To summarise yesterday’s post, this quote from Latham & Locke (2007):
The theory of goal setting states that there is a positive
linear relationship between a specific high goal and task
performance. Thus, the theory makes explicit that a specific
high goal leads to even higher performance than urging
people to do their best. A goal also affects satisfaction
in that it serves as the standard for evaluating one’s own
performance. A higher goal requires higher performance
for a person to experience positive affect than does commitment
to a lower goal. Two factors affect the goals that
a person chooses: the importance of the goal to the individual
and self-efficacy, namely, self-confidence that the
goal for a specific task is, indeed, attainable. The mediators
of goal setting are choice, effort, persistence, and
strategy. Goals are moderated by ability, goal commitment,
feedback in relation to goal pursuit, the complexity
of the task for an individual or group, and situational factors
(e.g., presence of needed resources).
Today we’ll look at feedback, goal complexity, the relationship between personal goals and incentives, and satisfaction with performance.
Feedback: Without some sort of indication of the difference between where the person is performing currently and where they need to be, it seems that people have trouble working out exactly how much effort they need to put in to achieve. Usually, people who find out they’re performing below the level expected will increase their effort – or seek an alternative strategy to use. The combination of goals plus providing feedback is more effective than just setting goals.
What this means for pain management is that
- if the individual is just given tasks such as ‘do this set of exercises’, but no target is ever specified, they probably won’t persist with the exercises.
- if they are given an exercise target, eg walk for 20 minutes once a day, but it is never reviewed with them, they’ll find it more difficult to persist.
- if, however, they work together to set an exercise programme, establish how often they need to do it, and it’s reviewed periodically, then the chances of the person persisting increase.
Difficulty: It seems paradoxical that people who have achieved a difficult goal will, next time they set a goal, set a more difficult one. From the research that Locke & Latham reviewed, it seems that Bandura’s observation that ‘goal setting is first and foremost a discrepancy-creating process’ holds true. We’re not machines, simply responding to situations in our environment (discrepancies), we actively search out and create situations that demand persistence and the development of skills.
This suggests that, with encouragement, people who start to develop new skills will find ways to extend themselves by setting themselves new goals – depending upon, however, their level of self efficacy and the times they find themselves able to succeed. As the saying goes, ‘success breeds success’.
- People with pain often find themselves in an ongoing cycle of failure, as their efforts to cope using skills they’ve found helpful in the past fail to support them in their goals, and their self efficacy drops.
As I mentioned yesterday, people begin facing challenges (goals) by using skills they already have, if they don’t have those skills, they try to find skills they’ve used elsewhere to help them manage. When they find themselves without the necessary skills, they seek help from others – but if those others (especially important people, such as health care providers) cannot provide them with appropriate skills and encouragement, their self efficacy drops and they begin to withdraw from what they perceive as unsatisfying and unachievable goals.
Complexity: Most of the goals that we encourage people to develop in pain management are quite complex. They involve multiple changes across a range of thoughts and behaviours. Locke & Latham (2002) found that ‘as the complexity of the task increases and higher level skills and strategies have yet to become automatized, goal effects are dependent on the ability to discover appropriate task strategies’.
It seems that the availability of different strategies to choose from can influence how readily a complex goal can be achieved. This effect is influenced by the type of goal being demanded: performance-outcome goals can interfere with learning and integrating new strategies.
For example, a goal like ‘move all these boxes within 20 minutes’ demands speed and as a result newly acquired skills such as pacing may be forgotten. If instead, a specific difficult learning goal is required, for example ‘use your pacing skills to help you move these boxes within 20 minutes’ is given, high goals lead to better performance as compared with a general request to ‘do your best to move these boxes’.
Proximate goals: To make these complex goals more easily achieved, research suggests that it’s better to develop smaller ‘proximate’ goals. Locke & Latham found that poor performance (or errors) may be due to poorly constructed proximate goals – that is, these smaller goals may not actually directly contribute to the longer-term goals. The benefit of smaller sub-goals is probably due to the feedback from errors in the performance of these goals giving an individual a picture of how realistic their longer-term goal may be.
Goals have an influence on the level of satisfaction an individual feels. To set a goal says that the person is not satisfied with their current level of performance, and their ‘satisfaction level’ drops. As a goal is achieved, people feel more satisfied. But paradoxically, people who achieve the highest goals are the least satisfied with the present situation. They do more because they’re dissatisfied with less. Their ‘satisfaction set-point’ is set very high – and so they work very hard to achieve.
In pain management this may work against some of our patients. For example, the person who typically strives to do well may find developing ‘working to quota’ or activity regulation very hard to do, because their satisfaction comes from having achieved a very high standard. For these people specific and difficult learning goals may be more helpful than performance goals.
The above model shows what Latham & Locke (2007) describe as the ‘high performance cycle’. Although, as for all of the information I’ve review so far, it’s about organizational performance, there are many similarities between this cycle and what we observe in the performance of pain management goals.
What I’ve discovered as I’ve worked my way through the literature on goal-setting, is that while we talk about goal-setting within pain management settings, there is very little empirical research on it with patient groups. Tomorrow I’ll review one of the few papers I’ve seen – so y’all come back now!
Latham, G.P., Locke, E.A. (2007). New Developments in and Directions for Goal-Setting Research. European Psychologist, 12(4), 290-300. DOI: 10.1027/1016-9040.12.4.290