Chronic Disease Management - Locus of Control and Explanatory Style

Transcript

1. Locus of Control and Explanatory style PHE2LCI 2010 Jon Willis Week 5
2. What is locus of control • Originally developed by Julian Rotter in the 1950s within the frame of social learning theory • Important aspect of personality • Refers to an individual's perception about the underlying main causes of events in life source:http://www.medetel.lu/download/2009/parallel_sessions/presentation/day3/locus_of_control.pdf
3. External Internal Individuals believe that their behaviour is guided by luck, fate, other people …, that forces outside themselves determine their life Individuals believe that they can control events related to their life, that their behaviour is guided by their hard work, personal decisions, efforts ... Others control my destiny I control my destiny source:http://www.medetel.lu/download/2009/parallel_sessions/presentation/day3/locus_of_control.pdf
4. Internal Locus of Control • A person with a high Internal Locus of Control believes they contribute significantly to how things happen in their life. People with a high Internal Locus of Control may hold beliefs such as: – My vote makes a difference, so it's important that I vote. – My behaviour has a huge effect on my health so it's important that I eat well, exercise regularly, avoid smoking and other harmful behaviours and get regular medical checkups. – I made a bad grade on that test because I didn't study hard enough. Next time I will study harder and get a better grade. – I didn't get that job because I didn't have the same credentials or experience as the other applicants. I'll keep going to school and working at night to improve my resume and apply again in the future. http://www.kellevision.com/kellevision/2009/06/depression-helplessness-hopelessness-and-external-locus-of-control.html
5. External Locus of Control • By contrast, people with a high External Locus of Control believe that they are largely powerless in their own lives. They attribute events in their lives to powers outside their control. Examples of thought patterns of people with a high External Locus of Control might be: – It doesn't matter whether I vote or not. They (the powers that be) elect who they want. – It doesn't really matter what I do for my health, cancer runs in my family and it's just a matter of time. – I made a bad grade on that test because the teacher doesn't like me, so it doesn't matter what I do. I just have to get into another class. – Getting a job is a shot in the dark. They either like you or they don't. There's not really much you can do about it. http://www.kellevision.com/kellevision/2009/06/depression-helplessness-hopelessness-and-external-locus-of-control.html
6. Why is it important? • May significantly influence decisions Health • Shapes individual health decisions and choices • The topic is studied since 1970s when the Health Locus of Control Scale and the Multidimensional Health Locus of Control Scale were created source:http://www.medetel.lu/download/2009/parallel_sessions/presentation/day3/locus_of_control.pdf
7. How does a high External Locus of Control contribute to depression? • In two different ways. – First, it affects the way a depressed person views the world. – Second, it affects the way a depressed person approaches a bout of depression. http://www.kellevision.com/kellevision/2009/06/depression-helplessness-hopelessness-and-external-locus-of-control.html
8. • People with a high Internal Locus of Control are less likely to feel helpless or hopeless in their lives. Because they feel they are the captain of their own ship they feel able to make changes in their lives to achieve desired outcomes http://www.kellevision.com/kellevision/2009/06/depression-helplessness-hopelessness-and-external-locus-of-control.html
9. People with a high External Locus of Control feel they cannot change their lives • They often feel they are at the mercy of the "powers that be" (whatever they perceive those powers to be) and that they cannot change the outcome. • This can lead to feelings of helplessness and hopelessness which contribute significantly to depression. • It may also contribute to the phenomenon called "Learned Helplessness" in which a person has learned through experiences in their life that they are powerless to change or control things or remove themselves from harm or danger. • This powerlessness leads to feelings of depression. http://www.kellevision.com/kellevision/2009/06/depression-helplessness-hopelessness-and-external-locus-of-control.html
10. Learned Helplessness • Martin Seligman's experiments with dogs demonstrated the phenomenon of Learned Helplessness – Two groups of dogs were subjected to electrical shocks but were given a bar by which they could stop the shocks. These dogs recovered quickly when removed from the experiment. – A third group of dogs were exposed to the shocks, but not given a means for stopping the shocks. They quickly learned that they were powerless to stop the shocks. Even in future experiments when they were given a bar they could press and stop the shocks, they did not use it. They simply stood docilely and endured the shocks. After the experiment stopped, the dogs in this third group exhibited symptoms of clinical depression. http://www.kellevision.com/kellevision/2009/06/depression-helplessness-hopelessness-and-external-locus-of-control.html
11. • An External Locus of Control can contribute to these same feelings of helplessness and depression if a person believes there is nothing they can do to stop what is happening to them. They have learned to be helpless and powerless. http://www.kellevision.com/kellevision/2009/06/depression-helplessness-hopelessness-and-external-locus-of-control.html
12. WHAT IS EXPLANATORY STYLE?
13. • When the theory of learned helplessness was extended to human behaviour, it provided a model for explaining depression, a state characterized by a lack of affect and feeling. – Depressed people became that way because they learned to be helpless – Depressed people learned that whatever they did, is futile – During the course of their lives, depressed people apparently learned that they have no control Source: http://www.noogenesis.com/malama/discouragement/helplessness.html
14. • Learned helplessness explained a lot of things, but then researchers began to find exceptions, of people who did not get depressed, even after many bad life experiences • Seligman discovered that a depressed person thought about the bad event in more pessimistic ways than a non-depressed person • He called this thinking, "explanatory style," borrowing ideas from attribution theory
15. For example, let’s say you fail a maths test • How do you explain why? You could think: 1. I am stupid 2. I'm not good in math 3. I was unlucky, it was Friday the 13th 4. The math teacher is prejudiced 5. The math teacher grades hard 6. I was feeling ill that day 7. The math teacher gave an especially hard test this time 8. I didn't have time to study 9. The teacher grades on a curve Source: http://www.noogenesis.com/malama/discouragement/helplessness.html
16. • Seligman found that these explanations could be rated along three dimensions: – personalization: internal vs. external – pervasiveness: specific vs. universal – permanence: temporary vs. permanent Source: http://www.noogenesis.com/malama/discouragement/helplessness.html
17. Explanatory styles Personalization • internal vs. external Pervasiveness • specific vs. universal Permanence • temporary vs. permanent
18. Pessimistic • He found that the most pessimistic explanatory style is correlated with the most depression • The statement "I am stupid" is classified as internal (use of I), universal, and permanent – This response conveys a sense of discouragement, hopelessness, and despair. Optimistic • On the other hand, a more optimistic person would blame someone or something else • "The math teacher gave an especially hard test this time" is external, specific and temporary
19. • Conversely, for a good event, the explanatory style reverses – For example, for a perfect score on the math exam, the depressive would say: "I was lucky that day," discounting his intelligence – The optimist would say something much more encouraging, such as "I am smart" • We often learn explanatory styles from our parents Source: http://www.noogenesis.com/malama/discouragement/helplessness.html
20. • There are advantages to both optimistic and pessimistic explanatory styles – Certain jobs call for an optimistic outlook, such as inventing or sales – Other jobs, such as accounting or quality control, call for a more pessimistic outlook Source: http://www.noogenesis.com/malama/discouragement/helplessness.html
21. A person's Locus of Control can also contribute to how they approach a bout of depression Internal Locus of Control • A person with a high Internal Locus of Control will research depression and look for things they can do to help themselves – They may change their diet, start an exercise program, reduce stressors in their life, make a point of getting more sunshine, and force themselves to get out of the house and socialize External Locus of Control • A person with a high External Locus of Control may focus only on what a doctor or therapist can do for them – They will not look for what they can do for themselves – They give the power to overcome the depression totally to the clinician – Working with people who have a high External Locus of Control may feed a clinician's ego because the clinician is viewed as all powerful in treating the depression, but it does little for the client's self-esteem. It also feeds into the hopelessness and helplessness of their depression http://www.kellevision.com/kellevision/2009/06/depression-helplessness-hopelessness-and-external-locus-of-control.html
22. • Seligman suggests in his book "Learned Optimism" that one can overcome depression by learning new explanatory styles • This is the basis of cognitive therapy – In such therapies, the counsellor challenges the client's beliefs and explanations of life's events – If you feel depressed because you failed that last exam, then dispute the explanation, and learn or search for a more optimistic one according to the above criteria. Or read a few jokes. • The whole self-help movement is based on the optimistic belief that we can change ourselves for the better
23. • If you have depression, it would be a good idea to examine your beliefs and thoughts to see what you attribute your depression to – Do you feel you are able to do something about it or that it is beyond your control? – Are your beliefs based on reality or were they learned somewhere along the way? – If they were learned, are they still true? http://www.kellevision.com/kellevision/2009/06/depression-helplessness-hopelessness-and-external-locus-of-control.html
24. It’s not just about depression • People reflecting an internal locus of control believe that they can exert control over their environment to bring about desirable consequences. – Consequently, those possessing an internal health locus of control believe that their personal health-related outcomes are for the most part determined by their own choices and behaviours. • Conversely, people with an external locus of control believe that larger social forces, powerful persons or groups, or plain luck will determine their fate. – Those displaying an external health locus of control consider their personal health-related outcomes largely a matter of influences extending beyond their own control Cockerham & Ritchey 1997; McGuigan 1999
25. How can negative health situations become beneficial? • How can the effect of experience on locus of control beliefs can be weakened? • Episodes of health ailments do not have to lead to adoption of negative beliefs in the realm of self-care; rather, they can be used to reinforce positive beliefs. • In congruence with classic reinforcement theory, doctors and parents could stress how the negative episode would not have occurred had certain self-care behaviours been performed. Or, ways in which the illness would have been more serious or occurred earlier if negative behaviours had been performed could be recognized (Lau, 1982).
26. • It is imperative to realize that the attributions people make after getting sick are critical in determining what effects that illness episode will have on related health beliefs and health behaviours (Lau, 1982). • Also crucial, is that health locus of control beliefs are primarily formed in childhood and remain relatively stable throughout the life span. • We empower ourselves when we recognize the benefits that internal HLC beliefs can have on the health behaviours we practice and encourage in others.
27. Altering control beliefs • Because control beliefs are learned, they can easily change as a function of life events (e.g. receiving a new medical diagnosis), or they can be systematically modified through the application of some form of cognitive- behavioural therapy. • E.g. Shapiro and Astin’s “control therapy”
28. • “Since it is true that internals appear more likely to engage in positive health and sick-role behaviors, it is apparent that health locus of control emphasizes the importance of the health educator’s need to involve themselves in training patients to hold more internal beliefs” (Mackie, 1999).
29. References • Lau, RR (1982) Origins of health locus of control beliefs. Journal of Personality and Social Psychology. 42(2):322-334 • Mackey A (1999). Power, Pessimism & Prevention: The impact of locus of control on physical health. http://www.units.muohio.edu/psybersite/control /health.shtml • Shipiri, DH & Astin, JA (1998). Control therapy: An integrated approach to psychotherapy, health and healing. New York: Wiley.