Autonomous motivation for therapy: A new common factor in brief treatments for depression

The authors propose a new common treatment factor, autonomous motivation (Deci & Ryan, 2000), defined as the extent to which patients experience participation in treatment as a freely made choice emanating from themselves. Ninety-five depressed outpatients were randomly assigned to receive 16 sessions of manualized interpersonal therapy, cognitive-behavior therapy, or pharmacotherapy with clinical management. Self-report and interviewer-based measures of depressive severity were collected at pretreatment and posttreatment. Autonomous motivation, therapeutic alliance, and perceived therapist autonomy support were assessed at Session 3. Autonomous motivation was a stronger predictor of outcome than therapeutic alliance, predicting higher probability of achieving remission and lower posttreatment depression severity across all three treatments. Patients who perceived their therapists as more autonomy supportive reported higher autonomous motivation.