Health Psychology, 2nd Edition

(Tuis.) #1

Self-efficacy (see Chapter 8) is a key element of motivation but also a foundation
for the development of behavioural skills. We do not usually continue to exert effort
on unattainable goals. People who believe they can succeed (i.e. have high self-efficacy)
set themselves more challenging goals, exert more effort, use more flexible problem-
solving strategies and are more persistent (Bandura, 1997). The four techniques
Bandura (1997) proposed as methods of enhancing self-efficacy (see Chapter 8) can
be employed when elicitation research reveals that self-efficacy is low.
Well-informed, motivated individuals with high self-efficacy can fail to change their
behaviour patterns because they lack the skills to undertake action sequences or to
re-establish reflective control over impulsively regulated behaviour patterns. In such
cases, information provision and motivation-building techniques are unlikely to lead
to behaviour change. Sustained weight management, for example, may necessitate
learning new cooking or exercising skills and skills to manage social situations that
involve food (e.g. refusing a slice of cake a friend has baked or avoiding Saturday night
takeaways with friends). The development of behavioural skills involves instruction
and sometimes modelling, practice, receiving feedback on performance and where
necessary further instruction and practice. This skill-development process ensures
proficiency of execution and enhances self-efficacy.
Three broad classes of skills can be defined. First, self-regulatory skills. Control
theory provides a useful way of thinking about self-regulation (Carver and Scheier,
1982). At its simplest the theory proposes that individuals’ behaviour is goal directed:
we set goals, assess how close (or far away) we are from attaining the goal, take action
to get closer to the goal, monitor progress and again take action to bring reality closer
to our goal. Control theory is based on a more general model of intelligent system
operation, the test-operate-test-exit model (Miller, Galanter and Pribam, 1960), which
proposes that systems test whether current stimuli (e.g. our perceptions) match a set
standard (e.g. our goal) and, if the two are not matched, operate to bring stimuli in
line with the set standard, before retesting. This feedback loop continues until the test
shows that the stimuli matches the set standard (that is, we perceive ourselves to have
attained the goal), at which point the system exits from the activity loop. So returning
to self-efficacy, if the test indicates that the goal is unattainable then we may ‘exit’
from goal striving at an early stage. The test-operate-test-exit model and control theory
provide a useful way of thinking about goal striving and the process by which we attain
new skills, including self-regulatory skills.
A series of cognitive skills can be assessed and, where needed, taught to enhance
self-regulation. For example, we can help people to (a) consider longer-term
consequences of current action patterns; (b) set attainable goals; (c) self-monitor their
behaviour; (d) evaluate their current behaviour against their goals; (e) set new goals
in light of the feedback from self-monitoring; (f) prioritize goals in the face of other
demands; (g) plan action before and during goal-relevant experiences; and (h) prompt
exertion of appropriate effort when opportunities present themselves.
We can teach people to set SMART goals (Doran, 1981). The acronym stands for
Specific(that is, specifying particular actions in particular contexts); Measurable(that is,
we can test whether the goal has been attained); Assignable(that is, we know who will
take action – although the ‘A’ is also sometimes used to stand for ‘attainable’ when it
is already clear who needs to take action); Realistic(that is, the goal is attainable within


CHANGING BEHAVIOUR 199
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