Self Efficacy and Multiple Sclerosis

We have discussed the individual steps that must be taken to achieve your desired health outcomes but have yet to discuss the most important issue; how do you actually do it?  It is easy for me to tell you to stop smoking, exercise, eat well, lose weight, and take your medications but why is it so difficult to accomplish these goals and why do so many people give up? Perhaps the best model to explain the success or failure of these human activities was developed by Albert Bandura at Stanford. According to his model, the success of any human endeavor requires a perceived belief that an action will achieve an outcome (i.e. stopping smoking will make me happier and healthier) and the sustained belief that you are capable of carrying out this action. This is collectively referred to as self-efficacy.

To quote Dr Bandara,

A strong sense of efficacy enhances human accomplishment and personal well being in many ways. People with high assurance in their capabilities approach difficult tasks as challenges to be mastered rather than as threats to be avoided. Such an efficacious outlook fosters intrinsic interest and deep engrossment in activities. They set themselves challenging goals and maintain strong commitment to them. They heighten and sustain their efforts in the face of failure. They quickly recover their sense of efficacy after failures and setbacks. They attribute failure to insufficient effort or deficient knowledge and skills, which are acquirable. They approach threatening situations with assurance that they can exercise control over them. Such an efficacious outlook produces personal accomplishments, reduces stress and lowers vulnerability to depression.

In contrast, people who doubt their capabililities shy away from difficulty tasks which they view as personal threats. They have low aspirations and weak commitment to the goals they choose to pursue. When faced with difficult tasks, they dwell on their personal deficiencies, on obstacles they will encounter, and all kinds of adverse outcomes rather than concentrate on how to perform successfully. They slacken their efforts and give up quickly in the face of difficulties. They are slow to recover their sense of efficacy following failure or setbacks. Because they view insufficient performance as deficient aptitude it does not require much failure for them to lose faith in their capabilities. They fall easy victim to stress and depression.

I face both sets of problems in my own life and in my attempts to help people with their health; first, I must deal with my own skepticism with regard to many treatments, particularly those that are untested, as well as the skepticism of patients regarding medical advice.  For instance, there are people who do not believe any of the drugs approved by the FDA will help their MS. While this is certainly an extreme example, I see many more people with smaller yet significant doubts regarding my medical recommendations. These doubts have persistent and enduring affects on their health outcomes. Perhaps the patient fails to take their medication regularly since they are not totally convinced it will help. Similarly, a person less committed to a treatment will give up on it whenever an event or a piece of information arises that serves to reinforce this opinion. Often this information is totally bogus but this makes little difference since it reinforces a preconceived notion. In all these cases it will not be possible for me to affect a desired outcome unless I can learn why the patient is only partially committed to my recommendation.  

The second problem, the perception of being incapable of accomplishing a goal, is far more pervasive and often reinforced unknowingly by those around us.

Thankfully, self-efficacy is not a built-in personality trait. This is something that varies from experience to experience; some people have high levels of self-efficacy for some activities and lower levels for others.  

So how do you improve self-efficacy? There are generally four ways to do this:

1. Build on your past successes: These successes did not come easily and would never have occur unless you learned to overcome obstacles and failures.  Use this knowledge to help you now.
2. Seek out positive role models: Find someone who has had to overcome similar obstacles. This is the reason why support groups and blogs are so popular.
3. Develop a strong social support network; it is hard to quit smoking when everyone around you smokes. Seek out non-smokers if you want to be successful
4. Reduce stress reactions: To do this you must alter your tendency to negative emotional states and misinterpretation of your physical symptoms as harmful. A person who tells me exercise makes them too tired or sore is a classic example.  Do not misinterpret these symptoms as harmful or a reason to stop. Similarly do not interpret your heart racing or your anxiety over an injection as a sign that taking the medication is harmful. Use this to facilitate performance not limit activities. Do not let these physical stress reactions become debilitating and give up.

Working with your health network (i.e. doctors, other health professionals, family and friends) to improve your self efficacy is the number one thing you can do to improve your health and is the foundation upon which rests all actions and behaviors to improve outcomes in people with chronic conditions.  Whenever you see yourself faltering in a recommended or required behavior, begin by asking what are you doing wrong and how can you solve it. Take responsibility and find help if required. Do not give in to self-doubts and self pity; accept set backs as a learning experience, correct your behavior and move on without regret and without looking back. If you are persistent you will achieve your goals.

PLEASE NOTE:  The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.