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The Process of Change

The process of change is concerned with understanding how the theory explains the mechanisms for therapeutic change. This is particularly important in the cognitive-behavioral area because there are many different theories and many different interventions.


The self-efficacy theory of Albert Bandura (1977,1986) has been used to provide a cognitive- behavioral theoretical explanation for how people change. It has been proposed as a common pathway to explain how people change despite using different therapeutic techniques. Self-efficacy theory asserts that individuals develop expectations for their success in performing specific behaviors and that these expectations influence their decision to try new behaviors and maintain behavioral changes (Bandura, 1977, 1986). Self-efficacy may be thought of as a sense of personal competence or feelings of mastery. The degree to which a person feels efficacious influences the amount of effort that he or she will apply in given situations. Thus, CBT may work through increasing self-efficacy of clients.

Bandura (1986) described four mechanisms through which self-efficacy can be developed: enactive attainments, vicarious experiences, verbal persuasion, and recognition of physiological states. Enactive attainments, the most powerful contributors to self-efficacy development, refer to an individual's own experience with achieving a goal. Vicarious experiences refer to observing others as they succeed or fail. Through the process of observing, individuals are provided with a basis for making comparisons to their own competence to perform the task. Verbal persuasion is a less powerful way to influence self-efficacy. The final source of self-efficacy, physiological states, refers to the emotional arousal or degree of apprehension one feels. Feelings of fear may lead to a decreased performance, whereas a moderate amount of anxiety may be helpful when performing a new task.

Examples of how clients learn assertive behavior can be used to apply these sources of self-efficacy. When clients are taught assertiveness skills, they practice making appropriate assertive comments. Enactive attainments are the experience of success that leads clients to feel able to repeat the assertive behavior. In assertiveness training groups, clients watch each other perform new behaviors; this is an example of vicarious experiences. Verbal persuasion is the source of self-efficacy based on telling clients "You can do it"; like encouragement, it might increase self-efficacy, but other sources are more powerful. The physiological states mechanism can be used in assertiveness training to inform clients that a moderate amount of anxiety may be helpful as they attempt to make changes in their behavior.

It is important to recognize that when applying the self-efficacy model to how cognitive therapy and other cognitive-behavioral interventions work, all four of the sources of self- efficacy are involved. In the process of learning that cognitions contribute to behavior and affective difficulties, enactive attainments, vicarious experiences, verbal persuasion, and physiological states play major roles.

Does Changing Beliefs Lead to Change in Behavior?

Addressing the question of how people change, Beck (1976) asserted that behavioral and affective change are hypothesized to occur through the change in cognitions. The assumption is clearly that changing beliefs is the key to helping people. Research has demonstrated that cognitive therapy does indeed change thoughts and that there are reductions in psychological disturbances.

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