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Building confidence: the first step in successful rehabilitation

At a glance:
“Self-efficacy' is a person's belief in their ability to perform tasks successfully, that they can cope with the various challenges of life. This study provides an overview of self-efficacy
An impression that one is capable of performing in a certain manner or attaining certain goals. Belief that one can manage whatever life brings.
 theories. It found four fundamental factors: previous experience, observations of others' achievements, verbal encouragement, and the person's emotional state. Improving self-efficacy improves outcomes. Rehabilitation is most successful when it addresses these four factors to improve self-efficacy.
Self-efficacy is the belief that one can cope with life's challenges.

People are more likely to cope well when they believe that they will do so. Their confidence is greater, and they are focused on finding solutions, rather than on the problems that may arise. A lack of confidence often means greater anxiety, which makes it harder to cope, and increases the person's suffering.

Some ways to improve self-efficacy are:

1. Build on success. Aim for small, manageable improvements, and recognize your achievements. Seeing positive change can give you the confidence to take on challenges and persist when obstacles arise. Make sure you're aware of the steps toward your end goal, rather than just having a general objective, like "getting back to normal'.

Think about improvements in pain levels and function over the last month. Recognise the effort you have made and what you have achieved. Recognising your successes is the first step to building on them.

2. Take advantage of the experience of others. It's easier to believe you can be successful when you are in contact with other people who are managing their situation well. If you can spend some time with someone who has succeeded in a similar situation, then you may be able to find out what strategies they found useful. Someone you trust and respect can often be helpful, even if they have not had an experience exactly like yours.

3. Recognise the importance of your emotional state. Fear and anxiety are normal. Everyone worries about the future and their ability to cope, especially when they are experiencing major, unexpected changes in their life. Following an illness or injury that affects work abilities, people often worry about their finances, their career, and their relationships. These worries can make rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 harder. Ask for help if you need it.
People who lack confidence in their ability to cope are often more distressed, more anxious, and require more time and support. Fear and anxiety can make people hesitant to return to work.

Employers can improve employees' confidence in their ability to cope with the return to work.

Putting the employee in touch with positive role models can be very helpful. Other people in the organisation who have successfully achieved a return to work are generally happy to share their experience, and can act as a role model or mentor. They can help with motivation, and offer strategies that were useful to them.
A return to work is particularly difficult for those with low self efficacy. Helpful approaches include:

Providing clear medical advice about the nature of the condition, and addressing concerns about the short and long-term outlook.

Providing advice about returning to activity. Activity prescriptions can often be valuable for people with low self-efficacy.

Acknowledging the emotional challenge of the condition and the return to work. Dealing with anxiety and depression
A symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection. Major depression is likely to interfere significantly with everyday activity, with symptoms including insomnia, irritability, weight loss, and a lack of interest in outside events. The disorder may last several months or longer and may recur, but it is generally reversible in the short run.
 may require specialist help.

Sometimes keeping a diary of functional abilities helps the patient recognise the gains they have made. People are more confident when they focus on past successes.
Claims managers can help claimants develop in confidence, and thus improve return to work outcomes. Setting realistic goals is important. When these are achieved they should be acknowledged and the person congratulated. This helps people to build on the progress they have made.

Mentoring from someone who has successfully achieved a return to work can also help a claimant identify useful strategies. Regular encouragement and reinforcement of positive achievements makes a difference.

If you think an individual is becoming depressed it is appropriate they talk to their doctor about what you are seeing.
Original Article, Authors & Publication Details:
D. R. Strauser1 (1995).

Applications of self-efficacy theory in rehabilitation counseling. Journal of Rehabilitation 61(1): 7-11.

1University of Wisconsin-Madison
Background, Study Objectives, How It Was Done:
“Self-efficacy' refers to a person's beliefs about their effectiveness and competency. These beliefs influence behaviour, coping, persistence, and willingness to interact with different environments.

An “efficacy expectation' is a belief that one can carry out a task. Even when someone has the necessary skills and knowledge to carry out a task, they're unlikely to be successful unless they believe themselves capable of success.
Study Findings:
Self-efficacy expectations are based on:

1. Previous experience:

Past success in a task is the strongest influence on self-efficacy.

An efficacy expectation in one task leads to efficacy expectations in other tasks. For example, someone might have higher expectations of their ability to bake food generally if they have successfully baked a cake.

2. The observed experiences of others

3. Verbal persuasion from others

4. Emotions

A person's beliefs about their abilities can be influenced by their emotional state. Anxiety, for example, can reduce their efficacy expectation.

A condition or function that leaves a person unable to do tasks that most other people can do.
 can make everyday tasks harder to manage, which can reduce self-efficacy. The disability can also lead to depression, anxiety and uncertainty about the future, lowering expectations of success even further.

Sometimes those with low self-efficacy can appear to others to be lacking in motivation. For example, people unsure of their ability and fearful of failure may miss appointments, appear reluctant to participate in rehabilitation, or drop out altogether.

Return to work outcomes can be improved when rehabilitation specifically aims at increasing self-efficacy. Health professionals can help people with disabilities to increase efficacy expectations by considering the four factors that influence self-efficacy:

1. Successful experiences

If a person with a disability is provided with assistance, specially-designed tools and strategies to achieve tasks they find difficult, they gradually develop their skills and increase their self-efficacy. Previous research has found this approach to be successful in patients with heart problems and chronic
continuing a long time or recurring frequently

For employment, mastering work tasks or improving job-seeking skills through workshops and training programs can be helpful. People who successfully complete training programs gain confidence to apply their new skills in the workplace.

People who are confident about their job-seeking abilities spend more time and energy looking for work and are more successful in finding it. It is also important that people have information about career options and the skills they need. This can be gained by interviewing employers and researching occupations.

2. The experiences of others

Group counselling or having a “role model' who has successfully adjusted to a similar condition can increase hope and confidence. This approach has been successful for patients with heart problems and chronic back pain.

A job seeking group can help people learn from each other's experience and increase self-efficacy.

3. Verbal persuasion

Encouragement, reinforcement and goal-setting help people to persist when difficulties arise. If a counsellor is involved, it is important that the client sees them as trustworthy and competent.

4. Emotional state

People with a disability can experience anxiety and depression. Directly addressing these issues is necessary, this will also influence self-efficacy and the success of rehabilitation. While working on difficult tasks, relaxation techniques, awareness of emotions, positive self-talk and problem-solving strategies can all be useful.
Disability makes everyday tasks more difficult, reducing self efficacy. The emotional consequences of the disability can amplify this impact. Once it is established, low self-efficacy makes people unsure of their abilities and fearful of failure, which can make them hesitant to participate in rehabilitation. When people do participate, it makes progress more difficult.

If rehabilitation is to be successful, it first needs to improve self-efficacy. This can be approached by addressing each of the four influences on self-efficacy. This means:

Making sure people experience success in manageable task
Allowing people to observe the positive experience of others
Providing encouragement
Helping people to establish a positive emotional state.
No PubMed Abstract Available
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