“Self-efficacy” is a concept that has been around for a long time in psychological science. Popularized by the famous psychologist Albert Bandura, PhD, the idea is simple: humans form beliefs about how well they can perform tasks successfully. Our performance in real-world tasks is influenced by how confident we are that we can perform those tasks to reach specific goals.

Self-efficacy is applicable to nearly every voluntary human behavior, but it becomes particularly interesting in the context of medical change, where tasks that may not have been much of a problem before the change are now significantly more difficult. For example, self-efficacy for memory ability (or memory self-efficacy) may decline in older adults who experience memory problems, or after a major medical event affecting thinking, like traumatic brain injury (TBI). Self-efficacy theory would also predict that a person’s negative memory beliefs affect their confidence and willingness to engage in everyday tasks that they perceive as memory-demanding. This decreased willingness to engage may, in turn, reduce participation in daily life activities broadly. In other words, poor memory self-efficacy can play a role in a chain of events potentially ending in poorer quality of life.

Umi Venkatesan, PhD, who directs the Brain Trauma and Behavior (BraTBehavior) Laboratory, recently published an article on a study examining memory self-efficacy in a unique group of individuals: adults 50 years of age or older with moderate-severe TBI. Co-authored by MRRI Institute Scientist Amanda Rabinowitz, PhD, and Penn State Professor of Psychology Frank Hillary, PhD, the study asked three main questions: 1) What individual characteristics (e.g., age or injury severity) are related to memory self-efficacy?; 2) How are memory self-efficacy, general psychological distress (e.g., depression and anxiety), and memory test performance related?; and 3) Is memory self-efficacy associated with self-reported ratings of health-related quality of life (e.g., satisfaction with cognitive, social, and physical health functioning)?

In 114 people with moderate-severe TBI, the study found that there is great variability in the level of self-reported memory self-efficacy (i.e., some have very negative memory beliefs, some are in the middle, and some have very positive memory beliefs). This variability was not related to demographic or injury characteristics, but this could have been due to the special nature of the group (middle-aged to older adults). Importantly, results showed that memory self-efficacy was related to general psychological distress, but it was also associated with memory performance even after taking this distress into account. Further, memory self-efficacy was associated with health-related quality of life independent of both psychological distress and memory test performance.

Putting all these results together, the study suggests that memory self-efficacy plays a role in both objective health indicators like memory test performance and in broader, subjective health outcomes like quality of life. While memory self-efficacy is related to general psychological distress, the two are distinct and should be considered separately in treatment.
A bigger picture lesson from the study is that researchers and clinicians should pay attention to what people think about their own functioning, rather than just how they score on clinical tests. This shift in perspective — from provider-determined to patient-driven — is an important step towards personalizing rehabilitation for adults with TBI.