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Self Efficacy in pain medicine - Explained

Updated: May 14, 2022

Self efficacy was defined by Bandura in 1977 after numerous studies analysing phobic behaviours.

Generally, self efficacy describes the confidence and belief in one's ability to achieve a desired outcome.

Within pain medicine, It is an individuals reported level of confidence to cope with pain, achieve their life goals, live a normal lifestyle, and maintain normal activities despite their pain

Low levels of self-efficacy have been shown to be predictors of disability and depression in different samples of chronic pain patients. It also directly impacts upon a patients adherence and involvement in management plan and therapeutic decisions/aims. It directly impacts goal setting as it is difficult to set a SMART goal if you do not think that it is ever possibly achievable!

There have been specific MDT programs that have incorporated specific therapies aimed at improving self efficacy. It is argued that the addition of these programs improved outcomes - but clearly defined comparison trials are lacking.

Bandura (1977) defined four salient sources of self-efficacy:

  1. Mastery experiences - Basically success within challenges which people perceived as difficult. They are personal and direct experiences from which you can infer success in the future - from success in the past. It also shows a link from direct effort - to direct success - linking the two.

  2. Vicarious Experiences - Seeing others succeed helps to build confidence that we can also succeed. This only works if the patient can relate to the other person who has succeeded (e.g. a 20yo succeeding in lifting heavy weight at the gym will not provide greater self efficacy to an 80yo that he can also succeed).

  3. Verbal Persuasion - Verbal encouragement basically! Always helpful

  4. Physiological Arousal - The association between fatigue or tiredness and a lack of capacity to perform. Unpleasant states such as depression and anxiety can also give us a global effect of feeling less competent overall. E.g. a climber about to go up a wall - who feels very tired and fatigued - will have less confidence in their possible success than those without those symptoms.

Another way of looking at self-efficacy is that a person with higher self efficacy may have more optimistic views than someone with pessimistic views.

Interestingly, those with lower self-efficacy are less likely to attempt challenges - and therefore provide a self-fulfilling prophecy of failure and learned helplessness.

A term used in Acceptance and Commitment therapy which relates to the concept of self-efficacy is flexible persistence. This is the concept of finding ways to achieve the end result - such as doing what you love - but using anything and everything you can to get there.

So how do you help improve someone's self efficacy?

Get out of the comfort zone - encouraging people to TRY!

Set SMART goals

Look at the bigger picture (have a longer term goal and aim)

Reframe obstacles (brainstorm possible barriers and come up with solutions, think of the obstacles as simple little tests only, and reflect back on previous challenges people have overcome in the past).

Look at their social activities as well - as those isolated will find it hard to gain external support and motivators to improve their self efficacy



1. Nicholas MK. The pain self-efficacy questionnaire: Taking pain into account. Eur J Pain. 2007 Feb;11(2):153-63. doi: 10.1016/j.ejpain.2005.12.008. Epub 2006 Jan 30. PMID: 16446108.

2. Fisioterapia, C. S., de Madrid, A., La, E. U., de Madrid, A., La Touche, R., Salud, C. S. D., & La Salle, E. U. (2019). How does selfefficacy influence pain perception, postural stability and range of motion in individuals with chronic low Back pain. Pain physician, 22, E1-3.

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