Some people doubt the existance of a theory that happens to be either practical or useful, but perhaps this review (which is now relatively old, but still good!) will prove the rule. While this review covers goal-setting within an industrial/organisational context, it still offers some helpful advice and findings from both experimental and ‘field’ research. I’ll comment, of course, in terms of how this may fit within a clinical pain management context!
So, what is a goal? Locke and Latham (2002) define goals as ‘the object or aim of an action, for example, to attain a specific standard of proficiency, usually within a specified time limit.’ Their definition refers to performance of work-related tasks rather than ‘discrete intentions to take specific actions’ (and they give the example of applying to graduate school, to get a medical examination). Their definition relates quite well to those in chronic pain management, where the goals referred to are often ‘to increase sitting tolerance to 20 minutes’, or ‘to be able to take a shower safely’.
How difficult should a goal be? Although during the 1950’s it had been found there was a curvilinear inverse relationship between difficulty and performance, (that is, a goal shouldn’t be too low, nor too high, or performance was affected), Locke and Latham proposed there was a positive, linear relationship between difficulty and level of performance. They found that performance levelled off only once the limits of ability were reached, or when commitment to that goal lapsed.
Additionally, Locke and Latham found that specific, difficult goals consistently lead to better performance than just telling people to ‘do their best’. Having a target seems to work better because people have something to aim for, and are clear on what needs to be done.
What this implies for pain management, is that without a specific target to achieve, people have trouble knowing whether they’re ‘doing enough’. It seems to be important to have goals that the person feels are ‘just out of reach’ but are actually within their ability, and to be very specific about how often, how much, or exactly what they have to do, in order for them to be committed to making it happen. This suggests that a vague goal to ‘try using relaxation during the next week’ probably will work less effectively than identifying exactly how often, what time of day, and what type of relaxation should be attempted.
Social cognitive theory (I’ve posted on this before! Remember Bandura?) suggests that self-efficacy, or confidence that the individual can successfully achieve his or her goals plays an important part in goal-setting. Latham and Locke state that ‘when goals are self-set, people with high self-efficacy set higher goals than do people with lower self-efficacy’.
We know that self-efficacy for many activities can be affected by pain – the Pain Self Efficacy Questionnaire (Nicholas, 1989) measures self-efficacy to participate in a range of daily activities such as work, future goals, social activities and leisure despite pain using a 1 – 10 Likert-type scale, and although the maximum score is 60, most of the people we see at Pain Management Centre will achieve less than 20.
Goals appear to affect performance through four mechanisms, according to Locke and Latham (2002).
They are directive – that is, they ‘direct attention and effort toward goal-relevant activities and away from irrelevant activities’.
They energise – high goals lead to greater effort than low goals. This has been demonstrated with goals that require physical effort, repeated performance of cognitive tasks, subjective effort as well as physiological indicators of effort.
They affect persistence – when people can control how long they spend on tasks, hard goals elicit more time being spent on them. But what often happens is that people increase their work pace in order to achieve a goal rather than work more slowly but less intensely over a longer period of time.
They affect action indirectly by leading people to discover relevant information and strategies that they can use to achieve the goal. So it seems that people actively seek and use the information they have around them to solve problems in order to achieve goals – without them, the information they have may never be integrated.
There seems to be a hierarchy of ways that people search for, and use information relevant to the task:
1. People automatically use knowledge and skills they already have to achieve a goal.
2. If already existing knowledge and skills don’t quite cut it, people draw from related skills they may have used elsewhere.
3. If the task is actually new, they will deliberately plan to develop the skills necessary to achieve the goal.
4. People with high self-efficacy are more likely than those with low self-efficacy to develop effective task strategies. People may take some time to look for ways to achieve goals they are set.
5. When people are asked to address a complex task, sometimes encouraging them to do their best can work more effectively than the usual specific performance goal because anxiety to succeed can make them look for strategies to deliver in an unsystematic way and fail to learn what actually works.
6. When people are, instead, trained to use systematic strategies, people who are given specific high-demand goals are more likely to use those strategies than people who are given either nonspecific goals, or goals that don’t really demand high performance.
Commitment to goals moderates, or changes the goal and performance relationship. This is most important when goals are difficult because they require persistence. As I mentioned yesterday, importance and confidence drive commitment to goals.
Some things seem, from Locke and Latham’s research, to increase commitment – being public about a goal can increase importance and therefore commitment (maybe because of a desire to maintain integrity in other’s eyes), others inspiring action and being supportive can create demand characteristics that can enhance commitment. Goals that are imposed on people may or may not influence commitment – it seems to be more about the way in which the purpose of the goal is given than whether the person participates in the goal setting process.
Self-efficacy or confidence is influenced by ensuring adequate training is available (so the person knows what to do, especially if that training leads to a successful experience prior to the goal), role models that demonstrate success, and through verbal communication that expresses confidence that the person can achieveit, including information about ways that goals can be achieved.
For more information on feedback, complexity and other factors known to influence goal-setting – come on back tomorrow!
For today, here is a specific goal – read one of the goals you have written with or for a client with chronic pain before tomorrow.
Check these four things:
1. Does your goal have specific actions that the client needs to do?
2. Does your goal include a timeframe?
3. Does your client think this goal is important?
4. Does your client believe he or she can successfully achieve this goal?
If you can answer these four questions, and feel like stretching yourself – check these things:
1. Does your client know exactly how to do the goal?
2. If this goals requires using skills that are new to the client, have they had a successful attempt with your support?
3. Has your client had an opportunity to see anyone else achieve this goal?
4. Has your client been given the opportunity to make his or her goal public? Have they told anyone?
Let me know in the comments section if you’ve been able to achieve these goals. More tomorrow!
Locke, E.A., Latham, G.P. (2002). Building a practically useful theory of goal setting and task motivation: A 35-year odyssey.. American Psychologist, 57(9), 705-717. DOI: 10.1037/0003-066X.57.9.705