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American geriatric and pre-school populations suffer in age-segregated captivity like the old-style zoo monkeys, tigers and bears.





The Functional Side of Motivation Theory 



Kim Byrd-Rider   



The Functional Side of Motivation Theory 

Zoos individually caged monkeys, tigers and bears for centuries. In the past 20 years, animal caregivers at zoos researched and replaced the outdated cage model with a habitat model for improved psychological and physical animal health (Rose & Croft, 2015, p. 123).  In the habitat model, the monkeys live all together on a large piece of property and their caregivers and healthcare providers come to them, on their natural turf.  

American geriatric and pre-school populations suffer in age-segregated captivity like the old-style zoo monkeys, tigers and bears. According to a journal article in The Science in the Service of Animal Welfare (Rose & Croft, 2015, p. 123), “Disruption to social bonds may lead to impoverished welfare and stress to individuals which have seen their social support compromised.” Like the monkeys, both geriatrics and preschoolers are given a minimal amount of choice about the cage they live in and who resides with them. Caregivers make those decisions.  

Inter-generational care and social living, generally, increases social stress.  Even though stress is usually interpreted as negative, two animal studies argue the opposite. The studies proclaim the goal of animal husbandry is to create conditions that enable a full range of behavior repertoire which include arousal and stress (Chamove & Anderson, 1989; Moodie & Chamove, 1990). Animal social living and it’s potential problems and complexity have been linked to the evolution of intelligence (Byrne & Whiten, 1988; Dunbar & Shultz, 2007; Psquaretta et al., 2014). Due to these animal studies, it is commonplace in zoos to provide challenging, complex social and physical environments (Buchanan-smith, Griciute, Daoudi, Leonardi, & Whiten, 2013; Hardie, 1997; Leonardi Buchanan-Smith, Dufour, Macdonald, & Whiten, 2011’ MacDonald & Whiten, 2011; Sodaro, 1999; Veasey & Jammer, 2010). The conclusion of the animal kingdom evidence points to, “Primate well-being is not so much a function of confinement as of the presence of relevant incentives to engage in species-appropriate behavior” (Chang, Forthman, Maple, 1999). Universally, humans have lived in inter-generational clans throughout time until the last century with the onslaught of daycare centers and nursing homes.  

I am proposing the same animal proven model for outpatient healthcare. Drop-in, hourly-charged, daycare services for geriatrics (50-100 y/o) and pre-school pediatrics (3-5 y/o) combine in a large space to create an inter-generational habitat of children, middle-aged daycare workers (25-65 y/o) and older people to create an inter-generational, natural habitat. Self-directed activities orbiting around self-actualization motives would be the “habitat” model.   

Healthcare providers like physical therapists, occupational therapists, speech therapists and psychologists (who are also middle aged), work in offices on the periphery of the inter-generational habitat. A healthcare worker treats a patient within the habitat. The other daycare participants would have freedom to choose from planned activities (interventions). If needed, the patient could be pulled aside from the group.  

The evolution of all things involves change. Introducing a new inter-generational medical model to insurance companies, investors and staff induces fear of change, fear of failure and fear of monetary loss for them. Motivating bureaucratic institutions (those overly concerned with procedure at the expense of common sense, efficiency or the good of others) to change presents obstacles. The obstacles must be overcome by motivations to change.  

A sound motivational strategy must be implemented to ensure everyone involved embraces change. A critical literature analysis of usable motivational theories for implementing this new rehab medical business model will be as follows: 1. critical analysis of effective motivation models on the business and the business’ culture, 2. critical analysis of motivational models’ protective and risk factors and 3. critical analysis of motivational models’ intervention measurements and intervention types. 


  1. Critical Analysis of Effective Motivation Models for Business and the Rehab Medical Model Culture  

In 2016, a meta-analytic review of 99 studies using 119 samples of basic need satisfaction at work supports the use of the Self-Determination Theory (Van den Broeck, Ferris, Chang, & Rosen, 2016). The Self Determination Theory (SDT) states: every person regardless of nationality is motivated to attain three fundamental universal needs: competence (mastery of tasks, skills), autonomy (control of environment, control of personal life, independence), and relatedness (sense of belonging and attachment to others). A need is a state of tension within a person and if not satisfied results in physical or psychological dysfunction (Jongman-Sereno, 2017).  

Van den Broeck et al.’s SDT meta analysis (2016) set out to determine the three needs’ ability for ongoing psychological growth, internalization and well-being. Their findings favored using the SDT for needs at work. Although, they found competence, autonomy and relatedness represented the positive outcomes of psychological growth, internalization and well-being better than negative outcomes (Van den Broeck et al., 2016). It is not appropriate to average competence, autonomy and relatedness needs together nor to use an overall needs satisfaction score (Van den Broeck et al., 2016). The SDT needs are highly correlated (p>.70) but not so strongly that they are redundant to each other. It is also not appropriate to view the needs as interchangeable and equal (Van den Broeck et al., 2016). The researchers (2016) conclude the Self-Determination Theory is one of the more comprehensive theories of basic psychological needs showing empirical support to use for the workplace. It will be the motivational approach for all work and business interactions involved in founding, developing and operating the new medical model.  The SDT model is capable of motivating business people quickly and easily to accomplish work goals (Van den Broeck et al., 2016). 

The SDT will not be used for motivation within the culture of the new rehabilitation medical model due to it’s inability to change people. Dr. Karen Horney’s motivational model will be used because for this culture the goal is to facilitate rehabilitative change and even self-actualization. This is very different than trying to generate basic need motivation for work. 

Self-actualization as defined by Dr. Horney is the process of shedding childhood-acquired, neurotic, false-self needs to reclaim and nurture the authentic true-self one was born with (1950). Dr. Karen Horney, a German psychiatrist, a founder of the Association for the Advancement of Psychoanalysis, a founder of the American Institute for Psychoanalysis and author of Neurosis and Human Growth provides an alternative lens for authentic motivation (1950). Her research and experience claim motivational needs result from an inner power struggle between the false-self and the true-self. The false-self, in her findings, imbodies the SDT motivations; relationship, autonomy and competence. The true-self doesn’t need motivations.  The true-self is self-actualized but needs resources (Horney, 1950).   

Maslow’s Classical Hierarchy of Needs Theory will not be used for either of the motivational solutions. In Maslow’s theory, motivational needs are catered to and arranged in a hierarchical or even parallel fashion (1943). According to Horney, motivational needs are an outward sign of an inner war between the false-self and the true-self (1950). Horney’s theory also offers a more usable self-actualization solution.  

Similarly, Maslow’s outlined three motivational characteristics show promise for significance when matched to other motivational models: strength and power, the primary need for love and those who give up all but biological needs by resigning from life (1943, p.13).  These three characteristics are found not only in the SDT model as competence, relatedness, and autonomy (Van den Broeck, 2016) but they closely match Horney’s three neurotic false-self personality options (1950): mastery (strength and power-competence), self-effacing (need for love-relationships) and resigned (freedom, giving up-autonomy).    

Horney’s solution (1950) ends the inner war and discards all motivational needs (the neurotic false-self) to rediscover, empower and actualize the true-self. The capabilities of the actualized true-self births authentic growth, genuine emotions and self-purpose. Horney explains, ‘to work at self-actualization is the prime moral obligation and moral privilege. We become free to grow, free to love and free to feel concern for other people’ (1950, p.15). Motivational needs become obsolete and unnecessary under the jurisdiction of the true-self (Horney, 1950). Dr. Horney’s motivational model is the choice for the rehabilitation medical model culture. It will be used as the central driver for intervention goals and activities. 


2. Critical Analysis of Motivational Models’ Protective and Risk Factors 

1. The False Self 

According to Dr. Horney (1950), the neurotic false-self is a life coping strategy rooted in childhood and is a risk factor. By association, this would make the Self Determination Theory a risk factor, too. But, it is a productive risk factor and will be used for the purpose of business relations. The false-self opporates by allowing the irrational imagination to branch out and externalize. The irrational imagination generates inner “shoulds”, the “search for glory” and the pride system involving self-hate. The goal of the false-self is to immobilize the true-self and bury it, undetectable, deep below the adopted outer bark of the externalizing false-self. Horney’s false-self reaches for the sun itself as the human imagination contrives self-distortions satisfying a supreme need: the “search for glory”, the realm of unlimited possibilities (1950, p. 34).  Dr. Horney believes every person struggles with this inner conflict of the neurotic false-self vs. the true-self. Three, neurotically growing, false-self solutions are to move toward (self-effacing-love), against (mastery-power) or away (resigned-freedom) from others (Horney, 1950). SDT names Horney’s three solutions as universal needs: relational, competence and autonomy (Van den Broeck, 2016).  Maslow names them as characteristic called love, strength/ power and freedom (1943). Horney’s examination of the three is much more sinister and destructive than in the other two theories.  Instead of catering to the three and using them as motivational leverage, Horney’s opinion is to uproot and shred them, then resurrect the authentic true-self and nurture it’s growth in the sunlight of healthy support (1950). 

  1. The True Self 

The true-self, on the other hand, is defined by Horney as, “the original force toward individual growth and fulfillment with which we may again achieve full identification when freed from the crippling shackles of neurosis (the false-self),” (1950, p.158). The true-self is a protective factor. Horney (1950, p. 17) explains the real-self as, “the clarity and depth of one’s own feelings, thoughts, wishes, interests, the ability to tap his own resources, the strength of his own resources, will power strength, special capacities or gifts, self-expression, and inter-relations with spontaneous feelings.” Baumeister et al. (1998) says, “Even a small amount of this (inner) resource would be extremely adaptive in enabling human behavior to become flexible, varied, and able to transcend the pattern of simply responding to immediate stimuli.” Horney (1950, p.113) adds, “The real-self is fighting for it’s life.” In the rehab medical model, the real-self will be given resources in the form of interventions and activities to emerge. 

  1. Self-Actualization 

How does one shed the imagination driven false-self and nurture the true-self to acquire the benefits of self-actualization? According to Harvard’s psychology course on personalities, living and diligently practicing the following helps one to achieve self-actualization, giving insight to what it is (Jongman-Sereno, 2017): 

1.   Think consciously about the future (set realistic goals, metacognition, etc.) 

  1. Introspect on inner states (mindful practices, positive psychology, etc.) 

  1. Observe and evaluate personal characteristics (self-empathy, self-compassion, reality checks, therapy, group therapy, mindful practices, etc.) 

  1. Imagine how we are perceived by others (other and self-empathy, reality checks, etc.) 

  1. Engage in volitional self-change (therapy, behavior modification strategies, effort, etc.) 

  1. Be a good consumer of psychological science (learn more about psychology research findings, religions, ancient psychology, philosophy, etc.) (Jongman-Sereno, 2017) 


Self-regulation is the essential thread running through all of the six self-actualization activities. For a critical analysis of what constitutes self-actualization, we can start by analyzing an obvious commonality of all of it’s facets; self-regulation. The building blocks and correlates of self-regulation are as follows:  

  1. A. Self-compassion + B. Emotion-regulation = C. Self-Regulation (Scolglio, 2015). 

  1. C. Self-regulation= D. Resilience (Scolglio, 2015). 

Self-actualization, as well as it’s constructs and components (A-D), is a protective factor. Due to the vagueness of terms A-D, a critical review of their definitions is necessary. 

  1. Self-Compassion 

Self-compassion is comprised of self-kindness, a sense of common humanity and mindfulness (Neff, 2003). It links one to greater knowledge and clarity about one’s own limitations because individuals do not have to hide their shortcomings from themselves in order to maintain a positive self-image (Neff, 2007). Unlike self-esteem, self-compassion is not contingent on performance evaluations, clarity and accuracy of self-appraisals (Baumeister, Heatherton, & Tice, 1993). Self-compassion may be especially useful as a means of countering negative self-attitudes in self-concept domains where self-improvement is difficult or impossible (Scolglio, 2015). Self-compassion is a useful emotional regulation strategy, in which painful or distressing feelings are not avoided but are instead held in awareness with kindness, understanding, and a sense of shared humanity helping to deal with disease, illness, and injury (Baumeister, 1996). Self-compassion may facilitate healthy behavior by helping people to monitor their health goals with less distraction and defensiveness, consider their situation with equanimity, disengage from goals that are not in their best interests, seek medical help when needed, adhere to treatment recommendations, and regulate negative affect (Baumeister, Bratslavsky, Muraven, & Tice, 1998). Thus, negative emotions are transformed into a more positive feeling state, allowing for clearer apprehension of one’s immediate situation. This allows one to adopt actions that change oneself and/or the environment in appropriate and effective ways (Folkman & Moskowitz, 2000; Isen, 2000). Self-compassion is a protective factor. 

  1. Emotion-regulation 

Emotion-regulation is one’s ability to effectively manage and respond to emotional situations. People adapt emotional regulation strategies to daily cope with life situations. Some are healthy and some are not (Rolston, & Lloyd-Richardson, 2017). 

People who score high in self-compassion do not suppress their emotional reactions. They experience negative events in a more mindful, less reactive manner. Because they experience less negative affect, they do not deplete self-regulatory resources trying to manage their emotions. As a result, their resources are available for other self-regulatory tasks, including adhering to medical regimens, instituting positive behavioral changes, or monitoring their progress toward health goals (Baumeister, Bratslavsky, Muraven, & Tice, 1998; Schmeichel, 2007, Neff et al., 2007). Emotional-regulation is a protective factor. 

  1. Self-Regulation  

Self-regulation leads to more effective selection of health goals, goal progress monitoring, engagement in behaviors to reach their goals, including seeking medical treatment and adhering to treatment recommendations (Baumeister, 1996). Self-regulation helps with elimination of impediments that can arise when people’s attention is derailed by judgmental, defensive, or otherwise non-self-compassionate thoughts. (Greeson & Brantley, 2009; Shapiro & Schwartz, 1999). 

Note:  Increasing self-esteem does not increase self-regulation. Attempts to raise self-esteem are often ineffective in general (Swann, 1990). Boosting individuals’ self-esteem may inadvertently foster self-centeredness and a sense of superiority (Damon, 1995). Raising self-esteem is often attempted by giving individuals indiscriminate praise or encouraging positive self-affirmations (Hewitt, 1998). Unrealistic praise is also dangerous in that it does not acknowledge that individuals may have patterns of behavior that need to be changed because they are unproductive, unhealthy or harmful (Damon, 1995). High self-esteem appears to be linked to narcissistic tendencies, egoistic illusions, adopting inappropriate goals that are beyond performance capabilities and self-regulation failure (Baumeister, Heatherton, & Tice, 1993).  

Successful self-regulation requires people to attend to and evaluate their behavior and health on an ongoing basis. Mindfulness (one of the three components of self-compassion) identified by Neff (2003), may play a role in the attentional component of self-regulation (Shapiro & Schwartz, 1999). People who are mindful pay attention to their experiences in a non-judgmental, and accepting manner (Terry, 2011). Mindfulness qualities promote self-regulation. (Greeson & Brantley, 2009; Shapiro & Schwartz, 1999). 

Self-regulation includes making decisions, responding actively and exerting self-control. It determines our control over ourselves and the world. The bad news: self-regulation (self-control) degrades quickly with use, unique for a cognitive process. Other cognitive structures improve with subsequent acts, similar to priming. Initial acts of self-regulation actually impair subsequent acts of self-regulation, leaving self-control vulnerable to depletion and it happens fast, sometimes within minutes. (Baumeister et al., 1996; Muraven & Baumeister, 2000; Sheppes et al., 2015; Bargh & Pietromanaco, 1982; Higgins & King, 1981; Wyer & Srull, 1980).  For example, a five minute activity of resisting chocolate while working a puzzle decreased by half on a second episode. The phenomenon crosses cultures and time. Western norms and forces seem especially conducive to self-control weakness (Baumeister et al., 1998). Historical evidence of self-control deterioration and failure appears even in medieval and Confucian writings (Baumeister et al., 1998). This problem is not new. 

In research studies, self-regulation responds more like a muscle than a cognitive function operating on a quantitative continuum, decreasing in strength over time. Self-regulation easily depletes, then eventually restores itself from an illusive inner resource (Baumeister et al., 1998). Even irrelevant self-regulation acts can tax the inner resource. According to researchers who admit, “We acknowledge that we do not have a clear understanding of the nature of this (inner) resource” (Baumeister et al., 1998, p. 1264).  Nor do they know the factors which speed or delay the replenishing process. Depletion of the inner resource not only lowers self-control but may result in “burnout, learned helplessness, and similar patterns of pathological passivity” (Baumeister et al., 1998). 

While the experimental outcomes in the articles cited here are valid enough, the conclusions may be convoluted. Four of the articles reached the same conclusion: self-regulation relies on a depleting inner resource which regenerates back over an unspecified amount of time. Although the articles are heavily researched with more than fifty references each, three of the four cited articles include one author on their team and a fourth article referenced him: Roy Baumeister. Without Baueister, would the researchers draw a different conclusion from the experiments? It seems illogical that only one cognitive function deteriorates with use and has a mystically, easily-depleted resource, while all the other cognitive functions strengthen with use. Maybe, something different is happening. 

Even Baumeister and Heaterthorn (1996) admit the situation could be more complex than just a self-regulation problem, “We suggested that self-regulation often involves an unpleasant inner conflict marked by competing wishes and uncertainty.” Muraven & Baumeister (2000) state, “The acts of self-control can take the form of an inner resource striving to overcome the power of some impulse, emotion, desire, habit, or other response.”   

Self-regulation is an attribute of the true-self according to Horney (1950). Deterioration of self-regulation may be the neurotic false-self caught in the act of burying the true-self. Brumeeiser et al. (1998) seem to be shocked at “the ease with which we have been able to produce ego (self-regulation) depletion.” For Horney, this would be evidence of the amount of neurotic power the false-self wields. Dr. Horney believes every person struggles with this inner conflict. In the earlier chocolate eater experiment, the false-self locks-up self-regulation (the true-self) in a quick five minutes but gains momentum and crushes self-regulation in half the time on the second go-round. Self-regulation is a protective factor. 

  1. Resilience  

Which came first, the chicken or the egg’ describes the conundrum: Where does human resilience come from? The answer to this question may hold the solution to obtaining resilience: the capacity to recover quickly from difficulties. The chicken represents positive affect and actions. The egg represents realistic positive coping skills. Researchers are not sure if positive affect and actions must be squared away to build positive coping skills or vice versa. A third element in addition to the chicken and the egg is the egg incubator: high self-esteem and feelings of self-efficacy. Like the incubator or hen’s warmth, they must be present for development. (Rutter,1985; Faulman & Moskowitz, 2000; Rutter, 2013). Attainment of any or all of the previous foundational elements of resilience is rather allusive. Let’s examine these elements and, more importantly, solve the puzzle of how to attain them. 

First is the chicken. Positive affect and actions described by Falkman & Moskowitz (2000) includes positive re-appraisal of events and infusing positive meaning into ordinary events. Personal significance of the event meaning is important, too. When people infuse personal meaning into events, it soon becomes a global meaning “that defines one’s identity in the aftermath of trauma” Falkman & Moskowitz (2000, p. 651). People with a negative affect (involved in emotional discharge, escape avoidance, and rumination) will have difficulty developing positive affect, making resilience quite illusive. Contrived positive affect and negative affect have equally limited power to help develop resilience. The positive affect must be genuine in order to contribute to resilience (Faulman & Moskowitz, 2000). 

Second is the egg. Goal-directed coping skills based in reality are necessary for resilience. Performing this process involves gathering information, evaluating resources and task-oriented actions based on realistic parameters (Rutter, 1985).  According to Karen Horney’s book, Neurosis and Human Growth (1950), the common condition of neurosis ensures the generation of unrealistic goals in humans due to the neurotic “search for glory” syndrome which develops in most everyone. The neurotic solution of “search for glory” grows from people’s desperate need to feel meaningful to themselves. People posses a compulsive need for power and significance which they achieve through their imagination and move toward, against or away from others to get it. Realistic goal setting does not predominantly occur in the epidemic human condition of neurosis (1950). For example, the possibility of normal walking for paraplegia patients with complete spinal lesions is extremely limited and not close to normal if achieved. Walking normally is an unrealistic goal. Yet, it ranks as the number one goal in popularity among those patients (Scivoletto, 2014). 

The third supporting or ‘incubator’ components to positive actions, affect and coping are high self-esteem and feelings of self-efficacy; the ability to succeed (Rutter,1985, p.608). Again, according to Dr. Horney, high self-esteem is not attainable by the typical person due to the presence of neurosis (the idealized false-self).  The typical person swims in a sea of neurotic dictates, taboos and ‘shoulds’.  Via their imagination, people evolve false artificial and strategic ways to cope with others and override genuine feelings, wishes and thoughts.  Genuine feelings, wishes and thoughts are the foundation of authentic high self-esteem/self-efficacy. The process of developing high self-esteem/self-efficacy is too laborious. Instead of persevering through the hard work of growing into them, people quickly and easily substitute a pride system for it (Horney, 1950). The pride system’s core consists of rationalizations, justifications and externalizations with the supremacy of the mind and the magic of imagination (Horney, 1950). Authentic high self-esteem/self-efficacy hence are unavailable to the typical person. Even though self-esteem does not improve self-regulation (as previously discussed), self-compassion can improve self-esteem/self-efficacy (Baumeister, Heatherton, & Tice, 1993).  If there is no ‘incubator’, there is no chicken produced. Neurotic pride of the false-self exponentially decreases the possibility of ever developing resilience. (Dr. Horney, 1950, p. 21). Resilience is a protective factor. 


3. Intervention Measurements and Intervention Types Needed for A. Business Motivations (SDT Model) and B. Rehab Medical Model Culture Motivations (Dr. Horney’s Model) 

  1. Business Motivations (Self-Determination Theory-SDT Model) 

Intervention Measurements 

 A meta-analysis reviewing 99 studies, declares the Self Determination Theory (SDT) to be a strong model to base work oriented motivation from (Van den Broeck et al., 2016). Intervention measurements have already been established for this model. 

Intervention Types 

All business and marketing interactions/correspondences will be oriented to motivate all three motivational styles within the SDT motivation model: 

1. Competence (mastery of tasks, skills)  

2. Autonomy (control of environment, control of personal life, independence) 

3. Relatedness (sense of belonging and attachment to others) 

The SDT model claims all people have all three motivations but many people are more motivated by one (Van den Broeck et al., 2016). If one type of motivation is identified for an individual or customer population, then business interactions with him may become slanted toward a particular motivational style. The following random topic examples of customer marketing interventions include all three motivational styles but use a single motivational style writing tone. 

Relatedness (sense of belonging and attachment to others) tone: “Learn the art of rug making (competence) with other beginners (relatedness) over a week long journey. Create unique holiday gifts (autonomy) for your loved ones (relatedness). Our teachers are service oriented and ready to help you (relatedness).” Product choice: a week long product, they will have time to bond with others.  Relatedness is in the sentence three times because it is their primary motivator. Relationship toned words added: loved ones, help you, give gifts and journey. Competence at a skill is as a beginner. Autonomy is mentioned but at a low level: making their own holiday gifts, not starting a business. Competence and autonomy are present but not at high levels.  These are needs but not primary motivators for relatedness motivation style. 

Competence (mastery of tasks, skills) tone: “Master teacher and Psychiatrist (competence) Dr.  Jill Smith jump starts students to super power status (competence) in only two days. Become a high-ranking CPA (autonomy with competence) with three easy steps (competence). Bonus: Private sessions with the instructor (relatedness) to answer your specific questions.” The teacher’s status, super power, and high-ranking are important tone setting words. Product choice: a two-day workshop works for a competence motivated person, not a week. The relationship focus is with the powerful teacher. The course has high leadership qualities and bonus personal material which appeals to competence motivation style.  

Autonomy (control of environment, control of personal life, independence) tone: “Learn two different types of fly fishing (competence) in one hour from our expert guide (relationship) and then apply the techniques during a day of secluded fishing (autonomy) near our quiet getaway cabins (autonomy).” The tone of the sentence relies on words like secluded, quiet getaway and only one hour with others, which appeals to a freedom oriented person. Competence is covered but minimally with only two types of fishing. Even though the sentence does not exclude the presence of other people in the learning group, it mentions the attendance of only one person, the expert, implying more independent learning.  

Plausible Self Determination Theory (SDT) intervention strategy examples: 


  1. To increase the accuracy of customers’ motivation style, distribute a motivation style measurement questionnaire to a large sample of current customers. 

  1. Business marketing and correspondences:  

  1. General, simple version: Evaluate products and decide which group would be motivated most by which product.  Write the copy for that product using the chosen motivation style associated with it.  


  1. Specific, complex version: Each person in question receives an incentive to take a motivation questionnaire and are grouped according to their motivational style.  Specialized copy is sent to a specific motivation style mailing lists to optimize opportunities.  


  1. Educated guessing: For example, if the neighborhood of a promotional mailer is known, the copy leans toward the stereotype. A women’s social group receives relational motivation copy.  A hospital administration receives competence motivation copy, etc. 


The conscientiousness trait needs to be given additional motivation consideration. It is one of the Big Five Universal Personality Traits and also motivates people on an independent scale from low to high (Jongman-Sereno, 2017). Conscientious does NOT correlate to the other personality trait scales of extrovert, agreeable, open and neurotic, nor to the other motivation styles. High conscientious characteristics include responsible, reliable, high self-control, persistent, timely, organized, orderly, clean, structured, fewer car accidents and tickets, increased IQ, school achievement and other similar attributes.   Since all people score somewhere on this scale, it is best for business to assume all people score high.  All products, services and communications should be on time, clean, orderly, reliable, organized and structured (Jongman-Sereno, 2017).  

  1. Rehab Medical Model Culture (Dr. Horney’s Model) 

Intervention Measurements 

The vagus nerve is the core component of the parasympathetic nervous system (PNS) and is the central player of Porges’s Polyvagal Theory (2007). The theory demonstrates positive correlations between 1. positive emotions and affect, 2. high vagal tone and 3. perceived positive social connections. Each influences the other in an upward positive spiral improving physical health (Kok & Fredrickson, 2010). The vagus nerve links to nerves coordinating eye gaze, facial expressions and tuning into human voices (Porges, 2007). High vagal tone is associated with prosocial behavior (Fabes, Eisenberg, & Eisenbud, 1993) and social closeness (Kok & Fredrickson, 2010). Vagus nerve tone reciprocally increases form intranasal oxytocin produced by positive social engagement (Kemp et al., 2012).  The practical question is: What interventions kick start the positive movement of any of the three to encourage the positive upward spiral of all three?  

This investigation begins with 2. high vagal nerve tone, because it can be measured quantifiably. The 10th cranial nerve (the vagus nerve) registers low tone when the “fight or flight” sympathetic nervous system (SNS) operates and high tone when the PNS operates. Together the SNS and PNS are the autonomic nervous system, which is responsible for unconscious bodily functions like breathing, heart rate and digestion. 

A multitude of studies connect high vagal nerve tone (PNS) to protective factors of the immune system for improved health (Kok, Coffey, Cohn, Catalino, Vacharkulksemsuk, Algoe, ... & Fredrickson, 2013). For example, human natural killer cells “eat” cancer, bacteria and virus cells.  Cortisol, a hormone increased by the SNS, “eats” natural killer cells belonging to the immune system.  Thus, low tone vagal activity lowers the amount of natural killer cells fighting for the immune system (Diego, Field, Sanders, & Hernandez-Reif, M.,2004; Brittenden, Heys, Ross, & Eremin, 1996). Low vagal tone also forecasts high inflammation (Thayer & Sternberg, 2006), myocardial infarction risk and lower survival odds after heart failure among other poor health outcomes (Bibevski & Dunlap, 2011). 

A research study (Kok, 2013), took advantage of known vagal tone outputs for it’s quantifiable measurements. High-frequency components (0.12-0.4 Hz) of the heart rate signal reflect vagal influences on the heart. Once considered stable and unchanging, vagal nerve baseline can indeed be changed (Kok, 2013). To prove this, researchers used 71 university faculty/staff and one intervention to test the baseline of the vagus nerve. For six weeks, subjects performed a mandatory one-hour per week loving-kindness meditation. Plus, they self-decided frequency and duration of daily meditations. Baseline vagal nerve tone was taken two weeks before the intervention and one week after. The baseline vagal tone was higher post intervention (Kok, 2013). Increasing 2. vagus nerve tone and 3. positive social engagement are reciprocally influenced by self-generated 1. positive emotion, as in the Kok study (2013). Of the three, the easiest variable to manipulate for interventions is 1. positive emotion, because it can be self-generated. 

Intervention Types 

New interventions are needed to self-generate positive emotions. Exercise interventions like aerobics and weight lifting require increases of SNS to increase heart rate, so low vagal tone (SNS) is associated with exercise and stress.  (Lucas, Heidi, Porges, & Rejeski, 2016). While cardio-vascular exercises have great benefits, they cannot be used as an intervention for a high tone vagal goal. There is the established “fake it until you make it” approach, which has psychological journal evidence (Ekman, 1992). For example, a person smiles even though he doesn’t feel like smiling and eventually he becomes happier. Positive affect and actions described by Faulman & Moskowitz (2000) includes positive re-appraisal of events and infusing positive meaning into ordinary events. Personal significance of the event meaning is important, too. When people infuse personal meaning into events, it soon becomes a global meaning “that defines one’s identity in the aftermath of trauma,” (Faulman & Moskowitz, 2000, p. 651). People with a negative affect (involved in emotional discharge, escape avoidance, and rumination) will have difficulty developing positive affect, making resilience quite out of their reach. Although contrived positive affect and negative affect present very differently to the observer, they have equally limited power to help develop resilience. The positive affect must be genuine in order to contribute to resilience (Horney, 1950). 

Self-compassion meditations are showing promise in the literature. According to psychology professor Dr. Kristin Neff, self-compassion is “extending compassion to one’s self in instances of perceived inadequacy, failure, or general suffering. Three main components: (a) self-kindness- being kind and understanding towards oneself in instances of pain or failure rather than being harshly self-critical, (b) common humanity-perceiving one’s experiences as part of the larger human experience rather than seeing them as a separating and isolating and (c) mindfulness- holding painful thoughts and feelings in balanced awareness rather than over-identifying with them” (Neff, 2003). Self-compassion meditations increases: self-esteem, successful aging, general well-being, life satisfaction, functioning, resilience and emotion regulation and they also decrease depression, fear of failure, anxiousness, fear of rejection, negative affect, self-pity, catastrophizing, resignation, emotional problems and PTSD symptom severity(Allen & Leary, 2010; Leary, Tate, Adams, Allen, & Hancock, 2007; Neff, 2003b; Neff, Kirkpatrick, & Rude, 2007; Scolglio, 2015). Patients often ignore doctors’ recommendations, fume about the inconvenience of being incapacitated, and blame themselves for the illness or injury (Putnam, Finney, Barkley, & Bonner, 1994). People’s attention is derailed by judgmental, defensive, or otherwise non-self-compassionate thoughts (Greeson & Brantley, 2009; Shapiro & Schwartz, 1999). Compassion in patient care is significantly decreasing for healthcare workers. (American Medical Association, 2001; Institute of Medicine, 2004; Francis, 2013; MacLean, 2014; Willis, 2015). Self-compassion meditations for the healthcare workers and care givers: findings suggest that an 8-week yoga and compassion meditation program can improve the quality of life, vitality, attention, and self-compassion of caregivers (Marcelo, 2017). Education for self-compassion, emotional intelligence, and mindfulness training need to be incorporated into medical students’ curricula and programs to promote healthcare worker and patient well-being (Patsiopoulos & Buchanan, 2011; Senyuva et al., 2014; Olson et al., 2015; Kemper et al., 2015; Beaumont et al., 2016). 

Also, three additional interventions to meditation show great promise: yoga, tai chi and massage therapy. Even in rigorous yoga and tai chi exercises the nervous system alternates from SNS to PNS promoting efficient shifting from arousal to calm (Lucas, 2016) leaving the practitioner with a higher vagal tone baseline post intervention (Sullivan, 2018).  Autonomic neural regulation, the ability to change from SNS to PNS reciprocally, links to improved breast and prostate cancer outcomes (Magnon, Hall, Lin, et al., 2013; Couck, Marechal, Moorthamers, Laethem, & Gidron, 2016). In a systematic review of 71 journal articles (Riley & Park, 2015), yoga improved positive affect, mindfulness and self-compassion with positive changes in the posterior hypothalamus, interleukin-6, C-reactive protein and decreasing cortisol levels. Yoga also raises vagal tone (Sullivan, Erb, Schmalzl, Moonaz, Noggle,… & Taylor 2018) as does massage therapy (Hernandez-Reif, Field, Ironson, Beutler, Vera, Hurley,... & Hernandez-Reif, M., 2005a; Hernandez-Reif, Ironson, Field, Hurley, Katz, Diego,... & Burman, I., 2004b). Research on tai chi shows high tone vagal activity, as well (Wei, Li, Yue, Ma, Chang, Yi,… & Zuo, 2016).  

 Each intervention requires different senses which means different brain processing pathways are activated and strengthened to achieve high vagal tone (Kayser & Shams, 2015). For example, yoga and tai chi require muscle movement, balance and eyesight brain processes. Sitting meditations and massage do not. Breath regulation, which directly effects the vagus nerve (Song, Liu, Proctor, & Yu, 2015), is required by all four interventions but at different tempos and efforts requiring different neuro-pathways (Kayser, 2015).  Yoga and massage researchers hypothesize the increase in vagal tone comes from pressure on the skin receptors (also part of the vagus nerve system) unlike tai chi and meditation (Hernandez-Reif, 2004b; Hernandez-Reif, 2005a). Combining the four interventions of yoga, meditation, massage therapy and tai chi may have cumulative health benefits due to their differences.  Research on this topic has not been done, yet. 

The key to finding more positively influential interventions may be to look at what the known interventions all have in common and then find similarly structured interventions. All four require the combination of the mind fixated in the present, body movement attention (either in controlled patterns or stillness) and breath regulation (whether high or low).  

Created by ancient people centuries ago, yoga, meditation, massage therapy and tai chi produce the appropriate stimuli combination for vagus nerve plasticity and brain plasticity to improve physical health. Few interventions match these criteria. Sports taught with a high level of mindfulness might qualify. American coaches and trainers would need to change their styles from win and push harder to focus intensely, regulate intensely, and recover frequently to a peaceful (PNS) state. The highest level athletes discover ‘the zone’ of focus and regulation on their own but most sports do not coach the previous approach. Yoga, meditation and tai chi are simple, adaptable and can be free. Minimal space, no equipment, no special floors, no shoes and no supervision are required, making them the optimal intervention choice to support 1. positive emotions and affect, 2. high vagal tone and 3. perceived positive social connections, for now. Activities in the Rehab Medical Model facility interventions will include: 

1. Yoga, meditation, tai chi and self-massage of neck, feet and hands. 

2. Functional activities of daily living with a parameter of fulfillment of self-actualization strategies listed below.  For example, setting realistic goals (a.) for walking distances and then patient reflecting (a. metacognition) on what one would realistically need to do to increase the distance. 

3. Activities which support any of the self-actualization strategies below. For example, all books in the facility will contain age appropriate subject matter of (f.) in order to qualify for the model’s curriculum: 

a.   Think consciously about the future (set realistic goals, metacognition, etc.) 

  1. Introspect on inner states (mindful practices, positive psychology, etc.) 

  1. Observe and evaluate personal characteristics (self-empathy, self-compassion, reality checks, therapy, group therapy, mindful practices, etc.) 

  1. Imagine how we are perceived by others (other and self-empathy, reality checks, etc.) 

  1. Engage in volitional self-change (therapy, behavior modification strategies, effort, etc.) 

  1. Be a good consumer of psychological science (learn more about psychology research findings, religions, ancient psychology, philosophy, etc.) (Jongman-Sereno, 2017) 


Some menus might describe a hamburger as, “Hamburger with 100% ground beef, lettuce, tomato and mayonnaise.” One might think…what else is on this menu?   

At another restaurant the menu might describe it like this, “Hamburger: Japanese Kobe beef, farm to table vegetables, and mayonnaise whipped by our own Chef Eric.”  This stops the reader. He definitely wants this burger!  Why? The sentence addresses his motivation for competence/power (Japanese beef is superior), his motivation for autonomy (freedom of choice to help local farmers) and his motivation for association (he thinks he knows Chef Eric). Voila! Purchase complete, fast and powerful, using the Self Determination Theory (SDT).  

The chef also acquired a repeat customer because the customer “feels” like the restaurant understands him. He is understood because of an easy formula based on motivational needs.  This theory will be used for all inter-generational business and work situations only. The Self-Determination Theory structure makes business and work motivationally simple but it only appeases the psychological need system without changing it.  

The goal of rehabilitation is change, which can be accomplished with Dr. Horney’s motivational model. As seen with the previous positive correlations, self-actualization is a worthwhile goal providing protective factors for physical and psychological health. The rehabilitation and daycare culture/habitat, within the business, will provide the appropriate stresses and healthy socialization opportunities to support nurturing growth, emulating zoo animal research findings.  

Both geriatric and pre-school populations have the precious commodity of spare-time. Time and remodeling resources, provided by the new inter-generational rehabilitation medical model, are needed for neurological brain regions and pathways to restructure from unhealthy mental process into self-actualization. It has yet to be seen but the outcome hypothesis is: when geriatric and the pediatric people self-actualize, their authentic healthy contributions to the world will become game changers for everyone on the planet, including themselves.  The world’s police systems, military systems and penal systems put out daily fires arising from people moving toward, against or away from each other (actions of the false-self). What if, by leveraging self-actualization as the retardant, the fires never started? What if the police, military and penal systems (firefighters) were replaced, or at least heavily aided, by healthcare professionals laying down self-actualization protective factors against fire initiation? What if a wisdom group (geriatrics) were around to champion and support preschoolers in self-actualization skills? The inter-generational medical rehab model motivational psychology is sound and potentially revolutionary. 



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