When we have self-efficacy, we believe we can control events that affect our lives. Self-efficacy determines how we feel, think, and behave. It plays a big role in our successfully managing a chronic illness over time and across situations. Self-efficacy makes us feel better about ourselves, more powerful, and in control. Patients who believe in their ability to control their illness look at tasks as challenges to be mastered rather than as threats to be avoided. If we have self-efficacy beliefs, we view medical instructions as something we understand and can carry out. If we have self-efficacy, we take a greater interest and are more involved in these and other activities that help us to manage our condition. We set goals and stay committed to them; we are also less likely to give up if we make mistakes. We bounce back from failure to recover a sense of being able to do whatever task we did poorly. We may blame failures on ourselves for either not doing the things we should or not knowing how to take care of ourselves. But if we believe that we can overcome challenges and our own weaknesses, we have confidence that we can eventually succeed. When we don't give up, we begin to feel a sense of our own power. We start to realize that we need to be in control of our own health and, at the same time, that our illness does not control us. There are too many other things to do with our lives than to surrender them to an illness. We need to believe that we are controlling our illness, not that our illness is controlling us.

Sources of self-efficacy
You may be wondering: How do I develop self-efficacy? Albert Bandura found there were four ways to do so.
A. The best way of creating a sense of efficacy is through mastery experiences. Successes build a belief in your personal efficacy. Failures undermine it, especially if they occur before we have established a sense of efficacy. If we only experience easy successes, we may come to expect quick results and be discouraged by failure. A strong sense of efficacy requires experience in overcoming obstacles by being persistent. Some setbacks and difficulties in our performance serve a useful purpose by teaching us that success usually requires sustained effort. After we become convinced that we have what it takes to succeed, we persevere in the face of adversity and rebound from setbacks. By sticking it out through tough times, we become stronger.
B. The second way of creating and strengthening self-efficacy is through observing others. Seeing people like ourselves succeed raises our beliefs that we too possess the capabilities to master similar activities. By the same token, watching others fail despite their high effort lowers our judgments of our own efficacy; this, in turn, can undermine our efforts. The impact of modeling on perceived self-efficacy is strongly influenced if we see the model as similar to us. The greater the similarity between models and ourselves, the more persuasive their successes and failures are to us. If we see models as different from ourselves, on the other hand, our self-efficacy is less influenced by their behavior and the results it produces. Modeling influences do more than provide us a standard against which to judge our own capabilities. We seek models that possess the competencies to which we aspire to perform. Through their behavior and expressed ways of thinking, competent models transmit knowledge and teach us effective skills and strategies for managing our environment.
C. Social persuasion is a third way of strengthening our beliefs that we have what it takes to succeed. People who can verbally persuade themselves that they have the capabilities to master given activities are likely to mobilize and sustain greater effort than if they have self-doubts and dwell on personal deficiencies. To the extent that persuasion leads us to try to succeed, it promotes the development of skills and a sense of personal efficacy. It is more difficult for us to gain beliefs of personal efficacy by social persuasion alone than it is to for us to lose it. Unrealistic boosts in self-efficacy, for example, are quickly shot down by if we are disappointed by the results of our efforts. People who have been persuaded that they lack capabilities tend to avoid challenging activities that cultivate potential and give up in the face of difficulties. By limiting activities and undermining motivation, a lack of belief in our own capabilities keeps us from moving forward. People with self-efficacy do more than look positively at the outcome of their efforts. In addition to raising beliefs in their capabilities, they structure situations for themselves in ways that bring success; they also avoid being placed prematurely in situations where they are likely to fail. In the long run, we measure success in terms of our self-improvement rather than by triumphing over others.
D. We also rely partly on our gut feelings and emotional states in judging our capabilities. We may interpret stress reactions and tension as signs that we will perform poorly. In activities involving strength and stamina, we judge fatigue, aches, and pains as signs of physical weakness. Mood also affects our judgments of personal efficacy in that positive moods increases self-efficacy while negative moods decreases it. Thus, the fourth way of modifying self-efficacy is to reduce stress reactions and alter negative emotional feelings. It is not the sheer intensity of emotional and physical reactions that is important but rather how we look at and interpret them. People with a high sense of efficacy are likely to view arousal as a facilitator of performance, whereas those with self- doubts regard arousal as interfering with their performance. Physical indicators of efficacy play an important role in how we manage our health and illnesses.

Processes of self-efficacy
Bandura described the four psychological processes through with self-efficacy affect our daily functions.
A. Cognitive Processes. The effects of self-efficacy on cognitive processes take a variety of forms. We control much of our behavior by thinking beforehand about the goals we wish to pursue. Personal goal setting, in turn, is influenced by how we look at our abilities to reach these goals. The stronger our self-efficacy, the higher the goals we can set for ourselves and the stronger the commitment we have to reach them. We attempt to think through most of the courses of action we take before we perform them. Our beliefs in our efficacy shape the types of thoughts we construct and rehearse. People who have a high sense of efficacy can visualize events they think will occur; these thoughts provide guides and support for their later performance. Those who doubt their efficacy tend to visualize failures and dwell on things that can go wrong. It is difficult to achieve much while fighting self-doubt. A major role of thought is to help us predict events and develop ways to control those that affect our lives. Effective skills require us to deal with processing information that may contain ambiguities and uncertainties. In learning rules to help us predict and regulate our behavior, we draw on our knowledge to consider options, to weight and fuse predictive factors, to test and revise our judgments against immediate and long-term results of our actions, and to remember which tactics we have tested and how well they worked. It requires strong self-efficacy to remain on task in the face of demands, and the failures and setbacks that have significant results for us. When we are faced with the tasks of managing difficult environmental demands under trying circumstances and beset by doubts about our self-efficacy, we may become unable to think clearly, limit our goals and, as a result, see our performance go to pieces. In contrast, those who maintain a strong sense of efficacy think clearly and set challenging goals for themselves. As a result, they are more apt to achieve the goals they have set.
B. Motivational processes. Beliefs of self-efficacy play a key role in how we regulate motivation. We generate most of our motivation by thinking through how we are going to guide our actions. People form beliefs about what they can do and anticipate the likely outcomes of their actions. We set goals for ourselves and plan the actions required to reach them. Bandura recognized three different ways by which we use thought to motivate ourselves. The first is attribution theory, or how we explain events to ourselves; the second is outcome expectancies, or what we think will happen if we perform a given action in a given situation; and the final is goal theory, or the goals we set for ourselves. Self-efficacy helps us to use these three factors to motivate ourselves. Attribution theory, for example, affects our motivation, performance, and reaction to our performance mainly through self-efficacy. If we think our actions will lead to a positive outcome, we will perform the actions; if they think they will result in failure, we may wonder, “Why bother?” With outcome expectations, motivation occurs through the anticipation that a given course of behavior will produce certain outcomes. People act on their beliefs about what they can do, as well as on their beliefs about the likely outcomes of their performance. The motivating influence of outcome expectancies is thus partly governed by self-efficacy. The ability to set goals for ourselves is the final mechanism of motivation. A body of evidence shows that explicit, challenging goals enhance and sustain motivation. Goals operate largely through the influence they have on us rather than how they directly regulate motivation and action. Motivation based on goal setting involves a comparison process. By making their satisfaction conditional on matching their goals, people give direction to their behavior and create incentives to persist in their efforts until they reach their goals. They seek satisfaction by fulfilling goals and are prompted to intensify their efforts if unhappy with substandard performances.
Three types of influences that we control govern motivation based on goals or personal standards. These include satisfying and unsatisfying reactions to our performance, self-efficacy for goal attainment, and adjustment of personal goals based on our progress. Self-efficacy contributes to motivation in several ways: They determine the goals we set for ourselves; how much effort we expend; how long we persist in the face of difficulties; and our resilience to failures. When faced with obstacles and failures, people who have self-doubts about their capabilities slacken their efforts or give up quickly. Those who have a strong belief in their capabilities exert greater effort when they fail to master the challenge. Hence, strong perseverance contributes to performance accomplishments.
C. Affective Processes
Our beliefs in our abilities to cope affect how much stress and depression we experience in threatening or difficult situations, as well as our level of motivation. Perceived self-efficacy to control stress plays a central role in anxiety arousal. People who believe they can control threats do not stir up disturbing thought patterns, while those who believe they can’t manage threats experience high anxiety arousal. They dwell on their deficiencies in coping and view many aspects of their environment as dangerous. They magnify the severity of possible threats and worry about things that rarely happen. Through such thinking, they upset themselves and impair their level of functioning. Perceived coping self-efficacy regulates avoidance behavior as well as anxiety arousal. The stronger their self-efficacy, the bolder people are in taking on difficult and threatening activities.
Anxiety is affected not only by perceived coping efficacy but also by your perceived efficacy to control disturbing thoughts. Bandura suggests that the exercise of control over our own consciousness is summed up well in the proverb: "You cannot prevent the birds of worry and care from flying over your head, but you can stop them from building a nest in your head." Perceived self-efficacy to control thought processes is a key factor in regulating how our thoughts produce stress and depression. It is not the sheer frequency of disturbing thoughts but the perceived inability to turn them off that is the major source of distress. Both perceived coping self-efficacy and the ability to control thought operate together to reduce anxiety and avoidant behavior.
Social cognitive theory prescribes mastery experiences as the principal means of personality change. Guided mastery is a powerful way to instill a robust sense of coping efficacy in people whose functioning is seriously impaired by intense apprehension and fearful self-protective reactions. Mastery experiences are structured in ways to build coping skills and induce beliefs that one can control potential threats. One must create an environment so that highly fearful and incapacitated people can perform successfully despite themselves. This can be achieved by using a variety of performance mastery aids. Feared activities are first modeled to show people how to cope with threats and eliminate their worst fears. Coping tasks are then broken down into subtasks of easily mastered steps. Performing feared activities together with others further enables highly fearful people to do things they would resist doing by themselves. Another way of overcoming resistance is to begin with being in the presence of stressors for short periods of time. Fearful people will refuse threatening tasks if they will have to endure stress for a long time, but will risk these tasks for a short period. As coping efficacy increases, the time they perform the activity can be gradually extended. Protective aids and the gradual presentation of the severity of threats also help to restore and develop a sense of coping efficacy. After functioning is fully restored, mastery aids can be withdrawn to show that coping successes stem from personal efficacy rather than from the aids. Self-directed mastery experiences, designed to test coping capabilities, can then be arranged to strengthen and generalize the sense of coping efficacy. Once people develop a resilient sense of efficacy, they can withstand difficulties and adversity. Guided mastery treatment of this kind can achieve widespread psychological changes in a relatively short time. It eliminates fearful behavior, anxiety and biological stress reactions, creates positive attitudes, and reduces fearful thoughts and nightmares.
A low sense of efficacy to exercise control produces depression, as well as anxiety, in several different ways. One route to depression, for example, occurs by failure to reach our goals. People who impose unrealistic standards of self-worth on themselves can drive themselves into bouts of depression. A second efficacy route to depression is through a low sense of social efficacy. People who judge themselves as socially competent seek out and cultivate social relationships that provide experience to manage difficult situations, cushion the adverse effects of chronic stress, and bring satisfaction to their lives. People who think they lack the social skills to develop satisfying and supportive relationships increase their likelihood of depression through social isolation. We generate much of our depressive feelings by repeatedly focusing on negative thoughts. A low sense of efficacy to control these kinds of thoughts also contributes to the occurrence, duration, and recurrence of depressive episodes. Other processes activated by self-efficacy affect the impact of coping self-efficacy on biological systems that control our health. Stress has been implicated as an important contributing factor to many physical conditions. Being able to control stress appears to be a key organizing principle regarding the nature these stressors have on our health. It is not stressful life conditions per se, but our perceived inability to manage them that can be harmful; however, exposure to stressors with the ability to control them has no adverse biological effects. The inability to control stress may, in particular, impair the immune system. The impairment of immune function increases susceptibility to infection, contributes to the development of physical disorders, and accelerates the progression of disease.
Biological systems are highly interdependent. A weak sense of self-efficacy to exercise control over stress activates a number of biological systems involved in the regulation of the immune system. Stress activated in the process of acquiring coping skills may have different effects than the stress we experience in aversive situations with no prospect of gaining any self-protective efficacy. There are substantial evolutionary benefits to experiencing improved immune function during the development of coping capabilities vital for effective adaptation. It would not be advantageous if acute stressors always impaired immune function because of their prevalence in everyday life. If this were the case, people would experience high vulnerability to infective agents that could quickly do them in. There is some evidence that providing people with effective means for managing stress, however, may have a positive effect on immune function. Moreover, stress aroused while gaining coping mastery over stressors can improve different components of the immune system. There are other ways in which perceived self-efficacy serves to promote health. Lifestyle habits can enhance or impair health. Positive habits enable us to exert behavioral influence over the vitality and quality of our health. Perceived self-efficacy affects every phase of personal change including whether people even consider changing their health habits; whether they enlist the motivation and perseverance needed to succeed should they choose to do so; and how well they maintain the habit changes they have achieved. The stronger their perceived self-efficacy, the more successful people are in reducing harmful health habits and including health-promoting habits into their regular lifestyle.
We provide this description of self-efficacy because in our research, we have found that it is key ingredient in whether or not people learn and perform self-management skills to control a chronic illness. Our experience has shown that up to seven years after being in a self-management program for asthma, patients thought that self-efficacy was the secret of their being able to manage their condition. Their experiences far exceeded any expectations we had of the program. More importantly, however, patients believed they were in control of their illness much more than their illness controlled them.
The above description of self-efficacy was adapted by a discussion in Bandura, A. (1994). Self-efficacy. In V. S. Ramachaudran (Ed.), Encyclopedia of human behavior (Vol. 4, pp. 71-81). New York: Academic Press. (Reprinted in H. Friedman [Ed.], Encyclopedia of mental health. San Diego: Academic Press, 1998). More writings on self-efficacy and social cognitive theory by Professor Bandura and others can be found at the following site: www.des.emory/mpf/self-efficacy.html