Treatment Self-Regulation Questionnaire TSRQ

Abstract

The Treatment Self-Regulation Questionnaire (TSRQ) is a psychological instrument developed within the framework of Self-Determination Theory (SDT). Its primary function is to assess the motivational quality underlying an individual’s engagement in specific health-relevant actions, such as entering treatment for a medical condition, adhering to a treatment regimen, or actively working to change an unhealthy behavior. The TSRQ quantifies the degree to which a person’s motivation for these behaviors is relatively autonomous (internalized and self-endorsed) versus controlled (driven by external pressures or introjected demands).

Keywords

Treatment Self-Regulation Questionnaire, Self-Determination Theory, Motivation, Autonomous Regulation, Controlled Regulation, Health Behavior, Treatment Adherence, Relative Autonomy Index, Psychological Assessment.

Authors

Williams, Grow, Freedman, Ryan, and Deci (initial developers/users in context of healthy behavior).

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Purpose

The fundamental purpose of the TSRQ is to measure the degree of self-regulation a patient exhibits concerning their healthcare behaviors. By adapting the wording to the specific behavior under investigation (e.g., controlling glucose level, not smoking, following a weight-loss program), the scale provides a context-specific assessment of motivational style.

This assessment is crucial because the quality of motivation, rather than just the quantity, is a powerful predictor of long-term adherence, persistence, and positive health outcomes. Researchers utilize the TSRQ to evaluate the effectiveness of interventions designed to foster more autonomous motivation in clinical settings.

Construct

The TSRQ measures the internalization of motivation based on the continuum proposed by Self-Determination Theory (SDT). It assesses where a person’s reasons for engaging in a health behavior fall on the spectrum from controlled to autonomous.

The scale primarily consists of two core subscales: Autonomous Regulation and Controlled Regulation. Autonomous Regulation items reflect intrinsic motivation and identified regulation (e.g., “I personally believe that controlling my diabetes will improve my health”). Controlled Regulation items reflect introjected or external regulation (e.g., “I would feel guilty if I didn’t,” or “Other people would be mad at me if I didn’t”). In some specialized versions, a subscale for Amotivation is also included, measuring the lack of intention or purpose regarding the behavior, though this is less common in standard published versions.

Validity

The validity of the TSRQ rests on its strong theoretical grounding in SDT. Empirical evidence derived from its use in diverse clinical populations (e.g., diabetes management, weight loss, smoking cessation) consistently supports its construct validity. Scores on the Autonomous Regulation subscale have been shown to predict sustained behavior change and superior psychological adjustment, while Controlled Regulation often predicts short-term compliance but is associated with greater psychological pressure and eventual drop-out.

Reliability

The TSRQ typically exhibits good internal consistency, ensuring the reliability of its subscales. The scale developers often include a greater number of items for the Controlled Regulation subscale compared to the Autonomous Regulation subscale. This design choice is intentional, as there are many varied controlled reasons (e.g., guilt, shame, fear of doctor disapproval, external pressure) for engaging in a behavior, and more items are necessary to obtain adequate reliability for this factor across different contexts.

Factor Analysis

Factor analytical studies generally support the distinct dimensions hypothesized by SDT. The items typically load onto separate factors corresponding to Autonomous Regulation and Controlled Regulation, confirming that the scale accurately captures these two independent motivational styles underlying health behavior. This clear factor structure across various adaptations demonstrates the scale’s robustness in measuring internalized self-regulation versus external compulsion across different health contexts.

Instrument

Test Type: Self-report questionnaire, psychometric scale

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

Language Available: English (Original), widely adapted for various languages.

Population Group: Individuals engaged in health-relevant behaviors, medical treatment, or behavior change programs (e.g., patients with chronic diseases, those in weight management programs).

Age Group: Primarily adults.

Population Details: Specific versions are tailored for populations such as patients with diabetes, morbidly obese patients entering a weight-loss program, or individuals attempting smoking cessation.

Test Methodology: Responses on autonomous items are averaged to form the Autonomous Regulation score. Responses on controlled items are averaged to form the Controlled Regulation score. These scores may be used separately or combined into a Relative Autonomy Index (RAI) by subtracting the average Controlled Regulation score from the average Autonomous Regulation score.

Keywords

Motivation assessment, SDT, Autonomous Motivation, Controlled Motivation, Relative Autonomy Index (RAI), Psychological assessment, Chronic disease management, Treatment compliance, Self-regulation.

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Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: N/A

Correspondence Address: Information available via the Self-Determination Theory website: http://selfdeterminationtheory.org

Permissions & Fee and Test Year

The TSRQ was first used for “behaving in a healthy way” in Williams, Grow, Freedman, Ryan, and Deci (1996). The various versions of the TSRQ are typically made available for research and non-commercial use by the SDT organization, often located within the Health Care section of their official website. Users should consult the website or contact the authors for specific permissions regarding adaptation or commercial use.

Reference’s

Key publications detailing the application and structure 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 and weight-loss maintenance.
• Williams, G. C., Freedman, Z. R., & Deci, E. L. (1998). Supporting autonomy for the maintenance of health behavior in patients with diabetes.
• Williams, G. C., Cox, E. M., Kouides, R. W., & Deci, E. L. (1999). Self-determination theory and the promotion of smoking cessation.

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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.

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. The scale is:

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.

The scale is:

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.

Please indicate how true each reason is for you‚ using the following scale:

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.