“Can-do” Attitude: Self Efficacy and Graded Exposure at IPPS 2019

In Pelvic Health by Kim BuonomoLeave a Comment

By Kim Buonomo, PT, DPT, PHRC Lexington

Here at PHRC we often write our blogs weeks in advance.  Kim wrote this post shortly after #IPPS2019 in October. Little did we know when she wrote it how relevant it could be for the current times here in 2020. Back in October we did not see this pandemic coming and we hope her informative posts help whatever challenges you may be facing today. We will all get through this, together. From Kim:

“Thinking back to when I wrote this article in November, I realized how much has changed in the world in only a few months. It can be really overwhelming to think about how our day to day lives are so different since COVID-19 started. We have all been spending more time at home, and I admit that I’ve been struggling to find the motivation even to do tasks that I love. It’s hard for us all to be away from our friends, family, and hobbies. 

Today, I took another look at this article and re-imagined self-efficacy in the post-COVID world. How do we change self-efficacy? Educate ourselves, observe others with similar experiences, and use our own experiences. This seems pretty similar to the advice I’ve heard on the news for strategies to manage stress and mental health in this time. By educating myself about COVID-19 (in small doses to avoid media overload), staying connected to my friends and family on the phone and on zoom, and using some graded exposure by forcing myself to do “small” things like shower, put on real clothes, and keeping my routines as normal as possible, I’m getting back to myself and building self-efficacy that I can do everything in my control to stay safe, even if that means staying home unless it’s absolutely necessary to go out (which is very hard for an extrovert like me!). These are hard times for us all, but we will get through them together. We may be apart, but we are not alone, and we got this! Stay safe and healthy, my friends!”

Today’s blog article is about what I learned at the International Pelvic Pain Society 2019 conference in Toronto. Between exploring the Great White North and getting to network with my amazing colleagues after lectures, I left IPPS feeling like I could do anything… which ties in perfectly with my blog post today!

At Sunday’s post-conference, Alison Sim and Carolyn Vandyken presented about the role of  physical activity in improving self efficacy. What’s self efficacy, you ask? It’s the confidence that a person has in their own ability to achieve a desired outcome. Studies have shown an association between higher self efficacy and lower levels of pain and disability in patients with chronic pain. 

The basic concept is that if I’m confident that I can accomplish a task, I’m generally more likely to be successful at it. This is huge for our patients with chronic pain. 

How do we change self efficacy? There are three strategies we discussed.

  1. Education- Look no farther than our amazing website and the book Pelvic Pain Explained for a ton of information! I am always educating my patients on what I think is contributing to their symtpoms and how PT can help. Knowledge is power!
  2. Observing others with similar experiences- There are countless support groups online for various conditions, and here at the Pelvic Health and Rehabilitation Center we share success stories from some of our patients to show that no one dealing with pelvic pain is alone and people recover! 
  3. Experience- I’m going to talk about how to improve self efficacy through experience by applying graded exposure techniques.

Graded exposure training is when you take a large goal and break it into smaller, more manageable tasks. This allows you to participate in the goal activity in a way that you can control and is less likely to become overwhelming. Taking small, successful steps helps improve confidence about the task and sets you up to achieve bigger goals. 

Personal story: I used graded exposure to help me start running and I finished my first 5K this Thanksgiving! I made a plan and used small steps to help me achieve my goal and feel successful. Mini-goal one wasn’t even physical… It was buying my workout clothes (a very important step!). Mini-goal two was walking a mile. Mini-goal three was walking a 5K. Mini-goal four was alternating jogging 30 seconds for every five minutes that I walked. I kept increasing my run time and decreasing my walk time to build up my tolerance slowly. Months after my training started, here is a picture of my sister and me at the end of the race!

Feeling Accomplished!

Two things that I did well in this example were 1) my use of graded exposure, and 2) setting attainable goals. If I had tried to run a 5K without stopping on day one of my training, or if my goal was to run a marathon next week, I wouldn’t be setting myself up for success and my self efficacy would have definitely taken a hit when I wasn’t able to meet my goals!

So let’s give an example for pelvic pain. (I hear this one a lot!)

Let’s say that your pelvic pain acts up after you sit for five minutes. If you went to sit for eight hours at work tomorrow, you would be in a ton of pain! You wouldn’t be able to pay attention. You wouldn’t be productive. You might feel like you need to quit your job because sitting for eight hours is such a big goal that there’s no way you could ever achieve it. I mean, you can’t even sit for five minutes! You can’t go out to dinner with your friends because sitting in the restaurant is too much to tolerate. (Don’t even get me started on those hard restaurant chairs that provide no support!) So suddenly you have no job, no friends, and no quality of life. 

Slow down, there… Take a deep breath… Reframe those goals and try graded exposure. 

Five minutes is your maximum sitting time without any help/support/cushions. Okay. So, mini goal one is to try to sit for four minutes, and use a cushion to improve your chances of success… That ends up being successful, achievable, and not painful. Great! So let’s try sitting for four and a half minutes. Now try for five… five and a half… six… Another mini-goal might be trying to sit for a few minutes without the cushion. See how you can build your way up by using those smaller steps? I’m not saying that there will not be discomfort through this process, and I can’t promise that you’ll have no pain after sitting through the work day, but the point is to use small goals, to move slowly, to progress when you’re ready, and to build your confidence in your own ability to function. If sitting for a work day is too much, make mini goal one be sitting for a coffee with a friend. Maybe mini goal two is sitting 30 minutes for a TV program. Maybe mini goal three is sitting for dinner. Before you know it, sitting to watch that two hour movie or trying to survive the work day won’t seem so intimidating! 

For the record, self efficacy is about how you feel about what you can do. So while these strategies are helpful in improving your confidence, it’s not designed to do much about your pain. There’s no guarantee that you’ll be completely without pain at the end of the day (just like my example is no guarantee that I’ll be able to run a marathon). But self efficacy does have significant associations with impairment, affective distress, and pain severity within chronic pain samples. This means that patients with higher self efficacy can typically function better despite their pain and limitations. And as a PT, function is what I’m all about! If you’re struggling with low self efficacy and anxiety around movement, it may also be a good idea to work with a pain psychologist. Your PT will suggest a referral for you if they think it is appropriate. 

All the best, and know that you got this! 

Additional Resources:

Check out Morgan Conner’s blog Tips on Reducing Stress During COVID19

Check out Elizabeth Akincilar’s blog on Mindful Meditation

And Meditation for Pelvic Pain Relief



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