Social Cognitive Theory: a Framework for Therapeutic Recreation Practice

THERAPEUTIC RECREATION JOURNAL Vol. 36, No. 4, 335-351, 2002

Social Cognitive Theory: A Framework for Therapeutic Recreation Practice

James B. Wise

The purpose of this article is to demonstrate the ability of social cognitive theory to serve as a framework for therapeutic recreation practice. The theory is well suited for such a role due to a number of characteristics. First, findings from a vast number of studies have shown it to be an accurate explanation of behavior and behavior change. Second, underlying constructs and relationships among those constructs have been clearly identified. In addition, research has illuminated specific techniques that can be employed to alter the constructs, which in turn, enhances the likelihood clients adopt and maintain desired behaviors. Therapeutic recreation specialists will find these features extremely useful as they implement TR interventions.

KEY WORDS: Disabling Conditions, Leisure, Outcome Expectancy, Reciprocal Determinism, Self-Efficacy, Self-Regulation

Therapeutic recreation (TR) services fre- believe there is a common mechanism under- quently focus upon the adoption, maintenance, lying behavior change. Thus, the TR profes- and generalization of desired behaviors with sion should strive to identify theories that the ultimate goal of improved health (Austin, accurately explain behavior and provide guid- 1998; Van Andel, 1998; Wilhite, Keller, & ance on the implementation of behavior Caldwell, 1999). While the specific behaviors change interventions. The purpose of this ar- may vary among clients, it is reasonable to tide is to demonstrate, through description and

James B. Wise, CTRS, Ph.D., is an assistant professor at Minnesota State University, Mankato. He teaches therapeutic recreation courses and advises therapeutic recreation students.

Fourth Quarter 2002 335 examples, that social cognitive theory (Ban- chological constructs such as self-efficacy and dura, 1986) is one such theory. self-regulation and biological features such as At this time, readers are alerted to two hormones and height. The second set of fac- points. First, a comprehensive overview of the tors, environmental, are characteristics of sit- theory is beyond the scope of this article and uations which reside outside of an individual those who desire such information are encour- and can include other people and weather aged to consult Bandura's (1986, 1991, 1997) conditions. The final set of factors consists of previous works. Second, though only one the- those behaviors performed by an individual. ory will be discussed, it is acknowledged that These three sets of factors exert influence there are numerous theories of human behav- upon one another and the term for this inter- ior; some of which have been applied to TR. action is reciprocal determinism (Bandura, An extremely abbreviated list includes: attri- 1986). For example, a personal factor such as bution theory which served as the basis for the self-efficacy toward one's ability to raise concept of perceived freedom in leisure (Ellis plants partially determines whether or not a & Morris, 1993); self-determination theory person will plant a garden. The more effica- which played a central role in the development cious a person is, the more likely he/she will of the self-determination and enjoyment en- plant a garden. However, personal factors are hancement practice model (Dattilo, Kleiber, & not the only consideration. Environmental fac- Williams, 1998); and planned behavior theory tors also influence the final decision. Living in which guided the solicitation and understand- an apartment with people who think gardening ing of aquatic instructors' beliefs toward is a waste of time will probably decrease the teaching swimming to people with disabilities likelihood that person will plant a garden. in an inclusion setting (Conatser & Block, However, if the person decides to start a gar- 2001). den and is successful, the actual performance Social cognitive theory, or at least one of the behavior may cause perceptions of per- component of it, is not new to TR. In the mid sonal capability to be altered to reflect the 1980s, therapeutic recreation specialists person's increased confidence toward his/her (TRSs) were encouraged to develop interven- ability to garden, regardless of environmental tions aimed at strengthening clients' self-effi- conditions. In another example, the decision cacy (Savell, 1986); the confidence people whether or not to attempt a challenging snow have in their abilities to perform specified ski run is often based upon a blend of personal, behaviors (Bandura, 1986, 1997). Even with environmental, and behavioral factors. A per- this explicit call for action, only a few thera- son may be confident in his/her ability (per- peutic recreation interventions utilizing the sonal factor) to successfully negotiate the run self-efficacy portion of the theory have been if the snow has been groomed but not if the reported in the TR literature (Ellis, Maughan- slope is covered with ice (environmental fac- Pritchett, & Ruddell, 1993; Ferguson & Jones, tor). If the person attempts the run and falls 2001; Maughan & Ellis, 1991; Wise & Hale, numerous times (behavioral factor), he/she 1999). With respect to the full theory, its may alter personal perceptions of efficacy. potential applications for therapeutic recre- Although each of the three sets of factors is ation services remain largely unexplored. hypothesized to influence and in turn be influ- enced by the others, the absolute level of Social Cognitive Theory contribution each factor makes toward an ac- According to social cognitive theory (Ban- tion and the relationship of contributions dura, 1986), human behavior results from the among factors are not fixed. Instead, the interaction of multiple factors: personal, envi- strength and direction of influence varies ronmental, and behavioral. Personal factors across situations, people, and activities. In reside within an individual and include psy- some cases, as with people with severely lim-

336 Therapeutic Recreation Journal ited cognitive abilities, environmental factors telling someone not to cut in front of them are the most influential contributors to action while standing in a line (Holloway, Beuter, & and have a strong effect on personal and be- Duda, 1988). havioral factors. In other cases, personal or behavioral factors emerge as the greatest in- Outcome Expectancy fluence on action. A second psychological construct, that has The remaining portion of this article will received considerably less attention from re- focus on personal factors, specifically self- searchers, is outcome expectancy (Bandura, efficacy, outcome expectancy, and self-regula- 1986). Outcome expectancy is the belief that tion. This does not imply that the other two the performance of a behavior will produce factors are unimportant. Rather, this article's one or more consequences. Consequences can restricted scope reflects the emphasis research- be categorized as social, physical, or self- ers have placed on the psychological con- evaluative. For instance, someone may believe structs portion of the personal factor. that bicycling with his/her family will result in greater family unity (social), muscular sore- Self-Efficacy ness (physical), and enjoyment (self-evalua- The most frequently studied construct of tive). Consequences can be positive or nega- social cognitive theory is self-efficacy. Percep- tive but people tend to perform behaviors they tions of self-efficacy influence what activities believe will yield desired, positive outcomes. people attempt, how much effort they expend Perceptions of efficacy and outcome ex- on those activities, and how long they perse- pectancy can provide a more complete under- vere when obstacles are encountered. Those standing of behavior when analyzed jointly who are efficacious try new activities, expend rather than in isolation (Williams & Bond, more effort, and persevere longer (Bandura, 2002). The probability of performing a behav- 1986, 1997). ior is greatly diminished if the outcomes asso- Perceptions of self-efficacy can generalize ciated with the behavior are not valued or across situations (Bandura, 1986, 1997). Ban- desired even if self-efficacy is high. Similarly, dura (1997) described five generalization pro- even though people may strongly desire the cesses but a more parsimonious explanation of outcomes associated with a behavior, they are generalization has been proposed by Cervone unlikely to perform the behavior if they lack (1997, 1999, 2000). According to Cervone, the confidence in their abilities to attain the efficacy generalizes across activities and situ- required level of performance. Although out- ations where personal strengths and weak- come expectancies can predict performance of nesses are considered relevant. In other words, health behaviors (O'Leary & The National people are more efficacious toward situations Institute of Mental Health Multisite HTV Pre- where their strengths are necessary ingredients vention Trial Group, 2001; Williams & Bond), for success and less efficacious toward situa- of the two constructs, self-efficacy is more tions where personal weaknesses are believed powerful (Bandura, 1986, 1997; Williams & to play an important role in determining suc- Bond). With health promotion activities, self- cess. For example, people who believe them- efficacy has been shown to influence behavior selves to be shy will be less confident and tend directly and also indirectly through its effects to avoid situations that require them to speak on outcome expectancies (Anderson, Winett, before large groups or engage strangers in & Wojcik, 2001; Anderson, Winett, Wojcik, conversation. However, these same people Winett, & Bowden, 2001; Bandura, 1997, may believe they are physically strong which 1998; Conn, 1998; Dilorio, Dudley, Soet, enables them to successfully handle situations Watkins, & Maibach, 2000). Those who are involving physical confrontations such as efficacious tend to focus on the positive out- when returning a defective item for a refund or comes of health promotion techniques.

Fourth Quarter 2002 337 Self-Regulation in their abilities to reach the desired levels of performance, they adopt lower standards that A third psychological construct proposed more accurately reflect their perceived capa- by social cognitive theory is the self-regula- bilities. However, those who are dissatisfied tory system. The theory postulates that people because they fall short of expectations but who regulate their behavior through a self-system are efficacious exert more effort and persevere composed of three subfunctions: (a) self-ob- in the pursuit of their standards. It should be servation, (b) judgment, and (c) self-reaction noted that with cognitively complex activities, (Bandura, 1986, 1991). First, people observe high levels of dissatisfaction lead to an in- their actions and extract relevant performance crease in effort and subsequent decrease in feedback from the environment. Second, they performance (Bandura & Jourden, 1991; Cer- judge the caliber of their performances against vone, Jiwani, & Wood, 1991; Cervone & personally desired levels of achievement re- Wood, 1995). On these types of tasks, simply ferred to as personal standards. Finally, they increasing effort is a poorly suited approach. reward themselves based upon how well their Rather, the optimal tactic is to carefully con- performances measure up to corresponding sider and systematically apply potential strat- personal standards. When performances are egies. Finally, if efficacious people meet or judged to have met or exceeded the corre- exceed internal standards but would be dissat- sponding standards, people reward themselves isfied with a repeat performance, they develop with intrinsic incentives such as positive self- more demanding standards. evaluations (e.g., self-satisfaction, enjoyment) or external, tangible items (e.g., a bowl of ice cream, a new pair of snow skis). Conversely, Social Cognitive Theory and when performances are judged as substandard, Disabling Conditions people punish themselves with negative self- TRSs may find the social cognitive theory evaluations (e.g., self-dissatisfaction, disap- framework useful when they work with indi- pointment) or tangible actions (e.g., refrain viduals with disabling conditions. Some dis- from participating in the desired recreation abling conditions, even though physical in activity of snow skiing). Self-reactions are nature, can have an effect on psychological based upon the relationship between perfor- constructs. For example, the majority of peo- mances and corresponding standards and not ple who experience spinal cord injuries are the absolute levels of performance. Therefore, young, physically active males. Suddenly, even though two people may perform at a these individuals, who were often at the peak similar level, due to differences in personal of their physical powers, find themselves de- standards, one may consider his/her perfor- pendent upon others for assistance with basic, mance successful while the other one may everyday activities. It seems reasonable to be- perceive failure (McAuley & Tammen, 1989). lieve that the drastic change in physical capa- The incentives people utilize, both positive bility would have a concomitant, negative im- and negative, serve as motivators. People pact on perceptions of personal efficacy. This strive to perform at levels that result in the belief receives support from studies that indi- self-administration of desired incentives. Like- cate those with more severe spinal cord inju- wise, they persevere until their performances ries are less confident they can successfully match standards in order to avoid self-punish- perform activities that were once completed ment. without a second thought (Horn, Yoels, Wal- lace, Macrina, & Wrigley, 1998; Wise, Ellis, Perceptions of self-efficacy affect self-reg- & Trunnell, 2002). ulation (Bandura, 1986, 1997; Bandura & Cer- vone, 1983, 1986). First, if performances are Other conditions, such as substance abuse, severely deficient and people lack confidence have psychological as well as physical aspects

338 Therapeutic Recreation Journal (Bandura, 1999). People may become depen- & Koopman, 1991; Holahan & Holahan, dent upon substances because they adopt per- 1987a; Holahan & Holahan, 1987b; McFar- sonal standards that do not stress abstinence or lane, Bellissimo, Norman, & Lange, 1994). moderation, believe use of the substance re- This relationship between self-efficacy and de- sults in positive outcomes, or lack confidence pression has also been noted in people with in their ability to resist societal and peer pres- spinal cord injuries and multiple sclerosis sures to indulge in substances. Even when they (Shnek et al., 1997). Perceptions of self-effi- complete rehabilitation, there is no guarantee cacy contribute to depression through a variety of life-long abstinence. Long after physical of pathways. In some cases, efficacy is a direct cravings and withdrawal symptoms have contributor (Bandura, Pastorelli, Barbaranelli, ceased, abusers often lapse into former pat- & Caprara, 1999; Maciejewski, Prigerson, & terns of use because of weak efficacy and Mazure, 2000) while in other cases it mediates poorly developed self-regulatory skills the effects of stressful life events (Maciejew- (Gwaltney et al., 2001). For example, they ski et al.) or affects depression indirectly may continue to associate with drug users through its impacts on other variables (Ban- because they do not believe they can establish dura et al., 1999). meaningful relationships with people who are Depressive symptoms are also associated not drug users. Also, they may lack the skills with faulty execution in each of the self-regu- to monitor their efforts at abstinence (e.g., lation system's subfunctions (Bandura, 1986). forget how many marijuana cigarettes they An exclusive focus on the negative aspects of have smoked) or identify non-drug related re- performance, adoption of standards that are wards to be self-administered upon achieve- too lofty, and self-administration of severe ment of personal standards. punishment when performances fall short of Interventions that strengthen self-efficacy, expectations can all contribute to depression. change outcome expectancies, and improve Cervone and his colleagues (Cervone, Kopp, self-regulatory capabilities are effective in Schaumann, & Scott, 1994; Tillema, Cervone, treating substance abuse (Bandura, 1999; La- & Scott, 2001) found that people who were rimer, Palmer, & Marlatt, 1999; Marlatt & dysphoric or in a negative mood tended to Gordon, 1985). A strong sense of self-efficacy raise their personal standards, believing that toward initiating actions to overcome depen- loftier accomplishments would result in per- dency, dealing with relapses, and maintaining sonal satisfaction. The investigators found that abstinence over a long period of time are while standards were raised, corresponding predictors of abstinence. The likelihood of perceptions of self-efficacy were not. In other maintaining abstinence is further enhanced words, people believed they needed to achieve when the inaccuracies regarding outcome ex- higher levels of performance but lacked the pectancies associated with substance abuse are confidence they could attain the new levels. corrected. Finally, those who are efficacious This discrepancy is likely to lead to substan- self-regulators are able to observe their em- dard performances and further administration ployment of coping skills, compare the effects of self-dissatisfaction or punishment. Fortu- of the coping skills against stringent personal nately, treatments that focus on instillation of standards of abstinence, and reward them- realistic standards, accurate observation of be- selves with desired nonsubstance related in- havior, and improvement of self-rewarding centives upon meeting personal standards. abilities result in decreased levels of self-reported depression (Heiby, 1986; Jackson, Depression is another disabling condition 1972). correlated with social cognitive theory (Ban- dura, 1986, 1997). Throughout the lifespan, Anxiety disorders and phobias have also people with a weaker sense of efficacy report been examined from the social cognitive the- more depressive symptoms (Ehrenberg, Cox, ory perspective. According to the theory, peo-

Fourth Quarter 2002 339 pie feel anxious or fearful toward situations & Weinstein, 1993; Lackner, Carosella, & they believe they are ill equipped to deal with Feuerstein, 1996). Those with stronger percep- and which may result in aversive outcomes tions of personal efficacy recovered quicker (Bandura, 1986). For instance, children diag- and exhibited higher levels of functioning. nosed with social phobia, separation anxiety Efficaciousness has also been associated with disorder, or generalized anxiety disorder are improvements in cardiovascular endurance not confident they can effectively deal with among clients with chronic obstructive pulmo- situations involving people and view these nary disease (Toshima, Kaplan, & Ries, 1990) situations as more dangerous than do children and adherence to disability related self-care without such diagnoses (Bogels & Zigterman, behaviors in people with diabetes (Hurley & 2000). Shea, 1992; Senecal, Nouwen, & White, 2000; People who receive treatment designed to Williams & Bond, 2002). increase competence in the subfunctions of How can self-efficacy beliefs be modified? self-regulation become less anxious in social Perceptions of self-efficacy are affected by situations (Rehm & Marston, 1968). Likewise, four sources of information: performance ac- treatments that focus on teaching coping skills complishments, vicarious experiences, verbal and instilling the confidence to use the skills in persuasive messages, and physiological sig- a variety of situations have been effective in nals (Bandura, 1986, 1997). Information pro- strengthening efficacy, increasing the perfor- vided by each source, depending upon how it mance of behaviors that were once avoided, is perceived, weighted, and integrated into and decreasing fear in people with phobias existing beliefs can either strengthen or (Bandura, Adams, Hardy, & Howells, 1980; weaken efficacy. Bandura, Jeffery, & Gajdos, 1975; Williams, Performance accomplishments are the most Kinney, & Falbo, 1989). powerful source of information because they provide direct evidence of personal capabili- Altering Psychological Variables ties. Generally, successful performance of a behavior strengthens efficacy while failure To maximize the impact of TR interven- weakens it. tions, the guiding theory must illuminate how Because performance accomplishments are the component constructs can be altered. With so influential, TRSs should concentrate on this knowledge, desired outcomes can be pro- ensuring that clients successfully perform the cured. desired behavior. Successful performances are more likely to occur when the behavior is task Self-Efficacy analyzed and an individualized teaching pro- Self-efficacy has been linked to numerous gression is developed. As clients attempt spe- health related outcomes. A strong sense of cific steps of the progression, they may require self-efficacy predicts higher quality of life, aids or physical assistance from TRSs (Ban- greater psychological well being (Hampton, dura et al., 1980; Bandura et al., 1975). Aids 2000), and shorter hospital stays (Horn et al., can include adjustments to rules or equipment 1998; Lou, Dai, & Catanzaro, 1997) in people (e.g., use of a racquet with a large hitting with spinal cord injuries. In addition, self- surface; Pellett & Lox, 1998). As steps are efficacy has been found to be an accurate mastered, aids and assistance are removed and predictor of recovery from surgery (Orbell, clients practice the behavior independently Johnston, Rowley, Davey, & Espley, 2001) (Bandura et al., 1975). and physical functioning in older adults Vicarious experiences, the second source (Rejeski, Miller, Foy, Messier, & Rapp, 2001; of information, occur when people observe a Resnik, 1999) and clients with chronic low model. When the model, who possesses char- back pain (Altmaier, Russell, Kao, Lehmann, acteristics similar to observers (e.g., gender,

340 Therapeutic Recreation Journal ability level, disability), is successful, observ- 1993; Wise, Posner et al.). When perfor- ers think, "If that person can do it then so can mances are successful, messages should indi- I" and their efficacy strengthens. Conversely, cate that success was due to internal and stable if the same model is not successful, observers personal factors such as ability and compe- think, "If that person cannot do it then how can tence (Ellis et al., 1993; Wise, Posner et al.; I?" and their efficacy weakens. Wise & Trunnell). For example, "Jim, you Vicarious experiences can be powerful, es- used correct technique in performing that be- pecially when actual performance of a behav- havior." When performances are unsuccessful, ior is not possible due to injury or lack of messages should attribute failure to factors necessary equipment (Wise & Trunnell, 2001). that reside outside of the individual. For ex- The models used to demonstrate behaviors can ample, "Jim, the wind was blowing hard and come from a variety of sources. TRSs or peers that is why you weren't able to hit the target." can act as models. To maximize their impact, Messages are also delivered prior to perfor- models should verbally describe their actions, mances. To strengthen efficacy, these mes- strategies, and how they overcome problems sages should convey the TRSs' confidence in (Gould & Weiss, 1981). Modeling perfor- clients' capabilities to perform the behaviors mances may be live or on videotape (Feltz, (Wise & Trunnell). Landers, & Raeder, 1979; George, Feltz, & The final source of efficacy information is Chase, 1992; Lirgg & Feltz, 1991; McCullagh, the interpretation of physiological signals. In- 1987). Clients themselves, through mental im- creases in heart rate and sweat production may agery, can be another source of models (Ban- be interpreted two ways, each with very dif- dura et al., 1980; Ellis et al., 1993; Feltz & ferent effects on perceptions of efficacy. Effi- Riessinger, 1990). In this technique, clients are cacy can be weakened when the increases are taught to mentally visualize themselves suc- viewed as indicators of impending poor per- cessfully performing behaviors. formance. Efficacy can be strengthened how- The third source of efficacy information, ever, when the same signals are believed to verbal persuasion statements, tends to trans- herald the body's preparation for performance. form efficacy expectations when someone who Not many techniques to alter self-efficacy is respected and considered competent and through physiological arousal have been de- knowledgeable about the behavior expresses scribed in research literature. But, it seems his/her belief in an individual's ability to be plausible that TRSs should become knowl- successful. If the expert is optimistic, then edgeable about various, possible causes of efficacy should be strengthened. However, if physiological signals such as fatigue, aches, the expert expresses doubt, efficacy is likely to pains, sweaty palms, racing heart rates, and be weakened. "butterflies" in the stomach. Then, when cli- For verbal persuasive messages to be effec- ents receive signals that may be interpreted in tive, TRSs need to be competent in the behav- a manner that results in weakened efficacy, iors they teach so they can be recognized as professionals should be adept at convincingly conveyers of accurate information. To en- presenting plausible alternative explanations hance the credibility of their messages, TRSs so as to minimize the negative impacts (Wise, should furnish other sources of concurring Ellis et al., 2002). For example, while partic- evidence (e.g., completed skills checklist, fin- ipating in a TR session the day following a ished craft project). Messages should follow weight training workout, Jane may mention to performances (Ewart, Taylor, Reese, & De- the TRS that she feels weak. The TRS could Busk, 1983; Taylor, Bandura, Ewart, Miller, & respond with, "Jane, it is perfectly normal to DeBusk, 1985; Wise, Posner, & Walker, 2002; feel weaker the day after a strenuous workout Wise & Trunnell, 2001) and provide specific because your body is still recovering. Recov- feedback (Schunk, 1995; Schunk & Swartz, ering is what makes you stronger. In a day or

Fourth Quarter 2002 341 so you will have completely recovered and be confident in their abilities to perform ADL stronger than you were before the workout." while those who did not receive the intervention reported no significant changes in ADL Efficacy Generalization efficacy. It is common for TRSs to strive for gener- Besides involving health care professionals alization from therapeutic activities and set- and people with disabilities, the previous four tings to activities and situations outside of the studies (Ewart et al., 1983; Kelley et al., 1997; treatment milieu. Much of the research on Taylor et al., 1985; Wise, Ellis et al., 2002) efficacy generalization has involved health share another similarity; researchers promoted care professionals and clients with disabling the generalization of efficacy through counsel- conditions (Ewart et al., 1983; Kelley, Cour- ing/discussion sessions. The purpose of these sey, & Selby, 1997; Taylor et al., 1985; Wise, sessions was to, within a short period of time, Ellis et al., 2002). In these studies, efficacy have participants recognize that their personal generalized from running on treadmills to hav- strengths (i.e., cardiac capability, ability to ing sexual intercourse; negotiating rock climb- surmount challenges, muscular strength) were ing routes to completing job interviews; and applicable in many situations. The interven- lifting weights to performing activities of daily tions by Ewart et al. and Taylor et al. achieved living. generalization of efficacy after one session. The study by Wise, Ellis et al. (2002) Wise, Ellis et al.'s and Kelley et al.'s interven- examined the effects of an intervention de- tions took slightly longer; 6 and 9 sessions, signed to generalize efficacy from weight respectively. When counseling/discussion ses- training exercises to activities of daily living sions are not employed, generalization takes (ADL) among adults with spinal injuries. The much longer (Holloway et al., 1988; Paxton, lead author, a certified therapeutic recreation 1998; Rejeski, Ettinger, Martin, & Morgan, specialist, developed and implemented the in- 1998) or does not occur (Wise, Ellis et al.). tervention. A variety of techniques were incor- A variety of techniques (Cervone, 1997, porated into the intervention to promote the 1999; Wise, Ellis et al., 2002) can be incorpo- generalization of efficacy. First, weight train- rated into a counseling/discussion session or ing exercises that mimicked ADL were se- applied throughout an intervention to increase lected. For example, dips and triceps push- the probability of efficacy generalization. downs were chosen because they involve These include selecting intervention behaviors muscle groups and movement patterns similar that are similar to the behaviors toward which to those used in the activities of transferring generalization is aimed, explicitly identifying and pushing a wheelchair, respectively. Sec- the similarities for clients, and periodically ond, strength was promoted as a coping skill. asking clients to describe the similarities. Many ADL such as transferring or carrying Three other techniques are having clients rec- large bags of groceries require strength to ognize that they gained a new personal perform and therefore, an increase in muscular strength or transformed a personal weakness strength should make the activities easier to into strength as a result of the intervention, perform. Third, the therapeutic recreation spe- listing situations where intervention behaviors cialist helped participants recognize that if are relevant, and encouraging clients to share, they could lift more than a ton of weight with each other, the positive impacts interven- cumulatively during a workout, then they tions have had upon different aspects of their should be able to do things like lift full baskets lives. of laundry. Finally, participants were encouraged to openly share the positive impacts Outcome Expectancy weight training had on their daily lives. Those The construct of outcome expectancy has who received the intervention became more been connected to the performance of health

342 Therapeutic Recreation Journal behaviors. In a study by Clark and Dodge 1987; King, Taylor, Haskell, & DeBusk, 1988; (1999), self-efficacy and outcome expectancy McAuley, 1993; McAuley, Courneya, Ru- predicted the degree to which women with dolph, & Lox, 1994; McAuley & Jacobson, heart disease followed prescribed recommen- 1991; Oman & McAuley, 1993). dations to manage their disease. Those with Weight loss is another behavior that re- stronger self-efficacy and who believed the quires a long-term commitment. People who behaviors would benefit their health adhered keep the weight off are characterized by the more closely to the recommendations. ability to self-regulate their behavior (Kitsan- Compared to self-efficacy, relatively little tas, 2000). They set weight loss goals, employ research exists regarding the alteration of out- strategies to increase the likelihood of goal come expectancies. However, some general achievement, monitor their behavior, and re- guidelines can be proposed (Bandura, 1986, ward themselves upon achievement of goals. 1998). Outcome expectancy has two aspects: In a similar vein, when individuals have beliefs that certain consequences are associ- chronic disabling conditions (e.g., lung dis- ated with a behavior and the evaluation, pos- ease, stroke, heart disease, arthritis), managing itive or negative, of those consequences. one's behavior to minimize associated nega- Therefore, interventions should strive to: in- tive effects and prevent complications calls for crease awareness of the positive consequences consistent, sustained, self-motivation (Clark & associated with performance of the desired Zimmerman, 1990). Patients with chronic con- behavior (e.g., reading books can be fun, new ditions who learn how to establish realistic people can be met by joining a local book standards, develop and employ coping strate- club); change negatively evaluated conse- gies, and serf-reward, experience fewer visits quences (e.g., pointing out that books are not to health care providers, hospitalizations, and always expensive—used books can often be number of days spent in hospitals as well as purchased for less than $1 at library sponsored decreases in pain and joint impairment book sales); and correct any factual errors (Dougherty, Johnson-Crowley, Lewis, & clients may possess (e.g., reading is the answer Thompson, 2001; Lorig et al., 1999; Lorig et to all of my problems, reading causes eye al., 2001; O'Leary, Shoor, Lorig, & Holman, problems). Also, because self-efficacy has a 1988). Besides being effective, serf-regulation positive, direct effect on outcome expectancy interventions are relatively inexpensive to im- (Bandura, 1986, 1997, 1998; Conn, 1998; plement, result in significant, yearly, health Dilorio et al., 2000), self-efficacy should be care cost savings (Groessel & Cronan, 2000; strengthened. Lorig et al., 2001), and can have concomitant, positive effects on serf-efficacy, outcome ex- Self-Regulation pectancies, and performance (Anderson, Wi- nett, Wojcik et al., 2001; Frayne & Geringer, The benefits of many health-promoting be- 2000; Frayne & Latham, 1987). haviors are only realized as long as the behaviors are performed. For example, benefits of Self-observation. In order to motivate exercise quickly vanish upon cessation of in- themselves, people must first determine how volvement. Long-term involvement in exer- they are doing (Bandura, 1986, 1991). Al- cise is marked by a strong sense of serf- though there are numerous elements that com- efficacy (Bock, Marcus, Pinto, & Forsyth, prise any situation, many of these do not pro- 2001; Rimal, 2001) while a weak sense of vide relevant information so people must learn efficacy is associated with relapse (Hovell et where to focus their attention. One method is al., 1990). Improved adherence to physical to inspect personal standards. For example, exercise programs has been a consistent prod- inspection may reveal that standards stress the uct of interventions based upon social cogni- use of correct technique. If so, then technique tive theory (Belisle, Roskies, & Levesque, should be the focus of attention. In a second

Fourth Quarter 2002 343 method, TRSs serve as formal identifiers. Each When models demonstrate an activity, they behavior is composed of numerous subskills provide visual images of how a properly exe- that must be blended together to create the cuted activity appears. These images become final action. Many people would quickly be- the criteria by which clients judge the ade- come confused, frustrated, and discouraged if quacy of their own performances. Another they had to observe every subskill of every way professionals model standards is through new behavior. TRSs can streamline the obser- personal behavior. When professionals consis- vation process by explicitly pointing out the tently subscribe to demanding personal stan- most critical subskills of each behavior. Cli- dards, clients are more apt to adopt demanding ents then focus their attention on the critical standards as well. subskills. Professionals also influence clients' stan- Even though clients may know what fea- dards through direct teaching. For example, tures to observe, for some behaviors, it may be professionals may instruct clients that at least physically impossible for them to do so or they one hour a day must be devoted to playing may forget or distort, over time, what they chess in order to become a proficient player. observed. In the first case, TRSs can verbally Clients then fashion this schedule into a stan- supply an accurate description of perfor- dard. mances, videotape clients, or strategically po- The final way professionals influence stan- sition mirrors to provide visual feedback dards is through their reactions to clients' (Berger, 1999). In the second case, simple, performances. When professionals congratu- unobtrusive, and convenient, recording instru- late clients for outstanding performances or ments (e.g., small audiotape recorders, hand express disappointment in mediocre perfor- held counters, stop watches) and techniques mances, clients develop more challenging (e.g., moving pennies from one pocket to an- standards. other pocket) can be employed with the col- Self-reactions. Lastly, people reward or lected information eventually transferred to a punish themselves depending on the adequacy tally sheet, time diary, or chart for future of their performances (Bandura, 1986, 1991). reference (Frayne & Latham, 1987; Kanfer & The self-evaluations people administer can Gaelick-Buys, 1991; Kanfer & Schefft, 1988). have a direct effect on performance (Bandura Judgment. People judge the adequacy of & Jourden, 1991; Cervone & Wood, 1995). their performances against personal standards When engaging in physical exercise, the self- (Bandura, 1986, 1991). TRSs can collaborate evaluations people experience motivate them with clients to ensure that clients' standards to intensify their efforts and improve perfor- are challenging, realistic, specific, and person- mance (Bandura & Cervone, 1983, 1986). ally important; stress personal mastery of There are several methods that can be ap- skills; and incorporate a short-term time frame plied to help people become more effective (Bandura, 1986, 1997; Bandura & Cervone, self-administrators of rewards and punish- 1983, 1986; Bandura & Schunk, 1981; Kavus- ments. First, TRSs can assist clients with the sanu & Roberts, 1996; Locke & Latham, identification of personally important rewards 1990). and punishments. Rewards and punishments Besides assisting clients with the formula- can be intrinsic or extrinsic in nature (Bandura, tion of personal standards, TRSs can supply 1986). Intrinsic is exemplified by self-evalua- information upon which to base standards. tions such as satisfaction or dissatisfaction. Information can be conveyed through model- Extrinsic consequences are those that originate ing, direct teaching, and social reactions (Ban- outside of an individual. Money, praise from dura, 1986, 1991). First, TRSs can influence others, and socially imposed penalties are clients' standards by acting as models them- some examples. Whether intrinsic or extrinsic, selves or using the clients' peers as models. consequences must be strongly liked or dis-

344 Therapeutic Recreation Journal liked and easily self-administered (Frayne & difficult to implement components of the the- Latham, 1987). ory into practice. Not so. Most TRSs probably A second method is direct tuition (Ban- already incorporate many elements of social dura, Grusec, & Menlove, 1967; Bandura & cognitive theory into their programs. To illus- Perloff, 1967; Jackson, 1972; Rehm & Mar- trate, professionals are encouraged to keep ston, 1968). In this method, TRSs explain how track of those techniques mentioned in the self-reaction works and its role in the adoption following scenario that they use in their own and maintenance of behaviors. Then, when practices. clients achieve or fall short of personal stan- Earlier in this paper, an intervention pro- dards, they are instructed to reward or punish gram designed to generalize efficacy from themselves, respectively. weight training exercises to ADL among peo- Modeling is a final method TRSs can em- ple with spinal injuries was introduced (Wise, ploy. With this method, clients observe a Ellis et al., 2002). Although the focus of that model administering him/herself a reward for discussion was efficacy generalization, the in- achieving a standard or punishment when a tervention program addressed several addi- performance falls short (Bandura et al., 1967; tional psychological concepts from social cog- Jackson, 1972). nitive theory. For example, during the initial Besides the techniques listed in the preced- session, participants identified outcomes they ing paragraphs on self-regulation, competency expected as a result of taking part in the in each subfunction can be enhanced through program. Outcomes included enjoyment, in- behavioral contracts (Frayne & Latham, creased physical strength and knowledge of 1987). In behavioral contracts, clients specify how to weight train with their disabilities, and personal standards, method(s) of data collec- opportunities to socialize with other people tion, the process and dates by which standards who were facing similar personal challenges. are to be met, and consequences for adequate The therapeutic recreation specialist rein- and inadequate performances. The contracts forced that these outcomes were likely and are periodically reviewed to note clients' mentioned other potential outcomes (e.g., progress and if necessary, make adjustments. learning how to develop personalized weight Two additional techniques are homework training routines). assignments and role-playing (Kanfer & As with many therapeutic recreation inter- Gaelick-Buys, 1991). Homework assignments ventions, continuation of the behavior (i.e., can be tailored to the needs of each client and weight training) beyond cessation of the for- role-playing allows them to gain immediate mal intervention program was desired. There- experience with the skills that have been pre- fore, to strengthen weight training efficacy, sented by TRSs. information from all four sources (i.e., vicarious experiences, performance accomplish- Conclusion ments, verbal messages, physiological arousal) It is hoped this article stimulates the TR was supplied through multiple techniques. For profession to consider adopting social cogni- instance, the therapeutic recreation specialist tive theory as a framework for TR practice. and some of the participants modeled each The theory provides a comprehensive expla- weight training exercise and then all partici- nation of behavior and guidance on how to pants practiced each exercise and received elicit desired behavior changes in clients. Fur- verbal feedback. When appropriate, feedback thermore, the theory has successfully directed focused on what lifters could do to improve therapeutic efforts with a variety of behaviors, their performances. Other times, it stressed in a variety of populations, in a variety of specific things they were doing correctly. settings (Bandura, 1986, 1997). Also, whenever the lifters said they were sore Some TR professionals may believe it too and this adversely affected their achievement

Fourth Quarter 2002 345 levels, the therapeutic recreation specialist ex- intervention program produced significantly plained how these were natural outcomes of stronger perceptions of efficacy toward con- beginning a weight training program and not tinuing to weight train and performing ADL. indicators of personal inability. Unfortunately, the long-term effects of the To generalize efficacy from the exercises to program are not fully known. However, one ADL, exercises that mimicked the movements participant reported strong weight training and of targeted ADL were incorporated into work- ADL efficacy values and continued involve- outs. Furthermore, the CTRS facilitated dis- ment in weight training eight months post cussion/processing sessions where participants treatment (Wise & Hale, 1999). This report came to recognize how outcomes of weight provides limited, yet promising, evidence of training (e.g., increased physical strength) the robustness of the psychological and behav- could be assets in many situations outside the ioral changes caused by an intervention pro- weight room. This recognition was fostered, in gram based upon social cognitive theory. a group format, through sharing the results of homework assignments (e.g., between now If the profession decides to adopt social and the next workout, note three situations cognitive theory, this paper can only serve as a where an increase in muscular strength could partial examination of how the theory can be beneficial) and responses to questions impact TR practice. Further explanation and raised by the CTRS (e.g., how are the triceps investigation are needed to clarify the theory's pushdown exercise and wheelchair transfer implications for TR. For example, how is the similar?). theory to be applied by professionals who The three subfunctions of self-regulation work with people with severe cognitive im- received attention throughout the intervention pairments? Most likely, this group of profes- program. To aid with self-observation, lifters sionals would focus more on the environmen- maintained a written record of the number of tal factors aspect of the theory rather than the sets and repetitions they performed and psychological constructs highlighted in this weights they lifted during each workout. Peri- paper. TR services delivered to this population odically, the records from initial workouts would be more concerned with the availability were compared against those of later work- of adapted equipment and presence of support- outs. It was not uncommon for lifters to make ive others rather than the alteration of efficacy verbal comments about how many more rep- perceptions or development of self-regulation etitions they were completing or how much skills. more weight they were lifting as the program progressed. Also during these comparisons, Also, because this paper dealt exclusively they frequently expressed how much they en- with the personal factors aspect of the theory, joyed lifting weights and becoming stronger. a thorough review of the other two aspects, environmental and behavioral factors, should How many of the techniques described in be a future goal. The review could cover how the intervention program do you employ in environmental and behavioral factors influ- your TR interventions? One? two? more? It is ence each other as well as personal factors. likely you recognized at least one technique and probably many more. Besides demonstrat- Finally, assessment and evaluation, two ing the ease with which TRSs could incorpo- fundamental elements of TR, were not part of rate theory-based techniques into practice, the the present discussion. Social cognitive theory preceding illustration displays how a theory, has implications for both of these phases of the when it is understood, can guide practice in a TR process. Future efforts should include a manner that increases the likelihood of elicit- review of the related literature and subsequent ing desired changes in clients. development of assessment and evaluation Post intervention analyses revealed that the tools using a social cognitive framework.

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