from satisfaction of the basic needs. An individual’s interactions with the environment will be oriented towards trying to satisfy those needs. They will adapt their behaviours in response to the environment that they find themselves in. Certain environments may require more heightened and more conscious effort in order to achieve their needs while others may not. Either way, the individual has oriented themselves and their behaviours, whether consciously or subconsciously, towards achieving their basic needs.

Strong controlled orientations come as a result of competence and relatedness needs but excludes autonomy; there is a link to regulation through both internal and external contingencies. This causes rigid functioning and diminished well-being, which are more negative outcomes rather than positive.

Impersonal orientations come from failure to fulfil all three needs, which leads to poor functioning and ill-being. According to the self-determination theory, each individual has each of these orientations to some extent. This makes it possible to predict their psychological and behavioural outcomes. When needs are satisfied, it has been shown to improve vitality, life satisfaction, and positive affect. On the other hand, need frustration can lead to more negative outcomes, such as emotional exhaustion.

The causality orientations may have various and unique impacts on an individual’s motivation. In one particular study, participants were presented a puzzle and asked to put it together. And, what researchers found was that those who were more oriented towards autonomy would put in more time into solving the puzzle as composed to their counterparts. Feedback was also an important contributing factor to the success and motivation of the participants.

Life Goals

Life goals are long-term goals people use to guide an individual’s activities. They may fit into a variety of different categories and vary from person to person. The period of time that the particular goal will also be different depending on the nature of the goal. Some goals may take decades while other may take a couple years. There have even been instances where a goal can last a lifetime and will not be fully achieved until the individual passes. These goals can be divided into two separate categories:

  • Intrinsic Aspirations: Contain life goals like affiliation, generativity and personal development.
  • Extrinsic Aspirations: Have life goals like wealth, fame and attractiveness.

There have been several studies on this subject that chart intrinsic goals being associated with greater health, well-being and performance. Intrinsic motivation has also been shown to be a better motivator, especially in relation to long-term goals as it leaves all motivation to be on an internal basis. It does not rely on external factors, that are typically temporary, to provide the necessary drive to complete a task. With intrinsic aspirations, they would relate to things that are more values rather than material things or have material manifestations, which fits with the examples provided. These life goals can also be related back to the needs that are stronger for the individual and that they are more motivated to satisfy. For example, the goal of affiliation would fit into the category of the need for relatedness. Wealth, on the other hand, would fit more under the category of competence.

The Connection

Both of these aspects can be related to many important aspects in a person’s life. The causality orientations held by an individual will have an impact on their life goals, including the type of goal and if they will be able to achieve it. An example of this is job engagement and its relationship to the number of resources available to employees. The researchers conducting this study found that “the autonomous and impersonal orientations were shown to moderate the relationship between job resources and work engagement; the positive relationship was weaker for both highly autonomy-oriented and highly impersonal-oriented individuals. The interaction between controlled orientation and job resources was insignificant.” So, those in these work environments will have various life goals related to their work. And, depending on their orientation, may be able to better navigate the various aspects related to how well they can perform their job. Learned helplessness may even come into play with the motivation individuals may be.

Classic Studies

Deci (1971): External Rewards on Intrinsic Motivation

Deci studied the effect of extrinsic rewards on intrinsic motivation in two labs and a field experiment. Based on the results from earlier animal and human studies on intrinsic motivation, the author explored two possibilities. In the first two experiments he looked at the effect of extrinsic rewards in terms of a decrease in intrinsic motivation to perform a task. Earlier studies showed contradictory or inconclusive findings regarding decrease in performance on a task following an external reward. The third experiment was based on findings of developmental learning theorists and looked at whether a different type of reward enhances intrinsic motivation to participate in an activity.

Experiment I

This experiment tested the hypothesis that if an individual is intrinsically motivated to perform an activity, introduction of an extrinsic reward decreases the degree of intrinsic motivation to perform the task.

Twenty-four undergraduate psychology students participated in the first laboratory experiment and were assigned to either an experimental (n = 12) or control group (n = 12). Each group participated in three sessions conducted on three different days. During the sessions, participants were engaged in working on a Soma cube puzzle – which the experimenters assumed was an activity college students would be intrinsically motivated to do. The puzzle could be put together to form numerous different configurations. In each session, the participants were shown four different configurations drawn on a piece of paper and were asked to use the puzzle to reproduce the configurations while they were being timed.

The first and third session of the experimental condition were identical to control, but in the second session the participants in the experimental condition were given a dollar for completing each puzzle within time. During the middle of each session, the experimenter left the room for eight minutes and the participants were told that they were free to do whatever they wanted during that time, while the experimenter observed during that period. The amount of time spent working on the puzzle during the free choice period was used to measure motivation.

As Deci expected, when external reward was introduced during session two, the participants spent more time working on the puzzles during the free choice period in comparison to session 1 and when the external reward was removed in the third session, the time spent working on the puzzle dropped lower than the first session. All subjects reported finding the task interesting and enjoyable at the end of each session, providing evidence for the experimenter’s assumption that the task was intrinsically motivating for the college students. The study showed some support of the experimenter’s hypothesis and a trend towards a decrease in intrinsic motivation was seen after money was provided to the participants as an external reward.

Experiment II

The second experiment was a field experiment, similar to laboratory Experiment I, but was conducted in a natural setting.

Eight student workers were observed at a college biweekly newspaper. Four of the students served as a control group and worked on Fridays. The experimental group worked on Tuesdays.

The control and experimental group students were not aware that they were being observed. The 10-week observation was divided into three time periods. The task in this study required the students to write headlines for the newspaper.

During “Time 2”, the students in the experimental group were given 50 cents for each headline they wrote. At the end of Time 2, they were told that in the future the newspaper cannot pay them 50 cent for each headline anymore as the newspaper ran out of the money allocated for that and they were not paid for the headlines during Time 3.

The speed of task completion (headlines) was used as a measure of motivation in this experiment. Absences were used as a measure of attitudes.

To assess the stability of the observed effect, the experimenter observed the students again (Time 4) for two weeks. There was a gap of five weeks between Time 3 and Time 4. Due to absences and change in assignment etc., motivation data was not available for all students. The results of this experiment were similar to Experiment I and monetary reward was found to decrease the intrinsic motivation of the students, supporting Deci’s hypothesis.

Experiment III

Experiment III was also conducted in the laboratory and was identical to Experiment I in all respects except for the kind of external reward provided to the students in the experimental condition during Session 2.

In this experiment, verbal praise was used as an extrinsic reward.

The experimenter hypothesized that a different type of reward—i.e., social approval in the form of verbal reinforcement and positive feedback for performing the task that a person is intrinsically motivated to perform—enhances the degree of external motivation, even after the extrinsic reward is removed.

The results of the experiment III confirmed the hypothesis and the students’ performance increased significantly during the third session in comparison to session one, showing that verbal praise and positive feedback enhances performance in tasks that a person is initially intrinsically motivated to perform. This provides evidence that verbal praise as an external reward increases intrinsic motivation.

The author explained differences between the two types of external rewards as having different effects on intrinsic motivation. When a person is intrinsically motivated to perform a task and money is introduced to work on the task, the individual cognitively re-evaluates the importance of the task and the intrinsic motivation to perform the task (because the individual finds it interesting) shifts to extrinsic motivation and the primary focus changes from enjoying the task to gaining financial reward. However, when verbal praise is provided in a similar situation, it increases intrinsic motivation as it is not evaluated to be controlled by external factors and the person sees the task as an enjoyable task that is performed autonomously. The increase in intrinsic motivation is explained by positive reinforcement and an increase in perceived locus of control to perform the task.

Pritchard et al. (1977): Evaluation of Deci’s Hypothesis

Pritchard et al. conducted a similar study to evaluate Deci’s hypothesis regarding the role of extrinsic rewards on decreasing intrinsic motivation.

Participants were randomly assigned to two groups. A chess-problem task was used in this study. Data was collected in two sessions.

Session I

Participants were asked to complete a background questionnaire that included questions on the amount of time the participant played chess during the week, the number of years that the participant has been playing chess for, amount of enjoyment the participant gets from playing the game, etc.

The participants in both groups were then told that the experimenter needed to enter the information in the computer and for the next 10 minutes the participant were free to do whatever they liked.

The experimenter left the room for 10 minutes. The room had similar chess-problem tasks on the table, some magazines as well as coffee was made available for the participants if they chose to have it.

The time spent on the chess-problem task was observed through a one way mirror by the experimenter during the 10 minute break and was used as a measure of intrinsic motivation. After the experimenter returned, the experimental group was told that there was a monetary reward for the participant who could work on the most chess problems in the given time and that the reward is for this session only and would not be offered during the next session. The control group was not offered a monetary reward.

Session II

The second session was the same for the two groups:

After a filler task, the experimenter left the room for 10 minutes and the time participants spent on the chess-problem task was observed. The experimental group was reminded that there was no reward for the task this time.

After both sessions the participants were required to respond to questionnaires evaluating the task, i.e. to what degree did they find the task interesting. Both groups reported that they found the task interesting.

The results of the study showed that the experimental group showed a significant decrease in time spent on the chess-problem task during the 10-minute free time from session 1 to session 2 in comparison to the group that was not paid, thus confirming the hypothesis presented by Deci that contingent monetary reward for an activity decreases the intrinsic motivation to perform that activity. Other studies were conducted around this time focusing on other types of rewards as well as other external factors that play a role in decreasing intrinsic motivation.

New Developments

Principles of SDT have been applied in many domains of life, e.g. job demands; parenting; teaching; health; including willingness to get vaccinated; morality; and technology design. Besides the domains mentioned above, SDT research has been widely applied to the field of sports.

Exercise and Physical Activity

Murcia et al. looked at the influence of peers on enjoyment in exercise. Specifically, the researchers looked at the effect of motivational climate generated by peers on exercisers by analysing data collected through questionnaires and rating scales. The assessment included evaluation of motivational climate, basic psychological needs satisfaction, levels of self-determination and self-regulation (amotivation, external, introjected, identified and intrinsic regulation) and also the assessment of the level of satisfaction and enjoyment in exercising.

Data analysis revealed that when peers are supportive and there is an emphasis on cooperation, effort, and personal improvement, the climate influences variables like basic psychological needs, motivation, and enjoyment. The task climate positively predicted the three basic psychological needs (competence, autonomy, and relatedness) and so positively predicted self-determined motivation. Task climate and the resulting self-determination were also found to positively influence the level of enjoyment that exercisers experienced during the activity.

Behzadniaa et al. studied how physical education teachers’ autonomy support versus control would relate to students’ wellness, knowledge, performance, and intentions to persist at physical activity beyond the PE classes. The study concluded that, “…perceived autonomy support was positively related to the positive outcomes via need satisfaction and frustration and autonomous motivation, and that perceptions of teachers’ control were related to students’ ill-being (positively) and knowledge (negatively) through need frustration.”

Identified regulation was found to be more consistently associated with regular physical activity than other forms of autonomous motivation, such as intrinsic regulation, which may be triggered by pleasure derived from the activity itself. This may be explained by physical activity often relating to more mundane or repetitive actions. More recent studies suggest that different types of motivation regulate different intensities of physical activity, which may be context dependent. For example, higher frequency of vigorous physical activity was associated with autonomous motivation, but not with controlled motivation in a study in rural Uganda. In an urban disadvantaged South African population, however, an association between moderate physical activity and autonomous motivation was found, but not with vigorous physical activity. The latter study also found the association between the basic psychological needs and more autonomous forms of motivation to be different across different contexts.

Awareness

Awareness has always been associated with autonomous functioning. However, only recently have the SDT researchers incorporated the concept of mindfulness and its relationship with autonomous functioning and emotional well-being into their studies.

Brown and Ryan conducted a series of five experiments to study mindfulness: They defined mindfulness as open, undivided attention to what is happening within and around oneself.

From their experiments, the authors concluded that when people act mindfully, their actions are consistent with their values and interest. Also, there is a possibility that being autonomous and performing an action because it is enjoyable to oneself increases mindful attention to one’s actions.

Vitality and Self-Regulation

Another area of interest for SDT researchers is the relationship between subjective vitality and self-regulation. Ryan and Deci define vitality as energy available to the self, either directly or indirectly, from basic psychological needs. This energy allows individuals to act autonomously.

Many theorists have posited that self-regulation depletes energy but SDT researchers have proposed and demonstrated that only controlled regulation depletes energy, autonomous regulation can actually be vitalising.

Ryan et al. used SDT to explain the effect of weekends on the well-being of adult working population. The study determined that people felt higher well-being on weekends due to greater feelings of autonomy, and feeling closer to others (relatedness), in weekend activities.

Education

In a study by Hyungshim Jang, the capacity of two different theoretical models of motivation were used to explain why an externally provided rationale for doing a particular assignment often helps in a student’s motivation, engagement, and learning during relatively uninteresting learning activities.

Undergraduate students (N = 136; 108 women, 28 men) worked on a relatively uninteresting short lesson after either receiving or not receiving a rationale. Students who received the rationale showed greater interest, work ethic, and determination.

Structural equation modelling was used to test three alternative explanatory models to understand why the rationale produced such benefits:

  • An identified regulation model based on SDT
  • An interest regulation model based on interest-enhancing strategies research
  • An additive model that integrated both models.

The data fit all three models; but only the model based on SDT helped students to engage and learn. Findings show the role that externally provided rationales can play in helping students generate the motivation they need to engage in and learn from uninteresting, but personally important, material.

The importance of these findings to those in the field of education is that when teachers try to find ways to promote student’s motivation during relatively uninteresting learning activities, they can successfully do so by promoting the value of the task. One way teachers can help students value what they may deem “uninteresting” is by providing a rationale that identifies the lesson’s otherwise hidden value, helps students understand why the lesson is genuinely worth their effort, and communicates why the lesson can be expected to be useful to them.

An example of SDT and education are Sudbury Model schools where people decide for themselves how to spend their days. In these schools, students of all ages determine what they do, as well as when, how, and where they do it. This freedom is at the heart of the school; it belongs to the students as their right, not to be violated. The fundamental premises of the school are simple: that all people are curious by nature; that the most efficient, long-lasting, and profound learning takes place when started and pursued by the learner; that all people are creative if they are allowed to develop their unique talents; that age-mixing among students promotes growth in all members of the group; and that freedom is essential to the development of personal responsibility. In practice this means that students initiate all their own activities and create their own environments. The physical plant, the staff, and the equipment are there for the students to use as the need arises. The school provides a setting in which students are independent, are trusted, and are treated as responsible people; and a community in which students are exposed to the complexities of life in the framework of a participatory democracy. Sudbury schools do not perform and do not offer evaluations, assessments, or recommendations, asserting that they do not rate people, and that school is not a judge; comparing students to each other, or to some standard that has been set is for them a violation of the student’s right to privacy and to self-determination. Students decide for themselves how to measure their progress as self-starting learners as a process of self-evaluation: real lifelong learning and the proper educational evaluation for the 21st century, they adduce.

Alcohol Use

According to SDT, individuals who attribute their actions to external circumstances rather than internal mechanisms are far more likely to succumb to peer pressure. In contrast, individuals who consider themselves autonomous tend to be initiators of actions rather than followers. Research examining the relationship between SDT and alcohol use among college students has indicated that individuals with the former criteria for decision making are associated with greater alcohol consumption and drinking as a function of social pressure. For instance, in a study conducted by Knee and Neighbours, external factors in the individuals who claim to not be motivated by internal factors were found to be associated with drinking for extrinsic reasons, and with stronger perceptions of peer pressure, which in turn was related to heavier alcohol use. Given the evidence suggesting a positive association between an outward motivation and drinking, and the potential role of perceived social influence in this association, understanding the precise nature of this relationship seems important. Further, it may be hypothesized that the relationship between self-determination and drinking may be mediated to some extent by the perceived approval of others.

Healthy Eating

Self-determination theory offers an explanatory framework to predict healthy eating and other dietary behaviour. Research on SDT in the domain of eating regulation is still in its early stages and most of these studies were conducted in high income settings. In support of SDT, A recent study in an urban township population in South Africa found that frequency of fruit, vegetable and non-refined starch intake was associated with identified regulation and negatively associated with introjected regulation among people with (pre)diabetes. The same study found perceived competence and relatedness to be positively associated with identified regulation and negatively associated with introjected regulation. In more concrete wording, individuals who experience support from friends or family and who feel competent in maintaining a healthy diet were more likely to become motivated by their own values such as having a good health. Motivation linked to pressure from others or feelings of guilt or shame showed to be negatively associated with maintaining a healthy diet.

Motivational Interviewing

Motivational interviewing (MI) is a popular approach to positive behavioural change. Used initially in the area of addiction (Miller & Rollnick, 2002), it is now used for a wider range of issues. It is a client-centred method that does not persuade or coerce patients to change and instead attempts to explore and resolve their ambivalent feelings, which allows them to choose themselves whether to change or not.

Markland, Ryan, Tobin, and Rollnick believe that SDT provides a framework behind how and the reasons why MI works. They believe that MI provides an autonomy-supportive atmosphere, which allows clients to find their own source of motivation and achieve their own success (in terms of overcoming addiction). Patients randomly assigned to an MI treatment group found the setting to be more autonomy-supportive than those in a regular support group.

Environmental Behaviours

Several studies explored the link between SDT and environmental behaviours to determine the role of intrinsic motivation for environmental behaviour performance and to account for the lack of success of current intervention strategies.

Consumer Behaviour

Self-determination theory identifies a basic psychological need for autonomy as a central feature for understanding effective self-regulation and well-being. As adopting these services increases both individual and collective well-being, research has to delve more deeply into the origins of consumers’ motivations. For this reason aim at augmenting the understanding of how different types of motivation determine consumers’ intention to adopt transformative services. They examine whether Self-Determination Theory (SDT) can be of help in fostering more sustainable food choices by taking a closer look at the relationship between food-related types of motivation and different aspects of meat consumption, based on a survey among 1083 consumers in the Netherlands.

Motivation toward the Environment Scale

Environmental attitudes and knowledge are not good predictors of behaviour. SDT suggests that motivation can predict behaviour performance. Pelletier et al. (1998) constructed a scale of motivation for environmental behaviour, which consists of 4×6 statements (4 statements for each type of motivation on the SDT motivation scale: intrinsic, integrated, identified, introjected, external, and amotivation) responding to a question ‘Why are you doing things for the environment?’. Each item is scored on a 1–7 Likert scale. Utilising MTES, Villacorta (2003) demonstrates a correlation between environmental concerns and intrinsic motivations together with peer and parental support; further, intrinsically motivated behaviours tend to persist longer.

Environmental Motivation

Pelletier et al. (1999) shows that four personal beliefs: helplessness, strategy, capacity, and effort, lead to greater amotivation, while self-determination has an inverse relationship with amotivation. The Amotivation toward the Environment Scale measures the four reasons for amotivation by answering the question ‘Why are you not doing things for the environment?’. The participants rank 16 total statements (four in each category of amotivation) on a 1–7 Likert scale.

Intervention Strategies

Intervention strategies have to be effective in bridging the gap between attitudes and behaviours. Monetary incentives, persuasive communication, and convenience are often successful in the short term, but when the intervention is removed, behaviour is discontinued. In the long run, such intervention strategies are therefore expensive and difficult to maintain.

SDT explains that environmental behaviour that is not motivated intrinsically is not persistent. On the other hand, when self-determination is high, behaviour is more likely to occur repeatedly. The importance of intrinsic motivation is particularly apparent with more difficult behaviours. While they are less likely to be performed in general, people with high internal motivation are more likely to perform them more frequently than people with low intrinsic motivation. 5 Subjects scoring high on intrinsic motivation and supporting ecological well-being also reported a high level of happiness.

According to Osbaldiston and Sheldon (2003), autonomy perceived by an individual leads to an increased frequency of environmental behaviour performance. In their study, 162 university students chose an environmental goal and performed it for a week. Perceived autonomy, success in performing chosen behaviour, and their future intention to continue were measured. The results suggested that people with higher degree of self-perceived autonomy successfully perform behaviours and are more likely to do so in the long term.

Based on the connection between SDT and environmental behaviours, Pelletier et al. suggest that successful intervention should emphasize self-determined motivation for performing environmental behaviours.

Industrial and Organisational Psychology

SDT has been applied to Industrial and organisational psychology.

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An Overview of Posttraumatic Growth

Introduction

In psychology, posttraumatic growth (PTG) is positive psychological change experienced as a result of struggling with highly challenging, highly stressful life circumstances.

These circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to the individual’s way of understanding the world and their place in it. Posttraumatic growth involves “life-changing” psychological shifts in thinking and relating to the world and the self, that contribute to a personal process of change, that is deeply meaningful.

Brief History

The general understanding that suffering and distress can potentially yield positive change is thousands of years old. For example, some of the early ideas and writing of the ancient Hebrews, Greeks, and early Christians, as well as some of the teachings of Hinduism, Buddhism, Islam and the Baháʼí Faith contain elements of the potentially transformative power of suffering. Attempts to understand and discover the meaning of human suffering represent a central theme of much philosophical inquiry and appear in the works of novelists, dramatists and poets.

Traditional psychology’s equivalent to thriving is resilience, which is reaching the previous level of functioning before a trauma, stressor, or challenge. The difference between resilience and thriving is the recovery point – thriving goes above and beyond resilience, and involves finding benefits within challenges.

The term “posttraumatic growth” was coined by psychologists at the University of North Carolina at Charlotte. According to Tedeschi, as many as 89% of survivors report at least one aspect of posttraumatic growth, such as a renewed appreciation for life.

Variants of the idea have included Crystal Park’s proposed stress related growth model, which highlighted the derived sense of meaning in the context of adjusting to challenging and stressful situations, and Joseph and Linley’s proposed adversarial growth model, which linked growth with psychological wellbeing. According to the adversarial growth model, whenever an individual is experiencing a challenging situation, they can either integrate the traumatic experience into their current belief system and worldviews or they can modify their beliefs based on their current experiences. If the individual positively accommodates the trauma-related information and assimilates prior beliefs, psychological growth can occur following adversity.

Causes

Posttraumatic growth occurs with the attempts to adapt to highly negative sets of circumstances that can engender high levels of psychological distress such as major life crises, which typically engender unpleasant psychological reactions.[1] Growth does not occur as a direct result of trauma; rather, it is the individual’s struggle with the new reality in the aftermath of trauma that is crucial in determining the extent to which posttraumatic growth occurs. Encouragingly, reports of growth experiences in the aftermath of traumatic events far outnumber reports of psychiatric disorders, since continuing personal distress and growth often coexist.

As far as predictors of posttraumatic growth, a number of factors have been associated with adaptive growth following exposure to a trauma. Spirituality has been shown to highly correlate with posttraumatic growth and in fact, many of the most deeply spiritual beliefs are a result of trauma exposure. Social support has been well documented as a buffer to mental illness and stress response. In regards to posttraumatic growth, not only are high levels of pre-exposure social support associated with growth, but there is some neurobiological evidence to support the idea that support will modulate a pathological response to stress in the hypothalamic-pituitary-adrenocortical (HPA) pathway in the brain. As Richard G. Tedeschi and other posttraumatic growth researchers have found, the ability to accept situations that cannot be changed is crucial for adapting to traumatic life events. They call it “acceptance coping”, and have determined that coming to terms with reality is a significant predictor of posttraumatic growth. It is also alleged, though currently under further investigation, that opportunity for emotional disclosure can lead to posttraumatic growth though did not significantly reduce post-traumatic stress symptomology. Gender roles did not reliably predict posttraumatic growth though are indicative of the type of trauma that an individual experiences. Women tend to experience victimisation on a more individual and interpersonal level (e.g. sexual victimisation) while men tend to experience more systemic and collective traumas (e.g. military and combat). Given that group dynamics appear to play a predictive role in posttraumatic growth, it can be argued that the type of exposure may indirectly predict growth in men.

Posttraumatic Growth and Personality

Historically, personality traits have been depicted as being stable following the age of 30. Since 1994, research findings suggested that personality traits can change in response to life transition events during middle and late adulthood. Life transition events may be related to work, relationships, or health. Moderate amounts of stress were associated with improvements in the traits of mastery and toughness. Individuals experiencing moderate amounts of stress were found to be more confident about their abilities and had a better sense of control over their lives. Further, moderate amounts of stress were also associated with better resilience, which can be defined as successful recovery to baseline following stress. An individual who experienced moderate amounts of stressful events was more likely to develop coping skills, seek support from their environment, and experience more confidence in their ability to overcome adversity.

Posttraumatic Growth

Posttraumatic growth refers to positive psychological change resulting from a struggle with traumatic or highly challenging life circumstances. Experiencing a traumatic event can have a transformational role in personality among certain individuals and facilitate growth. For example, individuals who have experienced trauma have been shown to exhibit greater optimism, positive affect, and satisfaction with social support, as well as increases in the number of social supportive resources. Similarly, research reveals personality changes among spouses of terminal cancer patients suggesting such traumatic life transitions facilitated increases in interpersonal orientation, prosocial behaviours, and dependability scores.

Importantly, experiencing a traumatic life event per se does not lead to posttraumatic growth. Not everyone who experiences a traumatic event will directly develop posttraumatic growth. Rather, an individual’s emotional response to the traumatic event is significant in determining the long-term outcome of that trauma. The outcome of traumatic events can be negatively impacted by factors occurring during and after the trauma, potentially increasing the risk of developing posttraumatic stress disorder, or other mental health difficulties.

Further, characteristics of the trauma and personality dynamics of the individual experiencing the trauma each independently contributed to posttraumatic growth. If the amounts of stress are too low or too overwhelming, a person cannot cope with the situation. Personality dynamics can either facilitate or impede posttraumatic growth, regardless of the impact of traumatic events.

Mixed Findings

Research of posttraumatic growth is emerging in the field of personality psychology, with mixed findings. Several researchers examined posttraumatic growth and its associations with the big five personality model. Posttraumatic growth was found to be associated with greater agreeableness, openness, and extraversion. Agreeableness relates to interpersonal behaviours which include trust, altruism, compliance, honesty, and modesty. Individuals who are agreeable are more likely to seek support when needed and to receive it from others. Higher scores on the agreeableness trait can facilitate the development of posttraumatic growth.

Individuals who score high on openness scales are more likely to be curious, open to new experiences, and emotionally responsive to their surroundings. It is hypothesized that following a traumatic event, individuals who score high on openness would more readily reconsider their beliefs and values that may have been altered. Openness to experiences is thus key for facilitating posttraumatic growth. Individuals who score high on extraversion were more likely to adopt more problem-solving strategies, cognitive restructuring, and seek more support from others. Individuals who score high on extraversion use coping strategies that enable posttraumatic growth. Research among veterans and among children of prisoners of war suggested that openness and extraversion contributed to posttraumatic growth.

Research among community samples suggested that openness, agreeableness, and conscientiousness contributed to posttraumatic growth. Individuals who score high on conscientiousness tend to be better at self-regulating their internal experience, have better impulse control, and are more likely to seek achievements across various domains. The conscientiousness trait has been associated with better problem-solving and cognitive restructuring. As such, individuals who are conscientious are more likely to better adjust to stressors and exhibit posttraumatic growth.

Other research among bereaved caregivers and among undergraduates indicated that posttraumatic growth was associated with extraversion, agreeableness, and conscientiousness. As such, the findings linking the big five personality traits with posttraumatic growth are mixed.

Trauma Types, Personality Dynamics, and Posttraumatic Growth

Recent research is examining the influence of trauma types and personality dynamics on posttraumatic growth. Individuals who aspire to standards and orderliness are more likely to develop posttraumatic growth and better overall mental health. It is hypothesized that such individuals can better process the meaning of hardships as they experience moderate amounts of stress. This tendency can facilitate positive personal growth. On the other hand, it was found that individuals who have trouble in regulating themselves are less likely to develop posttraumatic growth and more likely to develop trauma-spectrum disorders and mood disorders. This is in line with past research that suggested that individuals who scored higher on self-discrepancy were more likely to score higher on neuroticism and exhibit poor coping. Neuroticism relates to an individual’s tendency to respond with negative emotions to threat, frustration, or loss. As such, individuals with high neuroticism and self-discrepancy are less likely to develop posttraumatic growth. Research has highlighted the important role that collective processing of emotional experiences has on posttraumatic growth. Those who are more capable of engaging with their emotional experiences due to crisis and trauma, and make meaning of these are more likely to increase in their resilience and community engagement following the disaster. Furthermore, collective processing of these emotional experiences leads to greater individual growth and collective solidarity and belongingness.

Characteristics

People who have experienced posttraumatic growth report changes in the following 5 factors: Appreciation of life; Relating to others; Personal strength; New possibilities; and Spiritual, existential or philosophical change. Two personality characteristics that may affect the likelihood that people can make positive use of the aftermath of traumatic events that befall them include extraversion and openness to experience. Also, optimists may be better able to focus attention and resources on the most important matters, and disengage from uncontrollable or unsolvable problems. The ability to grieve and gradually accept trauma could also increase the likelihood of growth. It also benefits a person to have supportive others that can aid in posttraumatic growth by providing a way to craft narratives about the changes that have occurred, and by offering perspectives that can be integrated into schema change. These relationships help develop narratives; these narratives of trauma and survival are always important in posttraumatic growth because the development of these narratives forces survivors to confront questions of meaning and how answers to those questions can be reconstructed. Individual differences in coping strategies set some people on a maladaptive spiral, whereas others proceed on an adaptive spiral. With this in mind, some early success in coping could be a precursor to posttraumatic growth. A person’s level of confidence could also play a role in her or his ability to persist into growth or, out of lack of confidence, give up.

In 2011 Iversen and Christiansen & Elklit suggested that predictors of growth have different effects on PTG on micro-, meso-, and macro level, and a positive predictor of growth on one level can be a negative predictor of growth on another level. This might explain some of the inconsistent research results within the area.

Posttraumatic growth has been studied in children to a lesser extent. A review by Meyerson and colleagues found various relations between social and psychological factors and posttraumatic growth in children and adolescents, but concluded that fundamental questions about its value and function remain.

Theories and Findings

Resilience

In general, research in psychology shows that people are resilient overall. For example, Southwick and Charney, in a study of 250 prisoners of war from the Vietnam War, showed that participants developed much lower rates of depression and PTSD symptoms than expected. Donald Meichenbaum estimated that 60% of North Americans will experience trauma in their lifetime, and of these while no one is unscathed, some 70% show resilience and 30% show harmful effects. Similarly, 68 million women of the 150 million in America will be victimised over their lifetime, but a shocking 10% will suffer insofar as they must seek help from mental health professionals.

In general, traditional psychology’s approach to resiliency as exhibited in the studies above is a problem-oriented one, assuming that PTSD is the problem and that resiliency just means to avoid or fix that problem in order to maintain baseline well-being. This type of approach fails to acknowledge any growth that might occur beyond the previously set baseline, however. Positive psychology’s idea of thriving attempts to reconcile that failure. A meta-analysis of studies conducted by Shakespeare-Finch and Lurie-Beck in this area indicates that there is actually an association between PTSD symptoms and posttraumatic growth. The null hypothesis that there is no relationship between the two was rejected for the study. The correlation between the two was significant and was found to be dependent upon the nature of the event and the person’s age. For example, survivors of sexual assault show less posttraumatic growth than survivors of natural disaster. Ultimately, however, the meta-analysis serves to show that PTSD and posttraumatic growth are not mutually exclusive ends of a recovery spectrum and that they may actually co-occur during a successful process to thriving.

It is important to note that while aspects of resilience and growth aid an individual’s psychological well-being, they are not the same thing. Dr. Richard Tedeschi and Dr. Erika Felix specifically note that resilience suggests bouncing back and returning to one’s previous state of being, whereas post-traumatic growth fosters a transformed way of being or understanding for an individual. Often, traumatic or challenging experiences force an individual to re-evaluate core beliefs, values, or behaviours on both cognitive and emotional levels; the idea of post-traumatic growth is therefore rooted in the notion that these beliefs, values, or behaviours come with a new perspective and expectation after the event. Thus, post-traumatic growth centres around the concept of change, whereas resilience suggests the return to previous beliefs, values, or lifestyles.

Thriving

To understand the significance of thriving in the human experience, it is important to understand its role within the context of trauma and its separation from traditional psychology’s idea of resilience. Implicit in the idea of thriving and resilience both is the presence of adversity. O’Leary and Ickovics created a four-part diagram of the spectrum of human response to adversity, the possibilities of which include:

  1. Succumbing to adversity;
  2. Surviving with diminished quality of life;
  3. Resiliency (returning to baseline quality of life); and
  4. Thriving.

Thriving includes not only resiliency, but an additional further improvement over the quality of life previous to the adverse event.

Thriving in positive psychology definitely aims to promote growth beyond survival, but it is important to note that some of the theories surrounding the causes and effects of it are more ambiguous. Literature by Carver indicates that the concept of thriving is a difficult one to define objectively. He makes the distinction between physical and psychological thriving, implying that while physical thriving has obvious measurable results, psychological thriving does not as much. This is the origin of much ambiguity surrounding the concept. Carver lists several self-reportable indicators of thriving: greater acceptance of self, change in philosophy, and a change in priorities. These are factors that generally lead a person to feel that they have grown, but obviously are difficult to measure quantitatively.

The dynamic systems approach to thriving attempts to resolve some of the ambiguity in the quantitative definition of thriving, citing thriving as an improvement in adaptability to future trauma based on their model of attractors and attractor basins. This approach suggests that reorganisation of behaviours is required to make positive adaptive behaviour a more significant attractor basin, which is an area the system shows a tendency toward.

In general, as pointed out by Carver, the idea of thriving seems to be one that is hard to remove from subjective experience. However, work done by Meichenbaum to create his Posttraumatic Growth Inventory helps to set forth a more measurable map of thriving. The five fields of posttraumatic growth that Meichenbaum outlined include: relating to others, new possibilities, personal strength, spiritual change, and appreciation for life. Though literature that addresses “thriving” specifically is sparse, there is much research in the five areas Meichenbaum cites as facilitating thriving, all of which supports the idea that growth after adversity is a viable and significant possibility for human well-being.

Aspects of Posttraumatic Growth

Another attempt at quantitatively charting the concept of thriving is via the Posttraumatic Growth Inventory. The inventory has 21 items and is designed to measure the extent to which one experiences personal growth after adversity. The inventory includes elements from five key areas: relating to others, new possibilities, personal strength, spiritual change, and appreciation for life. These five categories are reminiscent of the subjective experiences Carver struggled to quantify in his own literature on thriving, but are imposed onto scales to maintain measurability. When considering the idea of thriving from the five-point approach, it is easier to place more research from psychology within the context of thriving. Additionally, a short form version of the Posttraumatic Growth Inventory has been created with only 10 items, selecting two questions for each of the five subscales. Studies have been conducted to better understand the validity of this scale and some have found that self-reported measures of posttraumatic growth are unreliable. Frazier et al. (2009) reported that further improvement could be made to this inventory to better capture actual change.

One of the key facets of posttraumatic growth set forth by Meichenbaum is relating to others. Accordingly, much work has been done to indicate that social support resources are extremely important to the facilitation of thriving. House, Cohen, and their colleagues indicate that perception of adequate social support is associated with improved adaptive tendency. This idea of better adaptive tendency is central to thriving in that it results in an improved approach to future adversity. Similarly, Hazan and Shaver reason that social support provides a solid base of security for human endeavour. The idea of human endeavour here is echoed in another of Meichenbaum’s facets of posttraumatic growth, new possibilities, the idea being that a person’s confidence to “endeavour” in the face of novelty is a sign of thriving.

Concurrent with a third facet of Meichenbaum’s posttraumatic growth, personal strength, a meta analysis of six qualitative studies done by Finfgeld focuses on courage as a path to thriving. Evidence from the analysis indicates that the ability to be courageous includes acceptance of reality, problem-solving, and determination. This not only directly supports the significance of personal strength in thriving, but can also be drawn to Meichenbaum’s concept of “new possibilities” through the idea that determination and adaptive problem-solving aid in constructively confronting new possibilities. Besides this, it was found in Finfgeld’s study that courage is promoted and sustained by intra- and interpersonal forces, further supporting Meichenbaum’s concept of “relating to others” and its effect on thriving.

On Meichenbaum’s idea of appreciation for life, research done by Tyson on a sample of people 2–5 years into grieving processing reveals the importance of creating meaning. The studies show that coping with bereavement optimally does not only involve just “getting over it and moving on”, but should also include creating meaning to facilitate the best recovery. The study showed that stories and creative forms of expression increase growth following bereavement. This evidence is supported strongly by work done by Michael and Cooper focused on facets of bereavement that facilitate growth including “the age of the bereaved”, “social support”, “time since death”, “religion”, and “active cognitive coping strategies”. The idea of coping strategies is echoed through the importance thriving places on improving adaptability. The significance of social support to growth found by Michael and Cooper clearly supports Meichenbaum’s concept of “relating to others”. Similarly, the significance of religion echoes Meichenbaum’s “spiritual change” facet of posttraumatic growth.

Positive Psychology

Posttraumatic growth can be seen as a form of positive psychology. In the 1990s, the field of psychology began a movement towards understanding positive psychological outcomes after trauma. Researchers initially referred to this phenomenon in number of different ways, “positive life changes”, “growing in the aftermath of suffering”, and “positive adaptation to trauma”. But it wasn’t until Tedeschi & Calhoun created the “Posttraumatic Growth Inventory (PTGI)” in 1996 in which the term “Posttraumatic Growth (PTG)” was born. Around the same time, a new area of strengths-based psychology emerged.

Positive Psychology

Positive psychology involves studying positive mental processes aimed at understanding positive psychological outcomes and “healthy” individuals. This framework was intended to serve as an answer to “mental illness” focused psychology. The core ideals of positive psychology are included, but not limited to:

  • Positive personality traits (optimism, subjective well-being, happiness, self-determination)
  • Authenticity
  • Finding meaning and purpose (self-actualisation)
  • Spirituality
  • Healthy interpersonal relationships
  • Satisfaction with life
  • Gratitude

Posttraumatic Growth

The concept of PTG has been described as a part of the positive psychology movement. Since PTG describes positive outcomes post trauma rather than negative outcomes, it falls under the category of positive psychological changes. Positive psychology intends to lay claim on all capacities of positive mental functioning. So, even though PTG (as a defined concept) was not initially described in the positive psychology framework, it is presently included in positive psychological theories. This is reinforced by the parallels between the core concepts of positive psychology and PTG. This is observable through comparing the 5 domains of the PTGI with the core ideals of positive psychology.

The Domains of the Posttraumatic Growth Inventory and Their Relationship to the Ideals of Positive Psychology

Positive psychological changes and outcomes are defined as a part of positive psychology. PTG is specifically the positive psychological changes post-trauma. The domains of PTG are defined as the different areas of positive psychological changes that are possible post-trauma. The PTGI, a measure designed by Tedeschi and Calhoun in 1996, measures PTG across the following areas or domains:

DomainOutline
New PossibilitiesThe positive psychological changes described by the domain of “New Possibilities” are developing new interests, establishing a new path in life, doing better things with one’s life, new opportunities, and an increased likelihood to change what is needed. This can be compared to the “finding meaning and purpose” core ideal of positive psychology.
Relating to OthersThe positive psychological changes described by the domain “Relating to Others” are increased reliability on others in times of trouble, greater sense of closeness with others, willingness to express emotions to others, increased compassion for others, increased effort in relationships, greater appreciation of how wonderful people are, and increased acceptance about needing others. This can be compared to the “healthy interpersonal relationships” core ideal of positive psychology.
Personal StrengthThe positive psychological changes described by the domain “Personal Strength” are a greater feeling of self-reliance, increased ability to handle difficulties, improved acceptance of life outcomes and new discovery of mental strength. This can be compared to the “positive personality traits (self-determination, optimism)” core ideals of positive psychology.
Spiritual ChangeThe positive psychological changes described by the domain “Spiritual Change” are a better understanding of spiritual matters and a stronger religious (or spiritual) faith. This can be compared to the “spirituality and authenticity” core ideal of positive psychology.
Appreciation of LifeThe positive psychological changes described by the domain “Appreciation of Life” are changed priorities regarding what is important in life, a greater appreciation of the value of one’s own life, and increased appreciation of each day. This can be compared to the “satisfaction with life” core ideal of positive psychology.

In 2004, Tedeschi & Calhoun released an updated framework of PTG. The overlaps between positive psychology and posttraumatic growth demonstrate an overwhelming association between these frameworks. However, Tedeschi and Calhoun note that even though these domains describe positive psychological changes post-trauma, the presence of PTG does not necessarily rule out the occurrence of any simultaneous negative post-trauma mental processes nor negative outcomes (such as psychological distress).

Clinical Application of Posttraumatic Growth within Positive Psychology

In a clinical setting, PTG is often included as a part of positive psychology in terms of methodology and treatment goals. Positive psychology interventions (PPI) generally include a multidimensional, therapeutic approach in which psychological tests are measurements to track progress. For clinical PPI involving recovery from trauma, there is usually at least one measure of PTG. Most trauma research and clinical intervention focuses on evaluating the negative outcomes post-trauma. But from a positive psychological perspective, a strengths-based approach might be more relevant for clinical intervention aimed at recovery. While PTG has been effectively measured in a number of relevant areas of psychology, it has been especially successful in health psychology.

In the exploration of PTG in health psychology settings (hospitals, long-term care clinics, etc.), well-being (a core ideal of positive psychology [60]) was linked to increased PTG in patients. PTG is seen more often in health psychology settings when PPI are utilised. While the focus in health psychology settings is to foster resilience, new research indicates that health psychology practitioners, doctors, and nurses should also aim to increase positive psychological outcomes (such as PTG) as a part of their recovery goals. Resilience is also central to positive psychology and is involved with PTG. Resilience has been distinguished as a pathway to PTG, but its exact relationship is currently still being explored. That being said, they are both positive psychological processes with strong ties to positive psychology.

Positive Psychology Treatment Results

The use of PPI post-trauma is not only effective in increasing PTG, but it has also been shown to reduce negative posttraumatic symptoms. These reductions on posttraumatic stress symptoms and increases in PTG have been demonstrated to be long-lasting. When participants were followed up at 12 months post PPI, not only was the PTG still present, it actually increased over time. PPI targeted at reducing stress have demonstrated promising results across a large number of studies.

Conclusion

Over the last 25 years, PTG has demonstrated its place in the framework of positive psychology in theory and in practice. The theoretical framework put forth by Seligman & Csikszentmihalyi and Tedeschi & Calhoun, have substantial overlap and both cite “positive psychological changes”. While positive psychology speaks to a general focus on positive aspects of human psychology, PTG speaks specifically to positive psychological change after trauma. This would inherently make PTG a sub-category of positive psychology. PTG has also been referred to in the literature as perceived benefits, positive changes, stress-related growth, and adversarial growth. However, it is made clear that regardless of the terminology, it is based is positive mental changes, which is the essence of positive psychology.

Positive Disintegration

The theory of positive disintegration by Kazimierz Dąbrowski is a theory that postulates that symptoms such as psychological tension and anxiety could be signs that a person might be in positive disintegration. The theory proposes that this can happen when an individual rejects previously adopted values (relating to their physical survival and their place in society), and adopts new values that are based on the higher possible version of who they can be. Rather than seeing disintegration as a negative state, the theory proposes that is a transient state which allows an individual to grow towards their personality ideal. The theory stipulates that individuals who have a high development potential (i.e. those with overexcitabilities), have a higher chance of re-integrating at a higher level of development, after disintegration. Scholarly work is needed to ascertain whether disintegrative processes, as specified by the theory, are traumatic, and whether reaching higher integration, e.g. Level IV (directed multilevel disintegration) or V (secondary integration), can be equated to posttraumatic growth.

Criticisms and Concerns

While posttraumatic growth is commonly self-reported by people from different cultures across the world, concerns have been raised on the basis that objectively measurable evidence of posttraumatic growth is limited. This has led some to question whether posttraumatic growth is real or illusory. However, biological research is finding real differences at the level of gene expression and brain activity.

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What is Milieu Therapy?

Introduction

Milieu therapy is a form of psychotherapy that involves the use of therapeutic communities.

Outline

Patients join a group of around 30, for between 9 and 18 months. During their stay, patients are encouraged to take responsibility for themselves and the others within the unit, based upon a hierarchy of collective consequences.

Patients are expected to hold one another to following rules, with more senior patients expected to model appropriate behaviour for newer patients. If one patient violates the rules, others who were aware of the violation but did not intervene may also be punished to varying extents based upon their involvement.

Milieu therapy is thought to be of value in treating personality disorders and behavioural problems, and can also be used with a goal of stimulating the patient’s remaining cognitive-communicative abilities.

Organisations known to use milieu therapy include Cassel Hospital, in London, Forest Heights Lodge in Evergreen, Colorado, the United States Veteran’s Administration, and the Kansas Industrial School for Girls in Beloit, Kansas.

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What is the International Expressive Arts Therapy Association?

Introduction

The International Expressive Arts Therapy Association (IEATA) is a non-profit organisation founded in 1994.

Outline

IEATA aims to encourage the “creative spirit” and supports expressive arts therapists, artists, educators, consultants and others using integrative, multi-modal arts processes for personal and community growth.

It provides:

  • A professional guild and an international network through sponsoring bi-annual conferences.
  • A global forum for dialogue, promotes guiding principles for professional practice, and works to increase recognition and use of expressive arts as a tool for psychological, physical and spiritual wellness.

Memberships

IEATA offers two kinds of registration for professional memberships.

  • “REAT” – registration is designed for those using the Expressive Arts in psychotherapy.
  • “REACE” – registration designed for expressive arts consultants and educators using the expressive arts in a broad range of approaches in education, organisational development, health fields and more.

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What is Empathy-Altruism?

Introduction

Empathy-altruism is a form of altruism based on moral emotions or feelings for others.

Social exchange theory holds that in seemingly altruistic behaviour benefits to the altruist outweigh the costs the altruist bears and thus such behaviour is self-interested. In contrast, C. Daniel Batson holds that people help others in need out of genuine concern for the well-being of the other person. The key ingredient to such helping is “empathic concern”. According to Batson’s “empathy-altruism hypothesis”, if someone feels empathy towards another person, they will help them, regardless of what they can gain from it. An alternative hypothesis is “empathy-joy”, which states a person helps because they find pleasure at seeing another person experience relief. When a person does not feel empathy, the standards of social exchange theory apply.

Evidence

Debate over whether other-helping behaviour is motivated by self- or other-interest has raged between (approximately) 2000 and 2022. The prime actors in this debate included Daniel Batson, arguing for empathy-altruism, and Robert Cialdini, arguing for self-interest.

Batson recognises that people sometimes help for selfish reasons. He and his team were interested in finding ways to distinguish between motives. In one experiment, students were asked to listen to tapes from a radio programme. One of the interviews was with a woman named Carol, who talked about her bad car accident in which both of her legs were broken, her struggles and how behind she was becoming in class. Students who were listening to this particular interview were given a letter asking the student to share lecture notes and meet with her. The experimenters changed the level of empathy by telling one group to try to focus on how she was feeling (high empathy level) and the other group not to be concerned with that (low empathy level). The experimenters also varied the cost of not helping: the high cost group was told that Carol would be in their psychology class after returning to school and the low cost group believed she would finish the class at home. The results confirmed the empathy-altruism hypothesis: those in the high empathy group were almost equally likely to help her in either circumstance, while the low empathy group helped out of self-interest (seeing her in class every day made them feel guilty if they did not help).

Countering Hypotheses

Batson and colleagues set out to show that empathy motivates other-regarding helping behaviour not out of self-interest but out of true interest in the well-being of others. They addressed two hypotheses that counter the empathy-altruism hypothesis:

  • Empathy Specific Reward: Empathy triggers the need for social reward which can be gained by helping.
  • Empathy Specific Punishment: Empathy triggers the fear of social punishment which can be avoided by helping.

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What is Dopamine Supersensitivity Psychosis?

Introduction

Dopamine supersensitivity psychosis is a hypothesis that attempts to explain the phenomenon in which psychosis (e.g. having hallucinations, which can mean hearing or seeing things that other people do not see or hear) occurs despite treatment with escalating doses of antipsychotics. Dopamine supersensitivity may be caused by the dopamine receptor D2 antagonising effect of antipsychotics, causing a compensatory increase in D2 receptors within the brain that sensitizes neurons to endogenous release of the neurotransmitter dopamine. Because psychosis is thought to be mediated—at least in part—by the activity of dopamine at D2 receptors, the activity of dopamine in the presence of supersensitivity may paradoxically give rise to worsening psychotic symptoms despite antipsychotic treatment at a given dose. This phenomenon may co-occur with tardive dyskinesia, a rare movement disorder that may also be due to dopamine supersensitivity.

Brief History

When supersensitivity psychosis was explored in 1978, a featured concern was increasing resistance to medication, requiring higher doses or not responding to higher doses. Some articles use the term tardive psychosis to reference to this specific concept. However, articles have disputed its validity. The condition has been discovered in very few people. Palmstierna asserts that tardive psychosis is a combination of “several different and not necessarily correlated phenomena related to neuroleptic treatment of schizophrenia.”

Mechanism

Dopamine supersensitivity psychosis may occur due to upregulation of dopamine 2 receptors (D2). The D2 receptor is the primary target of almost all antipsychotics, which oppose the action of the neurotransmitter dopamine at this receptor. The antagonising or “blockade” of D2 by antipsychotics may cause neurons, a type of cell within the brain, to undergo compensatory changes to make up for the loss of activity at D2 receptors. The D2 signalling pathway within neurons is complex, and involves multiple enzymes and other secondary messengers. It may be the case that, in response to antipsychotics, neurons increase the production of D2 receptors (upregulation), thereby sensitizing the neuron to dopamine. However, this is likely an oversimplification, as—despite differences in sensitivity to dopamine of around 3-fold in people that have taken antipsychotics chronically, there is a disproportionately low increase in the amount of D2 receptors in the brain in these people (around 1.4-fold in the striatum of the brain in people with schizophrenia). Other hypotheses include increases in the “active” D2 receptors (termed D2High) relative to the “inactive” conformation (D2Low).

The result is dopamine supersensitivity. It is thought that the psychotic symptoms within schizophrenia are primarily due to overactive dopamine activity in the mesolimbic area of the brain. Therefore, dopamine supersensitivity may reduce the effect of antipsychotics and increase the brain’s response to endogenous dopamine, leading to worsening psychosis.

Tardive dyskinesia, a type of rare movement disorder that can be caused by antipsychotics, may also be caused by dopamine receptor sensitization. This may explain why, for people with tardive dyskinesia, increasing the dose of the antipsychotic may temporarily improve symptoms.

Diagnosis

The original criteria for dopamine supersensitivity psychosis were the following:

A. Continuous use of antipsychotics for at least 3 months.
B. One of the following:

  1. Rebound psychosis within 6 weeks of a change (e.g. dose reduction, or antipsychotic switching) in an oral antipsychotic regimen or 3 months for long-acting injectable antipsychotics
  2. Tolerance to antipsychotic effects (requiring escalating doses, even beyond what has controlled symptoms in the past)
  3. Presence of tardive dyskinesia (which should occur when antipsychotics are withdrawn, and improve or disappear when antipsychotics are restarted)

Differential Diagnosis

It may sometimes be impossible to distinguish dopamine supersensitivity psychosis from psychosis that occurs “naturally” in the course of a primary psychotic disorder like schizophrenia, including cases in which the person was not taking their antipsychotic medication. Even in the presence of an alternative aetiology, or when it is impossible to determine the precise aetiology for a psychotic episode, it is possible that dopamine supersensitivity psychosis can play a role in the presentation. Recognising the possible role of dopamine supersensitivity psychosis in a psychotic episode has implications for how to best manage someone’s antipsychotic therapy.

Society and Culture

Dopamine supersensitivity is often dismissed as an inconsequential factor in the progression of psychotic disorders by psychiatrists in the medical literature. The dopamine supersensitivity hypothesis was discussed by investigative journalist and author Robert Whitaker in his book Anatomy of an Epidemic, published in 2010.

Research

As of 2017, much of the evidence for dopamine supersensitivity psychosis comes from studies performed in animals. There is still a need for robust, human research.

In a cohort study of people taking chronic antipsychotic therapy with either schizophrenia or schizoaffective disorder that presented for psychiatric care due to a relapse of their psychotic symptoms without a clear precipitating cause (e.g. new or worsening substance abuse, evidence of nonadherence to antipsychotics), 39% of the sample met the authors’ checklist for dopamine supersensitivity psychosis. The people that met the criteria were more likely than others to have worse symptoms when their psychosis returned (relapsed), have residual psychotic symptoms, had overall worse health outcomes at 6-month follow-ups, and were more likely to live in residential care.

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What is the Cognitive Behavioural Analysis System of Psychotherapy?

Introduction

The cognitive behavioural analysis system of psychotherapy (CBASP) is a talking therapy, a synthesis model of interpersonal and cognitive and behavioural therapies developed by James P. McCullough Jr. of Virginia Commonwealth University specifically for the treatment of all varieties of DSM-IV chronic depression.

McCullough writes that chronic depression (i.e. depressive disorder in adults that lasts continuously for two or more years, or one year continuously in adolescents), particularly the type beginning during adolescence (early-onset), is essentially a refractory mood disorder arising from traumatic experiences or interpersonal psychological insults delivered by the patient’s significant others (nuclear or extended family).

Basic Assumptions

Absence of felt interpersonal safety in patients. Chronic mood (e.g., chronic depression) denotes an absence of felt safety as regards (a) the precipitating (original) trauma event(s) or on a less sudden and violent level, (b) maltreating-hurtful significant others who have inflicted psychological insults on the individual through interpersonal rejection, harsh punishment, censure, or emotional abandonment/neglect. The lack of felt safety (c) has been transferred to a generalized fear of interpersonal relationships.

For patients, more often than not, “people are hell” to borrow a phrase from Jean-Paul Sartre. Whether the aetiology includes sudden trauma or psychological insults, the predominant coping strategy that maintains the dysphoric mood condition is an interpersonal avoidance of persons in the home, at work, or in the social environment. The patient’s successful situational and interpersonal avoidance pattern is the major treatment issue when the chronically depressed individual enters psychotherapy.

No change is possible as long as interpersonal avoidance patterns remain. As noted above, no emotional modification or termination of the chronic depression mood is possible apart from terminating patient interpersonal avoidance by enabling them to encounter the original precipitating trauma (violent/sudden event) or the psychological insults that stem from chronic interpersonal punishment, abuse or emotional neglect. The active arena where change processes are targeted and occur in CBASP psychotherapy involves the current interpersonal milieu within which the patient functions.

Treatment Strategies

In-session focus exercises in an atmosphere of felt safety help patients confront the feared stimuli and modify the Pavlovian fear driving the refractory emotional state. Learning appropriate non-avoidant ways to deal with the fear stimuli also decreases Skinnerian avoidance behaviour and prepares the way for mood change. In the beginning of therapy, it should be remembered that the chronic mood associated with trauma or psychological insults may involve stimulus events that remain tacit knowledge (out of awareness) for patients (i.e. the pain, fear and anxiety are clearly observable but the actual precipitating and maintaining stimuli may not be clearly understood or recognised by the patient). Material derived from the Significant Other History (SOH) often illustrates the tacit knowledge dimension of the patient’s avoidance patterns. In summary, another way to describe what’s going on in the beginning of therapy is to say that patients are avoiding others (including the therapist) and not responding to the interpersonal environment. Interpersonal avoidance always dictates that the patient’s primary focus remains on himself or herself (i.e. patients stay “in their heads”). In such a psychosocial functioning state, these individuals remain helpless and hopeless and continue to respond to themselves in a solitary and never-ending circle of pain, fear, anxiety (and depression); hence, they are unable to connect with their interpersonal world in any informing way.

Therapist Role

A feature of CBASP is the interpersonal role of the psychotherapist. CBASP clinicians enact a “disciplined personal involvement role” to heal the injurious interpersonal traumas and psychological insults patients have received at the hands of harmful significant others.

Outcome Goals of Treatment and Beyond

The goals of CBASP treatment are (1) to connect patients perceptually and behaviourally to the interpersonal world they live in so that their behaviour is informed by environmental (interpersonal) influences; (2) CBASP teaches patients how to make themselves feel better emotionally as well as how to maintain affective control; (3) patients are taught to negotiate interpersonal relationships successfully which means that patients acquire the requisite skills to obtain desirable interpersonal goals; finally, patients learn the crucial importance of “maintaining” the treatment gains after psychotherapy ends. Maintaining the gains requires daily practice of the in-session learning which protects (perpetuates) the extinction of the old pathological patterns of behaviour. Post-therapy practice for the rest of their lives holds in abeyance the ever-present danger of relapse and recurrence.

Combination Treatment

A large-scale study, published in 2000 by Martin Keller of Brown Medical School and others, compared the (then available) antidepressant Serzone (aka Nefazodone) with CBASP. Six hundred and eighty-one patients with severe chronic depression (some with other psychiatric illnesses) were enrolled in the trial, and were assigned to either Serzone, CBASP, or combination Serzone-CBASP for 12 weeks. The response rates to either Serzone or CBASP alone were 55 percent and 52 percent, respectively, for the 76 percent who completed the study. In other words, a little more than half of the completers in those two arms of the trial reduced their depression by 50 percent or better.

The Serzone findings roughly correspond with many other trial results for antidepressants, and underscore a major weakness in these drugs—that while they are effective, the benefit is often marginal and the treatment outcome problematic. Similarly, the CBASP findings validate other studies finding talking therapy about equal in efficacy to taking antidepressants.

The results for the combination drug-therapy group, however, were surprising, with 85% of the completing patients achieving a 50 percent reduction in symptoms or better. 42% in the combination group achieved remission (a virtual elimination of all depressive symptoms) compared to 22% in the Serzone group and 24% in the CBASP group.

The authors of the frequently cited study noted that “the rates of response and remission in the combined-treatment group were substantially higher than those that might have been anticipated on the basis of the outcomes of previous trials in similar patients.” Their figures show that treating depression with a combination of both an anti-depressant drug and a form of cognitive behaviour therapy can be highly effective, giving substantially better results than other methods of dealing with depression.

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What is the British Association for Counselling and Psychotherapy?

Introduction

The British Association for Counselling and Psychotherapy (BACP) is a professional body for counsellors and psychotherapists practising in the United Kingdom.

Brief History

Originally founded in 1977 as the British Association for Counselling, aided by a grant from the Home Office Voluntary Service Unit, it had emerged from the Standing Conference for the Advancement of Counselling. This body was inaugurated in 1970 at the instigation of the National Council for Voluntary Organisations. It was co-founded by the humanist activist Harold Blackham, and drew on detailed work Blackham had done for a non-religious counselling service for the British Humanist Association, which he led at the time. The organisation’s Chair was Nicholas Tyndall, Chief Officer at the National Marriage Guidance Council (which later become Relate).

In 1978, the headquarters were relocated from London to Rugby courtesy of the National Marriage Guidance Council which provided free accommodation to help the association establish itself. The Association is now located in Lutterworth.

In September 2000, the Association recognised that it no longer represented only those involved in counselling, but also psychotherapy, and changed its name to the British Association for Counselling and Psychotherapy.

In September 2017, the branding was refreshed introducing a new logo, colour scheme, typeface and the slogan “counselling changes lives”, based on a belief in the impact and benefits of the profession. This was Highly Commended in the 2018 memcom membership excellence awards stating that it “found success over various mediums” and “had a clear rationale for the brand relaunch and a strong proposition that counselling changes lives”.

In November 2019, the membership was reported to have surpassed 50,000, prompting the Association to share celebratory and rewarding comments from its members as a way to mark the achievement.

Governance

BACP is a company limited by guarantee and a registered charity, monitored by the Charity Commission to ensure that aims are charitable and funds used for the benefit of its members and communities in which they are active. BACP follows the Charity Commission’s Charity Governance Code as a tool for continuous improvement.

The governing instrument is the Memorandum and Articles of the Association.

The Trustees known collectively as the Board of Governors, govern the Association.

Committees

BACP operates six committees, with volunteer input, to oversee the activities of the association:

  • Audit, Risk and Performance Committee
  • Finance and Policy Committee
  • Membership and Professional Standards Committee
  • Public Protection Committee
  • Remuneration and Governance Committee
  • Research Committee

Operations

BACP works with commissioners and government to promote the counselling professions, seeking to advise and inform national and international policy and procedures concerned with counselling and psychotherapy, offering information and guidance to involved parties. BACP is consulted by government bodies, professional bodies, funding organisations, teaching institutions and many others on important issues concerning counselling and psychotherapy.

The Association sets and maintains standards for the profession. The Ethical Framework for Good Practice in Counselling and Psychotherapy along with the Professional Conduct Procedure is intended to ensure that members of BACP abide by an accepted code of conduct and accountability. The Association accredits counsellors with the appropriate training and experience via a rigorous accreditation process that requires continued education to maintain accreditation.

In October 2015, the Collaboration of the Counselling and Psychotherapy Professions (CCPP) was announced between BACP, BPC and UKCP. Whilst promising to maintain their unique differences, each organisation expressed their recognition of shared goals and a commitment to improving the nation’s mental health and wellbeing.

In June 2017, BACP presented their Female Genital Mutilation (FGM) research as a paper at the Society for Psychotherapy Research conference in Canada. Key research papers, including the FGM paper and a paper analysing data from the National Audit of Psychological Therapies, were published gold open access.

In March 2018, BACP and the SQA announced a unique partnership which promises to improve access to the counselling profession for students in Scotland through a new BACP Approved Qualification scheme.

Strategic Priorities

Following consultation with their members and stakeholders, BACP identified three key areas for particular focus where the value of counselling has the greatest potential to improve lives.

  • Older people
  • Four nations
  • Children, young people and families

Specialist Interest Divisions

BACP represent and promote specialist areas of interest within the profession by operating seven divisions, each managed by an executive committee of volunteers which run their own meetings and formulate strategies in line with BACP objectives, overseen by the BACP Board of Governors.

  • Children, young people and families
  • Healthcare
  • Workplace
  • Coaching
  • Higher and further education
  • Spiritual and pastoral
  • Private Practice

Regulation

Although counselling and psychotherapy are not statutorily regulated professions, BACP works alongside other associations to advise and appeal to government in attempts to ensure members of the public who access the counselling professions are safeguarded.

The BACP is registered for accreditation under the scheme set up by the Department of Health and regulated by the Professional Standards Authority for Health and Social Care. The Accredited status of the BACP Register is reviewed annually by the Professional Standards Authority to ensure that the highest standards are being met and good practices are being followed.

Publications

Therapy Today

The organisation’s Therapy Today magazine, with a circulation of 44,386 (ABC January-December 2016), is the most widely read specialist magazine for counsellors and psychotherapists in the UK, and has a strong international presence, publishing articles on topics crossing the breadth of counselling and psychotherapy practice, modalities and theoretical approaches.

Journals

The BACP publishes eight member-only journals:

  • Counselling and Psychotherapy Research
  • BACP Children, Young People and Families
  • BACP Workplace
  • Coaching Today
  • Healthcare Counselling and Psychotherapy
  • Private Practice
  • Thresholds
  • University and College Counselling

Notable People

  • Sue Bailey, DBE, Psychiatrist, BACP Vice-President
  • Helen Bamber, OBE, Psychotherapist, BACP Patron 2011–2016
  • Luciana Berger, Politician, BACP Vice-President
  • H.J. Blackham, Founder, and “architect of modern humanism”
  • Fiona Caldicott, DBE, Psychiatrist, former BACP President
  • Cary Cooper, CBE, Psychologist, Honorary BACP President 1976–1979
  • Derek Draper, Psychotherapist, former lobbyist and former editor of the LabourList website
  • Shreela Flather, Politician, former BACP Vice-President
  • Phillip Hodson, Journalist
  • Esther Rantzen, Television presenter, former BACP Vice-President
  • John Rowan, Psychologist
  • Diane Youdale, Psychotherapist, television personality
  • Lynne Gabriel, OBE, BACP Chair 2008-2011, BACP President 2023

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What is Adaptive Mentalisation-Based Integrative Treatment?

Introduction

Adaptive mentalisation-based integrative treatment (AMBIT) is a novel adaptation (by Dickon Bevington, Peter Fuggle, Liz Cracknell, Peter Fonagy, Eia Asen, Mary Target, Neil Dawson and Rabia Malik) of the theory of mentalisation and practices of mentalisation-based treatment to address the needs of chaotic, complex and multiply comorbid youth, via team-based (predominantly outreach) multimodal practices.

Background

Previously called “Adolescent Mentalisation Based Integrative Treatment”, AMBIT changed its name to “Adaptive…” in recognition of the fact that it is now being used by a wide range of teams across the UK and internationally, that extend beyond the adolescent age range (adults with severe and enduring relational difficulties, families with children where there are safeguarding concerns, young adults, etc.) Adaptation is also at the heart of AMBIT, which encourages local teams to adapt, build upon, and share these adaptations to its core components; AMBIT aspires to be an Open-source model of therapy innovation. This name change was recognised a book published by Oxford University Press (Bevington, D., Fuggle, P., Cracknell, L., and Fonagy, P. “Adaptive Mentalization Based Integrative Treatment: a guide for teams to develop systems of care” OUP 2017).

These practices, shaped by an eightfold principled therapeutic stance and using mentalization as the integrating framework, balance the development of a strong therapeutic attachment to a key worker with strong peer-to-peer relationships between workers that are designed counteract the potential for destabilising effects from such intense work.

Mentalization is applied and fostered explicitly in four directions in AMBIT:

  • Towards the young person and their family/carers.
  • Towards colleagues and peers at the level of the team.
  • Towards the wider multi-agency network.

In addition, a range of manualized ‘barefoot’ adaptations of existing evidence-based treatment modalities are available to workers, but the approach also encourages the development of a culture of team-based reflection upon practice and outcomes, of learning, and of sharing. This has much in common with the notion of a “learning organisation” stance (see the work of Peter Senge) within local teams, but AMBIT includes the promotion of constrained and disciplined approaches to the local adaptation of each team’s own wiki-based practice manual. These wikis come to represent specific local implementations that offer a “fit” for local cultures and service ecologies. The collaborative disciplines around their adaptation is a practice referred to as “manualisation”; manualisation is seen as analogous to mentalisation at the level of the team (making sense of “why we practice in this way in that kind of situation”, and broadcasting this transparently, with a view to improving this current understanding through feedback.)

Treatment Manual

AMBIT deploys an open-source wiki-based approach to treatment manualisation based on TiddlyWiki; a server-side hosting platform allows multiple teams to develop their own locally adapted versions, each drawing on a shared common core of AMBIT material. Drawing on developments in programming, the authors have described the approach as an “open source approach to therapy”.

Implementations

As at March 2018, approximately 200 teams around the UK and internationally have been trained in AMBIT by the AMBIT programme based at the Anna Freud National Centre for Children and Families charity in London. Encouraging early outcomes evaluative evidence has been published, but as a novel approach there are as yet no completed randomised controlled trials.

Independent Reviews, Awards and Sponsors

AMBIT is described in a number of independent reviews, including a 2018 review on “Psychotherapeutic interventions and contemporary developments: common and specific factors” in the BJPsych Advances journal. It is described in Chapter 42 of the 3rd edition of Child Psychology and Psychiatry Frameworks for Clinical Training and Practice and in a review by the Youth Justice Working Group (2012), the Centre for Mental Health (2010) and in a literature review on integrative psychotherapy for children and adolescents by Krueger and Glass.

The AMBIT Collaboration was awarded the “Innovation Nation” award for Innovation in Collaboration from The Guardian newspaper and Virgin Business Media in 2012.

AMBIT has been supported by grants from Comic Relief, the City Bridge Trust and the James Wentworth Stanley Memorial Fund.

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