C H A P T E R
17
SELF-MANAGEMENT STRATEGIES
SELF-MONITORING, STIMULUS CONTROL, SELF-REWARD, AND SELF-EFFICACY
LEARNING OUTCOMES
After completing this chapter, you will be able to
1. Given a written client case description, describe the use
of self-monitoring and stimulus control for the client.
2. Teach another person how to engage in self-monitoring
as a self-change strategy.
3. Given a written client case description, be able to de-
scribe the use of a culturally relevant self-management
program for the client.
4. Teach another person how to use self-monitoring, stimu-
lus control, and self-reward.
In self-management, the helping professional aids the client
to better understand naturally occurring processes (predom-
inantly behavioral and psychological) that are believed to
exert considerable influence over behaviors or responses that
have become problematic for the client. Self-management is
a very teaching-oriented approach. During formal sessions,
the helper teaches clients about processes that are fuel-
ing problems and about processes that will lead to desired
changes after clients undertake stages of activities outside for-
mal sessions to achieve sustainable changes. Thus, the client
does most of the work between sessions. One of the major
goals of self-management intervention is to assist clients in
gaining a greater capacity for self-determined initiative, or
“agency,” relative to their goals and to achieve increasing
independence in their desired functioning.
In several respects, self-management draws on various
tools and interventions; a meaningful set is pulled together
by the client and helper, depending on assessment, goals,
and conditions. Self-management is a strongly collaborative,
environmentally attentive strategy that has been used across
a wide range of specific problems in living and with varying
clientele (e.g., age groups, disability status, problem severity,
cultural heritage). We do urge caution, for self-management
strategies can be presented or approached in a decontex-
tualized manner—inattentive, for example, to current or
historical environmental inequities or stressors that are as
much if not more the true source of the issues that the client
is struggling with. We see the emphasis on “self ” here to
be valuable toward empowering, goal-achieving awareness,
and skill building, not as a question of approaching clients
as selves that need to be managed to accommodate flawed
circumstances.
Definitions of self-management vary in part because dif-
ferent theorists emphasize different processes and strategies,
and in part because of overlap among related terms that
are sometimes used interchangeably and can be confusing.
For example, self-change methods have been referred to
as self-control, self-regulation, and self-management. We use
self-management because it conveys the notion of handling
one’s life within a set of life conditions and because literature
searches on this term will turn up applications of change
techniques more than basic research on underlying pro-
cesses. Also, the term self-management avoids the concepts
of inhibition and restriction often associated with the words
control and regulation—although these associations can be
misleading as in some self-regulatory applications that are
more about insight, opening up new options, and inte-
grative linkages among physiology, psychology, and social
phenomena.
In spite of differing emphases, self-management tends
to be anchored in social learning and social cognitive theo-
ries underlying cognitive–behavioral models. According to
Bandura (1986, 1997), for example, the social cognitive
theory holds that human behavior is extensively motivated
and regulated by the ongoing exercise of self-influence. The
major self-management processes operate through four prin-
cipal subfunctions: (1) self-monitoring of one’s behavior, its
components, and its effects; (2) judgment of one’s behavior;
(3) affective self-reactions; and (4) self-efficacy. Self-efficacy
plays a central role in the exercise of personal agency by its
strong impact on thought, affect, motivation, and action.
Self-efficacy is very important in helping clients achieve
treatment goals and enhancing their confidence and abil-
ity to execute the self-management strategies. Behavioral
change is very often challenging and frequently not pleasant.
If clients are involved in negotiating treatment planning
and setting goals, they are much more likely to implement
517
518 CHAPTER 17
the strategies and to achieve the change goals successfully.
Of course, there are also situation difficulties or symptoms
that cannot be readily changed. Part of the goal then may be
assisting clients to achieve coping strategies to handle these
intractable situations as effectively as realistically possible.
Self-management strategies have several client outcomes
that may include the following: (1) to use more effective
task, interpersonal, cognitive, and emotional behaviors; (2)
to alter perceptions of and judgmental attitudes toward
problematic situations or persons; and (3) either to change
or to learn to cope with a stress-inducing situation (Kanfer &
Gaelick-Buys, 1991, p. 307). We focus here on
Self-monitoring: observing and recording your own
particular behaviors (thoughts, feelings, and actions)
about yourself and your interactions with environ-
mental events
Stimulus control: prearranging antecedents or cues to
increase or decrease your performance of a target be-
havior
Self-reward: giving yourself a positive stimulus following
a desired response
Self-efficacy: increasing one’s beliefs and expectations of
being able to perform certain things under certain
situations
These strategies may be viewed as self-management be-
cause in each procedure the client, in a self-directed fash-
ion, monitors, alters, rewards, models, and possesses self-
efficacy to perform a specific task to produce the desired
behavioral changes. Of course, none of these strategies is
entirely independent of the client’s personal history, gender,
age, culture, ethnicity, and environmental variables. In fact,
because self-management treatment planning is so greatly
dependent on careful assessment of concerns and needs
and also on the client’s ability to take on a self-manager
role, diversity and contextualizing factors are particularly
important considerations.
In addition to these four self-management procedures, a
wide range of other change strategies are often found in the
clinical literature (e.g., problem solving, coping, stress man-
agement). Broadly speaking, a client can use nearly any help-
ing strategy in a self-directed manner. For example, a client
could apply relaxation training to manage anxiety by using
a relaxation training CD or DVD without the assistance
of a helper. In fact, some degree of client self-management
may be a necessary component of many significant change
efforts. However, not all change strategies are predicated on
the same degree of understanding the learning principles
underlying processes that self-management is. These self-
managed aspects of any formal change procedure typically
include the following:
1. Client self-directed practice in the interview
2. Client self-directed practice in the in vivo setting (often
through homework tasks)
3. Client self-observation and recording of target behaviors
or of homework
4. Client self-reward (verbal or material) for successful com-
pletion of action steps and homework assignments
CLINICAL USES OF SELF-MANAGEMENT
STRATEGIES
Self-management strategies have been used for a wide range
of clinical concerns (see Box 17.1). They have been applied
to many health problems, including arthritis, asthma, breast
cancer, comorbid medical conditions, diabetes, and irritable
bowel syndrome. Among the psychological problems for
which self-management strategies have recently been investi-
gated are attention-deficit/hyperactivity disorder (ADHD),
anger, anxiety, depression, and chronic mental illness. Self-
management has also been used to decrease substance and
alcohol abuse, to help compensate for developmental dis-
abilities, and to improve effectiveness in classroom behavior
of students with emotional or behavioral disorders. Mea-
sures of self-management, self-regulation, and self-efficacy
have been developed and are available for use in practice.
APPLICATIONS OF SELF-MANAGEMENT
WITH DIVERSE GROUPS
Self-management has been used with diverse groups of cli-
ents in areas such as health management, school success, rela-
tionship conflict, and HIV intervention. Jacob, Penn, Kulik,
and Spieth (1992) researched the effects of self-management
and positive reinforcement on the self-reported compliance
rate of African American women who performed breast
self-examinations over a nine-month period. Both self-
management and positive reinforcement were associated
with high compliance rates, especially for women who were
designated initially as “monitors” (e.g., more likely to “track”
things about themselves).
Yip and colleagues (2007) used an arthritis self-management
program combined with exercise in a Chinese population
suffering from osteoarthritis. The authors tailored the pro-
gram to be culturally relevant in several ways, including
omitting a typically Western component of cognitive emo-
tional therapy, because a pilot study revealed that many
of the participants did not feel that learning emotional
management was relevant to their needs. Instead, the patients
desired to learn how to use exercise, including the tradition
of Tai Chi, to control their arthritis symptoms. The inter-
vention group showed significant improvement on most
measures compared to a control group, and the authors

BOX 17.1 RESEARCH ON SELF-MANAGEMENT
ADHD
Gureasko-Moore, S., DuPaul, G. J., & White, G. P. (2006).
The effects of self-management in general education class-
rooms on the organizational skills of adolescents with
ADHD. Behavior Modification, 30 (2), 159–183.
Arthritis
Goodacre, L. (2006). Women’s perceptions on managing
chronic arthritis. British Journal of Occupational Therapy,
69 (1), 7–14.
Yip, Y. B., Sit, J. W., Fung, K. K. Y., Wong, D. Y. S., Chong,
S. Y. C., Chung, L. H., & Ng, T. P. (2007). Impact of an
arthritis self-management programme with an added
exercise component for osteoarthritic knee sufferers on
improving pain, functional outcomes, and use of health care
services: An experimental study. Patient Education and
Counseling, 65 (1), 113–121.
Asthma
Clark, N. M., Gong, M., Kaciroti, N., Yu, J., Wu, G., Zeng,
Z., & Wu, Z. (2005). A trial of asthma self-management in
Beijing schools. Chronic Illness, 1(1), 31–38.
Horner, S. D. (2006). Home visiting for intervention delivery
to improve rural family asthma management. Journal of
Community Health Nursing, 23 (4), 213–223.
Breast Cancer Survivors
Cimprich, B., Janz, N. K., Northouse, L., Wren, P. A., Given, B., &
Given, C. W. (2005). Taking charge: A self-management
program for women following breast cancer treatment.
Psycho-Oncology, 14 (9), 704–717.
Damush, T. M., Perkins, A., & Miller, K. (2006). The
implementation of an oncologist referred, exercise self-
management program for older breast cancer survivors.
Psycho-Oncology, 15 (10), 884–890.
Career Development
Kuijpers, M. A. C. T., & Scheerens, J. (2006). Career compe-
tencies for the modern career. Journal of Career Develop-
ment, 32 (4), 303–319.
Chronic Illness
Harvey, I. S. (2006). Self-management of a chronic illness:
An exploratory study on the role of spirituality among
older African American women. Journal of Women and
Aging, 18 (3), 75–88.
Swerissen, H., Belfrage, J., Weeks, A., Jordan, L., Walker, C.,
Furler, J., et al. (2006). A randomised control trial of
a self-management program for people with a chronic
illness from Vietnamese, Chinese, Italian and Greek back-
grounds. Patient Education and Counseling, 64 (1–3),
360–368.
SELF-MANAGEMENT STRATEGIES 519
Comorbid Medical Conditions
Bayliss, E. A., Ellis, J. L., Steiner, J. F., & Main, D. S. (2005).
Initial validation of an instrument to identify barriers to
self-management for persons with co-morbidities. Chronic
Illness, 1(4), 315–320.
Depression
Bachman, J., Swenson, S., Reardon, M. E., & Miller, D. (2006).
Patient self-management in the primary care treatment of
depression. Adminstration and Policy in Mental Health and
Mental Health Services Research, 33 (1), 76–85.
Scholz, U., Knoll, N., Sniehotta, F. F., & Schwarzer, R. (2006).
Physical activity and depressive symptoms in cardiac reha-
bilitation: Long-term effects of a self-management interven-
tion. Social Science and Medicine, 62 (12), 3109–3120.
Diabetes
Bell, R. A., Stafford, J. M., Arcury, T. A., Snively, B. M., Smith,
S. L., Grzywacz, J. G., & Quandt, S. A. (2006). Comple-
mentary and alternative medicine use and diabetes self-
management among rural older adults. Complementary
Health Practice Review, 11(2), 95–106.
Nagelkerk, J., Reick, K., & Meengs, L. (2006). Perceived bar-
riers and effective strategies to diabetes self-management.
Journal of Advanced Nursing, 54 (2), 151–158.
Oster, N. V., Welch, V., Schild, L., Gazmararian, J. A., Rask, K.,
& Spettell, C. (2006). Differences in self-management
behaviors and use of preventive services among diabetes
management enrollees by race and ethnicity. Disease
Management, 9 (3),167–175.
HIV/AIDS
Kemppainen, J. K., Eller, L. S., Bunch, E., Hamilton, M. J.,
Dole, P., Holzemer, W., et al. (2006). Strategies for self-
management of HIV-related anxiety. AIDS Care, 18 (6),
597–607.
Irritable Bowel Syndrome
Bogalo, L., & Moss-Morris, R. (2006). The effectiveness of
homework tasks in an irritable bowel syndrome cognitive
behavioural self-management programme. New Zealand
Journal of Psychology, 35 (3), 120–125.
Medication Management
Muir-Cochrane, E., Fereday, J., Jureidini, J., Drummond, A.,
& Darbyshire, P. (2006). Self-management of medication
for mental health problems by homeless young people.
International Journal of Mental Health Nursing, 15 (3),
163–170.
Mental Retardation
Chapman, R. A., Shedlack, K. J., & France, J. (2006). Stop–
think–relax: An adapted self-control training strategy for
(continued )
520 CHAPTER 17
BOX 17.1 RESEARCH ON SELF-MANAGEMENT
(continued )
individuals with mental retardation and coexisting psy-
chiatric illness. Cognitive and Behavioral Practice,13 (3),
205–214.
Pain
Austrian, J. S., Kerns, R. D., & Reid, M. C. (2005). Perceived
barriers to trying self-management approaches for chronic
pain in older persons. Journal of the American Geriatrics
Society, 53 (5), 856–861.
Buck, R., & Morley, S. (2006). A daily process design
study of attentional pain control strategies in the self-
management of cancer pain. European Journal of Pain,
10 (5), 385–398.
posited that the cultural relevance and specificity of the
intervention was crucial.
Swerissen et al. (2006) tested the effectiveness of a chronic
disease self-management program with four immigrant
populations living in Victoria, Australia. This community-
based intervention was delivered in the native languages
of the immigrant groups—Chinese, Greek, Italian, and
Vietnamese—and consisted of symptom management,
problem solving, dealing with disease-related emotions, ex-
ercise and relaxation, meditation, healthy eating, and com-
munication skills. Participants had better outcomes on a
variety of measures, including energy, exercise, pain, and
fatigue. Results varied by group, however, with the Chinese
and Vietnamese participants demonstrating greater benefits.
The authors argue that self-management techniques may
not be equally effective across all populations. Given the
variability in how self-management interventions are opera-
tionalized, further research is required to understand more
about which components and strategies are more or less well
suited for differing populations.
Harvey (2006) conducted a qualitative, exploratory study
of the use of spirituality in the self-management of chronic
illness by African American women. In her interviews, four
themes emerged: (1) using spiritual practices in combina-
tion with traditional medicine in self-management; (2) em-
powerment to health-promotive practices; (3) using prayer
as a mediator of illness; and (4) spirituality as a coping
mechanism. Harvey argues that spirituality should be an
important aspect of interventions with older African Ameri-
can women, and that it can be used to improve self-efficacy,
coping, and health-promotive activities.
Roberson (1992) also explored the role of compliance and
self-management in adult rural African Americans who had
been diagnosed with chronic health conditions. She found
Students with Behavior and Emotional Disorders
Mooney, P., Ryan, J. B., Uhing, B. M., Reid, R., & Epstein,
M. H. (2005). A review of self-management interventions
targeting academic outcomes for students with emotional
and behavioral disorders. Journal of Behavioral Education,
14(3), 203–221.
Substance Abuse
Koerkel, J. (2006). Behavioural self-management with prob-
lem drinkers: One-year follow-up of a controlled drink-
ing group treatment approach. Addiction Research and
Theory, 14 (1), 35–49.
Sobell, M. B., & Sobell, L. C. (2005). Guided self-change
model of treatment for substance use disorders. Journal of
Cognitive Psychotherapy, 19 (3), 199–210.
that the patients and their health professionals had different
notions of compliance and also different treatment goals.
The patients defined compliance in terms of apparent “good
health” and wanted treatments that were manageable, viable,
and effective. They developed systems of self-management
to cope with their illnesses that were suitable to their life-
styles, belief patterns, and personal priorities. They believed
they were managing their illnesses and treatment regimens
effectively. Roberson (1992) suggested that as professionals
we need to focus less on noncompliance rates per se and
more on understanding differing perspectives and enhanc-
ing clients’ efforts to manage their own illnesses and to live
effectively with them.
Asthma has been a health focus. Haire-Joshu, Fisher,
Munro, and Wedner (1993) explored attitudes toward
asthma care within a sample of low-income African Ameri-
can adults receiving services at a public acute care facil-
ity versus patients receiving services at a private setting
that stressed preventive self-management. Those persons
in the acute care setting were more likely to engage in self-
treatment (such as relying on over-the-counter medication)
or to avoid or delay care, compared to the patients who had
learned preventive asthma self-management techniques—
findings that urge attention to factors such as access to
resources and differential histories with service providers
in planning interventions. An innovative computer-assisted
instructional program (the main character in the game could
match the subject on gender and ethnicity; the protagonist’s
asthma could be tailored similarly to the subjects) to improve
asthma self-management in inner-city children has achieved
promising initial results in both self-management behaviors
and health outcomes (Bartholomew et al., 2000). Rao and
Kramer (1993) found self-control to be an important aspect
of stress reduction and coping among African American

mothers who had infants with sickle cell conditions. Nota-
bly, other strategies complementary to self-control (positive
reappraisal, seeking social support, problem solving) were
also found useful.
Self-management has also been found to be an effective
component of HIV-infection risk reduction training with gay
men (Kelly & St. Lawrence, 1990; Martin, 1993). In a study
of several hundred African American youth, self-manage-
ment was part of an eight-week HIV-risk-reduction program
that compared receiving either information or skills training
versus both information and skills training (St. Lawrence
et al., 1995). Youth who received both information and skills
training lowered their risk to a greater degree, maintained
risk reduction changes better, and deferred the onset of sexual
activity to a greater extent than those who received only one
component of training. However, issues of dropout and per-
ceived self-relevance have also been raised in HIV-prevention
interventions for inner-city heterosexual African American
men (Kalichman, Rompa, & Coley, 1997).
Research has indicated the utility of broadening the view of
resources to be included in self-management interventions—
to draw upon environmental resources such as social sup-
port people and networks, spirituality, and opportunities to
work with families or communities to develop culturally rel-
evant approaches. A computer-assisted program applied to
asthma self-management is one such example. In addition to
research findings, Bartholomew and colleagues (2000) also
offer an overview of applying theory (e.g., about self-efficacy
and self-regulatory processes) to a self-management need
in a culturally sensitive manner. Wang and Abbott (1998)
describe a project to work with a Chinese community group
toward developing a culturally sensitive community-based
self-management program for chronic diseases such as dia-
betes and hypertension. Faith, prayer, and religious activities
were demonstrated to be importantly associated with health
management among a racially diverse group of rural older
adults (Arcury, Quandt, McDonald, & Bell, 2000), arguing
for the need to consider such factors in developing self-
management plans. In related work, factors that need to be
considered in working with rural populations, particularly
among vulnerable elders such as those widowed, have been
addressed relative to nutritional self-management (Quandt,
McDonald, Arcury, Bell, & Vitolins, 2000).
It would seem that self-management could be incorpo-
rated as a culturally effective intervention with many clients
from diverse groups, especially as self-management is time
limited, deals with the present, and focuses on pragmatic
problem resolution (Sue & Sue, 2003). Similarly, focus
on behavioral patterns as well as beliefs or orientations to
promote action and not just “talk” and self-exploration
would be consistent with the use of a self-management in-
tervention. However, we would note that self-management
need not be construed to be a “lone ranger” or nonreflective
SELF-MANAGEMENT STRATEGIES 521
method, but rather one that can sensibly build on environ-
mental resources and cultural perspectives about self and
problem solving. Self-management may also appeal to some
clients who do not like or feel comfortable with traditional
mental health services. Keep in mind that in self-management
efforts, the work is client managed, and most of it occurs
outside helping sessions. Values and belief systems (e.g., that
self-reliance, faith, and inclusion in community are impor-
tant general strategies for living) as well as characteristics
of the client’s environment—social, material, informational,
sociopolitical—can be important dimensions of assessment to
guide appropriate self-management intervention planning.
However, caution must be used in selecting self-management
as an appropriate intervention for all clients from diverse
cultural groups. McCafferty (1992) has suggested that the
process of self-regulation varies among cultures and soci-
eties. Some of the notions involved in self-management
strategies are decidedly Eurocentric. Casas (1988) asserts
that the basic notion underlying self-management may “not
be congruent with the life experiences of many racial/ethnic
minority persons. More specifically, as a result of life experi-
ences associated with racism, discrimination, and poverty,
people may have developed a cognitive set (e.g., an external
locus of control, an external locus of responsibility, and
learned helplessness) that . . . is antithetical to any self-
control approaches” (pp. 109–110). For example, within
a framework of worldviews, there are four quadrants in
Sue and Sue’s (2003) cultural identity model based on the
dimensions of locus of control and the locus of responsibil-
ity. These quadrants range from internal control to external
control and from internal responsibility to external responsibil-
ity. Thus, locus of control and locus of responsibility seem
to be mediating variables that affect the appropriateness of
using self-management for some women clients and for
some clients of color. In an innovative study conducted by
St. Lawrence (1993), African American female and male youth
completed measures of knowledge related to AIDS, attitudes
toward the use of condoms, vulnerability to HIV infection,
peer sexual norms, personal sexual behavior, contraceptive
preferences, and locus of control. Condom use as prevention
was associated with greater internal locus of control, which
was higher for the African American girls than for the boys.
In addition to the mediating variables of locus of control and
locus of responsibility, the client’s identification with his or
her cultural (collective) identity, acculturation status, and as-
similation may also be mediating variables that affect the use
of self-management for non-Euro-American clients.
GUIDELINES FOR USING SELF-MANAGEMENT
WITH DIVERSE GROUPS OF CLIENTS
We recommend the following guidelines in using self-
management approaches with diverse groups of clients.
522 CHAPTER 17
First, consider the client’s lifestyle, beliefs, behavioral pat-
terns, and personal priorities in assessing the usefulness of
self-management. For example, if the client is interested
in following the progress of events, a strategy such as self-
monitoring may be relevant to his or her personal and cogni-
tive style. For clients who have no interest in such tracking,
self-monitoring may appear to be a waste of time, an activity
that is personally and culturally irrelevant.
Second, adapt the intervention to the client’s culture and
background. Some clients have been socialized to be very
private and would feel most uncomfortable in publicly dis-
playing their self-monitoring data. Other clients would be
unlikely to discipline themselves to go to one place to obtain
stimulus control, such as using a smoking chair to help
control smoking. And, depending on the client’s history, the
idea of using self-rewards may be awkward or benefit from
reframing. At the very least, the rewards must be tailored to
the client’s gender, age, and culture.
Third, discover the client’s worldview and consider the
relevance of self-management based on this perception of
the world. For clients whose cultural identity or the targeted
issue is shaped by an external locus of control and an exter-
nal locus of responsibility, self-management may not be a
good match or may need to be discussed as an option with
such factors in mind.
Fourth, consider the relevance of self-management against
the client’s goals for helping intervention and also the context
of the client’s life. If the client is also struggling with multiple
problems in living, aversive external structures and discrimi-
nation, serious vulnerabilities, or overwhelming pressures,
self-management would have a limited role, if deemed ap-
propriate at all. Consider, for example, how it might feel if
you were a low-income mother with no social support and
few resources and were regularly beaten by your live-in male
partner—and your helping practitioner told you to engage in
some form of self-management. One or more self-management
strategies, however, may provide some concrete relief—
perhaps in better managing a health problem or in helping
her child better manage troubling classroom behavior—
that can be a meaningful part of a larger set of goals.
Fifth, consider the client’s access to resources, and be
aware that resources may differ for oppressed individuals
within society. Barriers can be due to personal characteris-
tics, such as literacy, disability, or transportation, as well as to
structural problems such as racism, homophobia, or similar
prejudices and inequities that may make it more difficult for
some clients to self-manage.
CHARACTERISTICS OF AN EFFECTIVE
SELF-MANAGEMENT PROGRAM
Well-constructed and well-executed self-management pro-
grams have some advantages over helper-administered
procedures. For instance, the use of a self-management
procedure may increase a person’s perceived control over
the environment and decrease dependence on the helper
or others. Perceived control over the environment often
motivates and supports a person to take some action.
Second, self-management approaches are practical—
inexpensive and portable (Thoresen & Mahoney, 1974,
p. 7). Third, such strategies are usable. By this we mean that
a person will occasionally refuse to go “into therapy” or
formalized helping to stop drinking or to lose weight but
will agree to use the self-administered instructions that a
self-management program provides. This may be particu-
larly advantageous with some clients who are mistrust-
ful of therapy or related forms of professional helping.
Finally, self-management strategies may enhance gener-
alization of learning—both from the interview to the
environment and from problematic to nonproblematic
situations (Thoresen & Mahoney, 1974, p. 7). These are
some of the possible advantages of self-management that
have spurred both researchers and practitioners to apply
and explore some of the components and effects of suc-
cessful self-management programs.
Although many questions remain unanswered, we can
tentatively say that the following factors may be important
in an effective self-management program:
1. A combination of strategies, some focusing on anteced-
ents of behavior and others on consequences
2. Consistent use of strategies over a period of time
3. Evidence of client self-evaluation, goal setting, and self-
efficacy
4. Use of covert, verbal, or material self-reinforcement
5. Some degree of external or environmental support
Combination of Strategies
We have mentioned that self-management is often com-
bined with other change strategies and that a combination
of self-management strategies is usually more useful than a
single strategy. In a weight-control study, Mahoney, Moura,
and Wade (1973) found that the addition of self-reward
significantly enhanced the procedures of self-monitoring and
stimulus control, and that those who combined self-reward
and self-punishment lost more weight than those who used
just one of the procedures. Stress inoculation training in-
cludes application of self-management principles within a
multicomponent package, with considerable support across
a variety of concerns (Meichenbaum, 1994) and with chil-
dren and adolescents (Ollendick & King, 2000). Examples
include combining self-management strategies with medita-
tion, relaxation methods, coping skill supports, reframing
techniques, cognitive restructuring, education, and exercise.
Consistent, regular use of the strategies is a very impor-
tant component of effective self-management. Seeming

ineffectiveness may be partly attributable to sporadic or
inconsistent use. Some individuals may be more likely
than others to apply self-management strategies with the
regularity that is needed. Lack of positive outcomes in a
self-management program may be due to lack of clarity
about how best to use the procedures, or it may reflect lack
of efficacy even with consistent application. Also, if self-
management efforts are not used over a certain period of
time, their effectiveness may be too limited to produce any
change. Ongoing assessment as to the fit of these techniques
for clients is needed. Those who have external supports and
encouragement for consistency of use are also likely to have
a more successful experience.
Self-Evaluation, Standard Setting, and Self-Efficacy
Self-evaluation in the form of standard setting (or goal set-
ting) and intention statements seems to be an important
component of a self-management program. Some evidence
also suggests that self-selected stringent standards affect
performance more positively than do lenient standards
(Bandura, 1971). It is important to distinguish outcome
expectations (one’s beliefs about whether a certain behavior
or event will produce a particular outcome) from self-efficacy
expectations (the belief or level of confidence a person has in
his or her ability to develop intentions, set behavioral goals,
and successfully execute the behaviors in question). A client
may have confidence that she or he can manage a certain ac-
tion but may not undertake it because of a belief that it will
not accomplish the desired outcome (or that obstacles will
intervene to prevent the desired outcome). In some cases,
these readings of a situation may be realistic, underscoring
the importance of careful assessment of a client’s circum-
stances and other agents or factors that may have significant
roles in the desired outcome.
In general, however, perceived self-efficacy is seen by many
as a centrally important component. Without this, it is dif-
ficult at best to build an intervention program that requires
substantial client involvement or to achieve incrementally
successful, reinforcing outcomes along the way. Strengthen-
ing efficacy expectations can augment an internal resource
crucial to subsequent successes in a self-management in-
tervention. For example, successful self-controllers usually
set higher goals and criteria for change than unsuccessful
self-controllers do. However, the standards set should be
realistic and within reach; otherwise, it is unlikely that
self-reinforcement will ever occur. Bandura (1997) offers a
discussion of sources through which self-efficacy expecta-
tions are typically influenced: (1) one’s own performance
accomplishments, (2) vicarious experience (e.g., observing
others, reading stories, imagining), (3) verbal persuasion, and
(4) physiological and affective states (e.g., strategies to pair
a positive mood and a relaxed state with conditions under
which self-efficacy is needed).
SELF-MANAGEMENT STRATEGIES 523
Use of Self-Reinforcement
Self-reinforcement, whether covert, verbal, or material,
appears to be an important ingredient of an effective self-
management program. Being able to praise oneself covertly
or to note positive improvement seems to be correlated with
self-change. In contrast, self-criticism (covert and verbal)
seems to mitigate against change (Mahoney & Mahoney,
1976). It is important to consider what any given cli-
ent will experience as genuinely reinforcing. For example,
some people may find that material self-reward (such as
money or valued items) may be more effective than either
self-monitoring or self-punishment; others may find vari-
ous forms of social support or pride to be more effective.
Self-reinforcement must also be relevant to the client’s
gender and culture.
Environmental Support
Some degree of external support is necessary to effect and
maintain the changes resulting from a self-management pro-
gram. For example, public display of self-monitoring data
and the help of another person provide opportunities for
social reinforcement that often augment behavior change.
Successful self-controllers may report receiving more posi-
tive feedback from others about their change efforts than do
unsuccessful self-controllers. To maintain any self-managed
change, there must be some support from the social and
physical environment, although how this is best achieved
may vary for clients from different cultural backgrounds, age
cohorts, or life circumstances. We previously used examples
to illuminate variability in how “self ” may be conceptual-
ized differently among people and how self-management
may be embedded for some within networks, communi-
ties, historical legacies, or current conditions that should
be considered. The examples illustrated ways that faith and
spirituality may be important along with support networks
and cultural identities (Gartett, 1999, provides an example
for Native American youth).
STEPS IN DEVELOPING A CLIENT
SELF-MANAGEMENT PROGRAM
We have incorporated those five characteristics of effective
self-management into a description of the steps associated
with a self-management program. The steps are applicable
to any program in which the client uses stimulus control,
self-monitoring, or self-reward. Figure 17.1 summarizes
the steps associated with developing a self-management
program; the characteristics of effective self-management
reflected in the steps are noted in the left column of the
figure.
For developing a self-management program, steps 1 and 2
both involve aspects of standard setting and self-evaluation.
524 CHAPTER 17

Characteristics of an Effective Steps in Developing a

Self-Management Program Self-Management Program

Standard setting, self-evaluation, Step 1

and self-efficacy Client identifies and records target
behavior, controlling antecedents, and
consequences (baseline); estimates
confidence in achieving target behavior

Standard setting, self-evaluation, Step 2

and self-efficacy Client identifies desired behavior and
direction of change (goals); estimates
confidence in achieving goals

Combination of strategies Step 3

Helper explains possible self-management
strategies

Combination of strategies Step 4

Client selects one or more self-management
strategies

Client commitment and Step 5

consistent use of strategies Client verbally commits to carry out
step 4

Consistent use of strategies Step 6

Helper instructs and models selected strategies

Consistent use of strategies Step 7

Client rehearses selected strategies

Consistent use Step 8 Step 9

of strategies Client uses selected strategies Client records use of strategies and
in vivo level of target behavior

Self-evaluation Step 10 Step 11

Self-reinforcement Client’s data are reviewed by helper Charting or posting of data results in
Environmental support and client; client continues as is or self- and environmental reinforcement
makes revisions in program for client progress

Figure 17.1 Developing an Effective Self-management Program

In step 1, the client identifies and records the target behavior
and its antecedents and consequences. This step involves
self-monitoring, in which the client collects baseline data
about the behavior to be changed. If baseline data have
not been collected as part of assessment, it is imperative
that such data be collected now, before using any self-
management strategies. In step 2, the client explicitly iden-
tifies the desired behavior, conditions, and level of change.
The behavior, conditions, and level of change are the three
parts of a counseling outcome goal. Defining the goal is an
important part of self-management because of the possible
motivating effects of standard setting. Establishing goals
may interact with some of the self-management procedures
and contribute to the desired effects.

Steps 3 and 4 are directed toward helping the client select
a combination of self-management strategies to use. The
helper will need to explain all the possible self-management
strategies to the client (step 3). The helper should empha-
size that the client should select some strategies that involve
prearrangement of the antecedents and some that involve
manipulation and self-administration of consequences.
Ultimately, the client is responsible for selecting which self-
management strategies should be used (step 4). Client se-
lection of the strategies is an important part of the overall
self-directed nature of self-management, although this step
may benefit from assistance from the professional helper or
others involved in supporting the client’s efforts in sorting
through the choices.
Steps 5–9 all involve procedural considerations that may
strengthen client commitment and may encourage consis-
tent use of the strategies over time. First, the client commits
himself or herself verbally by specifying what and how much
change is desired and the action steps (strategies) the client
will take to produce the change (step 5). Next, the helper
instructs the client in how to carry out the selected strate-
gies (step 6). (The helper can follow the guidelines listed
later in the chapter for self-monitoring, those for stimulus
control, and those for self-reward.) Explicit instructions and
modeling by the helper may encourage the client to use a
procedure more accurately and effectively. The instructional
set given by a helper may contribute to some degree to the
overall treatment outcome. The client also may use the strat-
egies more effectively if there is an opportunity to rehearse
the procedures in the interview under the helper’s direction
(step 7). Finally, the client applies the strategies in vivo (step 8)
and records (monitors) the frequency of use of each strategy
and the level of the target behavior (step 9). Some of the
treatment effects of self-management may also be a function
of the client’s self-recording.
Steps 10 and 11 involve aspects of self-evaluation, self-
reinforcement, and environmental support. The client has an
opportunity to evaluate progress toward the goal by review-
ing the self-recorded data collected during strategy imple-
mentation (step 10). Review of the data may indicate that
the program is progressing smoothly or that some adjust-
ments are needed. When the data suggest that some progress
toward the goal is being made, the client’s self-evaluation
may set the occasion for self-reinforcement. Charting or
posting the data (step 11) can enhance self-reinforcement
and can elicit important environmental support for long-
term maintenance of client change.
In the next section we describe how self-monitoring can
be used to record the target behavior. Such recording can
occur initially for problem assessment and goal setting, or it
can be introduced later as a self-change strategy. We discuss
how self-monitoring can be specifically used to promote
behavior change.
SELF-MANAGEMENT STRATEGIES 525
SELF-MONITORING: PURPOSES, USES,
AND PROCESSES
Purposes of Self-Monitoring
Self-monitoring is a process in which clients observe and
record things about themselves and their interactions with
environmental situations. Self-monitoring is a useful ad-
junct to assessment because the observational data can verify
or change the client’s verbal report about the target behavior.
We recommend that clients record their daily self-observa-
tions over a designated time period on a behavior log. Usu-
ally, the client observes and records the target behavior, the
controlling antecedents, and the resulting consequences.
Self-monitoring is a core first step in any self-change
program. The client must be able to discover what is hap-
pening before implementing a self-change strategy, just as the
helper must know what is going on before using any other
therapeutic procedure. In other words, any self-manage-
ment strategy, like any other strategy, should be preceded
by a baseline period of self-observation and recording. Dur-
ing this period, the client collects and records data about
the behavior to be changed (B), the antecedents (A) of the
behavior, and the consequences (C) of the behavior. In addi-
tion, the client may wish to note how much or how often the
behavior occurs. For example, a client might record the daily
amount of study time or the number of times he or she left
the study time and place to do something else. Behavior logs
used to collect assessment data can also be used by a client
to collect baseline data before implementing a self-manage-
ment program. If the helper introduces self-management
strategies after assessment, these self-observation data should
be already available.
Self-monitoring is also very useful for evaluation of goals
or outcomes. When a client self-monitors the target behav-
ior either before or during a treatment program, “the pri-
mary utility of self-monitoring lies in its assessment or data
collection function” (Ciminero, Nelson, & Lipinski, 1977,
p. 196). However, practitioners and researchers have realized
that the mere act of self-observation can produce change.
As one collects data about oneself, the data collection may
influence the behavior being observed. We now know that
self-monitoring is useful not only to collect data but also to
promote client change. If properly structured and executed,
self-monitoring can be used as one type of self-management
strategy. (See Learning Activity 17.1.)
Clinical Uses of Self-Monitoring
A number of research reports and clinical studies have ex-
plored self-monitoring as a major change strategy. Box 17.2
indicates a variety of subjects for which self-monitoring has
been recently investigated as a change strategy. These include
ADHD, binge eating, obesity, classroom behavior, depression,
psychosis, spinal cord injury, and stress. Other recently
526 CHAPTER 17
LEARNING ACTIVITY 17.1
This activity is designed to help you use self-
monitoring yourself. The instructions describe a
self-monitoring plan for you to try out.
1. Discrimination of a target response:
a. Specify one target behavior you would like to
change. Pick either the positive or the negative side
of the behavior to monitor—depending on which
you value more and whether you want to increase
or decrease this response.
b. Write down a definition of this behavior. How clear
is your definition?
c. Can you write some examples of this behavior? If
you had trouble with these, try to tighten up your
definition—or contrast positive and negative in-
stances of the behavior.
2. Recording of the response:
a. Specify the timing of your self-recording. Remember
the rules of thumb:
(1) Use prebehavior monitoring to decrease an un-
desired response.
(2) Use postbehavior monitoring to increase a de-
sired response.
(3) Record immediately—don’t wait.
(4) Record when there are no competing re-
sponses.
investigated applications include alcohol consumption, self-
injurious behavior, obsessive–compulsive behaviors, smok-
ing cessation, suicidal ideation, managing conditions such as
inflammatory bowel disease, and panic. Self-monitoring has
been used with many different populations. Examples from
recent research include people with a range of disabilities,
people with chronic mental illness, immigrants, children,
elders, and caregivers, and across cultures. Attention to self-
monitoring may help achieve a more nuanced understand-
ing of processes—such as Kosic, Mannetti, and Sam’s (2006)
finding that self-monitoring plays a role in moderating be-
tween differing acculturation strategies and the sociocultural
and psychological adaptation outcomes of immigrants.
Factors Influencing the Reactivity of Self-Monitoring
Two issues involved in self-monitoring are the reliability of
the self-recording and its reactivity. Reliability, the accuracy
of the self-recorded data, is important when self-monitoring
is used to evaluate the goal behaviors. However, when self-
Self-Monitoring
b. Select a method of recording (frequency, duration,
and so on). Remember:
(1) Frequency counts for clearly separate occur-
rences of the response
(2) Duration or latency measures for responses that
occur for a period of time
(3) Intensity measures to determine the severity of a
response
c. Select a device to assist you in recording. Remember
that the device should be
(1) Portable
(2) Accessible
(3) Economical
(4) Obtrusive enough to serve as a reminder to self-
record
d. After you have made these determinations, engage
in self-monitoring for at least a week (preferably
two). Then complete steps 3, 4, and 5.
3. Charting of the response: Take your daily self-recording
data and chart them on a simple line graph for each
day that you self-monitored.
4. Displaying of data: Arrange a place (that you feel com-
fortable with) to display your chart.
5. Analysis of data: Compare your chart with your stated
desired behavior change. What has happened to the
behavior?
monitoring is used as a change strategy, the accuracy of the
data may be less crucial. From a helping perspective, the
reactivity of self-monitoring can support its use as a change
strategy. As an example of reactivity, Kanfer and Gaelick-
Buys (1991) noted that a married or partnered couple using
self-monitoring to observe their frequent arguments reported
that whenever the monitoring device (a camcorder) was
turned on, the argument was avoided. Similarly, the process
of carefully monitoring one’s habits raises self-awareness,
which in itself can support self-control strategies that change
these habits (cf. Karoly, 2005).
Although the reactivity of self-monitoring can be a di-
lemma in data collection, it can be an asset when self-
monitoring is used intentionally as a helping strategy. In
using self-monitoring as a change strategy, try to maximize
the reactive effects of self-monitoring—at least to the point
of producing desired behavioral changes. Self-monitoring
for long periods of time maintains reactivity. A number of
factors seem to influence the reactivity of self-monitoring.

BOX 17.2 RESEARCH ON SELF-MONITORING
ADHD
Harris, K. R., Friedlander, B. D., Saddler, B., Frizzelle, R.,
& Graham, S. (2005). Self-monitoring of attention versus
self-monitoring of academic performance: Effects among
students with ADHD in the general education classroom.
Journal of Special Education, 39 (3), 145–156.
Binge Eating
Hildebrandt, T., & Latner, J. (2006). Effect of self-monitor-
ing on binge eating: Treatment response or “binge drift”?
European Eating Disorders Review, 14 (1), 17–22.
Child Obesity
Germann, J. N., Kirschenbaum, D. S., & Rich, B. H. (2007).
Child and parental self-monitoring as determinants of suc-
cess in the treatment of morbid obesity in low-income
minority children. Journal of Pediatric Psychology, 32 (1),
111–121.
Classroom Behavior
Amato Zech, N. A., Hoff, K. E., & Doepke, K. J. (2006).
Increasing on-task behavior in the classroom: Extension
of self-monitoring strategies. Psychology in the Schools,
43 (2), 211–221.
Classroom Social Skills
Peterson, L. D., Young, K. R., Salzberg, C. L., West, R. P.,
& Hill, M. (2006). Using self-management procedures to
improve classroom social skills in multiple general educa-
tion settings. Education and Treatment of Children, 29 (1),
1–21.
Classroom Staff
Petscher, E. S., & Bailey, J. S. (2006). Effects of training,
prompting, and self-monitoring on staff behavior in a
classroom for students with disabilities. Journal of Applied
Behavior Analysis, 39 (2), 215–226.
Depression
Chen, H., Guarnaccia, P. J., & Chung, H. (2003). Self-
attention as a mediator of cultural influences on depres-
sion. International Journal of Social Psychiatry, 49 (3),
192–203.
Dunn, B. D., Dalgleish, T., Lawrence, A. D., & Ogilvie, A. D.
(2007). The accuracy of self-monitoring and its relationship
to self-focused attention in dysphoria and clinical depres-
sion. Journal of Abnormal Psychology, 116 (1), 1–15.
A summary of these factors suggests that self-monitoring
is most likely to produce positive behavioral changes when
change-motivated subjects continuously monitor a lim-
ited number of discrete, positively valued target behaviors;
SELF-MANAGEMENT STRATEGIES 527
Kocovski, N. L., & Endler, N. S. (2000). Self-regulation:
Social anxiety and depression. Journal of Applied Biobe-
havioral Research, 5 (1), 80–91.
Immigrant Adaptation
Kosic, A., Mannetti, L., & Sam, D. L. (2006). Self-monitoring:
A moderating role between acculturation strategies and
adaptation of immigrants. International Journal of Intercul-
tural Relations, 30 (2), 141–157.
Psychophysiology
Hofmann, S. G. (2006). The emotional consequences of
social pragmatism: The psychophysiological correlates of
self-monitoring. Biological Psychology, 73 (2), 169–174.
Psychosis
Johns, L. C., Gregg, L., Allen, P., & McGuire, P. K. (2006).
Impaired verbal self-monitoring in psychosis: Effects of
state, trait and diagnosis. Psychological Medicine, 36 (4),
465–474.
Self-Prophecy
Spangenberg, E. R., & Sprott, D. E. (2006). Self-monitoring
and susceptibility to the influence of self-prophecy. Journal
of Consumer Research, 32 (4), 550–556.
Social Interactions
Flynn, F. J., Reagans, R. E., Amanatullah, E. T., & Ames,
D. R. (2006). Helping one’s way to the top: Self-monitors
achieve status by helping others and knowing who helps
whom. Journal of Personality and Social Psychology, 91(6),
1123–1137.
Ickes, W., Holloway, R., Stinson, L. L., & Hoodenpyle, T. G.
(2006). Self-monitoring in social interaction: The centrality
of self-affect. Journal of Personality, 74 (3), 659–684.
Spinal Cord Injury
Lee, Y., & McCormick, B. P. (2006). Examining the role of
self-monitoring and social leisure in the life quality of indi-
viduals with spinal cord injury. Journal of Leisure Research,
38 (1), 1–19.
Stress
Huflejt-Lukasik, M., & Czarnota-Bojarska, J. (2006). Short
communication: Self-focused attention and self-monitoring
influence on health and coping with stress. Stress and
Health: Journal of the International Society for the Investi-
gation of Stress, 22 (3), 153–159.
when performance feedback and goals or standards are
made available and are unambiguous; and when the moni-
toring act is both salient and closely related in time to the
target behaviors.
528 CHAPTER 17

Nelson (1977) has identified eight variables that seem to STEPS OF SELF-MONITORING
be related to the occurrence, intensity, and direction of the Self-monitoring involves at least six important steps: (1) rationale
reactive effects of self-monitoring: for the strategy, (2) discrimination of a response, (3) recording
of a response, (4) charting of a response, (5) displaying of
1. Motivation: Clients who are interested in changing the data, and (6) analysis of data. Each of these six steps and
self-monitored behavior are more likely to show reactive guidelines for their use are discussed here and summarized
effects when they self-monitor. in Table 17.1. Remember that the steps are interactive and
2. Valence of target behaviors: Behaviors that a person values that the presence of all of them may be required for a person
positively are likely to increase with self-monitoring; to use self-monitoring effectively. Also, remember that any
negative behaviors are likely to decrease; neutral behav- or all of these steps may need to be adapted, depending on
iors may not change. the client’s gender and culture.
3. Type of target behaviors: The nature of the behavior that
is being monitored may affect the degree to which self-
monitoring procedures effect change. Treatment Rationale
4. Standard setting (goals), reinforcement, and feedback: Re- First, the practitioner explains the rationale for self-monitoring.
activity is enhanced for people who self-monitor in con- Before using the strategy, the client should be aware of what
junction with goals and the availability of performance the self-monitoring procedure will involve and how the
reinforcement or feedback.
5. Timing of self-monitoring: The time when the person self-
records can influence the reactivity of self-monitoring.
TABLE 17.1 Steps of Self-Monitoring
Results may differ depending on whether self-monitor-
ing occurs before or after the target response. 1. Rationale for self-monitoring
6. Devices used for self-monitoring: More obtrusive or visible A. Purpose
recording devices seem to be more reactive than unob- B. Overview of procedure
trusive devices. 2. Discrimination of a response
7. Number of target responses monitored: Self-monitoring of A. Selection of target response to monitor
only one response increases reactivity. As more responses (1) Type of response
are concurrently monitored, reactivity decreases. (2) Valence of response
8. Schedule for self-monitoring: The frequency with which (3) Number of responses
a person self-monitors can affect reactivity. Continuous 3. Recording of a response
self-monitoring may result in more behavior change than A. Timing of recording
intermittent self-recording. (1) Prebehavior recording to decrease a response; postbehavior recording
to increase a response
(2) Immediate recording
Three factors may contribute to the reactive effects of
(3) Recording when no competing responses distract recorder
self-monitoring: B. Method of recording
(1) Frequency counts
1. Client characteristics: Client intellectual and physical (2) Duration measures
abilities may be associated with greater reactivity when (a) Continuous recording
self-monitoring. (b) Time sampling
2. Expectations: Clients seeking help may have some ex- C. Devices for recording
pectations for desirable behavior changes. However, it is (1) Portable
probably impossible to separate client expectations from (2) Accessible
implicit or explicit therapeutic “demands” to change the (3) Economical
target behavior. (4) Somewhat obtrusive
3. Behavior change skills: Reactivity may be influenced by 4. Charting of a response
the client’s knowledge and skills associated with be- A. Charting and graphing of daily totals of recorded behavior
havior change. For example, the reactivity of addictive 5. Displaying of data
behaviors may be affected by the client’s knowledge of A. Chart for environmental support
simple, short-term strategies such as fasting or absti- 6. Analysis of data
nence. These are general guidelines, and their effects A. Accuracy of data interpretation
may vary with the gender, class, race, and ethnicity of B. Knowledge of results for self-evaluation and self-reinforcement
each specific client.

procedure will help with the client’s concern. An example,
adapted from Benson and Stuart (1992), follows:
The purpose of self-monitoring is to increase your awareness
of your sleep patterns. Research has demonstrated that people
who have insomnia benefit from keeping a self-monitoring
diary. Each morning for a week you will record the time you
went to bed the previous night; approximately how many
minutes it took you to fall asleep; if you awakened during the
night, how many minutes you were awake; the total number
of hours you slept; and the time you got out of bed in the
morning. Also, on a scale you will rate how rested you feel in
the morning, how difficult it was to fall asleep the previous
night, the quality of sleep, your level of physical tension when
you went to bed the previous night, your level of mental activ-
ity when you went to bed, and how well you think you were
functioning the previous day. The diary will help us evaluate
your sleep and remedy issues. This kind of awareness helps
in correcting factors that might contribute to your insomnia.
How does that sound?
Discrimination of a Response
When a client engages in self-monitoring, an observation, or
discrimination, of a response is required first. For example,
a client who is monitoring fingernail biting must be able to
discriminate instances of nail biting from instances of other
behavior. Discrimination of a response indicates awareness,
reflecting the client’s ability to identify the presence or ab-
sence of the behavior and whether it is overt, like nail biting,
or covert, like a positive self-thought.
Discrimination of a response involves helping the client
identify what to monitor. This decision will often require
helper assistance. The type of the monitored response may af-
fect the results of self-monitoring. For example, self-monitoring
may produce greater weight loss for people who recorded
their daily weight and daily caloric intake than for those
who recorded only daily weight. What works for individuals
may vary; thus, the selection of target responses remains a
pragmatic choice as to what seems to work well. Mahoney
(1977, pp. 244–245) points out that there may be times
when self-monitoring of certain responses could detract
from intervention effectiveness, as in asking a suicidal client
to monitor depressive thoughts.
The effects of self-monitoring also vary with the valence of
the target response. There are always “two sides” of a behav-
ior that could be monitored—the positive and the negative.
There also seem to be times when one side is more important
for self-monitoring than the other. Unfortunately, there are
very few data to guide a decision about the exact type and
valence of responses to monitor. Because the reactivity of
self-monitoring is affected by the value assigned to a behavior
(Watson & Tharp, 2007), one guideline might be to have the
client monitor the behavior that she or he cares most about
changing. Generally, it is a good idea to encourage the client
SELF-MANAGEMENT STRATEGIES 529
to limit monitoring to one response, at least initially. If the
client engages in self-monitoring of one behavior with no
difficulties, then more items can be added.
Recording of a Response
After the client has learned to make discriminations about a
response, the helper can provide instructions and examples
about the method for recording the observed response. Most
clients have probably never recorded their behavior system-
atically. Systematic recording is crucial to the success of self-
monitoring, so it is imperative that the client understand the
importance and methods of recording. The client needs in-
structions about when and how to record and about devices
for recording. The timing, method, and recording devices
can all influence the effectiveness of self-monitoring.
Timing of Self-Monitoring: When to Record
One of the least understood processes of self-monitoring in-
volves timing, or the point when the client actually records
the target behavior. Instances have been reported of both
prebehavior and postbehavior monitoring. In prebehavior
monitoring, the client records the intention or urge to en-
gage in the behavior before doing so. In postbehavior moni-
toring, the client records each completed instance of the
target behavior—after the behavior occurs. Kazdin (1974,
p. 239) points out that the precise effects of self-monitoring
may depend on the point at which monitoring occurs in the
chain of responses relative to the response being recorded.
Effects of the timing of self-monitoring may depend partly
on whether other responses are competing for the person’s
attention at the time the response is recorded. Another factor
influencing the timing of self-monitoring is the amount of
time between the response and the actual recording. There
is general agreement that delayed recording of the behavior
weakens the efficacy of the monitoring process.
We suggest four guidelines that may help the helper and
client decide when to record. First, if the client is using
monitoring as a way to decrease an undesired behavior, pre-
behavior monitoring may be more effective, for this seems
to interrupt the response chain early in the process. An
example for self-monitoring an undesired response would
be to record whenever you have the urge to smoke or to eat.
Prebehavior monitoring may result in more change than
postbehavior monitoring. Second, if the client is using self-
monitoring to increase a desired response, then postbehavior
monitoring may be more helpful. Postbehavior monitoring
can make a person more aware of a low-frequency, desirable
behavior. Third, recording instances of a desired behavior as
it occurs or immediately after it occurs may be most help-
ful. The guideline is to “Record immediately after you have
the urge to smoke—or immediately after you have covertly
praised yourself; do not wait even for 15 or 20 minutes,
as the impact of recording may be lost.” Fourth, the client
530 CHAPTER 17
should be encouraged to record the response when not dis-
tracted by the situation or by other competing responses.
The client should be instructed to record the behavior in
vivo as it occurs, if possible, rather than at the end of the
day, when he or she is dependent on recall. In vivo recording
may not always be feasible, however, and in some cases the
client’s self-recording may have to be performed later.
Method of Self-Monitoring: How to Record
The helper needs to instruct the client in a method for re-
cording the target responses. McFall (1977) points out that
the method of recording can vary in a number of ways:
It can range from a very informal and unstructured operation,
as when subjects are asked to make mental notes of any event
that seems related to mood changes, to something fairly formal
and structured, as when subjects are asked to fill out a mood-
rating sheet according to a time-sampling schedule. It can be
fairly simple, as when subjects are asked to keep track of how
many cigarettes they smoke in a given time period; or it can
be complex and time-consuming, as when they are asked to
record not only how many cigarettes they smoke, but also the
time, place, circumstances, and affective response associated
with lighting each cigarette. It can be a relatively objective
matter, as when counting the calories consumed each day; or it
can be a very subjective matter, as when recording the number
of instances each day when they successfully resist the tempta-
tion to eat sweets. (p. 197)
Ciminero and associates (1977, p. 198) suggest that the
recording method should be “easy to implement, must pro-
duce a representative sample of the target behavior, and
must be sensitive to changes in the occurrence of the target
behavior.” Keep the method informal and unstructured for
clients who are not “monitors” or who do not value “tracking”
in such a systematic way.
Frequency, duration, and intensity can be recorded with
either a continuous recording or a time-sampling method.
Selection of one of these methods will depend mainly on
the type of target response and the frequency of its occur-
rence. To record the number of target responses, the client
can use a frequency count. Frequency counts are most useful
for monitoring responses that are discrete, do not occur all
the time, and are of short duration (Ciminero et al., 1977,
p. 190). For instance, clients might record the number of
times they have an urge to smoke or the number of times
they praise or compliment themselves covertly.
Other kinds of target responses are recorded more easily
and accurately by duration. Anytime a client wants to record
the amount or length of a response, a duration count can be
used. Ciminero and associates (1977, p. 198) recommend
the use of a duration measure whenever the target response
is not discrete and it varies in length. For example, a client
might use a duration count to note the amount of time
spent reading textbooks or practicing a competitive sport.
Or a client might want to keep track of the length of time
spent in a “happy mood.”
Sometimes a client may want to record two different
responses and use both the frequency and the duration
methods. For example, a client might use a frequency count
to record each urge to smoke and a duration count to moni-
tor the time spent smoking a cigarette. Watson and Tharp
(2007) suggest that the helper can recommend frequency
counts whenever it is easy to record clearly separate occur-
rences of the behavior and duration counts whenever the
behavior continues for long periods.
Clients also can self-record the intensity of responses
whenever data are desired about the relative severity of a
response. For example, a client might record the intensity of
happy, anxious, or depressed feelings or moods.
Format of Self-Monitoring Instruments
There are many formats of self-monitoring instruments that
a client can use to record the frequency, duration, and/or
intensity of the target response as well as information about
contributing variables. The particular format of the instru-
ment can affect reactivity and can increase client compliance
with self-monitoring. The format of the instrument should
be tailored to the client situation and goal and to the client.
Figure 17.2 shows three formats for monitoring instruments.
Each format can use a variety of self-recording devices. Watson
and Tharp (2007) provide a range of additional examples.
Example 1 shows a format useful for relatively frequent
recordings—for example, with couples for self-monitoring
of the content and quality of their interactions. In this for-
mat, each person records the content of the interaction with
the partner (for example, having dinner together, talking
about finances, discussing work, going to movies, dealing
with a parenting issue) and rates the quality of that interac-
tion. This kind of format aims to capture all substantial
interactions and characterize them. Other approaches may
focus on certain types of interactions, such as discussing a
sensitive topic or dealing with conflict, or may track aspects
of interactions, such as the use of active listening skills.
Example 2 shows a format useful when more detail is
needed and the client is likely to benefit from having her or
his attention directed to components (e.g., What was I say-
ing to myself just then?), to connections (e.g., the types of
events that seem to systematically trigger certain reactions),
and to the level of one’s reaction and views about how it was
handled. This example is designed for anxiety responses, but
it could readily be modified for a range of other affective
states, thinking patterns, or behaviors.
Example 3 illustrates a brief diary format. This integrates
attention to the triggering event but also includes recording
coping efforts and self-administered praise or reinforcement
as well as affective states before and after the coping efforts.
 Example 1: Content and Quality of Partnered Interactions
(Record the type of interaction under “Content.” For each interaction, circle one category that best represents the quality of that interaction.)
Quality of Interaction

Time Content of Interaction Very Pleasant Pleasant Neutral Unpleasant Very Unpleasant

______________________________________ ++ + 0 - --
______________________________________ ++ + 0 - --
______________________________________ ++ + 0 - --
______________________________________ ++ + 0 - --

Example 2: Self-Monitoring Log for Recording Anxiety Responses (This could be adapted for other feeling/thought/behavior targets.)
Date and Situation Features Internal Degree of Feeling Behavioral Factors Satisfaction in Handling Alternatives to Consider
Time Dialogue Situation
(Self-Statements)
Describe each prob- Note your thoughts Rate the intensity of the Note how you Rate how effectively you What different thoughts or
lematic situation; or things you said to anxiety: (1) a little intense, (2) responded—what believe you handled the situa- behaviors seem useful to try?
note what seemed to yourself when this somewhat intense, (3) very you did tion: (1) a little, (2) somewhat, What would help you prepare
trigger anxiety occurred intense, (4) extremely intense (3) very, (4) extremely to try this next time?

Example 3: Brief Diary Format

Instructions: For each situation in which you experience a headache, record the following. After several episodes, reflect on what you see to be trends and what
seems to be associated with reduced tension.

Headache Diary:
Stressful situation: ______________________________________________________
Negative thoughts: ______________________________________________________
Tension level rated 1 2 3 4 5 6 7 8 9 10
Coping strategies: ______________________________________________________
Praising self for coping: _________________________________________________
Resulting tension level 1 2 3 4 5 6 7 8 9 10

Figure 17.2 Examples of Formats for Self-Monitoring Instruments

531

Source: Adapted from Self-Directed Behavior (9th ed.), by D. L. Watson & R. G. Tharp, p. 87. Copyright © 2007 Thomson.
532 CHAPTER 17
The illustration uses headaches as a physical manifestation
of stress, but, again, the general format could be applied to
any number of targets.
Devices for Self-Monitoring
Clients often report that one of the most intriguing as-
pects of self-monitoring is the device or mechanism used
for recording. For recording to occur systematically and
accurately, the client must have access to some recording
device. A variety of devices have been used to help clients
keep accurate records. Note cards, daily log sheets, and
diaries can be used to make written notations. A popu-
lar self-recording device is a wrist counter, such as a golf
counter. The golf counter can be used for self-recording
in different settings. If several behaviors are being counted
simultaneously, the client can wear several wrist counters
or use knitting tallies. A wrist counter with rows of beads
permits the recording of several behaviors. Toothpicks, small
plastic tokens, or cell phone text messaging can also be used
as recording devices. Watson and Tharp (2007) report the
use of coins: a client can carry coins in one pocket and trans-
fer one coin to another pocket each time a behavior occurs.
Children can record frequencies by pasting stars on a chart
or by using a countoon, which has pictures and numbers for
three recording columns: “What do I do,” “My count,” and
“What happens.” Clocks, watches, and kitchen timers can be
used for duration counts. The nature of the device depends,
of course, on what kind of observations are most useful (e.g.,
notes about thoughts, feelings, circumstances, and reactions
require different devices than those needed for frequency or
duration).
Not surprisingly, information technology is opening up
new mediums. Many if not most paper-and-pencil formats
can be used via a computer and a common word pro-
cessing program, and some of the multimedia capabilities
of computers allow for more engaging devices. For some
people, this is a quicker and more accessible approach.
As an example, the form can be sent electronically as can
responses (aiding with communication between client and
helper between sessions, a particularly important issue for
people living in more remote or rural locations or with
transportation constraints) and is always available in a file
or at a website. A computer-based format may be easier to
keep up with than a piece of paper that’s gotten lost in the
pile on the dining room table. As with computer-assisted
assessment tools, there is some evidence that computers can
have a positive impact. For example, Calam, Cox, Glasgow,
Jimmieson, and Larsen (2000) discuss benefits for children
and for people with disabilities. McGuire and colleagues
(2000) describe advantages of using touchscreen technology
that does not require keyboard use. Newman and colleagues
(Newman, Consoli, & Taylor, 1997; Newman, Kenardy,
Herman, & Taylor, 1997) review the advantages and dis-
advantages of a number of computer tools in this regard,
including the use of palmtop computers that are sufficiently
small to be carried at all times (and, thus, more likely to
be available in target situations relevant to intervention).
Amato Zech, Hoff, and Doepke, (2006) describe the use of
an electronic, vibrating beeper as a tactile reminder to self-
monitor attention in a special-education classroom.
The helper and client select a recording device. Here is
an opportunity to be inventive! There are several practical
criteria to consider in helping a client. The device should
be portable and accessible so that it is present whenever
the behavior occurs (Watson & Tharp, 2007). It should be
easy, convenient, and economical. The obtrusiveness of the
device should also be considered. The recording device can
function as a cue (discriminative stimulus) for the client to
self-monitor, so it should be noticeable enough to remind
the client. However, a device that is too obtrusive may
draw attention from others who could reward or punish
the client for self-monitoring. Finally, the device should
be capable of giving cumulative frequency data so that the
client can chart daily totals of the behavior. Many of the
devices used for practice assessment may be useful for ongo-
ing self-monitoring.
After the client has been instructed in the timing and
method of recording, and after a recording device has been
selected, the client should practice using the recording sys-
tem. Breakdowns in self-monitoring often occur because
a client does not understand the recording process clearly.
Rehearsal of the recording procedures may ensure that the
client will record accurately. Generally, a client should en-
gage in self-recording for three to four weeks. Usually, the
effects of self-monitoring are not apparent in only one or
two weeks’ time.
Charting of a Response
The data recorded by the client should be translated onto
a more permanent storage record such as a chart or graph
that will enable the client to inspect the self-monitored data
visually.
This type of visual guide may provide the occasion for client
self-reinforcement (Kanfer & Gaelick-Buys, 1991), which, in
turn, can influence the reactivity of self-monitoring. The data
can be charted by days, using a simple line graph. For example,
a client counting the number of urges to smoke a cigarette
could chart these by days, as in Figure 17.3. A client recording
the amount of time spent studying each day could use the same
sort of line graph to chart duration of study time. The vertical
axis would be divided into time intervals such as 15 minutes,
30 minutes, 45 minutes, or 1 hour.
The client should receive either oral or written instructions
on a way to chart and graph the daily totals of the recorded
response. The helper can assist the client in interpreting the
chart in the sessions on data review and analysis. If a client
 SELF-MANAGEMENT STRATEGIES 533

Week 1 Week 2 Week 3

26
24
22
20
18
16
Urges to smoke

14
12
10
8
6
4
2

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Days

Figure 17.3 Self-monitoring Chart

is using self-monitoring to increase a behavior, the line on
the graph should go up gradually if the self-monitoring is
having the desired effect. If self-monitoring is influencing an
undesired response to decrease, the line on the graph should
go down gradually.
Displaying of Data
After the graph has been made, the client has the option of
displaying the completed chart. If the chart is displayed in a
“public” area, this display may prompt environmental rein-
forcement, a necessary part of an effective self-management
program. The effects of self-monitoring are usually aug-
mented when the data chart is displayed as a public record.
However, some clients will not want to make their data
public for reasons of confidentiality or shame avoidance.
Analysis of Data
If the client’s recording data are not reviewed and analyzed,
the client may soon feel as if he or she was told to make a
graph just for practice in drawing straight lines! A very im-
portant facet of self-monitoring is the information that it
can provide to the client. There is some evidence that people
who receive feedback about their self-recording change more
than those who do not. The recording and charting of data
should be used explicitly to provide the client with knowledge
of results about behavior or performance. Specifically, the
client should bring the data to weekly sessions for review and
analysis. In these sessions, the helper can encourage the client
to compare the data with the desired goals and standards.
The client can use the recorded data for self-evaluation and
determine whether the data indicate that the behavior is
within or outside the desired limits. The helper can also aid in
data analysis by helping the client interpret the data correctly.
Guidance on ways to meaningfully display and analyze client
self-monitoring data has been growing in sophistication over
the years. In general, many of the methods and guidelines
used for identifying, defining, and evaluating outcome goals
can be adapted for client self-monitoring.
MODEL EXAMPLE OF SELF-MONITORING:
THE CASE OF ISABELLA
Our case example, Isabella, indicated the goal of increasing
her positive thoughts (and simultaneously decreasing her
negative thoughts) about her ability to do well with math.
This goal lends itself to the application of self-management
strategies for several reasons. First, the goal represents a co-
vert behavior (positive thoughts), which is observable only
by Isabella. Second, the flip side of the goal (the negative
thoughts) represents a very well-learned habit. Probably
most of these negative thoughts occur outside the sessions. To
change this thought pattern, Isabella needs to use strategies
she can apply frequently (as needed) in vivo, and she needs
to use strategies that she can administer to herself.
534 CHAPTER 17

Here is a description of the way in which Isabella could
use self-monitoring to achieve this goal:
1. Treatment rationale: The helper provides an explanation
of what Isabella will self-monitor and why, emphasizing
that this is a strategy she can apply herself, can use with a
“private” behavior, and can use as frequently as possible
in the actual setting.
2. Discrimination of a response: The helper needs to help
Isabella define the target response explicitly. One defi-
nition could be “Anytime I think about myself doing
math or working with numbers successfully.” The helper
provides some possible examples of this response, such as
“Gee, I did well on my math homework today” or “I was
able to balance my checkbook today.” The helper also en-
courages Isabella to identify some examples of the target
response. Because Isabella wants to increase this behavior,
the target response will be stated in the “positive.”
3. Recording of a response: The helper instructs Isabella in tim-
ing, a method, and a device for recording. In this case,
because Isabella is using self-monitoring to increase a desired
behavior, she will use postbehavior monitoring. Isabella is in-
structed to record immediately after a target thought occurs.
She is interested in recording the number of such thoughts,
so she will use a frequency count. A tally on a note card or
a wrist counter can be selected as the device for recording.
After these instructions, Isabella will practice recording be-
fore actually doing it. The helper instructs her to engage in
self-monitoring for about four consecutive weeks.
4. Charting of a response: After each week of self-monitoring,
Isabella can add her daily frequency totals and chart them
by days on a simple line graph, as shown in Figure 17.4.
10
9
8 related to autism, eating disorders, insomnia, obesity, fitness
Thoughts of being successful in math
Isabella is using self-monitoring to increase a behavior; as
a result, if the monitoring has the desired effect, the line
on her graph will gradually rise. It is just starting to do
so here; additional data for the next few weeks will show
a greater increase if the self-monitoring is influencing the
target behavior in the desired direction.
5. Displaying of data: After Isabella makes a data chart, she
may wish to post it in a place such as her room, although
this is a very personal decision.
6. Analysis of data: During the period of self-monitoring,
Isabella brings in her data for weekly review sessions with
the helper. The helper provides reinforcement and helps
Isabella interpret the data accurately. Isabella can use the
data for self-evaluation by comparing the “story” of the
data with her stated desired behavior and level of change.
STIMULUS CONTROL
Kanfer and Gaelick-Buys (1991, p. 335) define stimulus
control as the predetermined arrangement of environmental
conditions that makes it impossible or unfavorable for an
undesired behavior to occur. Stimulus-control methods em-
phasize rearranging or modifying environmental conditions
that serve as cues or antecedents of a particular response.
Within the ABC model of behavior, a behavior is often
guided by certain things that precede it (antecedents) and
is maintained by positive or negative events that follow it
(consequences). Remember also that both antecedents and
consequences can be external (overt) or internal (covert).
For example, an antecedent could be a situation, an emo-
tion, a cognition, or an overt or covert verbal instruction.
Clinical Uses of Stimulus Control
Stimulus-control procedures have been used for a wide range
of concerns; see Box 17.3 for a sample of recent research on
stimulus control. This procedure has been used to treat issues

activities, anxiety, additive supports for attending and learn-

7 ing, and resistance and compliance responses. One study
6 (Almeida et al., 2005) provided an interesting example of
ways in which self-management strategies can also be helpful
5 in supporting desired changes in the behavior of service pro-
viders. Within the context of a busy clinical setting, members of
4
a physician group used a stimulus-control intervention to help
3 prompt their attention to assessing and considering referrals
for physical activity. The effort resulted in significantly higher
2
referrals to as well as initiation of physical activity—suggesting
1 such interventions may be practical methods for supporting
service-provider attention to areas of particular need.
1 2 3 4 5 6 7
Days How Antecedents Acquire Stimulus Control
When antecedents are consistently associated with a be-
Figure 17.4 Simple Line Graph for Self-monitoring havior that is reinforced in the presence (not the absence) of

BOX 17.3 RESEARCH ON STIMULUS CONTROL
Autism
Green, G. (2001). Behavior analytic instruction for learners with
autism: Advances in stimulus control technology. Focus on
Autism and Other Developmental Disabilities, 16 (2), 72–85.
Matthews, B., Shute, R., & Rees, R. (2001). An analysis of
stimulus overselectivity in adults with autism. Journal of In-
tellectual and Developmental Disability, 26 (2), 161–176.
Brain Injury
Schlund, M. W. (2000). When instructions fail: The effects of
stimulus control training on brain injury survivors’ attend-
ing and reporting during hearing screenings. Behavior
Modification, 24 (5), 658–672.
Child Obesity
Epstein, L. H., Paluch, R. A., Kilanowski, C. K., & Raynor, H. A.
(2004). The effect of reinforcement or stimulus control to
reduce sedentary behavior in the treatment of pediatric
obesity. Health Psychology, 23 (4), 371–380.
Insomnia
Hajak, G., Bandelow, B., Zulley, J., & Pittrow, D. (2002). “As
needed” pharmacotherapy combined with stimulus control
treatment in chronic insomnia—Assessment of a novel
intervention strategy in a primary care setting. Annals of
Clinical Psychiatry, 14 (1), 1–7.
Pallesen, S., Nordhus, I. H., Kvale, G., Nielsen, G. H., Havik,
O. E., Johnsen, B. H., & Skjotskift, S. (2003). Behavioral
treatment of insomnia in older adults: An open clinical
trial comparing two interventions. Behaviour Research and
Therapy, 41(1), 31–48.
these antecedent stimuli, they gain control over the behav-
ior. You might think of this as an antecedent working as a
stimulus for a certain response. When an antecedent gains
stimulus control over the response, there is a high prob-
ability that the response will be emitted in the presence of
these particular antecedent events. For example, most of us
automatically slow down, put our foot on the brake, and
stop the car when we see a red traffic light. The red light is
a stimulus that has gained control over our stopping-the-car
behavior. Generally, the fact that antecedents exert stimulus
control is helpful, as it is in driving: we go when we see a
green light and stop at the sight of a red light.
Inappropriate Stimulus Control in Troubling Behavior
Behaviors that trouble clients may occur because of inappro-
priate stimulus control. Inappropriate stimulus control may
be related to obesity, for example. Eating responses of over-
weight people tend to be associated with many environmental
SELF-MANAGEMENT STRATEGIES 535
Intellectual Disabilities
Dickson, C. A., Wang, S. S., Lombard, K. M., & Dube, W. V.
(2006). Overselective stimulus control in residential school
students with intellectual disabilities. Research in Develop-
mental Disabilities, 27 (6), 618–631.
Pathological Gambling
Echeburua, E., & Fernandez-Montalvo, J. (2002). Psycho-
logical treatment of slot machine pathological gambling: A
case study. Clinical Case Studies, 1(3), 40–253.
Phobia
Johnstone, K. A., & Page, A. C. (2004). Attention to phobic
stimuli during exposure: The effect of distraction on anxiety
reduction, self-efficacy and perceived control. Behaviour
Research and Therapy, 42 (3), 249–275.
Physician Referral
Almeida, F. A., Smith-Ray, R. L., Van Den Berg, R., Schriener,
P., Gonzales, M., Onda, P., & Estabrooks, P. A. (2005).
Utilizing a simple stimulus control strategy to increase phy-
sician referrals for physical activity promotion. Journal of
Sport and Exercise Psychology, 27 (4), 505–514.
Reading Ability
Chafouleas, S. M., Martens, B. K., Dobson, R. L., Weinstein, K. S.,
& Gardner, K. B. (2004). Fluent reading as the improve-
ment of stimulus control: Additive effects of performance-
based interventions to repeated reading on students’
reading and error rates. Journal of Behavioral Education,
13 (2), 67–81.
cues. If a person eats something not only at the dining table
but also when working in the kitchen, watching television,
walking by the refrigerator, and stopping at a Dairy Queen,
the sheer number of eating responses could soon result in
obesity. Too many environmental cues are often related to
other client difficulties, particularly “excesses” such as substance
use. In these cases, the primary aim of a self-management
stimulus-control method is to reduce the number of cues asso-
ciated with the undesired response, such as eating or smoking.
Other troubling behaviors have been observed that seem
to involve excessively narrow stimulus control. At the oppo-
site pole from obesity are people who eat so little that their
physical and psychological health suffers (anorexia nervosa).
For these people, there are too few eating cues, among other
elements involved with this issue. Lack of exercise can be a
function of too narrow stimulus control. For some people,
the paucity of environmental cues associated with exercise re-
sults in very little physical activity. In these cases, the primary
536 CHAPTER 17
TABLE 17.2 Principles and Examples of Stimulus-Control Strategies
Principle of change
To decrease a behavior: Reduce or narrow the frequency of cues associated
with the behavior.
To increase a behavior: Increase or prearrange the cues associated
with the response.
aim of a stimulus-control strategy is to establish or increase
the number of cues that will elicit the desired behavior.
To summarize, stimulus-control self-management in-
volves reducing the number of antecedent stimuli associated
with an undesirable behavior and simultaneously increasing
the antecedent cues associated with a desirable response
(Watson & Tharp, 2007). Table 17.2 shows the principal
methods of stimulus control and some examples.
Using Stimulus Control to Decrease Behavior
To decrease the rate of a behavior, the antecedent cues as-
sociated with the behavior should be reduced in frequency
or altered in time and place of occurrence. When cues are
separated from the habitual behavior by alteration or elimina-
tion, the old, undesired habit can be terminated (Watson
& Tharp, 2007). Many behavioral “excesses,” such as
eating, smoking, drinking, or self-criticism, are tied to
a great number of antecedent situations. Reducing these
cues can restrict the occurrence of the undesired behav-
ior. Existing cues can be prearranged to make the target
behavior so hard to execute that the person is unlikely to
do it. An example would be altering the place of smoking
by moving one’s smoking chair to an inconvenient place
like the basement. The smoker would have to go down-
stairs each time she or he wanted a cigarette. A person can
Example
1. Prearrange or alter cues associated with the place of the behavior:
a. Prearrange cues that make it hard to execute the behavior. Place fattening foods in
high, hard-to-reach places.
b. Prearrange cues so that they are controlled by others. Ask friends or family to
serve you only one helping of food and to avoid serving fattening foods to you.
2. Alter the time or sequence (chain) between the antecedent cues and the resulting
behaviors:
a. Break up the sequence. Buy and prepare food only on a full stomach.
b. Change the sequence. Substitute and engage in nonfood activities when you start to
move toward snacking (toward refrigerator, cupboard, or candy machine).
c. Build pauses into the sequence. Delay second helpings of food or snacks for a pre-
determined amount of time.
1. Seek out these cues deliberately to perform the desired behavior. Initially arrange only
one room with a desk to study. When you need to study, go to this place.
2. Concentrate on the behavior when in the situation. Concentrate only on studying in the
room. If you get distracted, get up and leave. Don’t mix study with other activities,
such as listening to records or talking.
3. Gradually extend the behavior to other situations. When you have control over study-
ing in one room, extend the behavior to another conducive room or place.
4. Promote the occurrence of helpful cues by other people or by self-generated remind-
ers. Ask your roommate to remind you to leave the desk when you are talking or
distracted. Remind yourself of good study procedures by posting a list over your study
desk or by using verbal or covert self-instructions.
prearrange cues by placing their control in the hands of
someone else. Giving your pack of cigarettes to a friend
is an example of this method. The friend should agree to
help you reduce smoking and should agree not to reinforce
or punish any instances of your smoking behavior (the
undesired response).
A behavior can also be reduced through stimulus control
by interrupting the learned pattern or sequence that begins
with one or more antecedent cues and results in the undesired
response. This sequence may be called a chain. A troubling be-
havior is often the result of a long chain of events. For example,
a variety of behaviors make up the sequence of smoking.
Before puffing on a cigarette, a person has to go to a store, buy
cigarettes, remove one cigarette from the pack, and light up.
A chain might be interrupted in a number of ways—for
example by breaking up or unlinking the chain of events,
changing the chain, or building pauses into the chain (Watson
& Tharp, 2007). All these methods involve prearranging or
altering the nature of the sequence and the way in which
the behavior in question is tied to stimuli events and to
patterned ways of responding. A chain of events can be
broken up by discovering and interrupting an event early in
the sequence or by scrambling the typical order of events.
For example, the smoker could break up the chain by not
going to stores that sell cigarettes. Or if the smoker typically

smokes at certain times, the usual order of events leading
to smoking could be mixed up. The smoker could also
change the typical chain of events. People who start to light
up a cigarette whenever they are bored, tense, or lacking
something to do with their hands could perform a different
activity at this point, such as calling a friend when bored,
relaxing when tense, or knitting or playing cards to provide
hand activity. Finally, smokers could interrupt the chain by
deliberately building pauses into it.
As you may recall, when antecedents exert control over
a behavior, the behavior occurs almost automatically. One
way to deal with this automatic quality is to pause before re-
sponding to a cue. For instance, whenever the smoker has an
urge to light up in response to a stress cue, a deliberate pause
of 10 minutes can be built in before the person actually does
light up. Gradually, this time interval can be increased. De-
liberately building in pauses to make a record (in a journal,
computer notebook, or other monitoring tool) can be useful
toward building in reflection—for example, about how one
is feeling, thoughts in the moment, environmental condi-
tions of the moment—which can help in breaking behavior
chains. Sometimes you can even strengthen the pause pro-
cedure by covertly instructing yourself on what you want to
do or by thinking about the benefits of not smoking. The
pause itself can then become a new antecedent.
Using Stimulus Control to Increase Behavior
Stimulus-control methods can also be used to increase a
desired response. As noted in Table 17.2, to increase the rate
of a response, a person increases or prearranges the anteced-
ent cues associated with the desired behavior. The person
deliberately seeks out these cues to perform the behavior and
concentrates only on this behavior when in the situation.
Competing or distracting responses must be avoided. Gradu-
ally, as stimulus control over the behavior in one situation is
achieved, the person can extend the behavior by perform-
ing it in another, similar situation. This process of stimulus
generalization means that a behavior learned in one situation
can be performed in different but similar situations (Watson
& Tharp, 2007). The person can promote the occurrence of
new antecedent cues by using reminders from others, self-
reminders, or overt or covert self-instructions. The rate of
a desired response is increased by increasing the times and
places in which the person performs the response.
Suppose that you are working with a client who wants
to increase his or her amount of daily exercise. First, more
cues would be established to which the person would re-
spond with isometric or physical activity. For example, the
person might perform isometric activities whenever sitting
in a chair or waiting for a traffic light. Or the person might
perform physical exercises each morning and evening on a
special exercise mat. The client would seek out these prear-
ranged cues and concentrate on performing the activity while
SELF-MANAGEMENT STRATEGIES 537
in the situation. Other behaviors should not be performed
while in these situations, for a competing response could
interfere with the exercise activity (Watson & Tharp, 2007).
Gradually, the client could extend the exercise activities to
new but similar situations—for example, doing isometrics
while sitting on the floor or waiting for a meeting to start.
The person could also promote exercise behavior in these situ-
ations by reminders—posting an exercise chart on the wall or
carrying it around in a pocket or wallet.
Stimulus-control instructions have also been used to increase
sleep. Clients were instructed as follows: (1) Go to bed or lie
down to sleep only when sleepy. (2) Do not read, watch TV, or
eat in bed. Use the bed only for sleeping and/or sexual activi-
ties. (3) If unable to fall asleep after 10 to 20 minutes, get out
of bed and engage in some activity. Return to bed only when
sleepy, and continue this procedure throughout the night as
necessary. (4) Set the alarm clock and get up at the same time
every morning regardless of the amount of sleep obtained dur-
ing the night. (5) Do not take naps during the day.
According to Kanfer and Gaelick-Buys (1991), one ad-
vantage of stimulus control is that only minimal self-
initiated steps are required to trigger environmental changes
that effect desired or undesired responses. However, stimulus-
control methods are often insufficient to modify behavior
without the support of other strategies. Stimulus-control
methods are usually not sufficient for long-term self-change
unless accompanied by other self-management methods that
exert control over the consequences of the target behavior.
One self-management method that involves self-presented
consequences is discussed in the following section and
illustrated in Learning Activity 17.2.
MODEL EXAMPLE OF STIMULUS CONTROL:
THE CASE OF ISABELLA
This model example illustrates how stimulus control can be
used to help Isabella achieve her goal of increasing positive
thoughts about her math ability. Recall that the principle of
change in using stimulus control to increase a behavior is to
increase the cues associated with the behavior. Here’s how
the helper will implement this principle with Isabella:
1. The helper will establish at least one cue that Isabella can
use as an antecedent for positive thoughts. The helper
might suggest something like putting a piece of tape over
her watch.
2. Isabella and the helper will develop a list of several posi-
tive thoughts about math. Each thought can be written
on a blank card that Isabella can carry with her.
3. The helper will instruct Isabella to read or think about
a thought on one card each time she looks at her watch.
The helper will instruct her to seek out the opportunity
deliberately by looking at her watch frequently and then
concentrating on one of the positive thoughts.
538 CHAPTER 17
LEARNING ACTIVITY 17.2
The purpose of this activity is to help you reduce
an unwanted behavior by using stimulus-control
methods.
1. Specify a behavior that you find undesirable and wish
to decrease. It can be an overt one, such as smoking,
eating, biting your nails, or making sarcastic com-
ments, or it can be a covert behavior, such as thinking
about yourself in negative ways or thinking how great
food or smoking tastes.
2. Select one or more stimulus-control methods to use for
behavior reduction from the list and examples given
in Table 17.2. Remember, you will be reducing the
number of cues or antecedent events associated with
this behavior by altering the times and places the unde-
sired response occurs.
4. When Isabella gets to the point where she automatically
thinks of a positive thought after looking at her watch,
other cues can be established that she can use in the same
way. For instance, she can put a smiley face on her math
book. Each time she gets out her math book and sees
the smiley face, she can use this cue to concentrate on
another positive thought.
5. Isabella can promote more stimulus control over these
thoughts by using reminders. For instance, she can put
a list of positive thoughts on the mirror or on the closet
door in her room. Each time she sees the list, it serves as a
reminder. Or she can ask a friend or classmate to remind
her to “think positively” whenever the subject of math or
math class is being discussed.
SELF-REWARD: PROCESSES AND USES
Self-monitoring and stimulus-control procedures may be
enough to maintain the desired goal behavior for many
people. However, for some people with low self-esteem, de-
pression, strong emotional reactions, environmental conse-
quences, or low self-efficacy, self-monitoring may not always
be effective in regulating behavior (Kanfer & Gaelick-Buys,
1991). In such cases, self-reward procedures are used to help
clients regulate and strengthen their behavior with the aid of
self-produced consequences. Many actions of an individual
are controlled by self-produced consequences as much as by
external consequences.
According to Bandura (1971), there are three necessary
conditions of self-reinforcement, or self-reward:
Stimulus Control
3. Implement these stimulus-control methods daily for two
weeks.
4. During the two weeks, engage in self-monitoring
of your target response. Record the type and use
of your method and the amount of your target
behavior, using frequency or duration methods of
recording.
5. At the end of two weeks, review your recorded data.
Did you use your selected method consistently? If you
did not, what contributed to your infrequent use? If you
used it consistently, did you notice any gradual reduc-
tion in the target behavior by the end of two weeks?
What problems did you encounter in applying a
stimulus-control method with yourself? What did you
learn about stimulus control that might help you when
using it with clients?
1. The individual (rather than someone else) determines
the criteria for adequacy of her or his performance and
for resulting reinforcement.
2. The individual (rather than someone else) controls access
to the reward.
3. The individual (rather than someone else) is his or her
own reinforcing agent and administers the rewards.
Notice that self-reward involves both the self-determination
and the self-administration of a reward. This distinction has,
at times, been overlooked in self-reinforcement research and
application. Nelson, Hayes, Spong, Jarrett, and McKnight
(1983, p. 565) propose that “self-reinforcement is effective
primarily because of its stimulus properties in cuing natural
environmental consequences.”
As a self-management procedure, self-reward is used to
strengthen or increase a desired response. The operations in-
volved in self-reward are assumed to parallel those that occur
in external reinforcement. In other words, a self-presented
reward, like an externally administered reward, is defined
by the function it exerts on the target behavior. A reinforcer
(self- or external) is something that when administered fol-
lowing a target response, tends to maintain or increase the
probability of that response in the future. A major advantage
of self-reward over external reward is that a person can use
and apply this strategy independently.
Self-rewards can be classified into two categories: positive
and negative. In positive self-reward, one presents oneself
with a positive stimulus (to which one has free access) after
engaging in a specified behavior. Examples of positive re-
ward include praising yourself after you have completed

a long and difficult task, buying yourself a new compact
disk after you have engaged in a specified amount of piano
practice, or imagining that you are resting in your favorite
spot after you have completed your daily exercises. Negative
self-reward involves the removal of a negative stimulus after
execution of a target response. Taking down an uncompli-
mentary picture or chart from your wall after performing
the target response is an example of negative self-reward.
Our discussion of self-reward as a therapeutic strategy is
limited to the use of positive self-reward for several reasons.
First, there has been very little research to validate the nega-
tive self-reward procedure. Second, by definition, negative
self-reward involves an aversive activity. It is usually unpleas-
ant for a person to keep suet in the refrigerator or to put an
ugly picture on the wall. Many people will not use a strategy
that is aversive. Third, we do not recommend that helpers
suggest strategies that seem aversive, because the client may
feel that terminating the helping relationship is preferable to
engaging in an unpleasant change process.
Like other management strategies, self-reward has been used
in many clinical applications. Degotardi et al. (2006), for exam-
ple, explored the use of self-reward in the context of a cognitive–
behavioral therapy intervention with juvenile fibromyalgia.
Children reported significant decreases in pain, somatic symp-
toms, anxiety, fatigue, and sleep disturbances. Kocovski and
Endler (2000) found a significant negative relationship be-
tween self-reinforcing behavior and anxiety and depression in a
sample of college-age students. In some instances, self-reward is
part of a cluster of interventions—for example, as one compo-
nent used with developmental disabilities (Harchik, Sherman, &
Sheldon, 1992), promoting physical activity and behavioral
control with elementary-age children (Cromie & Baker, 1997;
Marcoux et al., 1999), and enhancing the academic productiv-
ity of secondary students with learning problems (Seabaugh &
Schumaker, 1994). Other research has explored moderating
variables and alternative reward sources. For example, Enzle,
Roggeveen, and Look (1991) found that ambiguous standards
of performance coupled with self-administration of rewards
reduced intrinsic motivation, whereas clear standards with self-
administration of rewards maintained high levels of intrin-
sic motivation. Research also has examined factors that may
interfere with one’s capacity to productively use self-reward,
such as depression and self-defeating attitudes (Karoly & Lecci,
1997; Schill & Kramer, 1991). Finally, variables have been
examined relative to their likely support of self-reward, such as
the importance of explicit goals (preferably self-chosen) as part
of change strategies involving self-reward (Fuhrmann & Kuhl,
1998; Kuhl & Baumann, 2000).
Some of the clinical effects typically attributed to the
self-reinforcement procedure may also be due to certain
external factors, including a client’s previous reinforcement
history, client goal setting, the role of client self-monitoring,
surveillance by another person, external contingencies in the
SELF-MANAGEMENT STRATEGIES 539
client’s environment, and the instructional set given to the
client about the self-reward procedure. The exact role that
these external variables may play in self-reward is still rela-
tively unknown. However, a helper should acknowledge and
perhaps try to capitalize on some of these factors to heighten
the clinical effects of a self-reward strategy.
COMPONENTS OF SELF-REWARD
Self-reward involves planning by the client of appropriate
rewards and of the conditions in which they will be used.
Four components of self-reward are (1) selection of appro-
priate self-rewards, (2) delivery of self-rewards, (3) timing of
self-rewards, and (4) planning for self-change maintenance.
These components are described in this section and sum-
marized in the following list. Although we discuss them
separately, keep in mind that all of them are integral parts of
an effective self-reward procedure.
1. Selection of appropriate self-rewards
a. Individualize the reward.
b. Use accessible rewards.
c. Use several rewards.
d. Use different types of rewards (verbal/symbolic, ma-
terial, imaginal, current, potential).
e. Use potent rewards.
f. Use rewards that are not punishing to others.
g. Match rewards to the target response.
h. Use rewards that are relevant to the client’s culture,
gender, age, class, and so on.
2. Delivery of self-rewards
a. Self-monitor for data of the target response.
b. Specify what and how much is to be done for a re-
ward.
c. Specify frequent reinforcement in small amounts for
different levels of target response.
3. Timing of self-rewards
a. Reward should come after, not before, behavior.
b. Rewards should be immediate.
c. Rewards should follow performance, not promises.
4. Planning for self-change maintenance
a. Enlist help of others in sharing or dispensing rewards
(if desired).
b. Review data with helper.
Selection of Appropriate Self-Rewards
In helping a client to use self-reward effectively, the therapist
must devote some time and planning to selecting rewards
that are appropriate for the client and for the desired target
behavior. Selecting rewards can be time-consuming. How-
ever, effective use of self-reward is somewhat dependent on
the availability of events that are truly reinforcing to the cli-
ent. The helper can assist the client in selecting appropriate
540 CHAPTER 17
self-rewards; however, the client should have the major role
in determining the specific contingencies.
Rewards can take many different forms. A self-reward
may be verbal/symbolic, material, or imaginal. One verbal/
symbolic reward is self-praise, such as thinking or telling one-
self, “I did a good job.” This sort of reward may be especially
useful with a very self-critical client (Kanfer & Gaelick-Buys,
1991). A material reward is something tangible—an event
(such as a movie), a purchase (such as a banana split), or a
token or point that can be exchanged for a reinforcing event
or purchase. An imaginal reinforcer is the covert visualiza-
tion of a scene or situation that is pleasurable and produces
good feelings. Imaginal reinforcers might include picturing
yourself as a thin person after losing weight or imagining
that you are water-skiing on a lake you have all to yourself.
Self-rewards can also be classified as current or potential.
A current reward is something pleasurable that happens
routinely or occurs daily, such as eating, talking to a friend,
or reading a newspaper. A potential reward is something
that would be new and different if it happened, something
that a person does infrequently or anticipates doing in the
future. Examples of potential rewards include going on a
vacation or buying a “luxury” item (something you love but
rarely buy for yourself, not necessarily something expen-
sive). Engaging in a “luxury” activity—something you rarely
do—can be a potential reinforcer. For a person who is very
busy and constantly working, “doing nothing” might be a
luxury activity that is a potential reinforcer.
In selecting appropriate self-rewards, a client should con-
sider the availability of these various kinds of rewards. We
believe that a well-balanced self-reward program involves a
variety of types of self-rewards. A helper might encourage a
client to select both verbal/symbolic and material rewards.
Relying only on material rewards may ignore the important
role of positive self-evaluations in a self-change program.
Further, material rewards have been criticized for overuse and
misuse. Imaginal reinforcers may not be so powerful as verbal/
symbolic and material ones. However, they are completely
portable and can be used to supplement verbal/symbolic and
material rewards when it is impossible for an individual to use
these other types (Watson & Tharp, 2007).
In selecting self-rewards, a client should also consider the
use of both current and potential rewards. One of the easiest
ways for a client to use current rewards is to observe what
daily thoughts or activities are reinforcing and then to rear-
range these so that they are used in contingent rather than
noncontingent ways (Watson & Tharp, 2007). However,
whenever a client uses a current reward, some deprivation
or self-denial is involved. For example, agreeing to read the
newspaper only after cleaning the kitchen involves initially
denying oneself some pleasant, everyday event in order to use
it to reward a desired behavior. As Thoresen and Mahoney
(1974) point out, this initial self-denial introduces an
aversive element into the self-reward strategy. Some people
do not respond well to any aversiveness associated with
self-change or self-directed behavior. One of the authors,
in fact, consistently “abuses” the self-reward principle by
doing the reward before the response (reading the paper
before cleaning the kitchen)—precisely as a reaction against
the aversiveness of this “programmed” self-denial. One way
to prevent self-reward from becoming too much like pro-
grammed abstinence is to have the client select novel or
potential reinforcers to use in addition to current ones.
A helper can help a client identify and select various
kinds of self-rewards in several ways. One way is simply
with verbal report. Helper and client can discuss current
self-reward practices and desired luxury items and activities
(Kanfer & Gaelick-Buys, 1991). The client can also iden-
tify rewards by using in vivo observation. The client should
be instructed to observe and list current consequences that
seem to maintain some behaviors. Finally, the client can
identify and select rewards by completing preference and
reinforcement surveys.
A preference survey is designed to help the client identify
preferred and valued activities. Here is one that Watson and
Tharp (2007, pp. 210–211) recommend:
1. What will be the rewards of achieving your goal?
2. What kind of praise do you like to receive, from your-
self or from others?
3. What kinds of things do you like to have?
4. What are your major interests?
5. What are your hobbies?
6. What people do you like to be with?
7. What do you like to do with those people?
8. What do you do for fun?
9. What do you do to relax?
10. What do you do to get away from it all?
11. What makes you feel good?
12. What would be a nice present to receive?
13. What kinds of things are important to you?
14. What would you buy if you had an extra $20? $50?
$100?
15. On what do you spend your money each week?
16. What behaviors do you perform every day? (Don’t
overlook the obvious or the commonplace.)
17. Are there any behaviors that you usually perform in-
stead of the target behavior?
18. What would you hate to lose?
19. Of the things you do every day, which would you hate
to give up?
20. What are your favorite daydreams and fantasies?
21. What are the most relaxing scenes you can imagine?
The client can complete this sort of preference survey in
writing or in a discussion. Clients who find it difficult to

identify rewarding events might also benefit from complet-
ing a more formalized reinforcement survey, such as the
Reinforcement Survey Schedule or the Children’s Reinforce-
ment Survey Schedule, written by Cautela (1977). The cli-
ent can be given homework assignments to identify possible
verbal/symbolic and imaginal reinforcers. For instance, the
client might be asked to make a daily list for a week of posi-
tive self-thoughts or of the positive consequences of desired
change. Or the client could make a list of all the things about
which she or he likes to daydream or of some imagined scenes
that would be pleasurable (Watson & Tharp, 2007).
Sometimes a client may seem thwarted in initial attempts to
use self-reward because of difficulties in identifying rewards.
Watson and Tharp (2007) note that people whose behavior
consumes the reinforcer (such as smoking or eating), whose
behavior is reinforced intermittently, or whose avoidance be-
havior is maintained by negative reinforcement may not be
able to identify reinforcing consequences readily. Individuals
who are locked into demanding schedules may not be able to
find daily examples of reinforcers. Depressed people sometimes
have trouble identifying reinforcing events. In these cases, the
helper and client have several options that can be used to over-
come difficulties in selecting effective self-rewards.
A client who does not have the time or money for mate-
rial rewards might use imaginal rewards. Imagining pleasant
scenes following a target response has been described by
Cautela (1970) as covert positive reinforcement. Using this
procedure, the client usually imagines performing a desired
behavior, then imagines a reinforcing scene. A helper might
consider use of imaginal reinforcers only when other kinds
of reinforcers are not available.
A second option is to use a client’s everyday activity as a
self-reward. Some clinical cases have used a mundane activ-
ity such as answering the phone or opening the daily mail
as the self-reward. If a frequently occurring behavior is used
as a self-reward, it should be a desirable or at least a neutral
activity. As Watson and Tharp (2007) note, clients should
not use as a self-reward any high-frequency behavior that
they would stop immediately if they could. Using a nega-
tive high-frequency activity as a reward may seem more like
punishment than reinforcement.
No thought, event, or imagined scene is reinforcing for
everyone. Often, what one person finds rewarding is very
different from the rewards selected by someone else. When
self-rewards are used, it is important to help clients choose
rewards that will work well for them—not for the helper, a
friend, or a spouse. Kanfer and Gaelick-Buys (1991) note
the importance of considering the client’s history and also
of taking into account the client’s gender, culture, age, class,
and personal preferences.
The practitioner should use the following guidelines to
help the client determine some self-rewards that might be
used effectively.
SELF-MANAGEMENT STRATEGIES 541
1. Individualize the reward to the client.
2. The reward should be accessible and convenient to use
after the behavior is performed.
3. Several rewards should be used interchangeably to pre-
vent satiation (a reward can lose its reinforcing value
because of repeated presentations).
4. Different types of rewards should be selected (verbal/
symbolic, material, imaginal, current, potential).
5. The rewards should be potent but not so valuable that an
individual will not use them contingently.
6. The rewards should not be punishing to others. Watson
and Tharp (2007) suggest that if a reward involves some-
one else, the other person’s agreement should be ob-
tained.
7. The rewards should be compatible with the desired re-
sponse (Kanfer & Gaelick-Buys, 1991). For instance, a
person losing weight might use new clothing as a reward
or thoughts of a new body image after weight loss. Using
eating as a reward is not a good match for a weight-loss
target response.
8. The rewards should be relevant to the client’s values and
circumstances as well as appropriate to her or his cul-
ture, gender, age, socioeconomic status, and any other
salient features (e.g., personality and personal philo-
sophy).
Delivery of Self-Rewards
Specifying the conditions and method of delivering the
self-rewards is the second part of working out a self-reward
strategy with a client. A client cannot deliver or administer
a self-reward without some data. Self-reward delivery is de-
pendent on systematic data gathering, so self-monitoring is
an essential first step.
Second, the client needs to identify the precise condi-
tions under which a reward will be delivered. The client,
in other words, needs to state the rules of the game: what
and how much has to be done before administering a self-
reward. Self-reward is usually more effective when clients
reward themselves for small steps of progress. Performance
of a subgoal should be rewarded. Waiting to reward oneself
for demonstration of the overall goal usually introduces too
much of a delay between responses and rewards.
Finally, the client needs to indicate how much and what
kind of reward will be given for performing various re-
sponses or different levels of the goals. The client needs to
specify that doing so much of the response results in one
type of reward and how much of it. Reinforcement is usually
most effective when broken down into small units such as
tokens or points that are self-administered frequently. After
a certain amount of points or tokens is accumulated, these
units can be exchanged for a “larger” reinforcer. Learning
Activity 17.3 walks you through a self-reward exercise with
questions to consider.
542 CHAPTER 17
LEARNING ACTIVITY 17.3
This activity is designed to have you engage in
self-reward.
1. Select a target behavior you want to increase. Write
down your goal (the behavior to increase, the desired
level of increase, and conditions in which behavior will
be demonstrated).
2. Select several types of self-rewards to use, and write
them down. The types to use are verbal/symbolic, ma-
terial (both current and potential), and imaginal. See
whether your selected self-rewards meet the following
criteria:
a. Individually tailored to you?
b. Accessible and convenient to use?
c. Several self-rewards?
Timing of Self-Rewards
The helper needs to instruct the client about the timing
of self-reward: when a self-reward should be adminis-
tered. There are three ground rules for the timing of a self-
reward:
1. The client should administered a self-award after per-
forming the specified response, not before.
2. The client should administer a self-award immediately
after the response. Long delays may render the proce-
dure ineffective.
3. A self-reward should follow actual performance, not
promises to perform.
Planning for Self-Change Maintenance
Self-reward, like any self-change strategy, needs environ-
mental support for long-term maintenance of change. The
last part of using self-reward involves helping the client find
ways to plan for self-change maintenance. First, the helper
can give the client the option of enlisting the help of oth-
ers in a self-reward program. Other people can share in or
dispense some of the reinforcement if the client is comfort-
able with this idea (Watson & Tharp, 2007). Some evidence
indicates that certain people may benefit more from self-
reward if initially in the program they received their rewards
from others (Mahoney & Thoresen, 1974). Second, the cli-
ent should plan to review with the helper the data collected
during self-reward. The review sessions give the helper a
chance to reinforce the client and to help the client make
any necessary revisions in the use of the strategy. Helper
Self-Reward
d. Different types of self-rewards?
e. Potent rewards?
f. Rewards not punishing to others?
g. Rewards compatible with your desired goal?
h. Rewards relevant to your gender and culture?
3. Set up a plan for delivery of your self-reward: What
type of reinforcement and how much will be adminis-
tered? How much and what demonstration of the target
behavior are required?
4. When do you plan to administer a self-reward?
5. How could you enlist the aid of another person?
6. Apply self-reward for a specified time period. Did your
target response increase? To what extent?
7. What did you learn about self-reward that might help
you in suggesting its use to diverse groups of
clients?
expectations and approval for client progress may add to the
overall effects of the self-reward strategy if the helper serves
as a reinforcer to the client.
SOME CAUTIONS IN USING REWARDS
The use of rewards as a motivational and informational
device is a controversial issue (Eisenberger & Cameron,
1996). Using rewards, especially material ones, as incentives
has been criticized on the grounds that tangible rewards
are overused, are misused, and often discourage rather than
encourage the client.
As a change strategy, self-reward should not be used indis-
criminately. Before suggesting self-reward, the helper should
carefully consider the individual client, the client’s previous
reinforcement history, and the client’s desired change. Self-
reward may not be appropriate for clients from cultural
backgrounds in which the use of rewards is considered
“undesirable or immodest” (Kanfer & Gaelick-Buys, 1991,
p. 338). When a helper and client do decide to use self-
reward, two cautionary guidelines should be followed. First,
material rewards should not be used solely or indiscriminately.
The helper should seek ways to increase a person’s intrinsic
satisfaction in performance before automatically resorting to
extrinsic rewards as a motivational technique. Second, the
helper’s role in self-reward should be limited to providing
instructions about the procedure and encouragement for pro-
gress. The client should be the one who selects the rewards and
determines the criteria for delivery and timing of reinforce-
ment. When the target behaviors and the contingencies

are specified by someone other than the person using self-
reward, the procedure can hardly be described accurately as
a self-change operation.
MODEL EXAMPLE OF SELF-REWARD:
THE CASE OF ISABELLA
This example illustrates how self-reward can be used to help
Isabella increase her positive thoughts about her ability to
do well in math:
1. Selection of self-rewards: First, the helper helps Isabella
select some appropriate rewards to use for reaching her
predetermined goal. The helper encourages Isabella to
identify some self-praise she can use to reward herself
symbolically or verbally (“I did it”; “I can gradually
see my attitude about math changing”). Isabella can
give herself points for daily positive thoughts. She can
accumulate and exchange the points for material re-
wards, including current rewards (such as engaging in
a favorite daily event) and potential rewards (such as a
purchase of a desired item). These are suggestions; Isa-
bella is responsible for the actual selection. The helper
suggests that Isabella identify possible rewards through
observation or completion of a preference survey. The
helper makes sure that the rewards that Isabella selects
are accessible and easy to use. Several rewards are se-
lected to prevent satiation. The helper also makes sure
that the rewards selected are potent, compatible with
Isabella’s goal, not punishing to anyone else, and rel-
evant to Isabella.
2. Delivery of self-rewards: The helper helps Isabella de-
termine guidelines for delivery of the rewards selected.
Isabella might decide to give herself a point for each
positive thought. This allows for reinforcement of
small steps toward the overall goal. A predetermined
number of daily points, such as 5, might result in deliv-
ery of a current reward, such as watching TV or going
over to her friend’s house. A predetermined number of
weekly points could mean delivery of a potential self-
reward, such as going to a movie or purchasing a new
item. Isabella’s demonstration of her goal beyond the
specified level could result in the delivery of a bonus
self-reward.
3. Timing of self-rewards: The helper instructs Isabella to
administer the reward after the positive thoughts or
after the specified number of points is accumulated.
The helper emphasizes that the rewards follow per-
formance, not promises. The helper should encourage
Isabella to engage in the rewards as soon as possible
after the daily and weekly target goals are met.
4. Planning for self-change maintenance: The helper helps
Isabella find ways to plan for self-change maintenance.
SELF-MANAGEMENT STRATEGIES 543
One way is to schedule periodic “check-ins” with the
helper. In addition, Isabella might select a friend who
can help her share in the reward by watching TV or
going shopping with her or by praising Isabella for her
goal achievement.
SELF-EFFICACY
Self-efficacy is viewed as a cognitive process that mediates
behavioral change. Self-efficacy refers to our judgments and
subsequent beliefs of how capable we are of performing
certain things under specific situations. These capabilities
include but are not limited to overt behaviors—for example,
how capable we believe we are in managing our thoughts or
feelings in specific situations as well as how capably we can
undertake particular actions. If our self-efficacy beliefs are
broad, we think we can accomplish something in most situa-
tions (like walking, being able to communicate in our native
language). If our self-efficacy beliefs are situation specific,
we may believe we can be assertive or resist temptation in
some situations but not in others.
There are some important distinctions to keep in mind.
Self-efficacy beliefs foster expectations about our personal
abilities to accomplish something. They are related to but
are different from outcome expectations—that is, our beliefs
that our actions will result in desired outcomes (Bandura,
1986). We may feel that we have the ability to accomplish a
task—say, at school or work—and, thus we have high self-
efficacy in this regard. But if we believe that this ability alone
is not sufficient for achieving the desired outcome—like suc-
ceeding in a change or recognition of a job well done—then
we have low outcome expectations (due perhaps to beliefs
that the outcome is dependent on other people, events, or
forces that are not predictable or are not likely to be effica-
cious). Including outcome expectations and factors likely to
affect the outcome of an attempted task is clearly important
to assessment. As important as self-efficacy is to fueling
people’s pursuits of what is important to them, so too is real-
istic consideration of whether this is enough: Consideration
of barriers that can thwart success regardless of the skills and
beliefs that an individual can bring to the effort.
Self-efficacy is not the same as self-esteem. For example,
we can have high self-efficacy beliefs about certain tasks or
abilities but low overall self-esteem. Low self-esteem can be
due to a lot of reasons, such as not valuing things we do well
as much as things we believe we are not able to successfully
accomplish, or input from others that devalues what we
believe we can do well. In general, however, self-esteem is
enhanced when our self-efficacy is high in domains of life
that we care most about and in which we desire to exert
personal control—when we feel capable of doing what is
required to achieve success, or when we realize that we have
reached our goal. Underlying self-efficacy is either optimism
544 CHAPTER 17
BOX 17.4 RESEARCH ON SELF-EFFICACY
Alcohol Use
Holloway, A. S., Watson, H. E., & Starr, G. (2006). How do
we increase problem drinkers’ self-efficacy? A nurse-led
brief intervention putting theory into practice. Journal of
Substance Use, 11(6), 375–386.
Assessment
Pajares, F. (2007). Empirical properties of a scale to as-
sess writing self-efficacy in school contexts. Measurement
and Evaluation in Counseling and Development, 39 (4),
239–249.
Scherbaum, C. A., Cohen-Charash, Y., & Kern, M. J. (2006).
Measuring general self-efficacy: A comparison of three
measures using item response theory. Educational and
Psychological Measurement, 66 (6), 1047–1063.
Cardiac Illness
Joekes, K., Van Elderen, T., & Schreurs, K. (2007). Self-
efficacy and overprotection are related to quality of life,
psychological well-being and self-management in cardiac
patients. Journal of Health Psychology, 12 (1), 4–16.
Lau-Walker, M. (2006). Predicting self-efficacy using illness
perception components: A patient survey. British Journal of
Health Psychology, 11(4), 643–661.
Career Decisions
Bandura, A., Barbaranelli, C., Vittorio Caprara, G., &
Pastorelli, C. (2001). Self-efficacy beliefs as shapers of
children’s aspirations and career trajectories. Child Devel-
opment, 72 (1), 187–206.
Nauta, M. M., & Kahn, Jeffrey H. (2007). Identity status,
consistency and differentiation of interests, and career de-
cision self-efficacy. Journal of Career Assessment, 15 (1),
55–65.
Chronic Illness
Davis, A. H. T., Carrieri-Kohlman, V., Janson, S. L., Gold,
W. M., & Stulbarg, M. S. (2006). Effects of treatment on
two types of self-efficacy in people with chronic obstructive
pulmonary disease. Journal of Pain and Symptom Manage-
ment, 32 (1), 60–70.
Creativity
Beghetto, R. A. (2006). Creative self-efficacy: Correlates in
middle and secondary students. Creativity Research Jour-
nal, 18 (4), 447–457.
Depression
Pomaki, G., ter Doest, L., & Maes, S. (2006). Goals and
depressive symptoms: Cross-lagged effects of cognitive
versus emotional goal appraisals. Cognitive Therapy and
Research, 30 (4), 499–513.
Diabetes
Griva, K., Myers, L. B., & Newman, S. (2000). Illness per-
ceptions and self-efficacy beliefs in adolescents and young
adults with insulin dependent diabetes mellitus. Psychology
and Health, 15, 733–750.
Dietary Behavior
Annesi, J. J., & Unruh, J. L. (2006). Correlates of mood
changes in obese women initiating a moderate exercise
and nutrition information program. Psychological Reports,
99 (1), 225–229.
Hagler, A. S., Norman, G. J., Zabinski, M. F., Sallis, J. F.,
Calfas, K. J., & Patrick, K. (2007). Psychosocial corre-
lates of dietary intake among overweight and obese men.
American Journal of Health Behavior, 31(1), 3–12.
Epilepsy
Elliott, J. O., Jacobson, M. P., & Seals, B. F. (2006). Self-
efficacy, knowledge, health beliefs, quality of life, and
stigma in relation to osteoprotective behaviors in epilepsy.
Epilepsy and Behavior, 9 (3), 478–491.
Exercise
Beauchamp, M. R., Welch, A. S., & Hulley, A. J. (2007). Trans-
formational and transactional leadership and exercise-
related self-efficacy: An exploratory study. Journal of
Health Psychology, 12 (1), 83–88.
HIV/AIDS
Wolf, M. S., Davis, T. C., Osborn, C. Y., Skripkauskas, S.,
Bennett, C. L., & Makoul, G. (2007). Literacy, self-efficacy,
and HIV medication adherence. Patient Education and
Counseling, 65 (2), 253–260.
Maternal Self-Efficacy
Noel-Weiss, J., Bassett, V., & Cragg, B. (2006). Developing
a prenatal breastfeeding workshop to support maternal
breastfeeding self-efficacy. Journal of Obstetric, Gyneco-
logic, and Neonatal Nursing: Clinical Scholarship for the
Care of Women, Childbearing Families, and Newborns,
35 (3), 349–357.
Mental Health Nurses
Dunn, K., Elsom, S., & Cross, W. (2007). Self-efficacy and
locus of control affect management of aggression by men-
tal health nurses. Issues in Mental Health Nursing, 28 (2),
201–217.
Pain
Hadjistavropoulos, H., Dash, H., Hadjistavropoulos, T., &
Sullivan, T. (2007). Recurrent pain among university stu-
dents: Contributions of self-efficacy and perfectionism to

BOX 17.4 RESEARCH ON SELF-EFFICACY
the pain experience. Personality and Individual Differ-
ences, 42 (6), 1081–1091.
Taylor, W. J., Dean, S. G., & Siegert, R. J. (2006). Dif-
ferential association of general and health self-efficacy
with disability, health-related quality of life and psycho-
logical distress from musculoskeletal pain in a cross-
sectional general adult population survey. Pain, 125 (3),
225–232.
Parenting
Streisand, R., Swift, E., Wickmark, T., Chen, R., & Holmes,
C. S. (2005). Pediatric parenting stress among parents
of children with type 1 diabetes: The role of self-efficacy,
responsibility, and fear. Journal of Pediatric Psychology,
30 (6), 513–521.
Whittaker, K. A., & Cowley, S. (2006). Evaluating health
visitor parenting support: Validating outcome measures
for parental self-efficacy. Journal of Child Health Care,
10 (4), 296–308.
and hope that yield high efficacy, or helplessness and despair
that contribute to low efficacy.
We can have high self-efficacy in some life domains but
low self-efficacy in others, believing, for example, that
we are capable of being successful at work but are lousy
at parenting. In general, efficacy beliefs also build on ex-
perience, whether vicarious or actual, and draw from our
cognitive schemas about who we are (e.g., my experiences
with and input from others about my academic ability in-
cline me to have high or low self-efficacy about mastering
an academic challenge, depending on the nature of that
experience and input). Thus, self-efficacy is not fixed but
is largely learned and shaped by life experience, and it can
be relearned and reshaped through focused intervention.
Part of the reason why self-efficacy is so important is that
it has been found to be a significant component in many
issues germane to well-being, like tackling versus avoiding
challenges and opportunities, degree of effort expended,
persistence with the task, problem solving, coping, per-
formance, confidence, determination, optimism, hopeful-
ness, and enthusiasm.
Over the last several years, research about self-efficacy
has flourished. Box 17.4 lists a selected sample of these
studies. Here we see wide-ranging life domains and clini-
cal concerns such as substance use, health conditions
(asthma, cancer, cardiovascular, chronic illness, diabetes,
epilepsy, HIV/AIDS), achievement and performance, vo-
cational and work issues, dietary behavior, depression,
maternity and parenting, teaching, and outcome effec-
SELF-MANAGEMENT STRATEGIES 545
Smoking
Victoir, A., Eertmans, A., Van den Broucke, S., & Van den
Bergh, O. (2006). Smoking status moderates the contribu-
tion of social–cognitive and environmental determinants to
adolescents’ smoking intentions. Health Education Research,
21(5), 674–687.
Teaching
Caprara, G. V., Barbaranelli, C., Steca, P., & Malone, P. S.
(2006). Teachers’ self-efficacy beliefs as determinants of
job satisfaction and students’ academic achievement: A
study at the school level. Journal of School Psychology,
44 (6), 473–490.
Work Performance
Judge, T. A., Jackson, C. L., Shaw, J. C., Scott, B. A., & Rich,
B. L. (2007). Self-efficacy and work-related performance:
The integral role of individual differences. Journal of Ap-
plied Psychology, 92 (1), 107–127.
tiveness across a range of life domains. The list of self-
efficacy research is far greater than we can present here.
Thus, we encourage you to undertake your own literature
searches on problems, goals, or populations of particular
relevance to you.
Several sources contribute to self-efficacy and to similar
concepts in the constellation of one’s personality or personal
constructs. According to Bandura (1997), four factors influ-
ence efficacy expectations: (1) actual performance accom-
plishments, (2) mind–body states such as emotional arousal,
(3) environmental experiences such as vicarious learning,
and (4) verbal installation—as a prelude to treatment. Ver-
bal installation is the persuasion process that the helper uses
to enhance a client’s confidence or self-efficacy expecta-
tions about performing specific tasks. A helping profes-
sional might foster positive self-efficacy by talking with the
client about his or her past success in performing similar or
related tasks. Or the helper can attempt to build confidence
by discussing any of the client’s successful experiences if the
client has not engaged in tasks for which self-confidence or
efficacy was needed.
Performance Accomplishments
There is huge variability in how people perform. People
who have a high degree of self-efficacy recoup very quickly
from failure. At one extreme are people who are moti-
vated, energized, and risk taking despite the possibility of
failure—partly because they do not anticipate failure or are
able to interpret failure in ways that do not significantly
546 CHAPTER 17
diminish their future self-efficacy expectations. At the other
extreme are people who fall into a state of learned helpless-
ness (Seligman, 1990). These people are plagued with de-
pressed feelings that contribute to pessimism, a low level of
energy, negative internal dialogue, vulnerability, and hope-
lessness, resulting in low levels of attempted performance.
When these people experience failure, they are more likely
to interpret it as further evidence that they are not capable
(“It’s my fault,” “I always screw things up,” “This is just
another example that I can never do anything right”), thus
deepening future low efficacy expectations. You can see the
cognitive underpinnings of self-efficacy and ways in which
self-schemas, cognitive processing habits, and interactions
with the world can contribute either positively or negatively
to self-efficacy beliefs.
Most of us fall somewhere between these two extremes.
Perceived self-efficacy is a major determinant of whether
people engage in a task, the amount of effort they exert if
they do engage, and how long they will persevere with the
task if they encounter adverse circumstances. For example,
people who frequently surf the Internet on their personal
computers in search of a particular webpage feel competent
in performing this task. They may feel quite confident in
their abilities and persevere for some time in their search,
even when they are unsuccessful in locating a specific web-
page. However, the same people may feel less competent in
programming software and may avoid programming tasks.
Sometimes people feel competent at performing a task but
do not perform it because there is no incentive for doing
so. Also, some people may have unrealistic expectations
about performing a task simply because they are unfamiliar
with the task. For example, some people may feel overcon-
fident about doing something, and others may experience
less confidence. Generally, when we develop competence
of any kind, we enhance and strengthen our self-efficacy,
confidence, self-esteem, willingness to take risks, and ability
to perform the task.
Mind–Body Link to Self-Efficacy
What we are feeling emotionally and the bodily sensations
and phenomena accompanying differing emotions have im-
portant implications for what cognitions we are likely to
access from memory and to generate in that context. If we
are feeling highly anxious, for example, we will have a dif-
ferent set of cognitions salient to our information processing
in the moment than if we are feeling calm or excited. Thus,
if we are feeling anxious in a situation, it will be difficult to
access memories of when we were successful in the past or to
focus on aspects of the situation that address how we might
be successful, which, in turn, will result in a set of schemas
and perceptions active in that situation that are unlikely to
support high self-efficacy expectations. Thus, one’s ability to
be aware of and manage one’s emotional state (e.g., to shift
from a high level of emotional arousal to a lower level, from
anxiety more toward determination) is a valuable tool for
managing self-efficacy beliefs and expectations.
Similarly, we are becoming increasingly aware of the ways
in which our thoughts, feelings, and behaviors interact,
and how these affect and are affected by many bodily sys-
tems, such as biochemistry and neurological processes. For
example, there are chain reactions and interactions within
the mind–body information-processing system. Some of
this work involves the information molecules, peptides, and
receptors that serve as biochemicals of emotion (Pert, 1993)
and ways in which messenger molecules or neuropeptides
influence self-efficacy. As we’ve noted, a person who has
a high degree of self-confidence and higher perceptions of
personal control, compared with someone of lower self-
confidence, is inclined to attempt more difficult tasks, use
more energy, persevere longer at solutions when faced with
adversity, and refuse to blame himself or herself when en-
countering failure. One hypothesis here is that the produc-
tion of endogenous morphine (endorphins) in the brain is
high and that the production of catecholamines (stress hor-
mones) is low—relevant because production of endorphins
is positively correlated with confidence. It has an analgesic
effect, which spreads throughout the body, reducing sensi-
tivity to pain and lessening automatic activities like cardiac
reactivity and blood pressure (Bandura, Cioffi, Taylor, &
Brouillard, 1988; Pert, 1993).
In contrast, people without feelings of control have low
levels of perceived self-efficacy, avoid difficult tasks, have
lower expectancies, and have a weak commitment to achiev-
ing a goal. They are more vulnerable to dwelling on their
personal inadequacies, allowing negative self-talk, putting
forth less effort, having little energy for a task, and tak-
ing longer to recover from failure on some task. They are
very susceptible to stress and depression. When we feel we
are not in control, our feelings of low self-efficacy can in-
crease the production of catecholamines (Bandura, Taylor,
Williams, Mefford, & Barchas, 1985). Our emotional state
affects our perceived level of self-efficacy; this state, in turn,
causes information molecules or neuropeptides to produce
either stress hormones or brain opioids, depending on our
emotional state. The degree of perceived self-efficacy and
biochemical reactivity have many contributors, including
origins in the family (on both a genetic and a social basis)
and the environmental and cultural context in which the
family resides. Needless to say, this is but one small part of
the complex relationships of our psychoneuroendocrinol-
ogy, thoughts, feelings, and actions (Zillmann & Zillmann,
1996).
Although self-efficacy fundamentally refers to beliefs, it, like
other cognitions, is far from being “all in the head.” Thinking
and feeling (such as hope, forgiveness, optimism, and deter-
minism) are intricately interwoven with our physiology and

genetic makeup, which collectively interact with our social
conditions to shape our behaviors and outcomes (Snyder &
Lopez, 2007).
Environmental Influences
A person’s self-efficacy is influenced by reciprocal inter-
actions of cognitive, affective, behavioral, relational, and
environmental and/or cultural variables. Family of origin,
culture, and environmental setting mold a person’s per-
ceived self-efficacy, which contributes to cognitive devel-
opment and functioning. Bandura (1993) proposed that
perceived self-efficacy exerts a powerful influence on four
major developmental processes: cognitive, motivational,
affective, and perceptual selection. For example, Bandura
(1993) illustrates ways in which perceived self-efficacy can
operate at multiple levels, both individual and collective.
Relative to academic development, for example, we can see
the following: (1) Individual students’ beliefs in their effi-
cacy to regulate their own learning and to master academic
activities determine their level of motivation and academic
accomplishments. (2) Individual teachers’ beliefs in their
efficacy to motivate and promote learning affect the types
of learning environments that teachers create and the degree
of their students’ academic progress. (3) Whole faculties’
beliefs in their collective instructional efficacy contribute
significantly to their schools’ level of achievement. (4) Col-
lective student body characteristics can influence school-
level achievement in part by altering faculties’ beliefs in their
collective efficacy.
Note that these four levels of perceived self-efficacy are
also affected by a person’s worldview, often reflective of one’s
cultural perspective (Bandura, 1995). Oettingen (1995), for
example, examines cultural effects on self-efficacy relative
to differences based on individualism versus collectivism,
power differential, masculinity, and avoidance of uncer-
tainty. In collectivist cultures, members of core groups are
likely to be a primary source of efficacy information for each
individual. In contrast, in individualistic cultures, there is
higher reliance on one’s own evaluations and emotional reac-
tions. Cultures or social conditions in which there are large
power differentials are likely to find those with greater power
as stronger sources of environmental influences as opposed
to conditions with less power disparity. In the latter, individ-
uals may be more inclined to see their actions and outcomes
as more closely tied to their skill, and efficacy belief and less
vulnerable to external impediments. Although a centrally
important therapeutic factor, it is essential to realize that
real-world factors have historically and continue to impinge
differently on people’s actual ability to be efficacious. For
some, even if one can be successful in accomplishing a task,
this may not be sufficient to achieving desired goals given
more powerful external factors that can negatively affect
actual outcomes.
SELF-MANAGEMENT STRATEGIES 547
Self-Efficacy as a Prelude for Treatment
A client’s expectations, based on his or her perceived self-
efficacy, shape the underlying cognitive process that accounts,
at least in part, for changes in therapeutic outcomes and
the achievement of treatment goals. Clients must acquire
self-efficacy (confidence) to perform the specific skills as-
sociated with a particular therapeutic strategy so that they
can achieve their therapeutic goals. Self-efficacy has been
found associated with planning for change, harder effort,
better problem solving, and greater persistence even in the
face of failure (Cervone, 2000). Self-efficacy is a mental
precondition that has a striking influence on the successful
application of treatment. We believe that if the helper can
maximize the client’s perceived self-efficacy and expectan-
cies about treatment, the client will be confident about us-
ing the specific steps associated with the treatment protocol,
and that confidence will enhance the potential benefits and
effectiveness of treatment. Although the success of achiev-
ing therapeutic goals may be largely a function of a client’s
self-efficacy, factors such as a client’s age, gender, social
class, and cultural and ethnic background may influence
the degree of efficacy or confidence he or she brings to the
therapeutic tasks.
APPLICATIONS OF SELF-EFFICACY
WITH DIVERSE GROUPS
Increasingly, self-efficacy is being investigated with diverse
groups of clients and research participants. As is evident in
Box 17.5, the topics on which self-efficacy has been empiri-
cally studied with diverse groups are varied. In the area of
prevention and risk reduction, for example, self-efficacy has
been examined as a factor relative to drug and alcohol use,
smoking, HIV and other sexually transmitted diseases, car-
diovascular disease, and other health conditions. Depression,
social support, mental distress, and other dimensions of emo-
tional and psychological well-being include self-efficacy as a
factor. Studies of academic performance and various aspects
of job seeking, work, and career have long implicated self-
efficacy, and continue with diverse client samples. Increas-
ingly, older adults, people with disabilities, and those strug-
gling with poverty are included in self-efficacy research, in
addition to examination of cultural differences, both in the
United States and elsewhere.
The concept of resilience is gaining attention, and self-
efficacy appraisals are a part of that analysis. Zimmerman,
Ramirez-Valles, and Maton (1999), for example, tested the
protective effects of African American male adolescents’
beliefs about their efficacy in social and political systems
(termed sociopolitical control ) on the link between helpless-
ness and mental health (psychological symptoms and self-
esteem). They found that high sociopolitical self-efficacy
beliefs limited the negative consequences of helplessness
548 CHAPTER 17
BOX 17.5 APPLICATION OF SELF-EFFICACY WITH DIVERSE GROUPS
Academic Achievement
Reed, M. C. (2003). The relation of neighborhood variables,
parental monitoring, and school self-efficacy on academic
achievement among urban African American girls. Disser-
tation Abstracts International: Section B: The Sciences and
Engineering, 64 (6-B), 2987.
Zimmerman, B. J., & Kitsantas, A. (2005). Homework prac-
tices and academic achievement: The mediating role of
self-efficacy and perceived responsibility beliefs. Contem-
porary Educational Psychology, 30 (4), 397–417.
Alcoholism
Oei, T. P. S., & Jardim, C. L. (2007). Alcohol expectancies,
drinking refusal self-efficacy and drinking behaviour in
Asian and Australian students. Drug and Alcohol Depend-
ence, 87 (2–3), 281–287.
Spiller, V., Zavan, V., & Guelfi, G. P. (2006). Assessing mo-
tivation for change in subjects with alcohol problems: The
MAC2-A Questionnaire. Alcohol and Alcoholism, 41(6),
616–623.
Career Decisions
Gushue, G. V., & Whitson, M. L. (2006). The relation-
ship among support, ethnic identity, career decision self-
efficacy, and outcome expectations in African American
high school students: Applying social cognitive career the-
ory. Journal of Career Development, 33 (2), 112–124.
Condom Use
Barkley, T. W., Jr., & Burns, J. L. (2000). Factor analysis of the
Condom Use Self-Efficacy Scale among multicultural col-
lege students. Health Education Research, 15, 485–489.
Bogart, L. M., Cecil, H., & Pinkerton, S. D. (2000). Intentions
to use the female condom among African American adults.
Journal of Applied Social Psychology, 30, 1923–1953.
Cultural Differences
Durndell, A., Haag, Z., & Laithwaite, H. (2000). Computer
self-efficacy and gender: A cross-cultural study of Scotland
and Romania. Personality and Individual Differences, 28,
1037–1044.
Piontkowski, U., Florack, A., Hoelker, P., & Obdrzalek, P.
(2000). Predicting acculturation attitudes of dominant and
non-dominant groups. International Journal of Intercultural
Relations, 24 (1), 1–26.
Schaubroeck, J., Lam, S. S., & Xie, J. L. (2000). Collective
efficacy versus self-efficacy in coping responses to stres-
sors and control: A cross-cultural study. Journal of Applied
Psychology, 85, 512–525.
Depression
Casten, R. J., Rovner, B. W., Pasternak, R. E., & Pelchat, R.
(2000). A comparison of self-reported function assessed
before and after depression treatment among depressed
geriatric patients. International Journal of Geriatric Psy-
chiatry, 15, 813–818.
Makaremi, A. (2000). Self-efficacy and depression among Ira-
nian college students. Psychological Reports, 86, 386–388.
Diabetes
Kara, M., van der Bijl, J. J., Shortridge-Baggett, L. M., Asti, T.,
& Erguney, S. (2006). Cross-cultural adaptation of the
diabetes management self-efficacy scale for patients with
type 2 diabetes mellitus: Scale development. International
Journal of Nursing Studies, 43 (5), 611–621.
Educational Technology
Wu, Y., & Tsai, C. (2006). University students’ Internet attitudes
and Internet self-efficacy: A study at three universities in Tai-
wan. CyberPsychology and Behavior, 9 (4), 441–450.
Gender
Blanchard, C. M., Reid, R. D., Morrin, L. I., Beaton, L. J., Pipe,
A., Courneya, K. S., & Plotnikoff, R. C. (2007). Barrier
self-efficacy and physical activity over a 12-month period
in men and women who do and do not attend cardiac
rehabilitation. Rehabilitation Psychology, 52 (1), 65–73.
HIV
Barclay, T. R., Hinkin, C. H., Castellon, S. A., Mason, K. I.,
Reinhard, M. J., Marion, S. D., et al. (2007). Age-associated
predictors of medication adherence in HIV-positive adults:
Health beliefs, self-efficacy, and neurocognitive status.
Health Psychology, 26 (1), 40–49.
HIV/AIDS Education
Kyrychenko, P., Kohler, C., & Sathiakumar, N. (2006). Evalua-
tion of a school-based HIV/AIDS educational intervention in
Ukraine. Journal of Adolescent Health, 39 (6), 900–907.
Meyer-Weitz, A. (2005). Understanding fatalism in HIV/AIDS
protection: The individual in dialogue with contextual fac-
tors. African Journal of AIDS Research, 4 (2), 75–82.
Older Adults
Lucidi, F., Grano, C., Barbaranelli, C., & Violani, C. (2006).
Social–cognitive determinants of physical activity atten-
dance in older adults. Journal of Aging and Physical Activity,
14 (3), 344–359.
Stretton, C. M., Latham, N. K., Carter, K. N., Lee, A. C., &
Anderson, C. S. (2006). Determinants of physical health in

BOX 17.5 APPLICATION OF SELF-EFFICACY WITH DIVERSE GROUPS
frail older people: The importance of self-efficacy. Clinical
Rehabilitation, 20 (4), 357–366.
Physical Impairment
Sanford, J. A., Griffiths, P. C., Richardson, P., Hargraves, K.,
Butterfield, T., & Hoenig, H. (2006). The effects of in-home
rehabilitation on task self-efficacy in mobility-impaired
adults: A randomized clinical trial. Journal of the Ameri-
can Geriatrics Society, 54 (11), 1641–1648.
Racism
Lightsey, O. R., & Barnes, P. W, (2007). Discrimination, attri-
butional tendencies, generalized self-efficacy, and assertive-
ness as predictors of psychological distress among African
Americans. Journal of Black Psychology, 33 (1), 27–50.
Rollins, V. B., & Valdez, J. N. (2006). Perceived racism and
career self-efficacy in African American adolescents. Jour-
nal of Black Psychology, 32 (2), 176–198.
Sexual Behaviors
Ozakinci, G., & Weinman, J. A. (2006). Determinants
of condom use intentions and behavior among Turkish
on mental health, suggesting the value of this form of self-
efficacy in buffering or protecting youth from negative con-
sequences of feeling helplessness.
One of the premises behind self-efficacy theory is that
its effect is often one of mediating the relationship of
background variables to outcomes. Smith, Walker, Fields,
Brookins, and Seay (1999) found support for this among
a sample of male and female early adolescents from differ-
ent racial/ethic backgrounds. Specifically, they found that,
ethnic identity and self-esteem, though related, were distinct
from each other and that both contributed to prosocial
attitudes about goal attainment operating through (and
mediated by) self-efficacy of their ability to achieve. This
type of finding supports the argument that efforts to foster
healthy identity and positive self-esteem, though critically
important, may not be sufficient in supporting achievement
of outcome goals if self-efficacy beliefs do not correspond.
Attention has also been directed to environmental and
contextual factors, for these influence or interact with self-
efficacy. Boardman and Robert (2000) focused on people’s
socioeconomic status, questioning whether neighborhood
socioeconomic characteristics were related to individuals’
self-efficacy. Their findings showed that lower socioeco-
nomic status (SES) corresponded with lower self-efficacy.
SELF-MANAGEMENT STRATEGIES 549
youth: A theoretically based investigation. Journal of
HIV/AIDS Prevention in Children and Youth, 7 (1), 73–
95.
Traeen, B., & Kvalem, I. L. (2007). Investigating the relation-
ship between past contraceptive behaviour, self-efficacy,
and anticipated shame and guilt in sexual contexts among
Norwegian adolescents. Journal of Community and Ap-
plied Social Psychology, 17 (1), 19–34.
Smoking
Chang, F., Lee, C., Lai, H., Chiang, J., Lee, P., & Chen, W.
(2006). Social influences and self-efficacy as predictors of
youth smoking initiation and cessation: A 3-year longitu-
dinal study of vocational high school students in Taiwan.
Addiction, 101(11), 1645–1655.
Social Development
Yuen, M., Hui, E. K. P., Lau, P. S. Y., Gysbers, N. C., Leung,
T. M. K., Chan, R. M. C., & Shea, P. M. K. (2006). Assessing
the personal–social development of Hong Kong Chinese
adolescents. International Journal for the Advancement of
Counselling, 28 (4), 317–330.
Of particular note was the finding that neighborhood indi-
cators of lower SES (high proportions of unemployment and
public assistance) were associated with lower self-efficacy above
and beyond the relationship of individual-level SES to self-
efficacy. Findings also indicate, however, that structural factors
are not inherently predictive. Bandura, Barbaranelli, Caprara,
and Pastorelli (2001), for example, found that effects of socio-
economic status were mediated by parent’s expectations of and
aspirations for their adolescent children and were powerful
predictors of their children’s perceived self-efficacy and career
aspirations. Reed (2003) found that parental monitoring and
self-efficacy significantly related to youths’ academic achieve-
ment whereas neighborhood characteristics such as crime and
impoverishment did not. Wolf et al. (2007) found that patient
illiteracy could be positively mediated by positive self-efficacy
relative to successful HIV-medication adherence. Findings
such as these remind us that helping efforts with individuals
and their families are best pursued with the critical awareness
that people are always embedded in many types of environ-
ments—social, material, cultural, political—that are impor-
tant considerations in assessment and intervention.
Considerable research on HIV/AIDS continues, including
diverse samples relative to race, sexual orientation, and socio-
economic status. The bulk of research continues to suggest
550 CHAPTER 17
the importance of self-efficacy to predict HIV-related risk
behaviors as well as predicting treatment adherence (Barclay
et al., 2007). However, findings are also indicating complexi-
ties, including the need for theoretical models of behavior
change to include dimensions of diversity and identity. To
illustrate, Faryna and Morales (2000) found within an eth-
nically diverse sample of high school students that ethnicity
consistently appeared a stronger predictor of HIV-related
risk behaviors than did gender, self-efficacy, or knowledge,
attitudes, and beliefs regarding sexual activity and substance
use. Cochran and Mays (1993) discuss some potential issues
in the application of models to predict risk behaviors, not-
ing that many of these models emphasize the importance of
individualistic, direct control of behavioral choices and de-
emphasize external factors such as racism and poverty that
are particularly relevant to many communities at highest risk
of HIV infection. Other researchers have also discussed the
need for AIDS education and prevention that mobilize the
will of members of communities of color, acknowledging
the role of environment in conditioning behavior (Gasch,
Poulson, Fullilove, & Fullilove, 1991).
In a related vein, Van-Hasselt, Hersen, Null, and Ammerman
(1993) describe a drug use prevention program for Afri-
can American children that focuses on the development of
family-based alternative activities to promote self-efficacy,
achievement, and self-esteem. Investigating the relationship
of self-efficacy to career decisions, ethnic identity, and pa-
rental and teacher support in African American high school
students, Gushue and Whiston (2006) found that parental/
and teacher support were related to self-efficacy but ethnic
identity was not. Health has been a significant focus of study,
indicating the importance of self-efficacy about one’s ability
to successfully undertake specific health promotive activities
to be significantly predictive of those activities and inten-
tions to sustain them—such as exercise (Chou, Macfarlane,
Chi, & Cheng, 2006; Lucidi, Grano, Barbaranelli, & Violani,
2006), falls (Stretton, Latham, Carter, Lee, & Anderson,
2006), and mobility (Sanford et al., 2006).
Self-efficacy is also an important variable in academic suc-
cess. Bryan and Bryan (1991) found self-efficacy and posi-
tive mood induction to be related to performance of both
junior high and high school students with a learning dis-
ability. At the postsecondary level, college self-efficacy—or
the degree of confidence that one can successfully complete
college—was an important determinant of student adjust-
ment for Mexican American and Latino American college
students (Solberg, O’Brien, Villareal, & Kennel, 1993).
With an ethnically mixed group of high school equivalency
students (predominantly Hispanic and Native American
girls and boys) from seasonal farmwork backgrounds, stu-
dents’ interests, perceived incentives, and self-efficacy ex-
pectations (beliefs about their ability to learn to engage in
an occupation successfully) predicted their willingness to
consider future occupations (Church, Teresa, Rosebrook,
& Szendre, 1992). Among an ethnically mixed high school
population of over 800 rural girls and boys (Hispanic, Native
American, and White youth), Lauver and Jones (1991)
found differences in self-efficacy estimates for career choice
among varied ethnic groups, with efficacy lowest for 7 of
the 18 occupations studied among the Native American
youth.
From a multicultural standpoint, the goal of strengthen-
ing self-efficacy, when used alone, raises questions meriting
careful attention. Out of context, the self-efficacy model
can be seen to assume direct control of behavioral choices,
reflecting a worldview that is high in internal locus of
control and internal locus of responsibility. People from
cultures that stress collectivity and unity may not feel com-
fortable with this model, and neither may individuals who
have experienced unjust societal conditions such as racism
and poverty. Increasingly, self-efficacy is being researched
and approached from a life-span perspective and in a more
contextualized manner. This includes more attention to his-
torical, cultural, developmental, linguistic, social network,
privilege, and other environmental factors that are likely to
exert influence on individuals’ evolving sense of self-efficacy
as well as how their self-efficacy schemas and appraisals are
activated or interpreted in specific situations.
MODEL EXAMPLE OF SELF-EFFICACY:
THE CASE OF ISABELLA
One of Isabella’s goals—asking questions and making rea-
sonable requests—has four subgoals: (1) to decrease anxiety
ratings associated with anticipation of failure in math class
and rejection by parents, (2) to increase positive self-talk
and thoughts that “girls are capable” in math class and
other competitive situations from zero or two times a week
to four or five times a week over the next two weeks, (3) to
increase attendance in math class from two or three times
a week to four or five times a week during treatment, and
(4) to increase verbal participation and initiation in math
class and with her parents from none or once a week to
three or four times a week over the next two weeks during
treatment. Verbal participation is defined as asking and
answering questions posed by teachers or parents, vol-
unteering answers or offering opinions, or going to the
chalkboard.
The helper can determine the extent of Isabella’s self-
efficacy (confidence) for each of the goal behaviors. Self-
efficacy can be measured by asking Isabella to give a verbal
rating of her confidence for each goal on a scale from 0 (no
confidence) to 100 (a great deal of confidence). Alternatively,
the helper can design a rating scale and ask Isabella to circle
her rating of confidence for each goal (see Learning Activity
17.4). Three examples for goals are shown with the metric

LEARNING ACTIVITY 17.4
In this activity, you are to determine and assess
your self-efficacy.
1. Select some goals you would like to
achieve. Your general goal may have to be divided
into subgoals.
2. Write down your goals and/or subgoals. Make sure
that your written goals are behaviorally defined, spec-
ify the context or circumstances in which the behavior
is to occur, and identify the level or amount or change
sought for any given step.
3. For the goal you would like to achieve, make a scale
(0 to 100) to measure your self-efficacy (confidence)
below; they are followed by other examples shown without
the 0–100 metric to conserve space.
Sample Goals for Math Class or Parents
Confidence in decreasing anxiety (from 70 to 50) about
possible failure in math class
0 10 20 30 40 50 60 70 80 90 100
Uncertain Total certainty
Confidence to increase positive self-talk and thoughts—
“girls are capable”—to four or five times a week in
math class
0 10 20 30 40 50 60 70 80 90 100
Uncertain Total certainty
Confidence in answering questions asked by parents
0 10 20 30 40 50 60 70 80 90 100
Uncertain Total certainty
Other Examples
• Confidence in decreasing anxiety (from 70 to 50) about
possible rejection by parents
• Confidence to increase attendance in math class to four
or five times a week
• Confidence in asking questions in math class
• Confidence in answering questions in math class
• Confidence in volunteering answers in math class
• Confidence in going to the chalkboard in math class
• Confidence in asking parents questions
• Confidence in offering opinions to parents
As Isabella becomes more successful in achieving her goal
behaviors, measures of her self-efficacy or confidence will
increase.
SELF-MANAGEMENT STRATEGIES 551
Self-Efficacy
in performing your goal behaviors, thoughts, or
feelings for each subgoal, and for each person with
whom and each setting in which the goal is to be
performed.
4. Assess your self-efficacy by circling the number
on each scale that reflects your degree of uncer-
tainty or certainty (confidence) in performing each
goal.
5. You might wish to use the self-efficacy scales to self-
monitor your confidence over a period of time as
you gain more experience in performing the goal
behaviors.
CHAPTER SUMMARY
Self-management is a process in which clients direct their
own behavior change by using any one change intervention
strategy or a combination of strategies. Four strategies are re-
viewed here: self-monitoring, stimulus-control procedures,
self-reward techniques, and self-efficacy enhancement. Pro-
moting client commitment to using self-management strat-
egies can be achieved by introducing these strategies later
in the helping process, assessing the client’s motivation for
change, creating a social support system to aid the client in
the use of the strategy, and maintaining contact with the cli-
ent while self-management strategies are being used. All of
these self-management strategies are affected by self-efficacy,
a cognitive process that mediates behavioral change. These
change strategies and tools can—and, we argue, should—be
applied collaboratively with clients and in the service of
building on strengths, supporting empowerment and self-
determination, and being critically attentive to environ-
mental factors that may be relevant targets of change as well
as potential resources. Processes involved in self-regulation
appear to vary across cultures and societies, and factors such
as the client’s cultural or collective identity and accultura-
tion and assimilation status may affect the appropriateness
of self-management or ways in which these tools and inter-
ventions are applied.
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17 K N O W L E D G E
Part One
For Learning Outcome 1, describe the use
of self-monitoring and stimulus control in
the following client case. Feedback follows
on page 560.
The client, Maria, is a 30-something Puerto Rican woman who
was physically separated from her husband of 15 years when
they came to the United States in separate trips. Although
they were reunited about a year ago, Maria reports that dur-
ing the past year she has had “ataques de nervios”—which
she describes as trembling and faintness. She worries that her
husband will die young and she will be left alone. Her history
reveals no evidence of early loss or abandonment; however,
she experienced losses with her immigration. Also, she seems
to be self-sacrificing and dependent on Juan, her husband.
She reports being very religious and praying a lot about this.
Maria asks for assistance in gaining some control over her
“ataques de nervios.” How would you use self-monitoring
and stimulus control to help her decrease them?
What else would you focus on in addition to the use of these
two strategies, given Maria’s cultural background and the
case description?
Part Two
Learning Outcome 2 asks you to teach another person how
to engage in self-monitoring. Your teaching should follow
the six guidelines listed in Table 17.1: rationale, response
SELF-MANAGEMENT STRATEGIES 559
A N D S K I L L B U I L D E R
discrimination, self-recording, data charting, data display,
and data analysis. Feedback follows.
Part Three
Learning Outcome 3 asks you to describe the application of
a culturally relevant self-management program (self-efficacy,
self-monitoring, self-reward, and stimulus control) in a given
client case. Feedback follows.
The client, Thad, is a young African American man who
recently identified himself as gay. Thad has been working
with you in coming to terms with his sexual orientation. He
has visited some gay bars and has participated in some
gay activities, but he has not asked anyone out. He would
like to go out at least once a week with a male partner. You
have discussed with Thad the use of self-monitoring and self-
reward as possible interventions for this goal. He is interested
in these strategies.
How would you use and adapt the interventions of self-
monitoring, self-reward, stimulus control, and self-efficacy with
this particular client?
Part Four
Learning Outcome 4 asks you to teach another person how to
use self-reward, self-monitoring, and stimulus control. You can
use the steps of self-monitoring, the stimulus-control principles,
and the components for self-reward. Feedback follows.
560 CHAPTER 17
17 KNOWLEDGE AND SKILL BUILDER FEEDBACK
Part One
Self-Monitoring
1. Treatment rationale: In the rationale, you would empha-
size how this strategy can help provide information about
the client’s direction. You would explain that Maria will
be recording defined “ataques de nervios” in vivo on a
daily basis for several weeks. You need to be careful to
frame the rationale in a way that respects Maria’s cultural
values.
2. Discrimination of a response: Response-discrimination
training would involve selecting, defining, and giving
examples of the response to be monitored. You should
model some examples of the defined behavior and elicit
some others from the client. Specifically, you would help
Maria define the nature and content of the behaviors she
will be recording, such as feeling faint.
3. Timing of self-monitoring: Because this client is using self-
monitoring to decrease an undesired behavior, she will
engage in prebehavior monitoring. Each time she feels
faint or worried, she will record.
4. Method of self-monitoring: The client should be instructed
to use a frequency count and record the number of times
she feels faint or worried. If she is unable to discern when
these start and end, she can record with time sampling.
For example, she can divide a day into equal time inter-
vals and use the “all or none” method. If such thoughts
occurred during an interval, she would record “yes”; if
they did not, she would record “no”. Or, during each
interval, she could rate the approximate frequency of
these behaviors on a numerical scale, such as 0 for never
occurring, 1 for occasionally, 2 for often, and 3 for very
frequently.
5. Device for self-monitoring: There is no one right device to
assist this client with recording. She could use tallies on a
note card, a golf wrist counter, or a handheld computer
to count the frequency. Or she could use a daily log sheet
to keep track of interval occurrences.
6. Charting of a response: A simple chart might have days
along the horizontal axis and frequency of behaviors
along the vertical axis.
7. Displaying of data: This client may not wish to display the
data in a public place at home. She could carry the data
in her purse or backpack.
8. Analysis of data: The client could engage in data analysis
by reviewing the data with the helper or by comparing
the data with the baseline or with her goal (desired level
of behavior change). The latter involves self-evaluation
and may set the stage for self-reinforcement.
Stimulus Control
You can explain the use of stimulus control as another way to
help Maria gain some feeling of personal control surround-
ing her “ataques de nervios” by confining them to particular
places and times so that they don’t occur so randomly and
unpredictably. You could suggest the use of a worry spot or
worry chair that she goes to at a designated time to do her
worrying, and you would tell her that she is to stop worrying
when she leaves this place or chair.
In addition to those two self-management interventions, it
would be useful to explore Maria’s feelings of loss and safety
surrounding her immigration experience, the adaptations she
is having to make to a different culture, and the conflicts she
may be experiencing between the two cultures.
Part Two
Use Table 17.1 as a guide to assist your teaching. You might
determine whether the person you taught implemented self-
monitoring accurately.
Part Three
You need to determine how well the use of self-management
“fits” with Thad’s beliefs, values, worldview, and lifestyle.
If Thad is receptive to the use of self-management and is
oriented toward an internal rather than an external locus of
control and responsibility, you can proceed. (However, it is
important to explore whether any external social factors may
be contributing to his sense of discomfort.) You may first wish
to assess and work with self-efficacy, or Thad’s confidence in
himself and the contacts he will make with other men. Notice
that Thad’s sense of self-efficacy is related to his identity de-
velopment as a gay male and as an African American. We
anticipate that as Thad uses various self-management tools,
his sense of self-efficacy will increase.
Self-reward can be used in conjunction with times Thad
actually makes social contacts with men and goes out with a
man. Verbal symbolic rewards used by Thad could consist of
self-praise or covert verbalizations about the positive conse-
quences of his behavior. Here are some examples: “I did it! I
asked him out.” “I did just what I wanted to do.” “Wow! What
a good time I’ll have with ______.”
Material rewards would be things or events that Thad
indicates he prefers or enjoys, such as watching TV, listen-
ing to music, or playing sports. Both current and potential
rewards should be used. Of course, these activities are
only possibilities; Thad has to decide whether they are
reinforcing.
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17 KNOWLEDGE AND SKILL BUILDER FEEDBACK

Imaginal rewards may include pleasant scenes or scenes
related to going out: imagining oneself on a raft on a lake,
imagining oneself on a football field, imagining oneself with
one’s partner at a movie, imagining oneself with one’s part-
ner lying on a warm beach.
Self-monitoring can be used to help Thad track the number
of social contacts he has with other men.
Stimulus control can be used to help Thad increase the
number of cues associated with increasing his social contacts
with other men. For example, he might start in one place
or with one activity where he feels most comfortable; then
gradually he can increase his visits to other places and activi-
ties where he will find other gay men.
Part Four
Use the following:
Self-monitoring steps—see Table 17.1 and the related sec-
tion of the chapter.
Principles of stimulus control—see Table 17.2 and the
related section of the chapters.
Components of self-reward—see the section with this
title.