THERAPEUTIC RECREATION JOURNAL Vol.35,No.4,357-364, 2001
Cross-Country Skiing as a Self- Efficacy Intervention with an Adolescent Female: An Innovative Application of Bandura's Theory to Therapeutic Recreation
Daniel D. Ferguson and Kama Jones
Bandura's theory of self-efficacy can be a useful tool in developing theory based therapeutic recreation interventions. This case report used Bandura's theory as a basis for designing a therapeutic recreation intervention for a 15 year-old female with severe depression and opposi- tional defiant disorder (ODD) in a long term residential treatment facility for adolescents. Cross-country skiing was used as a modality to facilitate an increase in self confidence. The intervention also aided her in discovering positive ways to manage her anger by helping her make stronger efficacy judgments about herself. These outcomes seemed to generalize to improved relations with family members.
KEY WORDS: Cross-Country Skiing, Depression, Learned Helplessness, Oppositional Defiant Disorder, Self-Efficacy Theory, Theory Based Programming
Daniel D. Ferguson is an Associate Professor in the Department of Recreation Management and Youth Leadership at Brigham Young University. Kama Jones is a graduate of the Department of Recreation Management and Youth Leadership at Brigham Young University. This case report was developed while Ms. Jones was a therapeutic recreation student at BYU. Correspondence concerning this article should be addressed to Dr. Daniel D. Ferguson, Dept. of RMYL, Brigham Young University, 273 Richards Bldg. Provo, UT 84602. Electronic mail can be sent to dan_ferguson@byu.edu.
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Adolescent depression and oppositional de- fiant disorder (ODD) are major concerns among those who treat America's youth. "By one estimate, mild to severe depression effects 36.3% of adolescents" (Hodgman & McAnar- ney, 1992, p. 73). Kovacs (1989) indicated that the effects of adolescent depression are now thought to be longer lasting than originally suspected, and Blackman (1995) reported that more than 30% of adolescents attending psy- chiatric clinics have been diagnosed with de- pression. Y et this illness is under diagnosed in the adolescent population according to Hodg- man and McAnarney.
ODD is characterized by frequently losing one's temper, being argumentative with adults, actively defying or refusing adult requests, blaming others for their mistakes, becoming easily annoyed, being angry, annoying people deliberately, and/or being spiteful and venge- ful. This list of behaviors makes young people with ODD difficult to deal with, especially by their parents (Home & Sayger, 1990; Riley, 1997). Unfortunately there may be as many as 5-8% of adolescents who have this disorder (Barkley & Benton, 1998).
The incidence of depression in the adoles- cent population is of great concern as effective treatment interventions seem to elude profes- sionals. Combinations of therapy and medica- tion are commonly used to treat depression in adults. The use of medications to treat adoles- cents, however, is controversial (National In- stitute of Mental Health [NIMH], 2000). Tri- cyclic antidepressants have not demonstrated long term effectiveness with adolescents and have been deemed appropriate only in cases where there has been no response to psycho- therapy according to NIMH. The NIMH fur- ther states that selective use of serotonin re- uptake inhibitors has been shown safe and effective; however, since many doctors are hesitant to use them there is a continuing
search for better ways to treat depressed youth without using medications. As a result, psy- chotherapy remains the treatment of prefer- ence.
Psychotherapy is also the preferred method
of treatment for ODD in conjunction with medications being used only in extreme cases (Riley, 1997). Consequently, when depression and ODD present comorbidly, psychotherapy may be used exclusively without the use of medication. This was the case with the female student who was the participant in this case report.
Albert Bandura's (1986) theory of self- efficacy was used as a theoretical base for therapeutic recreation intervention with the participant in this report. Self-efficacy is a component of Bandura's social learning the- ory. He views personality as the dynamic in- teraction between behavior, situation and per- sonal variables. His theory stresses the importance of observational learning and self- efficacy. Leibert and Spiegler (1990) defined observational learning as follows:
Observational learning is the process through which the behavior o f . . . an observer changes as a result of merely being exposed to the behavior of an- other. By observing the behavior of oth- ers in specific situations people make judgments as to how they might behave or perform were they in the same situ- ation. The person's belief in how well they might perform provides the basis of a self-efficacy judgment (p. 452).
"Self-efficacy" is sometimes confused with self-concept or self-esteem. Self-efficacy is distinct from these terms, however. Bandura defined self-efficacy as "a person's judgments of their capabilities to organize and execute courses of action required to attain designated types of performances" (Bandura, 1986, p. 391). Liebert and Spiegler (p. 452) put it more simply by stating that self-efficacy "is the conviction that one can successfully perform the behavior needed to produce a desired out- come." Self-concept, say Liebert and Spiegler, is a view constructed of one's self, which is developed through direct experience and eval- uations adopted from significant others. Self-
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esteem, on the other hand, is a personal eval- uation of one's self worth.
In Bandura's theory, decisions involving following social rules, making goals, and in- teracting with people all require a person to make efficacy judgments. The more a person judges that they can be successful in an area such as goal setting, the stronger is their per- ceived self-efficacy. As self-efficacy increases a person will judge that they can set and achieve higher personal goals. Conversely, the weaker the efficacy judgment, the more situa- tions, tasks, and learning experiences will be avoided if these are believed to exceed one's abilities.
Bandura (1986) describes four principal sources from which people glean self-efficacy information: enactive attainment, vicarious ex- perience, verbal persuasion and physiological state. The most influential source is called "enactive attainment" which is the actual com- pletion of a task for oneself. Vicarious expe- rience involves watching someone of a similar skill level to yourself perform a desired task and believing that you can perform the same task. Verbal persuasion is a technique in which a participant is encouraged or persuaded by another person to believe that they can per- form a particular task. This is most successful when the persuasion is specific, realistic and believable. The final information source is relying on one's physiological state to gain efficacy information. A distance runner who wakes up feeling rested and vigorous on the day of a marathon is more likely to believe he can succeed. All of these sources of self- efficacy are explored in relation to the case report of an adolescent with ODD utilizing a programmatic intervention of cross-country skiing.
Biographical and Demographic Information Related to the Case
Molly (a pseudonym) was a 15-year-old female. She was single and had grown up in California with her mother, father, an older brother, and a younger sister. Her parents were
Israeli and moved to the United States several years before Molly was born. In her own words, Molly's chief compliant upon admis- sion was, "I got depressed last year and got behind in school." Molly's parents described her as being slow in learning to speak when she was very young, "She seemed like she simply did not want to talk." She habitually practiced "learned helplessness" (Peterson, Maier & Seligman, 1993) as a small child which won her the aid and attention of others. Her parents also reported that she had a diffi- cult time making and keeping friends. When the recreation therapist interviewed Molly, she related that dance and gymnastics were among her favorite interests when she was young, but she discontinued both of them because "you had to work too hard" to keep up.
At age 14 Molly began being promiscuous with boys, smoking, experimenting with drugs, refusing to help with chores at home or to baby-sit her little sister. She refused to go to school for approximately six months unless her mother drove her because she was "de- pressed." She tried to commit suicide twice with pills and was hospitalized both times. She began individual counseling one year before being admitted to an adolescent treatment facility but had not responded well to treat- ment. She was admitted to Provo Canyon School after running away with a 22 year old male.
Provo Canyon School, located in Orem, Utah, is a long term, for-profit, residential treatment program for adolescents. The school serves boys and girls, ages 12-18. Clients are separated by gender with a campus for boys and one for girls. The length of stay generally ranges between 6 and 12 months. The school is located very close to a national forest and several public parks providing therapists with many sites to engage in outdoor activities of all types. Cross-country skiing is just one available modality with therapeutic potential.
Case Content
Upon admission, Molly underwent several evaluations, including the Kaufman Test of
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Educational Achievement (Kaufman & Kauf- man, 1997), which was used for academic placement purposes. Molly's initial assess- ment also included the Self-Esteem Index (Brown & Alexander, 1991) which was ad- ministered by a unit psychologist. The recre- ation therapist (a CTRS) administered a brief, facility specific, recreation therapy question- naire. The psychiatrist gave Molly a physical examination and interviews were conducted by other members of the treatment team in- cluding the social worker and nurse who de- veloped social and medical histories for her. Based on this battery of assessments and in- formation from the DSM-IV (American Psy- chiatric Association, 1994), Molly was diag- nosed with major depression and recurrent, severe oppositional defiant disorder (ODD).
The admitting psychiatrist recorded that Molly's intake interview revealed many prob- lems and left the impression that she was not a good historian, was oppositional, had low self esteem, was very dramatic, had difficulty in following limits, and was manipulative to achieve goals. Test results on the Self-Esteem Index (Brown & Alexander, 1991) indicated that she had a very low level of self-esteem.
A recreation therapist who also interviewed Molly found that she had an emotional need to identify positive self-traits to improve her self- esteem. She also needed to be able to discover appropriate outlets for her anger and positive ways to deal with her depression. She identi- fied one of her strengths as being dramatic and acting, and one of her deficiencies was that she could not think very well.
As a student at Provo Canyon School Molly avoided many responsibilities, like completing her chores while she was at home, or even participating in groups at the school. She exhibited a significant level of learned helplessness by saying that she "couldn't" do her chores because she was "given too much work," or she could not participate in a group because she did not trust her peers.
Molly was assigned to a primary therapist (a social worker) who was responsible for making an overall assessment, developing a
master treatment plan for her and then moni- toring the plan through the course of her treat- ment. In addition to interviewing Molly, he also reviewed the assessments of all the other treatment team members before writing the master treatment plan. The initial treatment plan focused on finding constructive ways to treat Molly's depression, build her self-esteem and find appropriate outlets for her anger.
Intervention Plan
Initially, Molly was placed in a family issues group and a relations group that were both conducted by her primary therapist. She was also placed in a self-esteem recreation therapy group facilitated by a recreation ther- apist.
The progress notes for Molly indicated that peers did not accept her. She would set others up by getting them to break unit rules so they would receive a "consequence" or punishment for negative behavior. Sometimes she would lie about her peers to staff. She continued her manipulative behavior for some time and was defensive when confronted. In treatment groups, she would deny her problems at home with her family and in her relationships with males generally.
Because her treatment was not progressing, Molly's primary therapist decided to develop a new treatment plan for her and he consulted with each member of the treatment team in- cluding the recreation therapist. A few days prior to the discussion between the primary therapist and the recreation therapist, Molly had been part of a cross-country skiing treat- ment group, which took place at a county park. The group was what Provo Canyon School calls a "caseload activity." These are recre- ation activities that occur monthly. Each pri- mary therapist works with a recreation thera- pist to plan a treatment oriented activity involving every person on their caseload. The group for this particular activity was made up of all the patients that Molly's primary thera- pist carried on his caseload. The activity was co-facilitated by the recreation therapist and the primary therapist. Before the activity, each
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student was given an assignment related to her treatment goals.
Molly had demonstrated a pattern of rely- ing completely on her peers to help her com- plete difficult tasks in unfamiliar situations. If she was not immediately successful, or if her peers did not help her complete a task, she would compensate by complaining loudly about the activity, the staff, other patients, etc. Molly was instructed, before the activity by the primary therapist that, no matter what happened, she was not to complain, talk neg- atively or ask for help while skiing.
At the park the students were first in- structed in basic cross-country skiing tech- nique. The group then skied behind the recre- ation therapist on a small tour of the park. Both therapists noticed that Molly struggled to stay upright on her skis. She fell numerous times and each time she had great difficulty getting up again. She skied clumsily and she was a full 20 minutes behind the rest of the group at the end of the tour. She appeared both frustrated and exhausted as she finally joined the group at the point where they had originally started. Yet, through it all she had obeyed the primary therapist's instructions and had not com- plained or sought help from peers. During the group meeting at the end of the activity she said in a convincing way that she "could never learn to ski!"
Because Molly complied with the instruc- tions she was given and completed a specific assignment related to her treatment goals with- out coaching or prompting, the primary thera- pist and the recreation therapist discussed us- ing cross-country skiing as a possible treatment intervention in Molly's new treat- ment plan to be developed. Together the pri- mary and recreation therapists decided to cou- ple cross-country skiing with Bandura's theory of self-efficacy to help improve Molly's con- fidence level in accomplishing other tasks. They theorized that through verbal persuasion and vicarious experience, Molly could achieve enactive attainment and become proficient at cross-country skiing (which she believed was an unattainable goal). They felt that as her
sense of self-efficacy improved she might also show improvement in four other areas of be- havior. The four anticipated areas of improve- ment were: (a) to develop the insight to under- stand that she could get along better with her family and peers; (b) to find different ways to positively manage her anger; (c) to be willing to try new, unknown, and challenging activi- ties; and (d) to be persistent when working on a difficult task. The process of development in these four areas would be observed over time as the cross-country skiing intervention was implemented and noted in Molly's chart.
Implementation of the Intervention Strategy
The primary therapist and recreation ther- apist devised a plan to take Molly cross-coun- try skiing for one hour, two times a week until the next caseload activity which was still nearly a month away. During each of these outings, a new cross-country skiing skill was to be taught to her. She was to practice each new skill until she was proficient at it.
Molly's proficiency level was determined during the outings in one of two ways. Either she would state verbally that she felt comfort- able with the skill or the recreation therapist would observe her level of competence and determine that the skill had been mastered. Molly was instructed to work in these sessions on coping appropriately with her frustration. She was not allowed to complain or talk neg- atively. If she did not follow through with either of these requirements, she would be given a verbal warning. For a second offense she would be given a consequence such as having some privilege taken away for a period of time.
Molly had seven sessions with the recre- ation therapist to ski and practice her skills before the next caseload activity took place. She was first taught how to glide properly on her skis without using her poles. Next, she was taught how to get up again after falling. She practiced these skills during the first two ses- sions on the school campus because of snowy
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conditions in the area. The recreation therapist used verbal persuasion to help Molly believe she could perform these skills which had been so frustrating for her originally. Her own en- active attainment of the skills seemed to in- crease her confidence and elevate self-effi- ciacy considerably.
Molly built on her new skills in the third session, learning to turn around by moving her skis in a circle several degrees at a time. She practiced gliding, turning and getting up after falling. She learned the correct use of her ski poles in session four and she also learned to use the poles for balance and for pushing off while skiing. In session five the kick turn was introduced, where one ski is lifted perpendic- ular to the ground and turned outward 180 degrees so as to be facing the opposite direc- tion from the second ski. The second ski is then brought around parallel to the first ski. The kick turn proved to be very difficult for Molly. After several haphazard attempts, which resulted in her falling to the ground, she refused to try the kick turn again. The recre- ation therapist demonstrated the kick turn a few times (vicarious experience) and em- ployed verbal persuasion. She was offered support so she would not fall but she refused that. She was finally given a consequence for complaining and refusing to comply with di- rections and the session was cut short.
At session six Molly practiced the kick turn in the gymnasium with mats beneath her. This time the practice condition was warm and dry. The recreation therapist demonstrated the kick turn and Molly learned the skill quite easily. The adaptation of the session made by the recreation therapist was successful as far as helping Molly to master a critical skill for cross-country skiing. Theoretically speaking, vicarious experience and verbal persuasion re- sulted in enactive attainment.
At the seventh and final session Molly put all the skills together and had a race with her primary therapist and the recreation therapist. Surprisingly, at the end of the session she admitted that she had even had some fun. In this case Molly's efficacy judgment was that
she had sufficient skills to be successful and she experienced a physiological state where she felt she could compete with two other skiers. This lead to a decision to race and proved to be an enjoyable experience.
The next caseload activity was again a cross-country skiing trip. The primary thera- pist and the recreation therapist agreed to ask Molly to be the leader of the group for the activity. Following the skiing, as the group processed the events of the day back at the school, both therapists and peers made com- ments to Molly about how much she had improved in the month since the last activity. They praised her on her performance as group leader as well.
Evaluation
Had Molly's efficacy judgment of herself increased according to Bandura's theory? Did she continue to try when she was afraid? Was she a positive influence in her family? Would she be courageous and persistent in the face of unknown or difficult tasks or challenging ac- tivities? These were major questions for Mol- ly's primary therapist and the recreation ther- apist who theorized that heightened self- efficacy would lead to improvement in these areas.
During individual, group, and family ther- apy her primary therapist observed Molly closely to see if she made increased effort to participate. The recreation therapist also inter- viewed her. Molly was happy she had learned a new skill and that she had not given up. She stated that she was excited to take her family cross-country skiing with her the next time they came to visit. She followed through on her statement and was proud to show her family her new skill. Her family in turn re- sponded positively to Molly's enthusiasm.
Molly was observed being persistent dur- ing a challenging initiative activity in her self- esteem therapeutic recreation group. The ac- tivity required her to place trust in her peers to support her body while she was lifted a few feet above the ground. Initially, she was very hesitant to participate, but she did complete
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the task without incident. She commented af- terwards that it felt good to be able to trust her peers. She also expressed relief that she was able to do her part as a member of the group.
As Molly prepared for her family to visit again a few weeks later, she participated in the same initiative activity in her family issues group. Her therapist asked her to try to stand up and balance herself with her peers holding onto her. She did try and fell over. She was not hurt but was afraid and teary-eyed. She de- cided not to try the task again herself but she did continue to support her peers within the group as they tried the task. Based on previous experiences, if this scenario would have played out before the cross-country skiing in- tervention, Molly would very likely have sat out of the activity and been angry that she had been eliminated for the remainder of the group. Her decision to remain in the group this time was evidence of positive self-manage- ment and possible behavior change.
Molly's family again came to visit her, very shortly after this incident. While they were at the school the primary therapist had the whole family participate in an initiative activity together. During the processing por- tion of the activity Molly was able to share her feelings appropriately with her family and was able to work with family members without arguing. She also took a self-initiated leader- ship role in completing the family's experi- mential task. Prior to this visit her behavior had always been to set the family up for an argument and then sit back and watch while they argued. Her participation would be sullen as she let her parents do everything for her. The change in Molly was noticeable enough that her mother commented on her increased confidence, her ability to complete tasks, and her willingness to work with the family during group tasks rather than sabotaging every fam- ily exercise.
Author's Discussion
Bandura's theory of self-efficacy was ap- plied with Molly by taking a specific recre- ation task (cross-country skiing), and using
enactive attainment (practicing the activity herself), vicarious experience and verbal per- suasion (demonstration and encouragement from a recreation therapist), to help her be- come confident that she could become a pro- ficient cross-country skier. The therapists felt that the confidence Molly obtained from be- coming a proficient cross-country skier would generalize to other areas of her life. For exam- ple, by developing confidence in her skiing abilities, she might also develop confidence in setting age appropriate boundaries and posi- tive relationships with males without having sexual relations. She might become more con- fident that she could be a positive influence within her family.
Molly showed substantial improvements in her self-confidence, in her ability to trust her peers and in her willingness to work with her family after one month of learning how to cross-country ski. It appeared that her ability to be successful at learning one specific skill had generalized to other areas of her life. Her self-efficacy judgment increased significantly as she was able to succeed at a task which she initially thought to be impossible. While this does not prove a cause and effect relationship between the cross-country skiing intervention and her improved efficacy judgments, the fact that she was not receiving medication does mean that the improvements were not chemi- cally induced or influenced. This provides en- couragement that cross-country skiing can be an effective intervention in the treatment of adolescents who present with both depression and ODD.
The theory of self-efficacy has great poten- tial as an approach to treatment intervention when working to increase a person's self- confidence while decreasing depression and oppositional defiance. As in the case of Molly, after a person has discovered that they are able to succeed at one task, they may be more willing to try a new task over and over again without displaying such frustration and anger as before. They may also generalize their abil- ity to be successful from one task to another, not just in recreation but in broader life skill
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areas. In this case it appeared that a generali- zation was made from (a) being able to cross- country ski to being able to confidently lead a group of cross-country skiers; (b) to being supportive to peers after failing an initiative task; (c) to being able to remain in a group; and (d) to being able to work positively with family members in an experiential exercise.
By using theory-based interventions such as this one, recreation therapists can develop a common language with which to communicate with other recreation therapists. They can also increase their repertoire of activity interven- tion because self-efficacy theory can be ap- plied to virtually any recreational activity. The repeated use of self-efficacy theory is one avenue to bring the field of therapeutic recre- ation closer to having a common practice as called for during the past decade (Connolly & Keogh-Hoss, 1991; Ferguson, 1997).
References
American Psychiatric Association. (1994). Diag- nostic and statistical manual of mental disorders (4th ed.), Washington, D.C.: Author.
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.
Barkley, R. A., & Benton, C. M. (1998). Your defiant child: Eight steps to better behavior. New York: The Guilford Press.
Blackman, M. (1995). You asked about... Ado- lescent depression. The Canadian Journal of Continuing Medical Education May 1995. [On- line] Available: Internet Mental Health (www. mentalhealth.com).
Brown, L., & Alexander, J. (1991). Self-Esteem Index. Austin, TX: Pro-Ed, Inc.
Connolly, P., & Keogh-Hoss, M. A. (1991). The development and use of intervention protocols in therapeutic recreation: Documentary field-based practices. In B. Riley (Ed.), Quality management: Application for therapeutic recreation (pp. 117- 136). State College, PA: Venture Publishing, Inc.
Ferguson, D. D . (1997). Protocols in therapeutic recreation: Dancing on the bubble. In D. M. Comp- ton (Ed.), Issues in therapeutic recreation: Toward a new millennium (2nd ed.; pp. 403-417). Cham- paign, DL: Sagamore Publishing.
Hodgman, C. H., & McAnarney, E. R. (1992). Adolescent depression and suicide: Rising prob- lems. Hospital Practice 27 (4), 73-96.
Home, A . M ., & Sayger, T . V . (1990). Treating conduct and oppositional defiant disorders in chil- dren. New York: Pergaman Press.
Kaufman, A., & Kaufman, N. (1997). Kaufman Test of Educational Achievement. Circle Pines, MN: American Guidance Service.
Kovacs, M. (1989). Affective disorders in chil- dren and adolescents. American Psychologist, 44, 209-215.
Liebert, R. M., & Spiegler, M. D. (1990). Per- sonality strategies and issues (6th ed.). Belmont, CA: Wadsworth, Inc.
National Institute of Mental Health. (2000). De- pression in children and adolescents: A fact sheet for physicians. (NIMH Publication N o . 00-4744). Bethesda, MD: U.S. Government Printing Office.
Peterson, C, Maier, S.F., & Seligman, M. E. P. (1993). Learned helplessness: A theory for the age of personal control. New York: Oxford University Press.
Riley, D. A. (1997). The defiant child: A par- ent's guide to oppositional defiant disorder. Dallas, Texas: Taylor Publishing Company.
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A
Critique of the Article
Emilie
V Adams
Cross-Country Skiing as a Self-Efficacy
Intervention: A Critique of the Article
This article was a report of the experience of a
15-year-old female in a residential treatment center, who was not responding to
treatment. Her therapist prescribed
cross-country skiing to increase self-efficacy that would generalize to other
domains. This was successful in her
case, and the example illustrates effective uses of theory in program
planning. The treatment cannot, however,
be generalized to other clients since the sample size was one. Therapists can use this article to understand
better how to apply theory generally, and self-efficacy theory
specifically.
Summary
Albert Bandura’s theory
of self-efficacy was used as a theoretical base for the intervention described
in this report. Self-efficacy is defined
by Bandura as "a person's judgments of their capabilities to organize and
execute courses of action required to attain designated types of
performances" (Bandura, 1986, p. 391).
The intervention took place at Provo Canyon School, a residential
treatment center, with a 15 year old female, Molly, who suffered from severe
depression and oppositional defiant disorder (ODD). Treatment for the first two
months of Molly’s stay was not effective.
A new treatment plan proscribed Molly would going cross-country skiing a
task she had previously stated she “could never learn to do” for one hour twice
a week, (p. 361). Her therapists
believed that gaining self-efficacy of her ability to learn new skills even when
she was challenged or afraid would generalize to other domains of life. They listed four areas of improvement they
hoped to see: getting along with better
with family and peers; anger management; being willing to try new, unknown,
challenging activities; and “to be
persistent when working on a difficult task” (Ferguson & Jones, 2001,
p.361).
Findings.
Molly’s ability to succeed in learning a new skill seemed to generalize to
other areas of life. Her self-efficacy in learning new skills increased because
of her ability to master cross-country skiing, which she had previously though
was impossible. This affected the way
she was willing to interact with her peers and her family, by enabling her to
trust peers and family even if trusting felt risky. The authors state, “In this case it
appeared that a generalization
was made from (a) being
able to cross-country ski to being able to confidently lead a group of
cross-country skiers; (b) to being supportive to peers after failing an
initiative task; (c) to being able to remain in a group; and (d) to being able
to work positively with family members in an experiential exercise” (Ferguson
& Jones, 2001, p. 364).
Strengths
This article contributes
to the literature by providing a solid example of how to apply theory to
achieve desired results, and the power of utilizing theory based
interventions. The article provides
extensive details about Molly’s issues, and the treatment process. There are many good practical suggestions
such as taking the client inside to practice ski turns on crash pads in a warm
dry environment when their anxiety level was too high to continue practicing
outside in the snow. This article is a
good resource for anyone trying to get an idea of how self-efficacy gained through
recreational activities can generalize to other areas.
Weaknesses
While this is a very interesting case, and an inspiring
antidote of the impact of therapeutic recreation, the article discussed the effects
of treatment in only one subject, which make the results interesting, but not
generalizable. The authors conclude that “cross-country skiing can be an
effective intervention in the treatment of adolescence who present with both
depression and ODD” (p. 363). This
statement simply cannot supported by the data.
Additionally, because there was no control group, it is impossible to
determine non-spuriousness. While they know medication was not a factor in
Molly’s increased functioning, there is no way to know that her cross-country
skiing sessions were the cause of her improved functioning. Even if it were the cause of increased
self-efficacy and progress in Molly, we cannot conclude that it would have the
same effect on another individual. Molly
was not skilled at cross-country skiing, did not believe she could ever
succeed, and had a history of giving up when faced with challenges. If cross-country skiing was not an activity
that presented a formidable challenge to an individual, experiencing the mastery
of the skill may not influence their self-efficacy in being able to learn new
skills.
Application
Even if it is impossible to make
conclusions for the general population based on this report, recreation
therapists can read this documentation, and determine if there are issues,
practices, and solutions presented that are applicable to their clients. Because it is theory-based even if
cross-country skiing was not a viable option for an intervention, a CTRS could
still utilize the principles of using alternative recreation activities to give
enactive experience, virtual experience, and verbal persuasion to help adolescent’s be more efficacious in
learning new skills.
Personal
Reaction and Interest
I was interested in general in the process of the generalizing of
self-efficacy to other domains, and specifically interested to see which tasks
they thought would generalize. I was
also interested to see what instruments they used to measure those specific
tasks. While their performance measure
of observation was not particularly helpful, reading about the process was
beneficial.
References
(1997). Self-efficacy: toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215.
Ferguson,
D. D. & Jones, K. (2001). Cross-country skiing as a self-efficacy
intervention with an adolescent female: An innovative application of Bandura’s
theory to therapeutic recreation. Therapeutic
Recreation Journal, 35(4), 357-364.
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