When a client comes into one of our pain management programs, their injury, pain and related symptoms are comprehensively assessed to ensure a tailored individualised program can be provided. One scale administered is called the Pain Self-Efficacy Questionnaire (PSEQ) (1). The scale looks at the concept of “self-efficacy.” Psychologist Albert Bandura defined self-efficacy as: "how well one can execute courses of action required to deal with prospective situations.”(2) Another way of understanding self-efficacy, might be whether someone moves toward obstacles/challenges, or whether they move away from them.
In terms of an injury and persistent pain condition, the PSEQ asks clients how confident they are to do things, despite pain, such as: “I can enjoy things, despite the pain,” or “I can still accomplish most of my goals in life, despite the pain.” The more someone is confident (becomes confident during and after their pain management program) to engage in different activities with pain, the better off their life generally will be.
Note the questions don’t ask: “I can accomplish most of my life goals, once my pain goes away.” The reason for this is that improvement in pain, often occurs over longer timeframes, like 6-12 months. Waiting for the pain to go in the short-term before engaging in activities, may simply leave someone stuck in a cycle of pain, increasing their distress. So, the focus needs to be on doing things with the pain, not doing things without the pain. With self-efficacy in this context, pain might be seen as the obstacle and the person’s willingness to move towards this, rather than away, might affect how quickly they can start coping with their pain and begin moving forward with their life.
So how does someone improve self-efficacy? Here are a few tips:
Have value-based goals:
If you are going to do things with pain, try to make sure this is done in the service of something that matters. Having pain, whilst you watch your kids play sport, go to lunch with your partner, or go on a holiday might help to make the experience worthwhile. It might also give someone the ongoing motivation to continue trying activities (ongoing moves toward) and not stop (move away) when faced with the pain and related obstacles.
Practice pain willingness/acceptance:
Consider whether you are treating your pain as “part of your team” or as “the enemy”. Trying to catch-up with a friend whilst you are fighting to get rid of your pain or waiting for it to go away, might simply result in lost energy, distress and disappointment. Willingness to have some pain, might help someone give just the required energy to their pain, whilst opening the door to try different strategies to cope and to still enjoy the activity, or experience. Willingness requires someone to gently turn towards their pain and incorporate it as part of their current team.
Learn from direct experience:
If you imagine a physical obstacle like a deep hole, you cannot think your way out. You can plan (decide which side seems best to climb first), but actions (not thinking) are required to actually get out. Often there also needs to be learning from direct experience. If you climb one side and discover the dirt is too soft, you might need to change directions and try another side. This can only be done once there is direct experience. So, if someone with pain is willing to try several times to have a coffee with a friend, the direct learning experiences (including successes and failures) will help them determine whether they should go in the morning or afternoon, whether to go to coffee shop A or B, or whether to sit in bench seat or the couches etc. It will often lead to helping the person to also try other related activities.
Consistency of effort over time:
Overcoming obstacles often requires effort over time (long-term, not short-term). Climbing out of a deep hole may take considerable time and effort. It doesn’t just happen because someone wants to get out of the hole and often reward for effort is not easily seen in the short-term. Engaging in more activities in life with pain, also requires significant time and effort. Often rewards can only be seen over months, not days. Being kind to yourself, asking for help or different perspectives when trying to engage in activities with pain, might help someone with consistent effort.
If you have persistent pain, hopefully you can take on board some tips on improving self-efficacy and engagement in life.
1. Nicholas, MK (2007). “The pain self-efficacy questionnaire: Taking pain into account”. European Journal of Pain. 11(2):153-63.
2. Bandura, Albert (1982). "Self-efficacy mechanism in human agency". American Psychologist. 37 (2): 122–147.