Self Determination Theory in Injury Rehabilitation
Self-Determination Theory as a proposed aid to Athletic Injury Rehabilitation
Just as Honda Motor Company advertises widely that the technology it places in its Formula I racing program finds its way to each consumer automobile it sells, one can find the same justification for utilizing psychological interventions to increase the performance of athletes, especially after potentially career-ending or –derailing injuries. The success of such interventions, much as is efficacy of the technology in 200+mph race cars, is exceptionally clarified during moments of intense sport action. Similarly, by incorporating elements of Self-Determination Theory and motivational interviewing during the “pit time” of an athlete in rehab, their likelihood of emerging as strong as or perhaps even stronger than before the injury are increased.
In fine scientific tradition, the basis of Self-Determination Theory (SDT) is found in the continual evolution of prior theories that were found lacking. For example, in one early model, Hull’s Drive Theory, motivation was posited to simply be a factor of unmet physiological needs. While this is true for some ‘drives’, for other needs such as emotional or even play, this theory was notably silent (Deci & Ryan 2000, p. 228). Another example of an ‘unfinished’ theory would be Skinner’s operant conditioning, a very useful theory that nonetheless omits intrinsic motivations (Deci & Ryan 2000, p. 233). Fundamental precepts of SDT indicate that people “have an innate organizational tendency toward growth, integration of the self, and the resolution of psychological inconsistency” (Markland, Ryan, Tobin & Rollnick 2005, p.815). These three concepts are both the “what” and the “why” of motivation have been demonstrated to not only be valid theoretically but also in real-world field research where actual behaviors occur (Ryan & Deci 2000, pp. 228 and 258).
In first speculating about and then later in predicting and then influencing behavior, SDT argues that motivation must first be understood. According to SDT, behaviors lie on a continuum from externally motivated, in which others control behavior through reinforcements, to identification which is very “self-determined”. In between these extremes is behavior motivated by introspective regulations as would be the case when someone partially internalizes motivation, often because of self-esteem type issues that are unstable as sources of continual motivation (Markland, et al 2005, p. 816).
To begin bridging motivation with actual performance, that is to bring together intent with actual outcome, it is well documented that those with a greater degree of internal motivation do better in “motivational persistence, quality of behavior and learning, and well-being outcomes in… education, work, sports, exercise….” (Markland, et al 2005, p. 817). Though it is not enough to say that these things just “happen”, there are methods designed to facilitate the internalization of goals. Such techniques as Motivation Interviewing, in fact, make a purposeful facilitation of this objective.
In short, Motivational Interviewing is style of counseling that has been widely adopted for behavioral change. Beginning with the reasonable assumption that there is not a single behavior that did not first begin as a thought or motive emotion, the key to changing behavior is to change one’s motivation. It achieves this through the exploration and resolution of the client’s ambivalence in choosing one “desired” behavior over another “undesired” behavior (Markland, et al 2005, p. 813). By assisting the client to clarify the conflicts of change and the choices they make and rationalize, the therapist is able to facilitate the client to want to change, thus overcoming their own ambivalence.
To better illustrate how these methods might work, consider the following case:
John is a third year high school athlete in a top-third soccer program. He consistently plays at a high level and has been told that he has potential to possibly play at a top college program. The key to this seems to be to continue to evolve as a total player, attend a top-flight summer camp program and have a predictably excellent final year. Everything proceeds according to plan when, at the summer camp, he has a severe grade II hamstring pull. Though he immediately iced it, he was unable to move faster than a limping walk for two days. Surgical repair was ill advised due to the specific nature and location and aggressive therapy was prescribed.
Clearly, John seems to be properly motivated for ‘his best efforts’ at recovery prior to the fall season only 3 months away. On the line is a college scholarship, the admiration of his peers and the otherwise ‘abandonment’ of his team. Seemingly, all the ingredients for motivational performance in the “sport of rehabilitation” are present yet, when one examines these, it is not apparent the extent to which he is internally motivated. Is he playing to save his parent’s money? Will his girlfriend reject him if he becomes a “spectator”? These are potentially powerful motivators yet SDT research clearly indicates an almost linear relationship between performance and the degree of internal motivation.
To utilize the SDT and motivational interviewing precepts to John’s advantage, the first order of business is to become “client-centric” by giving John choices in his care. The greater extent that John can control the outcome in a medically acceptable way, the greater the extent that he will feel as though he is in charge and therefore motivation is more intrinsic and thus he is more likely to perform better during and consequently after rehab as well (Podlog & Eklund 2005, p. 23; Markland et al 2005, p. 818).
In addition, in direct support of SDT, the following motivational interview techniques are recommended:
SDT Functional Area
Competence
Autonomy
Relatedness
Clear & neutral information about goals and outcomes
Avoid coercion
Express empathy
Develop appropriate goals
“Roll with resistance”
Explore concerns
Positive feedback
Explore Options
Demonstrate understanding of the client’s position
Self-efficacy is supported
Client-centric decision making
Avoid judgment and blame
(Markland et al 2005, p. 821)
As an additional adjunct to utilizing SDT theory and as indicated earlier, it is not a great stretch of the imagination to envision rehab as a form of sport in which you continually compete against one’s on “personal best”, the admonitions of your medical “coaches” and the coming next game or season, as applicable. By doing so, not only does this perspective further enable one to apply SDT to rehab as to other settings but is also allows the athlete to leverage the intrinsic competitiveness and drive to achieve greater gains in rehabilitation. An example in which we might apply a broader portion of sports psychology to a rehab setting would be to utilize mental rehearsal not just of a sporting moment but of rehab exercises. By focusing on the specific components of a rehab exercise, performance is likely to be increased just as visualizing on-the-field performance can enhance the performance of a healthy athlete (Wrisberg & Fisher 2005, p. 58).
In conclusion, by utilizing sport psychology and SDT and Motivational Interviewing techniques in particular, there is a great likelihood that John, our case study, performance could be significantly enhanced not only in rehab but in the following season as well. By clearing the mind of its barriers and ambivalence to performance, the body will be enabled to reach its utmost performance potentials.
Works Consulted
Deci, E. and R. Ryan. (2000). “The “What” and “Why” of Goal Pursuits: Human Needs and the Self-Determination of Behavior”. Psychological Inquiry, (11), 4, pp. 227-268.
Markland, D., R. Ryan, V. Tobin, and S. Rollnick. (2005). “Motivational Interviewing and Self-Determination Theory”. Journal of Social and Clinical Psychology, (24), 6, pp. 811-831.
Podlog, L. and R. Eklund. (2005). “Return to Sport After Serious Injury: A Retrospective Examination of Motivation and Psychological Outcomes”. Journal of Sport Rehabilitation, (14), pp. 20-34.
Wrisberg, C. and L. Fisher. (2005). “Mental Rehearsal During Rehabilitation”. Athletic Therapy Today, (6),10, pp. 58-59.
