Applications of self-efficacy theory in rehabilitation counseling.

Self-efficacy is a construct that has been widely applied in the behavioral sciences and human services. However, applications of self-efficacy have not frequently appeared in the rehabilitation counseling literature and it would seem likely that practicing rehabilitation counselors do not frequently use the construct in understanding client needs. The purpose of this paper is to provide a review of self-efficacy theory and to show how this construct can be applied in rehabilitation counseling.

The term, self-efficacy, is often used interchangeably with locus of control and self-esteem. However, these terms are not equivalent. Self-esteem refers to an individual's perceptions of his of her self worth (Bandura, 1986), and locus of control refers to an individual's beliefs in explaining outcomes, the relative influences of external forces beyond the individual's control and internal forces which are under the individual's control (Rotter, 1966). In contrast, self-efficacy refers to an individual's perception of his or her skills and abilities to act effectively and competently, and these beliefs influence actions and coping behaviors, the situations and environments that individuals choose to access, and their persistence in performing certain tasks (Bandura, 1977).

Overview of Theory

Basics of Self-Efficacy

Self-efficacy theory draws upon both cognitive and behavioral concepts. Bandura (1977) indicated that self-efficacy theory is based on the principle that cognitive processes can mediate behavioral change but that cognitive events are induced and altered most readily by the experience of mastery arising from effective performance. Bandura went on to state that focusing only on cognitive process does not provide for successful behavioral change. Cognitively based interventions can provide individuals with the knowledge and awareness of the skills and abilities underlying the execution of the behavior. However, if individuals do not believe that they can actually execute the behavior effectively, the behavior will not occur. So for example, an individual may know the behaviors that need to be performed and the arguments that need to be presented in asking for a pay raise; however, if the individual does not have confidence in their ability to effectively present the request, the individual will be less likely to follow through in performing the task.

Efficacy Expectations

Central to the theory of self-efficacy is the concept of efficacy expectations as contrasted with outcome expectations. Efficacy expectations are defined as an individual's conviction that he or she can successfully execute the behaviors required to produce a desired outcome (Bandura, 1977). In contrast, outcome expectations are defined as the individual's belief that particular courses of action will ultimately produce certain outcomes (Bandura, 1977). Individuals may believe that a particular course of action will produce certain outcomes (outcome expectations) but, if they entertain serious doubts about whether they can effectively perform the necessary actions, the outcome expectations will have little influence on their behavior (Bandura, 1977).

Efficacy expectations affect both an individual's choice of settings, behaviors, and persistence in performance. Individuals with low efficacy expectations are likely to avoid situations and environments that exceed their perceptions of their own coping skills. Instead they will seek out activities and environments which they judge themselves to be capable of handling (Bandura, 1977).

Efficacy expectations will also affect the extent and persistence of effort in executing activities. Individuals with greater self-efficacy will persist longer in the face of obstacles and, by demonstrating mastery in the situation, their efficacy expectations will further increase. Individuals with lower self-efficacy expectations will be more likely to cease their efforts prematurely, and their beliefs that they do not have the skills needed to perform successfully in the given situation will be reinforced.

Bandura (1977) has stated that efficacy expectations may be conceptualized as having three dimensions, each with important performance implications. First, efficacy expectations differ in magnitude, influencing the difficulty and complexity of tasks that will be undertaken. Efficacy expectations also differ in terms of generality, influencing the extent to which expectations will generalize and affect performance in a variety of tasks and environments. Finally, efficacy expectations differ in strength, influencing the extent to which an individual will persevere in his or her efforts despite negative experiences in performing the task.

It is important to note that efficacy expectations alone will not produce the desired performance. There must be adequate incentives for individuals to perform desired behaviors. Many times individuals have the skills needed to perform a behavior, but choose not to do so because the necessary incentives are not perceived to be present. However, given adequate incentives, efficacy expectations are a major determinant of a person's behavior, the extent of effort that will be put forth, and the extent to which effort will be sustained when difficulties arise (Bandura, 1977).

Sources of Efficacy Expectations

Bandura (1977) indicated that expectations of personal efficacy are based on four major sources of information: performance accomplishment, vicarious experiences, verbal persuasion, and emotional arousal. These sources of information then form the basis for counseling interventions designed to facilitate efficacy expectations.

Performance accomplishments are based on the personal mastery experiences and are the most influential source of efficacy information. Success increases efficacy expectations, while failure decreases efficacy expectations. Strong self-efficacy expectations are developed through repeated successes. Once self-efficacy is established, it tends to generalize to new situations. Generalization effects occur most predictably in activities that are most similar to those in which self-efficacy has been restored through intervention (Bandura, 1977). Methods used to develop performance accomplishments include participant modeling, performance desensitization, performance exposure, and self-instructed performance.

The development of self-efficacy through a vicarious experience occurs when an individual sees others performing the target tasks without adverse consequences. By observing successful performances the individual comes to believe that he or she can also perform the task effectively. Modeling in which the outcome is very clear produces the best results. Efficacy is also increased when an individual observes a variety of models achieving success, instead of just one model. Methods used to facilitate behavior change through vicarious methods include both live and symbolic modeling. In general vicarious experiences tend to have less influence on self-efficacy than the direct evidence of personal accomplishments.

Verbal persuasion provides another method to increase self-efficacy. People are led to believe through suggestion that they are able to cope successfully with a situation that has previously been overwhelming. As with vicarious experience, verbal persuasion also has less influence on self-efficacy than performance accomplishments. Individuals may show an initial increase in self-efficacy as a result of verbal persuasion; however, self-efficacy is weakened quite easily if failure is experienced. Verbal suggestion, exhortation, self-instruction, and interpretive treatments are strategies of verbal persuasion that may frequently be used.

Emotional arousal may also affect self-efficacy. Stressful and taxing situations generally elicit emotional arousal that, depending on the circumstances, might have informative value concerning personal competency (Bandura, 1977). For example, if anxiety is experienced in performing a task, that emotional arousal may be interpreted by the individual that he or she is not coping effectively. The use of attribution, relaxation, biofeedback, symbolic desensitization, and symbolic exposure are all methods in which emotional arousal can be decreased in order to increase efficacy expectations.

Perception and Interpretation of Efficacy Information

To increase self-efficacy, individuals need to cognitively interpret efficacy information. Situational, social and temporal circumstances in which events occur affect appraisals of self-efficacy.

Self-efficacy is more likely to be increased if individuals attribute success to their individual skill instead of other factors, such as effort expended and task difficulty. If an individual is able to obtain success at a task without much effort, self-efficacy will increase. But if tremendous effort is required efficacy may decrease with the effort required being attributed to a lack of skill. Further, if success is achieved and perceived to be "easy", self-efficacy may not be affected. In contrast, if an individual achieves success at a perceived to be a difficult task, self-efficacy will tend to increase. The rate and pattern of attainments provide further information on the development of self-efficacy. An individual who may experience a single setback may not experience a corresponding decrease in self-efficacy because a steady progress of achievement is perceived. However, an individual who experiences a setback and views his/her performance as leveling off or declining will experience a decrease in self-efficacy.

Applications to Rehabilitation Counseling

Self-efficacy theory can be applied in the practice of rehabilitation counseling. A central tenet of self-efficacy theory is that cognitive processes can mediate change, but that cognitive events are induced and altered most readily by the experience of mastery arising from effective performance (Bandura, 1977), and this tenet can be applied in all the phases of rehabilitation counseling practice. Mitchell, Brodwin, and Benoit (1990) hypothesized that individuals who sustain industrial injuries may enter rehabilitation with lower self-efficacy because they no longer are providing income for themselves or their families, have lost their jobs, and have lost friendships associated with employment. Enhancing an individual's self-efficacy through counseling can help individuals deal with these issues and increase the likelihood of returning to work (Mitchell, Brodwin, & Bonoit, 1990). The following sections of this paper will focus on interventions and strategies designed to enhance an individual's self-efficacy and improve rehabilitation outcomes in terms of assisting with adjustment to disability and with career development.

Adjustment to Disability

The onset of a disability has a profound impact on many facets of a person's life including vocational, economic, medical, psychological, and social functioning (Cook, 1992). Dodd, Bailey, and Yates (1991) indicated that individuals with recent visual impairments often experience depression and anxiety as a result of their difficulties in carrying out simple daily living tasks. In addition, individuals may express uncertainty regarding their future. This set of circumstances may then lead to negative self-evaluations, producing low expectations of success in accomplishing rehabilitation goals.

Counselors working with rehabilitation clients should consider enhanced self-efficacy as an explicit goal of rehabilitation (Altmaier, Russell, Kao, Lehmann & Weinnstein, 1993). Rehabilitation counselors can use performance accomplishments, vicarious experiences, verbal persuasion, and emotional arousal to increase efficacy expectations which, in turn, can lead to more positive rehabilitation outcomes. Shoor and Holman (1984) documented that an individual's perceived self-efficacy in pain management plays a influential role in managing pain associated with arthritis. Altmaier et al. (1993) found that low back pain patients who received counseling to increase self-efficacy in coping skills had lower self-reported back pain at a six month follow-up. The same study also found changes in self-efficacy during treatment were predictive of an individual's level of functioning on both functional measures (e.g. range of motion exercises) and self-report pain measures. Thus, self-efficacy enhancement appears to play a key role in maintaining gains in function achieved through treatment, and counseling interventions (Altmaier, et al., 1993). The first step in applying self-efficacy theory would be a thorough assessment of the client's background to identify domains to be targeted for self-efficacy improvement.

In discussing how self-efficacy theory can be used to assist an individual in adjusting to a disability, an individual with a visual impairment will be used as an example. Since individuals with recent visual impairments often experience depression and anxiety as a result of difficulties in carrying out daily living tasks (Dodd, Bailey, & Yates, 1991), counselors may view daily living skills as an area on which to concentrate. To increase self-efficacy through performance accomplishments a counselor might provide assistive devices and consult with a rehabilitation engineer to assist the individual in performing daily living tasks. As the individual develops skills in using the assistive devices, self-efficacy will improve. Increasing self-efficacy through performance accomplishments, such as physical reconditioning, has been found to be an effective means to increase rehabilitation outcomes with cardiac rehabilitation patients (Bandura, 1986) and individuals who suffer from chronic pain (Altmaier, et al., 1993).

Using vicarious experiences, a counselor might find a "role model" with a visual impairment who has successfully adjusted to a similar disability. By interacting with this person, the individual experiences hope and increased confidence in his or her own ability to perform target tasks and cope effectively with the challenges faced. Enhancing an individual's self-efficacy through role models has been used effectively for increasing outcomes in cardiac rehabilitation (Bandura, 1986). Group counseling can also be used as sources of vicarious experiences. The participation in a group where individuals are able to observe and interact with others who have successfully dealt with issues similar to those that they are facing provides role models who can enhance self-efficacy. Group activities in which individuals received support and obtained educational information were found to be extremely effective vicarious experiences for individuals with chronic low back pain (Altmaier, et al.,1993).

Verbal persuasion can be used to encourage individuals and provide reinforcement for successful accomplishments. Encouragement might be especially useful when an individual is engaged in experiences that are designed to increase self-efficacy. People who are persuaded verbally that they possess the capabilities to master given tasks are likely to mobilize greater sustained effort then if they have self doubts and dwell on personal deficiencies when difficulties arise (Bandura, 1986). Goal setting in trying new or feared behaviors, and reinforcement for accomplishing those goals can provide encouragement to enhance self-efficacy (Betz, 1992).

As noted above, the onset of visual impairments may result in depression and anxiety. The use of techniques designed to directly diminish these emotional reactions can also facilitate self-efficacy. Treatments that eliminate emotional arousal to subjective threats heighten perceived self-efficacy with corresponding improvements in performance (Bandura, 1986). It is important for the counselor to help the individuals focus on problem solving behaviors rather then negative thoughts. Counselors can use relaxation, positive self-talk and thought stopping as methods to counter and diminish emotional arousal to improve self-efficacy (Betz, 1992).

Many times individuals who encounter difficulty in adjusting to disabilities may appear unmotivated to participate in rehabilitation activities. These individuals may not show up for appointments, may sabotage interviews, may be reluctant to participate in counseling sessions, or may drop out of rehabilitation completely. Counselors often become frustrated and may label these individuals as "unmotivated". As an alternative lack of motivation can be reconceptualized in terms of the self-efficacy model. In most cases individuals experience low self-efficacy and are reluctant to participate due to a fear of failure and uncertainty regarding their abilities (Bandura, 1986). A counselor who can identify and target the areas of low self-efficacy and intervene appropriately, can facilitate participation in rehabilitation activities and increase the potential for successful outcomes.

Career Development

In many cases, the goal of rehabilitation counseling is successful employment. Work is a central force in peoples' lives. The loss of a job is a major life event that effects nearly 10 million people annually (Riegle, 1982). In addition to providing economic support, work contributes to an individual's social status and self concept (Roe, 1969). However, in many cases individuals with disabilities do not reenter the work force and again become productive workers. Louis Harris and Associates (1986) indicated that individuals with disabilities have dramatically high rates of unemployment and underemployment, which adversely affects not only economic and social status, but self-image (Szymanski & Hershenson, 1992). Studies indicate that job loss places people at increased risk of poor mental health in terms of increased depression, anxiety, minor psychiatric morbidity, and decreased self-esteem and life satisfaction (Caplan, Vinokur, Price, & van Ryn, 1989). In addition, unemployment can lend to weakened work identity, making it more difficult to return to work (Gallagher et al., 1989), and perceived difficulties in changing jobs enters into career decisions. Individuals who perceive a job change as easy have been found to be three times more likely to return to work than individuals who perceive a job change as difficult (Gallagher et al., 1989). With the employment difficulties that people with disabilities encounter, improving self-efficacy can assist in the career decision making process. An individual's self-efficacy regarding career choices is often referred to as career self-efficacy. Betz and Hackett (1986) identified career self-efficacy as a general construct impacting upon career choice and development.

To enhance self-efficacy regarding career development, Bandura's four sources of efficacy information can again be used as a basis for intervention. The successful performance of a task is the paramount source of strong career self-efficacy (Hackett & Betz, 1981). Performance accomplishments can be used to increase efficacy by developing mastery of work and job seeking skills. Rak and O'Dell (1994) identified job search skills as critical to the success of impaired or isolated clients seeking employment. Activities such as reviewing the employment section of the paper, completing applications, developing interviewing skills, and developing the skills necessary for targeting employers should be stressed in programs preparing individuals for entry into the labor market (Rak & O'Dell, 1994). By using workshops and training programs that provide successful practice experiences, an individual can gain a sense of mastery of these target skills. An individual who successfully completes a training program that provides work skills or job seeking skills will have increased self-efficacy, which will allow the application of these new skills to the work force or job search. Eden and Aviram (1993) found that increasing an individual's job search self-efficacy caused an intensification of job search activity and an increase in obtaining employment. Many individuals with disabilities lack information about jobs and careers that are available in the work force. The lack of knowledge regarding careers can cause indecision which lowers career self-efficacy (Taylor & Betz, 1983). An individual can increase occupational knowledge by interviewing employers and researching occupations. By successfully completing these tasks, individuals gain an understanding of their current skill level and understand what skills need to be developed to enhance employment efforts. Gaining an understanding of their skills, individuals will increase their confidence regarding career decision making, therefore, improving their attitude toward the career decision making process (Luzzo, 1993).

Vicarious learning can provide information and examples of successes through role models who have achieved success in the client's area of question (Betz, 1992). For example, an individual may express doubts about seeking employment in a certain occupation. Having the individual talk to or observe an individual who has successfully obtained employment in that occupation can increase self-efficacy (McAuliffe, 1992). Betz (1992) noted that it is especially important with women and minority clients to provide at least one or two same sex or same race models. Finding role models with a disability, preferably the same disability as the client, is important for rehabilitation counselors. If actual role models are not available, films, books and videos provide an alternative (Betz, 1992). Again, group counseling can be an effective means of vicarious learning. If an individual participates in a job seeking group, where others are contacting employers and seeking employment, it is possible to observe others who are successfully modeling proper job seeking skills. By observing others successfully performing job seeking behaviors, an individual's self-efficacy regarding these tasks is increased (Whiston, 1993).

Verbal persuasion, although a weaker method of increasing self-efficacy, can be easily integrated into many career counseling exercises (Whiston, 1993). Verbal persuasion can be effective if the individual perceives the counselor as trustworthy and competent. If a counselor is perceived as being trustworthy and competent, he/she will be able to provide constructive feedback to the individual and assist the individual in identifying appropriate actions, facilitating continued effort (McAuliffe, 1992). In many cases verbal persuasion is used in combination with performance accomplishments and vicarious experiences to enhance their effects. Combining encouragement and support is particularly important as the client is attempting performance experiences in new career areas (Betz, 1992).

As previously discussed, emotional arousal can have a detrimental effect on self-efficacy (Bandura, 1986). For example, an individual who experiences anxiety about interviewing for a job in a chosen occupation may demur from either the decision making process or from applying for that job (McAuliffe, 1992). Relaxation training and biofeedback are examples of strategies that can be used to diminish the adverse emotional arousal experienced (McAuliffe, 1992).

Lent, Brown, and Larkin (1987) found that an individual's self-efficacy is very useful in predicting career relevant behaviors. Individuals who have poor career self-efficacy may be reluctant to participate in rehabilitation activities such as job seeking clubs, career workshops, training programs, schools, or career counseling sessions. Again, these individuals may be labeled as poorly motivated. Using the self-efficacy model to reconceptualize the individual's behaviors may assist the counselor in gaining a better understanding of the individuals behaviors which can lead to successful interventions. Using counseling techniques and strategies that encompass the four domains identified by Bandura can help the counselor deal with avoidance behaviors effectively facilitating career development.

Conclusion

Principles of self-efficacy can be used by rehabilitation counselors in conceptualizing client problems and identifying intervention strategies to promote positive outcomes. Adjustment to disability and career development are two common goals of the rehabilitation process to which self-efficacy theory can be applied. However, self-efficacy can also be used in all phases of the rehabilitation process. It would appear that self-efficacy theory can provide a sound theoretical basis for improving rehabilitation counseling practice. In addition self-efficacy theory can provide a strong foundation for research to better understand the needs of people with disabilities and the development of more effective intervention strategies.

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Received: October 1993 Revised: March 1994 Acceptance: April 1994