(PS9-77) Associations Between Intrinsic Motivation for Therapy and Symptomatology in Adolescents in Acute Care

Adolescents enter and engage in therapy for a variety of reasons. They may be forced by parents, school personnel, or doctors to attend therapy, they may believe therapy to be important for their long-term wellbeing, or they may enjoy engaging in therapy. According to Self-Determination Theory (SDT; Ryan & Deci, 2017), our motivation for behaviors spans from extrinsically motivated reasons (behaviors motivated by external pressure and control) to intrinsically motivated reasons (behaviors motivated by inherent interest and pleasure). In between these two extremes are behaviors that are motivated by the desire to reduce feelings of guilt (introjected regulation) and behaviors motivated by what we value or know to be important (identified regulation; Ryan & Connell, 1989). Adolescents experience the most positive outcomes (e.g., lower anxiety and depression symptoms, higher self-esteem, better academic functioning) when they are more intrinsically motivated to engage in their behaviors of daily living (Grolnick & Ryan, 1989).

This study will use an SDT framework to measure what is motivating adolescents (ages 13-18) in a day treatment program to implement and practice the skills they learn in cognitive behavioral therapy. This setting is most relevant to examine this question, as patients are usually extrinsically motivated to enter the program from the start (i.e., required by parents or providers). Upon completing the four to six week program patients were asked - When you use the coping skills you have learned in therapy to control your emotions, why do you do it? An example of this would be using deep breathing or muscle tensing strategies when you feel anxious. Patients were provided with a number of possible motivators to use skills on a spectrum from most intrinsic (e.g., because using my skills is important to me; because I think there are good reasons for using skills) to most extrinsic (e.g., because I’ll get in trouble if I don’t use my skills; because my parents or therapist say I have to), and were asked to rate how true each motivator was for them. We also measured adolescent anxiety and depression symptoms using the Screen for Child Anxiety Related Disorders (SCARED) and The Patient Health Questionnaire (PHQ-9). Data is actively being collected.

The goal of this study is to identify whether adolescents’ more intrinsic motivation to engage in therapy is associated with their lower symptoms, and ultimately better treatment outcomes. We hypothesize that adolescent patients’ greater intrinsic motivation to practice skills learned in therapy will be correlated with their lower anxiety and depression symptoms. If our hypothesis is confirmed, this will highlight the importance of clinicians setting up autonomy supportive therapy environments that instill intrinsic motivation for skill building, such that patients experience therapy as collaborative and are given choices in acute care, rather than being forced to practice skills by external pressures (e.g., consequences). Results will inform discussion of ideas for how clinicians can be most effective at implementing interventions and encouraging skills practice in a way that increases adolescent patients’ intrinsic motivation to engage in therapy in an acute care setting.