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Outcomes of a Therapeutic Fly-Fishing Program for Veterans with Combat-Related Disabilities: A Community-Based Rehabilitation Initiative

DOI:10.1007/s10597-017-0124-9
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Jessie L. Bennett
Jessie L. Bennett
Jessie L. Bennett
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Jennifer Piatt at Indiana University Bloomington
Jennifer Piatt
Marieke Van Puymbroeck
Marieke Van Puymbroeck
Marieke Van Puymbroeck
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Abstract

The purpose of this study was to examine the outcomes of a therapeutic fly-fishing program for veterans with combat-related disabilities. A total of 40 veterans participated in the 4-day therapeutic fly-fishing program and this study. The outcomes examined included reducing symptoms of posttraumatic stress (PTS), depression, perceived stress, functional impairment (i.e., work, relationships, physical, and everyday life), increasing self-determination, and leisure satisfaction. Each research participant completed pretest, posttest, and 3-month follow-up questionnaires. Repeated measures MANOVA and ANOVA were conducted to examine the differences between the three time points on each outcomes. The results indicated significant decreases from the pretest to posttest for symptoms of PTS, depression, perceived stress, and functional impairment, and an increase in leisure satisfaction from pretest to 3-month follow-up. These results highlight the use of therapeutic recreation programming for veterans with disabilities as a holistic approach to treatment and recovery.
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Vol:.(1234567890)
Community Ment Health J (2017) 53:756–765
DOI 10.1007/s10597-017-0124-9
1 3
ORIGINAL PAPER
Outcomes ofaTherapeutic Fly-Fishing Program forVeterans
withCombat-Related Disabilities: ACommunity-Based
Rehabilitation Initiative
JessieL.Bennett1· JenniferA.Piatt2· MariekeVanPuymbroeck3
Received: 13 September 2016 / Accepted: 7 March 2017 / Published online: 16 March 2017
© Springer Science+Business Media New York 2017
Introduction
The United States has an estimated 21.8million veterans,
with 3.8 million of these veterans reporting a service-
connected disability (Census Bureau 2015). As the United
States continues in the War on Terror, the number of veter-
ans and those requiring rehabilitative services will continue
to increase. Operation Iraqi Freedom (OIF) and Opera-
tion Enduring Freedom (OEF) have been identified as the
most physically and psychologically destructive conflicts in
United States history (Aronson 2005; Warden 2006). Due
to the improvements in protective armor, medical care,
and evacuation procedures in the OIF/OEF wars, nine out
of ten people survive their initial injury in combat (Mea-
gher 2007). In addition, the two signature wounds from
these conflicts are posttraumatic stress (PTS) and traumatic
brain injury (TBI) (Tanielian and Jaycox 2008), and it is
estimated that 20% of OIF/OEF veterans experience PTS,
while 15–20% experience a TBI (Hoge etal. 2004).
PTS is a mental disorder originating from experiencing
a traumatic event (e.g., witnessing a violent act, sustaining
a debilitating physical injury, combat). The symptoms of
PTS cluster into three groups, last for more than 1 month,
and range in severity (American Psychiatric Association
2000). Re-experiencing, one cluster of symptoms, include
flashbacks, hallucinations, or nightmares. Hyperarousal,
another cluster of symptoms, include hyper-vigilance,
heightened startle response, or difficulty falling asleep.
Avoidance/emotional numbing, the last cluster of symp-
toms, include avoiding people or places that are reminders
of the trauma, reduced participation in activities, or pulling
away from loved ones. These symptoms make it difficult
for individuals with PTS to relax, enjoy, and participate in
activities with others due to the fear of triggering symp-
toms (Schiraldi 2009). PTS symptoms can lead to impaired
Abstract The purpose of this study was to examine the
outcomes of a therapeutic fly-fishing program for veter-
ans with combat-related disabilities. A total of 40 veterans
participated in the 4-day therapeutic fly-fishing program
and this study. The outcomes examined included reducing
symptoms of posttraumatic stress (PTS), depression, per-
ceived stress, functional impairment (i.e., work, relation-
ships, physical, and everyday life), increasing self-determi-
nation, and leisure satisfaction. Each research participant
completed pretest, posttest, and 3-month follow-up ques-
tionnaires. Repeated measures MANOVA and ANOVA
were conducted to examine the differences between the
three time points on each outcomes. The results indicated
significant decreases from the pretest to posttest for symp-
toms of PTS, depression, perceived stress, and functional
impairment, and an increase in leisure satisfaction from
pretest to 3-month follow-up. These results highlight the
use of therapeutic recreation programming for veterans
with disabilities as a holistic approach to treatment and
recovery.
Keywords Fly-fishing· Mental health· Therapeutic
recreation· Veterans
* Jessie L. Bennett
Jessie.bennett@unh.edu
1 University ofNew Hampshire, 4 Library Way, Durham,
NH03824, USA
2 Indiana University, HPER Building 133, 1025 E. Seventh
Street, Bloomington, IN47405-7109, USA
3 Clemson University, 128 McGinty Court, 283 Lehotsky Hall,
Clemson, SC29634-0735, USA
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Although limited, several studies have provided preliminary quantitative data supporting the positive influence of recreational and adaptive sports programs on psychological symptoms among veterans and service members. Engagement in various recreation programs, with activities such as fly-fishing, kayaking, and surfing, has resulted in reduced depression (Bennett et al., 2017;Crawford, 2016;Lundberg et al., 2011;Rogers et al., 2014;Walter et al., 2019), PTSD (Bennett et al., 2017;Crawford, 2016;Gelkopf et al., 2013;Rogers et al., 2014;Townsend et al., 2018;Vella et al., 2013;Walter et al., 2019), and anxiety symptoms (Townsend et al., 2018;Walter et al., 2019) following program participation. One study even found immediate improvements in depression/anxiety and positive affect among service members within each session of a surf therapy program (Walter et al., 2019). ...
... Although limited, several studies have provided preliminary quantitative data supporting the positive influence of recreational and adaptive sports programs on psychological symptoms among veterans and service members. Engagement in various recreation programs, with activities such as fly-fishing, kayaking, and surfing, has resulted in reduced depression (Bennett et al., 2017;Crawford, 2016;Lundberg et al., 2011;Rogers et al., 2014;Walter et al., 2019), PTSD (Bennett et al., 2017;Crawford, 2016;Gelkopf et al., 2013;Rogers et al., 2014;Townsend et al., 2018;Vella et al., 2013;Walter et al., 2019), and anxiety symptoms (Townsend et al., 2018;Walter et al., 2019) following program participation. One study even found immediate improvements in depression/anxiety and positive affect among service members within each session of a surf therapy program (Walter et al., 2019). ...
... One study even found immediate improvements in depression/anxiety and positive affect among service members within each session of a surf therapy program (Walter et al., 2019). Other related psychosocial constructs have demonstrated similar improvements from pre-to postprogram including affect (Duvall & Kaplan, 2014;Walter et al., 2019), functioning (Bennett et al., 2017;Gelkopf et al., 2013;Townsend et al., 2018), social connectedness (Duvall & Kaplan, 2014), insomnia (Vella et al., 2013), and negative mood (e.g., Lundberg et al., 2011). Taken together, these studies offer initial evidence for psychological benefits following recreational and adaptive sports programs. ...
The National Veterans Summer Sports Clinic: Change and Duration of Psychological Outcomes
Article
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Introduction Recreational and adaptive sports programs are often provided to veterans with a variety of psychological and physical conditions; however, limited data exist regarding the outcomes of these programs. The current study evaluated the psychological outcomes of attendees of the 2017 and 2018 National Veterans Summer Sports Clinic (NVSSC) in San Diego, California. Method Seventy-four veteran participants completed self-report assessments before and after the week-long program, as well as 3 months following program completion. In addition, participants completed brief assessments before and after each of the daily recreational activities (cycling, surfing, sailing, kayaking, and archery/pickleball). Results Findings showed that depression, anxiety, social functioning, and positive and negative affect significantly improved from pre-to postprogram, but returned to baseline levels at 3-month follow-up. Within sessions, depression/anxiety and positive affect significantly improved each day, with no differences in the amount of change across days. Depression/anxiety and positive affect also significantly improved within each activity, regardless of order, with no differences in the magnitude of change across activities. Conclusions The NVSSC produced significant changes in psychological outcomes among veteran participants within immediate and short-term time periods; however, gains were not maintained longer-term. Follow-on engagement in exercise activities is likely necessary for continued benefit; future research, including studies with control groups, would provide greater clarity.
... Recreational therapy interventions have shown promise in improving symptom management, strengthening social relationships, supporting physical health, and enhancing community reintegration among Veteran and military populations (Bennett et al., 2014;Craig et al., 2020;Lundberg, Bennett, et al., 2011;Lundberg, Taniguchi, et al., 2011;Mowatt & Bennett, 2011;Thompson et al., 2016;Vella et al., 2013;Wheeler et al., 2020). Further, there is a growing evidence-base for the efficacy of RT interventions in facilitating functional outcomes, coping, and posttraumatic growth for Veteran and military populations with PTSD and comorbid behavioral health conditions (Bennett et al., 2017;Duvall & Kaplan, 2013;Hawkins et al., 2016;Price et al., 2015;Rogers et al., 2016). Although this line of research is in its relative infancy, initial results and findings suggest that RT deserves continued investigation to evaluate its efficacy and implementation within the VA, DoD, and community-based RT settings serving Veterans and military personnel and behavioral health conditions (Townsend et al., 2018). ...
Community-Based Recreational Therapy for Veterans with Behavioral Health Disorders: Impacts on Quality of Life, Participation, and Happiness
Article
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Identifying evidenced-based interventions that improve health outcomes for Veterans with behavioral health disorders is a national priority. Thus, this study examined the outcomes of a community-based recreational therapy (RT) program focused on health promotion for Veterans with behavioral health disorders. Fifty-five Veterans with disabilities completed pretest and posttest questionnaires that assessed Quality of Life (QOL), Participation, and Happiness. Significant improvements were found in Overall QOL, Environmental QOL, Psychological QOL, QOL Rated, Satisfaction with Health, Participation, and Happiness. Younger age and female gender were significantly associated with improved Overall QOL. Factors significantly associated with improved Environmental QOL included younger age and non-Caucasian race. Older age was significantly associated with improved Participation. Female gender was positively associated with improved Happiness, while being divorced/separated was negatively associated with Happiness. These results have important implications for the use and expansion of community-based RT health promotion programs for Veterans with behavioral health disorders.
... The delineation of the conceptual framework for the current study was built upon the ICF (10). Essential domains of health in relation to PTSD as conceptualized using a community-based inclusive development approach were delineated based on the literature (3,9,(13)(14)(15)(16)(17)(18)(19). ...
Building and Testing of a Conceptual Model to Describe and Measure the Health of People as Affected by Post-traumatic Stress Disorder During Social Unrest: A Confirmatory Factor Analysis and Structural Equation Modeling
Article
Full-text available
  • Mar 2022
Background Social unrest affects people's health and well-being. People's health-related needs during social unrest are concerns in both research and clinical practice. This study aimed to build and test a framework to describe and understand the health status and needs of people with post-traumatic stress disorder (PTSD) during social unrest. Methods This study was a cross-sectional survey. A total of 460 people who had experienced post-traumatic distress as a result of the social unrest in 2019 and 2020 were included. A conceptual model comprised four essential areas, namely posttraumatic distress symptoms, participation restrictions, perceived stigma and functional disability, was built from literature. Part 1 validated four instruments that evaluate and define the factor structure of these four areas, In Part II, structural equation modeling was used to test and validate a combined model. Results Factors underlying the four areas were defined. Analysis using structural equation modeling confirmed a best fit of the model. PTSD symptoms, perceived stigma and participation restriction during social unrest contributed significantly to functional disability; PTSD symptoms exerted a direct effect on participation restriction and perceived stigma; and the effect of PTSD symptoms on functional disability was mediated through its influence on perceived stigma during social unrest. Conclusions A community-based inclusive approach is essential to understand the holistic needs of people with PTSD during social unrest. To improve health and well-being in addition to evaluating mental health impacts, considering interactions with the rapid change and stressful social environment is essential.
... A small number of published articles highlight fly-fishing as a form of recreation therapy that appears to aid in alleviating symptoms, assist with stress management and instil a positive future focus among combat veterans diagnosed with PTSD. 7,8,9 Despite being discussed as a therapy for PTSD, a complex mental disorder, no researched form of therapeutic fly-fishing appears to be facilitated by licensed mental health professionals. Likewise, there seems to be no research that integrates evidencebased treatment for PTSD with therapeutic flyfishing. ...
Treating combat-related Posttraumatic Stress Disorder using Therapeutic Fly-Fishing with EMDR (TF-EMDR)
Article
Full-text available
  • Jan 2022
Therapeutic fly-fishing is a nature-based intervention that is experiencing increased use to adjunct mental health treatment with current and former uniformed service professionals. While promising, literature suggesting the use of therapeutic fly-fishing with evidenced-based psychotherapy for posttraumatic stress disorder (PTSD), or any other mode of psychotherapy, does not appear to exist. This raises several questions regarding the ethics and fidelity of current uses of fly-fishing during a person's mental health care. Because of these concerns, the author explores literature surrounding the use of therapeutic fly-fishing for combat-related PTSD and offers a way to integrate fly-fishing directly within a well-researched and widely used PTSD treatment modality: Eye Movement Desensitization and Reprocessing (EMDR) therapy. The distinct phases of EMDR are demonstrated through a treatment protocol, followed by implementation suggestions for interested mental health professionals, organisations and other treatment providers worldwide. The author hopes that clinicians and treatment programs will better understand the importance of using trained psychotherapists to facilitate trauma treatment-with the model presented as one way to integrate the worlds of nature-based treatment and evidence-based practice easily. Finally, this paper serves as a call for research into the concept of Therapeutic Fly-Fishing with EMDR (TF-EMDR) and other such integrations of nature-and evidence-based PTSD treatment approaches.
... These positive social interactions and emotional ties were also crucial for supporting veterans overcoming a pervasive sense of social isolation associated with mental or physical conditions [42]. Some studies which investigated the long-term effects of different alternative activities indicated that positive post-intervention effect was not sustained over time (e.g., 2, 3 or 6 months post-intervention) [49][50][51]. Nevertheless, current findings suggested that continuous participation steadily enhanced veterans' subjective well-being and in turn led to improvements in many aspects of their personal and professional lives. ...
Extreme sport as an intervention for physically injured military veterans: the example of competitive motorsport
Article
Full-text available
  • Oct 2021
Purpose: Physically or psychologically injured military veterans are motivated and benefited by physical activity or sport that may involve high levels of achievement. The aim of this study was to provide an in-depth insight into the impact of Competitive Motorsport (CM) on physically injured/disabled veterans' subjective well-being and in turn determine if it improves the quality of their lives. Methods: This is a qualitative study. Two sets of semi-structured interviews were conducted with 14 male British military veterans including a 6-month follow-up. All participants were subjected to a permanent, moderate or severe, physical injury/disability. Data were analysed in accordance with the principles of Thematic Analysis. Results/conclusions: Five key elements (familiar environment, team spirit, adrenaline rush, competition and equality) made CM a unique experience for physically injured/disabled veterans. Various psychological and physical benefits were found, including an increased sense of accomplishment, opportunity to socialise in a non-clinical environment, embracement of body image and adoption of a healthier lifestyle. Since physical activity and sport are among growing research on alternative interventions for military veterans, they deserve serious consideration as part of the treatment regimens and rehabilitation programmes to improve physically inured/disabled veterans' physical and mental health.Implications for RehabilitationCompetitive Motorsport is an effective means of improving physical health and subjective well-being of physically injured/disabled military veterans.Multiple perceived psychological and physical benefits were identified over time, including motivation for living, embracement of body image and adoption of a healthier lifestyle.Competitive Motorsport deserves consideration as part of the treatment regimens and rehabilitation programmes to improve physically injured/disabled veterans' physical and mental health while facilitating transition to civilian life.
... One environmental context that has received less attention is water-based physical activity, with researchers suggesting that swimming and other water-based activities (e.g., kayaking, surfing) may provide superior benefits for the promotion of human well-being due to greater affordances (Foley and Kistemann, 2015;Araujo et al., 2019). These activities have heightened the psychological benefits (e.g., reduced anxiety, depression, and perceived stress, increased positive affect, and increased quality of life) associated with exercise and nature among US war veterans (Lundberg et al., 2011;Bennett et al., 2017;Walter et al., 2019). Further, there is increasing evidence suggesting that participation in action and adventure sports, such as surfing, is meaningful and life-enhancing (Immonen et al., 2017). ...
“Feels Good to Get Wet”: The Unique Affordances of Surf Therapy Among Australian Youth
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Full-text available
  • Oct 2021
Increasing prevalence rates of mental health problems among adolescents is an issue of growing concern. Surf therapy is a novel intervention that may provide tangible benefits to address this problem. Congruent with the ecological dynamics perspective (EDP), the existing research postulates that surf therapy yields psychological benefits in part due to the unique affordances of immersion in a blue space such as the ocean. Evidence worldwide has validated the use of surfing as a therapeutic mediator to achieve positive change, however, no such research has been conducted on Australian adolescents. The current study aimed to evaluate the impact of the Waves of Wellness (WOW) Foundation’s eight-week surf therapy program on mental health outcomes in Australian at-risk youth. The study employed a mixed-methods design to examine the experiences of participants. Nine adolescents (Mage = 14.9; SD = 1.2; 8 female) participated in the quantitative stage, with four completing the qualitative interview. Results indicated positive changes in resilience, self-esteem, social connectedness, and depressive symptoms post intervention, however, improvements were not maintained at follow-up. Participants unanimously agreed that the program normalised their experiences with mental health through the unique leaning environment and fostered personal growth through mastery experiences and the development of healthy relationships. The EDP provided the most compelling explanation of the results denoting that benefits arise from the reciprocal relationship between individual, task, and environment. Despite the small and heterogenous sample, the findings provided preliminary evidence of the efficacy of surf therapy among Australian youth and offer a potential starting point for further research utilising larger more diverse samples.
... [43][44][45][46][47][48] A number of studies have documented benefits from green exercise in Veteran populations and among individuals with PTSD. [45][46][47][48][49][50][51][52][53][54][55] The specific interventions studied (from care farming to river rafting), dose/duration and inclusion of additional, explicit therapeutic components vary substantially among studies. A 2019 systematic review that examined evidence for the proposed additive effects of exercise in the presence of nature observed some benefits (eg, lower perceived exertion and enjoyment). ...
Nature versus urban hiking for Veterans with post-traumatic stress disorder: a pilot randomised trial conducted in the Pacific Northwest USA
Article
Full-text available
  • Sep 2021
Objectives To evaluate feasibility and acceptability of a group-based nature recreation intervention (nature hiking) and control condition (urban hiking) for military Veterans with post-traumatic stress disorder (PTSD). Design and setting A pilot randomised controlled trial conducted in the US Pacific Northwest. Participants Veterans with PTSD due to any cause. Interventions Twenty-six participants were randomised to a 12-week intervention involving either six nature hikes (n=13) or six urban hikes (n=13). Primary and secondary outcome measures Feasibility was assessed based on recruitment, retention and attendance. Questionnaires and postintervention qualitative interviews were conducted to explore intervention acceptability. Questionnaires assessing acceptability and outcomes planned for the future trial (eg, PTSD symptoms) were collected at baseline, 6 weeks, 12 weeks (immediately after the final hike) and 24 weeks follow-up. Results Of 415 people assessed for eligibility/interest, 97 were interested and passed preliminary eligibility screening, and 26 were randomised. Mean completion of all questionnaires was 91% among those in the nature hiking group and 68% in those in the urban hiking group. Over the course of the intervention, participants in the nature and urban groups attended an average of 56% and 58%, respectively, of scheduled hikes. Acceptability of both urban and nature hikes was high; over 70% reported a positive rating (ie, good/excellent) for the study communication, as well as hike locations, distance and pace. Median PTSD symptom scores (PTSD Checklist-5) improved more at 12 weeks and 24 weeks among those in the nature versus urban hiking group. Conclusions This pilot study largely confirmed the feasibility and acceptability of nature hiking as a potential treatment for Veterans with PTSD. Adaptations will be needed to improve recruitment and increase hike attendance for a future randomised controlled trial to effectively test and isolate the ways in which nature contact, physical activity and social support conferred by the group impact outcomes. Trial registration number NCT03997344 .
... Such interventions, provided by charitable organizations, are usually free of charge and may provide an opportunity to conduct expensive outdoor activities that participants would otherwise find unaffordable. For example, physical activity interventions in the form of fly-fishing (Bennett et al., 2017), horse riding (Gehrke et al., 2018), and outdoor recreation-based health and wellness programs (Townsend et al., 2018) may, as activities in themselves, provide incentives to participate. Practitioners may find the use of such activity-based incentives beneficial in the promotion of physical activity among WIS veterans. ...
Exploring the Perceived Barriers and Benefits of Physical Activity Among Wounded, Injured, and/or Sick Military Veterans
Article
Full-text available
  • Jun 2021
Wounded, injured, and/or sick (WIS) military veterans face significant physical and psychosocial challenges following discharge from service. Physical activity can have many positive effects on the holistic wellbeing of such individuals. However, little knowledge exists regarding the perceived barriers and benefits of physical activity within this population, creating challenges surrounding physical activity promotion. Therefore, this study was designed to identify key barriers and benefits among this population, so that informed approaches to encourage participation in physical activity can be developed. A questionnaire related to the perceived barriers and benefits of physical activity was completed by 105 WIS British military veterans. Participants were predominantly male, physically active, served in the British Army, and described their injury as frequently impacting their daily living. Factor analysis revealed that poor mental health, negative beliefs about physical activity, and low beliefs about physical capability were prominent barriers represented in the data. However, only veterans’ beliefs about their physical capability were related to physical activity levels and differed between active and insufficiently active participants. Beliefs identified as benefits of physical activity that correlated with physical activity levels were improved mental and physical health, a sense of purpose, and increased physical fitness. Subsequently, barriers and benefits were categorized using the Behaviour Change Wheel, a behavior change framework, that indicated intervention functions of education, incentivization, and persuasion might be effective methods of increasing physical activity behavior among WIS veterans. Ultimately, this will lead to greater engagement with physical activity and improved health and wellbeing within this population.
... It is important to mention that many anglers consider fly fishing to be a spiritual activity, referring to nature as something sacred to them [84]. Fly fishing can therefore be described as recreational but also personal identity activity, and has been so for at least two thousand years [85] with demonstrated healing benefits with PTSD patients and other traumas [86,87]. ...
Insect Cultural Services: How Insects Have Changed Our Lives and How Can We Do Better for Them
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  • Apr 2021
Societies have benefited directly and indirectly from ecosystem services provided by insects for centuries (e.g., pollination by bees and waste recycling by beetles). The relationship between people and insect ecosystem services has evolved and influenced how societies perceive and relate to nature and with each other, for example, by shaping cultural values (‘cultural ecosystem services’). Thus, better understanding the significance of insect cultural services can change societies’ motivations underpinning conservation efforts. To date, however, we still overlook the significance of many insect cultural services in shaping our societies, which in turn likely contributes to the generalised misconceptions and misrepresentations of insects in the media such as television and the internet. To address this gap, we have reviewed an identified list of insect cultural services that influence our societies on a daily basis, including cultural services related to art, recreation, and the development of traditional belief systems. This list allowed us to formulate a multi-level framework which aims to serve as a compass to guide societies to better appreciate and potentially change the perception of insect cultural services from individual to global levels. This framework can become an important tool for gaining public support for conservation interventions targeting insects and the services that they provide. More broadly, this framework highlights the importance of considering cultural ecosystems services—for which values can be difficult to quantify in traditional terms—in shaping the relationship between people and nature.
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Participation in meaningful occupations is central to health, well-being, and adjustment during the transition from military service. The aim of the present study was to identify what occupations transitioning Australian Defence Force members participate in for the purpose of improving their health and well-being. A secondary aim was to identify if participation in various occupations was associated with better self-reported health and/or adjustment outcomes. One hundred and ninety-eight former Australian Defence Force members discharged on or after January 1, 2004 responded to a cross-sectional survey measuring adjustment, physical and mental health, and participation in occupations. Occupations were coded using the Time Use Classification system developed by the Australian Bureau of Statistics. An easier adjustment was reported by former service members who participated in employment-related activities, domestic activities, voluntary work and care activities, and social and community interaction (MD = −0.63 to −0.45, d = .37 to .52). Participation in employment-related activities, social and community interaction, and sport and outdoor activity was associated with better physical health (MD = 3.20 to 3.73, d = .34 to .40). Participation in employment-related activities was also associated with better mental health (MD = −3.75, d = .54). This research indicates that participation in occupation is a factor that may be utilized with former service members to positively influence health and adjustment during military transitions. Given differences in participation and outcomes among different sub-groups, it is recommended that occupation-based programs be tailored to individual preferences and transition needs.
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I: Background.- 1. An Introduction.- 2. Conceptualizations of Intrinsic Motivation and Self-Determination.- II: Self-Determination Theory.- 3. Cognitive Evaluation Theory: Perceived Causality and Perceived Competence.- 4. Cognitive Evaluation Theory: Interpersonal Communication and Intrapersonal Regulation.- 5. Toward an Organismic Integration Theory: Motivation and Development.- 6. Causality Orientations Theory: Personality Influences on Motivation.- III: Alternative Approaches.- 7. Operant and Attributional Theories.- 8. Information-Processing Theories.- IV: Applications and Implications.- 9. Education.- 10. Psychotherapy.- 11. Work.- 12. Sports.- References.- Author Index.
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