The PSMP, like the other Stanford programmes, works by building participants Self-Efficacy in relation to their health. Self-Efficacy is the confidence or belief that you can make changes that will help you to manage aspects of life better. Participants often refer to this effect of the programme as feeling “more in control” or being “more confident.”

Given that the programmes encourage changes in health behaviours, and that participants do in fact make changes it was initially assumed that reported improvements in health status resulted from changed behaviour. However further investigation showed little correlation between changes in behaviours and changes in health status and that the main factor was participants’ beliefs about what they could achieve.

Work by Albert Bandura, Professor of Social Psychology at Stanford had demonstrated that:

• Belief in one’s ability is a good predictor of motivation and behaviour.
• Self-Efficacy beliefs can be enhanced.
• Enhanced self-efficacy leads to improved motivation, thinking patterns and emotional well-being.

Thus someone who is confident that they can exert some control over the emotional distress resulting from their condition is likely to experience less distress. When new scales to measure these effects were developed it became clear that the principle effect of the programmes was in enhancing Self-Efficacy.

During the PSMP Self-Efficacy is enhanced in a number of ways:

1. Skills mastery:

Skills such as Action Planning, Problem Solving and relaxation techniques are learnt and practiced – the main skills are used repeatedly in different contexts during the course to ensure that they are internalised. The programme encourages success by keeping the skills simple and by encouraging participants in making small achievable steps. Participants are able to build on these successes and grow in confidence.

2. Modelling:

The techniques learnt in the course are modelled by the leaders when they are introduced. The fact that they are people living with HIV themselves is key to participants’ belief that they too can achieve change. Confidence is also derived from observing and participating in the success of others within the group.

3. Reinterpreting symptoms:

The course challenges the belief that everything negative experienced by the participant is a direct result of HIV. It encourages problem solving behaviours, which build confidence that “something can be done” to break out of negative cycles.

4. Persuasion:

By setting goals, making action plans and learning skills in a safe environment people are persuaded to try new activities and make changes. The group support each other in successfully achieving against goals and in problem solving any barriers experienced and the effect seems to be cumulative.

It is clear that Self-Efficacy is a transferable attitude. Many participants make changes in areas of life, such as returning to work, which may not be directly connected to health. It is also apparent that for many participants regaining Self-Efficacy is a catalyst for longer-term changes which continue well after the programme.