ANXIETY AND PHOBIC DYSFUNCTIONS (319)

• Most people admit to some phobic tendencies of varying intensity
• They have acute misgivings and suffer chronic distress
• They can't do things they find subjectively threatening (but which are objectively safe)
• They shun easily manageable activities
• For example, snake phobia inflicts suffering on human lives
• People abandon recreational activities
• Affects job
• Firemen who won't fight grass fires
• Biologists/geologists who avoid field work
• Plumbers who cannot work outdoors
• Often plagued by ruminating thoughts and nightmares
• Spider phobia
• Affects marital relationships
• People are unable to enter places they perceive have spiders
• They constantly want to take baths
• They suffer from physiological reactions such as vomiting, shortness of breath
• Some human debilities stem not so much from perceived inability to control the environment as from one's self (mental functioning)
• Actors forget lines
• Singers forget lyrics
• Soloists forget well rehearsed sequences
• inefficacy can lead to memory lapses
• Traumatic experiences - severe stress in relationships long after trauma
• Re-experience traumatic events in flashbacks
• Recurrent nightmares
• Hyper vigilant arousal
• Depression
• Self-devaluation
• Emotional detachment from others
• "The experience of powerlessness exacts a heavy toll on a sense of personal efficacy" (321)
• Social anxiety - overly concerned about what others think of them
• Shy away from social activities
• Are reluctant to express themselves
• Suffer discomfort in social situations
• Socially anxious individuals differ from those who are not socially anxious mainly in dysfunctional beliefs of inefficacy rather than in their actual social skills"
• "Once people form beliefs bout their social efficacy they construe their social successes and failures in accordance with those beliefs"

Self-efficacy and Anxiety Control Theories (323)

"the notion that anticipatory anxiety controls avoidant behavior has been investigated and found seriously wanting"

• Studies
• Feedback of autonomic arousal is eliminated or medically blocked
• Occurrence of avoidant behavior is measured after anxiety arousal to threats has been eliminated
• Change in anxiety arousal are related to changes in avoidant behavior during and after treatment -> avoidant behavior is not controlled by anticipatory anxiety
• Routine avoidant acts prevent anxiety arousal rather than being motivated by it.
• Anxiety expectations are not sourceless . . .anxiety and biological stress reactions are largely the products of perceived inefficacy to exert control over potentially aversive events
• Social cognitive view of anxiety
• It is mainly perceived inefficacy in coping with potential threats that gives rise to anticipatory anxiety and avoidant behavior
• People avoid situations and activities that can be aversive not because they are not beset with anxiety but because they believe they are unable to manage the risky aspects
• Those who judge themselves efficacious in managing threats neither fear nor shun them
• Those who are inefficacious envisage their inept coping as producing all kinds of aversive outcomes
• Human accomplishment requires efficacious thought to overrule visceral arousal in the regulation of behavior
• Agoraphobia
• Fear that they will be overcome by fear or panic attacks
• Neither anticipatory anxiety nor perceived danger predicts agoraphobic behavior
• Efficacy beliefs are highly predictive
• Self-efficacy and anxiety arousal
• Accounts for variation in threatening academic performances
• Predicts performance on intimidating athletic tasks
• Predicts catastrophic worrying
• Predicts engagement in physical activity

Therapeutic Strategies: Stimulus Exposure Versus Mastery Experiences (326)

"Guided mastery is the most powerful form for enhancing beliefs of personal-efficacy, reducing anxiety, and restoring behavioral functioning" (327).

"in vicarious modes of treatment, it is not mere exposure to models but the exemplification of effective coping strategies and socially comparative indicants of capability that constitute the critical influence" (328)

Guided Mastery (329)

"Although verbal analyses and social persuasion can produce some results, it is difficult to achieve consistently major changes in human behavior by talk alone" (329).

• Social cognitive theory prescribes mastery experience as the principal vehicle of personal change
• Therapists must create enabling environmental conditions so that . . . phobics can perform successfully despite themselves
• Feared activities are first modeled to show people how to cope effectively with threats
• Modeling aids that cultivate competencies are especially important
• Modeling alone produces some heightening of perceived self-efficacy
• Difficult or intimidating tasks are broken down into subtasks of readily mastered steps
• At any given point people are asked to do what is in their capabilities with extra effort and perseverance
• Example: driving phobics
• Start with brief trips on secluded streets, then advance to longer drives on more active routes, and culminate with lengthy drives on the freeway
• if phobics fail, they are quick to ascribe their difficulty to inherent capability. The therapist must then ascribe the difficulty to the size of the task demand. More easily achievable tasks are selected and attempted
• Joint performance of intimidating activities with the therapist can aid in several ways
• Presence of familiar persons reduces stress reactions and increases boldness
• People are not always aware and attentive when strategies are modeled in safe settings
• they benefit greatly from ongoing corrective modeling specifically focused on the problematic aspects of their capabilities
• Rituals often increase exercise of control over outcomes - therapist ought to get rid of them
• Modification of faulty thought patterns
• Clients may adopt different thought patterns in benign interview settings
• In the participant arrangement the therapist is present to identify and correct dysfunctional patterns of thinking as they arise in taxing situations and suggest strategies to foster successful performance
• Graduated time
• Enduring stressors in short bursts to develop coping efficacy
• Gradually increasing durations
• Mastery aids are useful here too

Facets of Personal Change (332)

• There are four processes of change
• Acquisition - development of knowledge, skills, and self-beliefs that govern human though, affect, and action
• Generality - how widely acquired capabilities are used
• Generality across situations
• Toward different persons
• Across modalities of thought, affect, and action
• Durability - how well changes are sustained over time
• Resilience - ability to recover readily from aversive experiences
• Social Cognitive Theory asks analytic questions
• What is the power of treatment to produce personal change?
• Do the changes generalize or are they narrow in scope?
• How well are they maintained over time
• Does treatment build resilience to adversity?
• the goal is to create treatments that realize all four facets of personal change
• How the treatments affect vulnerability to aversive experiences
• Treatments should build resilience reflected in the ability to bounce back from adverse experiences
• A resilient sense of efficacy is not created by a few successes
• Mastering increasingly tougher challenges
• Independent personal accomplishments build resilience

Distinguishing between mechanisms and modes of change (333)

• There is a common misconception that the modality of treatment must match the
• modality of dysfunction
• behavioral dysfunctions require action oriented treatment
• emotional distresses require emotive oriented thinking
• faulty thinking requires a cognitively oriented treatment
• "In fact, powerful experiences produce changes in all modalities of functioning - behavioral, cognitive, and affective" (p. 333)
• "we do not think our way into a pattern of living, we live our way into a pattern of thought" John Dewey67
• Two diverging roads in psychology
• Explaining psychological changes relies increasingly on cognitive mechanisms
• Performance based treatments operating through mastery experiences are proving most powerful in producing cognitive, affective, and behavioral change

Common Mediating Mechanisms (334)

• Enactive - produces highest, strongest, and most generalized increases in personal efficacy
• Vicarious - modeling conveys information on the predictability and controllability of threats
• Cognitive - generating cognitive scenarios in which they repeatedly confront threatening situations and gain mastery
• Emotive - threats are broken down into a graded hierarchy of menacing encounters for visualization

"Results confirm that differing modes of treatment all raise and strengthen beliefs in coping efficacy" (335).

Next step: Understanding the restructuring of efficacy-beliefs

• Cognitive behavior therapy
• Human problems and distresses arise from faulty thinking
• Treatments seek to eradicate phobic dysfunctions by altering faulty modes of thinking
• "To christen thought as verbal behavior is to stretch the definition of behavior to the point where it ceases to have any meaning. One can have thoughts without words" (338).
• "Distressed people create perturbing realities by how they behave as well as by misreading what they encounter in their everyday life" (338)

DEPRESSION (343)

"Depression has come to be regarded as the common cold of psychosocial functioning" (343).

• Depression is caused by many different things, and, thus, no one treatment can effectively mitigate its effects.
• Interpersonal model - depression in rooted in relationship models
• Lives devoid of affection and companionship or beset by interpersonal discord and severed affectional relationships are prone to suffer bouts of depression
• Despondency turns people off which leads to more despondency
• Self-schema theory - depression is basically a thinking disorder
• People prone to depression negatively distort and misinterpret events
• Male erroneous inferences
• Take things out of context
• Overgeneralize personal deficiencies
• Turn ordinary mistakes and setbacks into catastrophes
• Personalize negative happenings that have little or nothing to do with them
• Think dichotomously (astute or stupid, courageous or cowardly)
• Become skilled at discounting their successes and positives
• Harsh standards of self-evaluation give rise to chronic depression, feelings of worthlessness, and lack of purposefulness
• e.g. Ernest Hemingway
• Unattainable demands
• Demeaned his own accomplishments
• Dysfunctional self-evaluation system. People who are prone to depression
• Are not charitable with themselves
• Are self-belittling when others surpass them
• Impose unreachable standards
• Are self-denying and punitive for failures
• Biochemical dysfunctions
• Depletion of neurotransmitters
• Biological and psychological functions operate bidirectionally
• Mastery oriented treatment that instills a strong sense of coping efficacy normalizes neurotransmitter functioning

EATING DISORDERS (249)

• The most disordered eating patterns appear in anorexia and bulemia
• Crash and liquid diets do not work
• The body adjusts by slowing down the rate at which it burns calories, so it takes fewer calories to put on pounds
• Restrictive eating patterns and self-devaluation are the problems requiring treatment

Obesity (350)

• A variety of factors contribute to obesity
• Genetic makeup
• Fats cells developed during growth spurts
• Metabolism
• Caloric intake
• Activity level
• Obesity is more prevalent among people of low SES
• Less likely to adopt exercise programs
• less likely to eat low calorie, nutritious food
• More prevalent in the Midwest and among ethnic minorities
• Efforts to control obesity psychological center on 2 factors
• Change in eating habits
• Adoption of exercise habits
• "Lasting control of obesity requires lifestyle changes rather than just cutting calories intermittently" (350)
• Effective self-regulation operated through a set of psychological subfunctions that facilitate and maintain habit change
• Regular self-monitoring of eating habits
• adopting attainable sub goals
• Arranging self-incentives
• Altering dysfunctional styles of thinking about eating that undermine self-regulatory behavior
• Substituting other activities for eating
• Restructuring the environment to reduce instigators

Self-Efficacy in the Regulation of Eating and Exercise Habits (351)

• Perceived self-efficacy to exercise control over eating habits encompasses a variety of aspects
• Perceived self-efficacy to resist overeating when
• Experiencing negative emotions
• Social pressures to eat
• Engaging in enjoyable activities
• When high calorie foods are available]

Bulemia (354)

• The preoccupation with thinness has seeped down to preadolecence breeding eating disorders that often plague later life
• 1/3 of young girls resort to unhealthy dieting or purging
• Bulimics hold a distorted view of themselves as portly
• Emotional states often trigger binges and purges
• "It is not emotional distress per se, but perceived inefficacy to mange emotional distress that gives rise to overeating" (p. 354)
• "A low sense of efficacy to manage stressful events and to resist urges to eat was predictive of bulimic behavior" (p. 354)
• Bulemia is part of a larger life-management problem
• Rooted in dysfunctional personal relationships
• High standards of performance
• Stereotyped sex-roles
• Excessive investment of self-worth in physical appearances
• In studies, the more individuals raised their perceived self-regulatory efficacy the less they purged

Socially Oriented Initiatives (356)

• Part of the effort to ameliorate the epidemic problem of dieting and eating disorders should be directed at raising collective efficacy to alter sociocultural values and standards of physical attractiveness that breed health problems and self-devaluation.
• The media must be sensitized to the fact that the svelte models of beauty they propagate create severe pressures on young women to try to conform to this ideal of femininity

ALCOHOL AND DRUG ABUSE (357)

Studies of the life course of alcohol abuse reveal that it develops gradually over a long period of social drinking rather than abruptly as the disease model would lead one to believe

• In the biopsychosocial interactional model
• Alcoholism is a multidetermined behavior pattern that varies across individuals in severity, patterns of causal influence, and amenability to personal control.
• Treatment strategies must be tailored to the particular constellation of determinants operating in any given case.
• Whatever treatment is selected, it must address the client's sense of efficacy to control their drinking and their outcome expectations
• Genetic factors may operate indirectly thorough their influence on temperamental personality characteristics that predispose some youngsters to drinking as well as other problem behaviors
• Social models are powerful sharers of alcohol consumption
• Televised modeling of drinking increase pro-drinking attitudes
• Societies where alcoholic beverages are used as a food and not a drug are less plagued with drinking problems

Self-Regulatory Efficacy in Alcohol Abuse (p. 358)

• Alcohol is used by adults as a social facilitator and drinking is a significant part of social activities
• A low sense of efficacy to regulate drinking in situations of social pressure is a strong predictor of alcohol consumption
• If heavy drinkers are to manage their alcohol consumption, they must exercise control over where and with whom they hang out.
• People base their actions more on what they believe than on what is objectively the case.
• Males believe that liquor incenses sexual prowess when in fact it impairs physiological sexual response
• It is a widely shared belief that alcohol reduces tension but that may work because of the belief that it reduces tension "individuals who have learned to respond to stress and dysphoric mood by heavy drinking need to develop more effective ways of managing stressors" (p. 359)
• The types of treatments that have been shown effective include
• Training in interpersonal skills
• Counteracting social pressures to drink
• Stress management
• Developing positive peer relations
• Cognitive skills for managing stressors

Self-Efficacy Mechanisms in Treatment Effects (361)

• Perceived self-efficacy is an important operative factor in initiation, attainment, and maintenance of changes in drinking behavior
• Those with low efficacy will not even try
• Those who enter treatment with nagging doubts give up quickly
• The benefits from drinking have been considered one of the factors that maintains drinking behavior
• Positive and negative consequences
• Contributes to
• Health
• Self-respect
• Better future
• And may lead to
• Loneliness
• Reduction in expressiveness and outgoingness
• Increased boredom
• Drug Dependence (364)

Scope and Use of Self-Efficacy Analysis in Addictive Habits (367)

• The overall findings provide converging evidence that perceived self-efficacy partly determines success in altering detrimental addictive and consummatory habits and in adhering to altered habits over the long term
• Most people who enter treatment do not do so with a robust sense of confidence
• They are not gladdened to hear that therapists an provide guidance but that they will have to serve as the main agents of their own change
• There are several sources of motivation that drive people to seek help with detrimental habits
• Aversive effects of such habits
• Social pressures to alter them
• Self-dissatisfaction with ones life
• Anticipated benefits of eliminating injurious habits
• These may bring people to treatment but will not keep them there for long
• Self-efficacy theory accounts for
• initiation of self-change
• Level of behavioral changes
• Rate of change during the course of treatment
• Variations in behavioral changes achieved by individual receiving the same treatment
• And provides explicit guidelines for how to structure and implement powerful treatments