Treatment Self-Regulation Questionnaire TSRQ

Abstract

The Treatment Self-Regulation Questionnaire (TSRQ) is a widely utilized psychological instrument designed to assess the quality of an individual’s motivation concerning various health behaviors, such as following a medical treatment regimen, attempting to change an unhealthy behavior, or entering a specialized program. Grounded in Self-Determination Theory (SDT), the TSRQ specifically measures the degree to which engagement in these behaviors is relatively autonomous or controlled. The wording of the questionnaire is adapted depending on the specific health behavior being investigated, ensuring relevance across diverse clinical contexts, including diabetes management, weight loss, and smoking cessation.

Keywords

Treatment Self-Regulation Questionnaire, TSRQ, Self-Determination Theory, SDT, health behavior, treatment adherence, motivation, autonomous regulation, controlled regulation, Relative Autonomy Index.

Authors

Geoffrey C. Williams, Richard M. Ryan, Edward L. Deci, Grow, Freedman, Cox, Kouides.

Purpose

The primary purpose of the TSRQ is to identify the underlying reasons why individuals initiate, engage in, and maintain health-relevant behaviors. The instrument moves beyond simply measuring the frequency of behavior, focusing instead on the qualitative aspect of motivation, which is a stronger predictor of long-term adherence and successful behavioral change.

The scale is crucial for clinical research because scores indicating higher Autonomous Regulation are consistently associated with better patient outcomes, including improved metabolic control in chronic conditions and greater persistence in demanding treatment programs. By identifying the source of regulation, clinicians and researchers can tailor interventions to foster more self-determined forms of motivation.

Construct

The TSRQ is theoretically anchored in the continuum of Self-Determination Theory (SDT), which posits that human motivation exists along a spectrum from highly controlled to highly autonomous. The questionnaire operationalizes two primary regulatory styles:

• Autonomous Regulation: This subscale assesses the extent to which a person engages in the health behavior because they find it personally important, valuable, or inherently enjoyable. This represents self-endorsed action.
• Controlled Regulation: This subscale assesses the extent to which the behavior is regulated by external pressures, suched as rewards, punishments, coercion, or internal pressures like guilt, shame, or the desire to please others.

While some specialized versions of the TSRQ have included a third subscale for Amotivation (a state of lacking intentionality), the standard versions provided for common health behaviors focus on quantifying the balance between Autonomous Regulation and Controlled Regulation.

Validity

The TSRQ has demonstrated robust predictive and construct validity across diverse medical populations, confirming its theoretical basis in SDT. Longitudinal studies have shown that autonomous motivation, as measured by the TSRQ, reliably predicts positive outcomes, such as sustained abstinence from smoking and maintenance of weight loss. The scale successfully differentiates between types of motivation, demonstrating that even when the overall level of effort is high, the quality of that effort (autonomous vs. controlled) significantly impacts long-term success and psychological well-being.

Reliability

Internal consistency reliability, typically measured by Cronbach’s alpha, is reported to be generally high for both the Autonomous and Controlled subscales across various populations and versions. It is notable that the Controlled Regulation subscale often includes more items than the Autonomous Regulation subscale. This is a deliberate design feature intended to capture the many distinct types of controlled reasons (e.g., external pressure, introjected guilt, compliance) and ensure adequate reliability for this factor.

Factor Analysis

Factor analytic procedures typically support the conceptual two-factor structure of the TSRQ, confirming the distinct measurement of Autonomous and Controlled regulatory styles. These factors are often utilized both independently to assess specific pressures and in combination to calculate the Relative Autonomy Index (RAI). The RAI is derived by subtracting the average score of the Controlled Regulation items from the average score of the Autonomous Regulation items, providing a single score that reflects the overall degree of self-determination guiding the target behavior.

Instrument

Test Type: Self-report questionnaire, psychological scale.

Format: 7-point Likert scale (ranging from 1 = not at all true, to 7 = very true).

Language Available: Multiple translations are available for researchers globally (not specified in source but common for SDT scales).

Population Group: Patients and individuals engaged in complex health behaviors, including those with chronic medical conditions or those undertaking supervised behavioral change programs.

Age Group: Typically utilized with adult populations.

Population Details: Specific versions are tailored for patients managing diabetes, and morbidly obese patients entering or participating in very low-calorie, medically supervised weight-loss programs.

Test Methodology: The scale uses different stems relevant to the specific behavior (e.g., medication adherence, exercise, program entry). Subscale scores are calculated via item averaging. Scores can be combined into the Relative Autonomy Index (RAI).

Keywords

Health psychology, behavioral change, self-determination, adherence, diabetes treatment, weight loss, psychological assessment, controlled regulation, Relative Autonomy Index (RAI).

Authors

Author ORCID Identifier: N/A (Information not provided in source)

Affiliation Email addresses: N/A (Information not provided in source)

Correspondence Address: N/A (Information not provided in source)

Permissions & Fee and Test Year

The TSRQ is generally available for non-commercial academic research use through the official Self-Determination Theory website. The earliest cited use for measuring health behavior regulation was in 1996 (Williams et al.). Researchers are typically advised to consult the SDT website for the most current versions and usage permissions.

Reference’s

The foundational studies demonstrating the utility of the TSRQ include:

• Williams, G. C., Grow, V. M., Freedman, Z. R., Ryan, R. M., & Deci, E. L. (1996). Motivational predictors of weight-loss program adherence and weight loss.
• Williams, G. C., Freedman, Z. R., & Deci, E. L. (1998). Supporting autonomy to motivate patients with diabetes for glucose control.
• Williams, G. C., Cox, E. M., Kouides, R. W., & Deci, E. L. (1999). Extrinsic and intrinsic sources of motivation for the health behavior of “not smoking.”

Items of the Treatment Self-Regulation Questionnaire TSRQ

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The scale used for response grading is:

Treatment Questionnaire Concerning Diabetes

There are a variety of reasons why patients take their medications, check their glucose, follow their diet, or exercise regularly. Please consider the following behaviors and indicate how true each of these reason is for you.

A. I take my medications for diabetes and/or check my glucose because:

1. Other people would be mad at me if I didn’t.
2. I find it a personal challenge to do so.
3. I personally believe that controlling my diabetes will improve my health.
4. I would feel guilty if I didn’t do what my doctor said.
5. I want my doctor to think I’m a good patient.
6. I would feel bad about myself if I didn’t.
7. It’s exciting to try to keep my glucose in a healthy range.
8. I don’t want other people to be disappointed in me.

B. The reason I follow my diet and exercise regularly is that:

9. Other people would be upset with me if I didn’t.
10. I personally believe that these are important in remaining healthy.
11. I would be ashamed of myself if I didn’t.
12. It is easier to do what I’m told than to think about it.
13. I’ve carefully thought about my diet and exercising and believe it’s the right thing to do.
14. I want others to see that I can follow my diet and stay fit.
15. I just do it because my doctor said to.
16. I feel personally that watching my diet and exercising are the best things for me.
17. I’d feel guilty if I didn’t watch my diet and exercise.
18. Exercising regularly and following my diet are choices I really want to make.
19. It’s a challenge to learn how to live with diabetes.

Treatment Questionnaire Concerning Entering the Weight Loss Program

There are a variety of reasons why patients decide to enter a weight-loss program such as this and follow its procedures. The items on this questionnaire are broken into four groups. Please read the statement at the beginning of each group and then consider the reasons that follow it in terms of how true that reason is for you.

A. I decided to enter this weight-loss program because:

1. I won’t like myself very much until I lose weight.
2. People will like me better when I’m thin.
3. It feels important to me personally to be thinner.
4. I really want to make some changes in my life.

B. If I remain in treatment it will probably be because:

5. I’ll feel like a failure if I don’t.
6. People will think I’m a weak person if I don’t.
7. I’ll feel very bad about myself if I don’t.
8. Others will be angry at me if I don’t.
9. I feel like it’s the best way to help myself.

C. I plan to lose weight because:

10. I’ll be ashamed of myself if I don’t.
11. I’ll hate myself if I can’t get my weight under control.
12. My friends/family don’t like the way I look.
13. Being overweight makes it hard to do many things.

D. I have agreed to follow the procedures of the program because:

14. I am worried that I will get in trouble with the staff if I don’t follow all the guidelines.
15. I’ll feel guilty if I don’t comply with all the procedures.
16. I want others to see that I am really trying to lose weight.
17. I believe they will help me solve my problem.
18. It’s important to me that my efforts succeed.

Treatment Questionnaire Concerning Continued Program Participation

The following questions relate to your reasons for continuing to participate in the weight-loss program. Different people have different reasons for continuing in such a program, and we want to know how true each of these reasons is for you. There are two groups of questions. The questions in each group pertain to the sentence that begins that group.

A. I have remained in treatment because:

1. I would have felt bad about myself if I didn’t.
2. Others would have been angry at me if I didn’t.
3. I would have felt like a failure if I didn’t.
4. I feel like it’s the best way to help myself.
5. People would think I’m a weak person if I didn’t.
6. I have chosen not to leave the program.
7. It is a challenge to accomplish my goal.
8. I have invested so much money in this program.

B. I have been following the procedures of the program because:

9. I believe they help me solve my problem.
10. I have been worried that I would get in trouble with the staff if I didn’t follow all the guidelines.
11. I want others to see that I am really trying to lose weight.
12. It is important to me that my efforts succeed.
13. I feel guilty if I don’t comply with all the procedures.