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Understanding self-efficacy: how to believe you can

There’s so much research being published this year to talk about the softer aspects of treatment when it comes to effective pain management.

From the words you choose to say to yourself to what you choose to believe, studies are repeatedly showing that non-physical aspects of treatments can make a difference to your pain experience.

So, when are we going to start listening?

What is self-efficacy?

chronic pain, self efficacy
Source: Self-Efficacy and Social Cognitive Theories via The Pennsylvania State University

Self-efficacy refers to a person’s belief in their capacity to execute behaviours that are important to their desired outcomes. It’s your belief in your ability to perform tasks or overcome challenges.

It should be noted that self-efficacy is 100% perception-based — it’s a person’s perceived ability to perform a task or overcome a challenge.

This is distinctively separate from the person’s actual ability to perform a task or overcome a challenge (sometimes loosely referred to as agency in psychology).

This means that it is possible for you to have high (or low) self-efficacy regardless of your physical capacity.

Why should you care about your self-efficacy?

There are at least two papers published in this month alone that highlights the benefit of self-efficacy:

High Self-Efficacy: A Predictor of Reduced Pain and Higher Levels of Physical Activity Among Patients With Osteoarthritis.
• Are Changes in Fear-Avoidance Beliefs and Self-efficacy Mediators of Function and Pain at Discharge in Patients With Acute and Chronic Low Back Pain?

Both studies found self-efficacy to be important in recovery. In the first paper, knee pain patients with high self-efficacy experienced less pain and engaged in more physical activity. In the second paper, self-efficacy has an influence on physical function in patients with lower back pain.

The good news here is that self-efficacy modifiable.

That means you can work towards increasing it for the purposing of improving treatment outcomes.

You may think it’s soft and fluffy and that it’s not hard science. I totally hear you but I’ll invite you to put aside your beliefs and consider what would you do if all standard treatments fail?

In the 12 months alone, at least two studies examining the effects of chiropractic adjustments have found that there are no immediate or short-term changes in pain threshold.

Previously it was accepted that chiropractic adjustments were not a long-term solution because it didn’t fit into the current understanding of pain. It was assumed that people felt better because of transient improvements in physical sensations.

However, research that compares spinal adjustments to sham manipulations is starting to show that perhaps there is no measurable changes in a patient’s pain experience (after an adjustment) after all.

It’s plausible that people are feeling better after adjustments more because of the shiok experience than the actual true clinical change.

The truth is that 20% of the population worldwide lives with chronic pain and that there are patients who do not seem to get better despite exhausting all standard medical treatments — pharmacologic and surgical interventions inclusive.

chronic pain, effective change, physical activity

This is why a solution-focused, self-management program is superior.

In such models, the patient plays the central role in managing their symptoms.

My role? To provide you with the necessary knowledge, skills, and confidence to achieve that.

Working with the softer aspects of recovery in conjunction with exercise facilitate the change required to get long-term results. It is likely deliver better treatment outcomes than with just exercise alone.

Tasks you need to be able to perform

A review of research evidence in 2005 identified 12 tasks that a patient needs be able to do to effectively self-manage:

• Correct use of medication
• Exercise
• Maintain body weight in healthy weight range
• Choose the right foods to maintain healthy nutrition levels
• Manage stress
• Engage in behaviours that improve symptom experience or slow disease progression
• Make correct health decisions
• Modify the environment to allow daily activities
• Adjust to new social and economic circumstances
• Communicate well with health care providers, family members, and caretakers
• Modify living and work environment as well as valued activities

From what they are asking for, it should be clear that knowledge alone is not enough. You’ll also need to be able to make good decisions or engage in a problem-solving process for yourself.

I do work with my pain clients on that and you can read more about my coaching work with a pain client at understanding coaching: what if exercising hurts?

It’s not good enough to know or to understand

It’s not good enough to do as you are told.

As we start to pay more attention to improving wellbeing and quality of life, you need to be able to work with your body in a meaningful way that doesn’t involve being dependent on a chiropractor or a physiotherapist.

In short, you need to think for yourself.

This is why I introduced coaching principles into my work.

How is self-efficacy developed?

Now that we have covered why you should give self-efficacy a fair shot, let’s talk about how we can work together to make it work for you.

Start with achievable, small steps

achieve mastery, small steps, success coach
Source: Eye Level

Mastery begins with repeated successes.

To a large extend, the more often you fail at a task, the less confident you would be of achieving success.

This is why most learning is stratified into various levels of difficulty.

If you are learning how to play the piano or the violin, there is often a grade-by-grade syllabus for you to follow.

In sports, climbing gyms rate the difficulty of each route via a climbing ratings system.

We are also familiar with quotes such as Lao Tzu’s “journey of a thousand miles begin with a single step.”

For more contemporary versions, J.K. Rowling said in her 2008 Harvard Commencement Speech:

“Delivering a commencement address is a great responsibility; or so I thought until I cast my mind back to my own graduation. The commencement speaker that day was the distinguished British philosopher Baroness Mary Warnock. Reflecting on her speech has helped me enormously in writing this one, because it turns out that I can’t remember a single word she said. This liberating discovery enables me to proceed without any fear that I might inadvertently influence you to abandon promising careers in business, the law or politics for the giddy delights of becoming a gay wizard.

You see? If all you remember in years to come is the ‘gay wizard’ joke, I’ve come out ahead of Baroness Mary Warnock. Achievable goals: the first step to self improvement.

My point is that regardless of your end goal, we should start with attainable, small steps.

Very often clients may discount the importance of “easy” exercises in the first two to three sessions. Before they know it, the exercises to follow are tremendously more challenging that it really comes down to grit and resilience.

The clients with the quickest recovery are not those who can perform each exercise with brilliance and mastery.

The most successful clients are those can see the exercises as their small steps to their larger, sometimes seemingly unattainable, goal of pain-free living.

The purpose of the low-intensity exercises at the start of recovery is to help you:

• Increase self-efficacy
• Build your foundational fitness/competency
• Allow us to increase safely increase intensity without the risk of injury

While they may seem easy to perform, the inherent benefits to doing them is often invaluable.

Clients who chose to ignore recommendations and to jump ahead often end up not achieving the goals they desire. This can be attributed to the yo-yo progression in their recovery – i.e. lots of improvements in some weeks but having to circle back to “easy” exercises later because can no longer progress.

In rare cases, they may re-injure themselves and their recovery time exponentially increases due to the downtime as a result of the injury. More often than not, these clients DO NOT achieve their recovery goals due to lack of motivation, low self-efficacy (e.g. saw a chiropractor already but still end up injured, what’s the point?)

Expose yourself to those who are more successful than you

robert cialdini, social proof, coaching singapore
Robert Cialdini’s social proof principle examines how people are more likely to follow the behaviour of what we can observe in others.

Social proof is a term coined by my favourite author/psychologist Robert Cialdini.

In his book, he wrote about how we tend to view a behaviour as more correct in a given situation when we see other people performing it.

In that sense, if you see some one with back pain lifting heavy weights, you are more inclined to think that lifting heavy weight for back pain is acceptable or good for you.

By extension of that, you may start to perceive yourself being able to do more in spite of your pain.

To increase self-efficacy with social proof, start looking into what more people in a comparable circumstance as you can do.

Look into how many professional athletes return to sport after surgery. If they can push their bodies to perform at the highest level despite their injuries, sitting at the computer or climbing stairs pain-free is really not a big ask.

When we watch other people perform, we inevitable compare ourselves to them.

If they can do it, why can’t I?

If I don’t think much of their performance, I may start to think to myself that I can do better.

This is how we can use others’ performance or social proof to manipulate our self-efficacy.

P.S. When I found out that his book Influence: The Psychology of Persuasion came in Chinese edition, I wrote to Robert Cialdini to ask where I could get a copy for my parents. Instead of directing me to a bookstore, his team sent a copy to my parents for free! They even covered postage.

Verbal feedback; spend more time with positive people

For all of you who grew up in Singapore, you’d be loosely familiar with feedback such as:

• “Other people can, why you cannot?”
• “If you don’t study hard, you will become a road sweeper!”

By some great wisdom of life, parents — specifically tiger mothers — intuitively knew the influence of verbal persuasion.

To a very large extend, you want to be careful who you choose to spend time with.

You see, our bodies are built to be robust and resilient. Quite often patients lose confidence in what their bodies can do because of the negative narratives that we expose ourselves to.

These false beliefs often become the reason why most people don’t recover.

The easiest way to make verbal persuasion in your favour is to choose the narratives and the people you are exposing yourself to carefully.

If your chiropractor or physiotherapist is telling you about all their patients who ended up in wheelchairs because they didn’t come for thrice a week adjustments or treatments, fire them!

Strengthening positive self-beliefs, reduce negative/unhelpful reactions

positive self-belief, life coaching, solution-focused coach
I don’t think you need to be somebody else to start believing in yourself. Positive self-belief is often the other side of the same coin. Even to choose to not engage with it, it is still there! Source: Bournmoor Primary School

Positive self-beliefs ties in quite nicely with the compassion framework that I have made tons of references to over the past few months.

I am addressing both strengthening positive self-beliefs and reducing negative reactions together. However, it should be noted that they are distinctively separate.

Successfully reducing unhelpful reactions on its own doesn’t encourage positive self-beliefs. For example, you can stop telling yourself that you are a failure without thinking that you are able to overcome the problem you have at hand.

On the other hand, if you are to engage in positive self-talk, you are less likely to use unhelpful feedback on yourself.

To promote positive self-beliefs, you can ask yourself the following questions:

• What are three things that have gone well for me this week?
• What are my strengths that will help me get over this difficult period?
• I’m good at … and it has worked out well for me. Why would I think it’s not a big deal?
• What can I do right now that will help me inch one baby step closer towards my goal?

Sometimes it’s about reframing daily life situations into a more positive expression. For example:

• My legs are really sore today I had a good leg workout
• I am so tired today I have been working hard with … (insert task)…
• I have so many problems to fix There is a lot of opportunities for growth

You may have your reservations over such cup-half-full or even cup-totally-full approach. However, these are two sides of the same coin!

You can complain about how your back is hurting more with exercises or you can celebrate that you have actually done them!

If you could remind yourself over and over again of all the good things that are already inherently present in your life, you are more likely to perceive yourself to be able to do more.

This is how changing your thoughts or beliefs to those that are more helpful can help you increase self-efficacy.

Whole-person approach to recovery

chiropractor singapore, chiropractic treatment, pain solution
Greg Lehman’s Cup Analogy that so adequately summarises how a good pain solution should look. Effective pain treatment is not about trying to make the pain go away for a few days or weeks. It’s about how we can work with your body’s robustness and resilience to help you find freedom from pain.

Square One Active Recovery takes a whole-person approach to pain treatment.

I address both physical and non-physical factors when working with my clients.

If you are not exercising enough, I work with you to exercise more.

If you struggle with exercising more because of a lack in motivation, I use behavioural change strategies to help you overcome the resistance to exercise.

If you are exercising too much, I work with you to find what is your optimum physical activity levels.

If you don’t want to cut down on exercising, that is okay too! I work with you to develop your body’s robustness so you can keep to the high-intensity exercise routine without unnecessary injury risk.

You see, Square One Active Recovery doesn’t take a cookie-cutter approach to helping you.

This is why we deliver results our competitors struggle to match.

To discover the difference the right care can make for you, book an appointment with me via the form below. I promise you it will be an experience like you never had before.


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.