Examining the relationships between self-efficacy, task-relevant attentional control , and task performance: Evidence from event-related brain potentials

Effects of self-efficacy on frontal midline theta power and golf putting performance

Introduction

Self-efficacy (SE), defined as an individual's belief in their ability to complete a task, is linked to top-down attentional control, influencing motor performance in sports. Although the behavioral effects of SE are well-documented, there is a lack of research on the mechanisms through which SE affects sports performance. Our research aims to elucidate the neurophysiological mechanisms that underlie the impact of self-efficacy on sports performance. Specifically, we intend to explore the effects of low and high SE on frontal midline theta (Fmθ) activity, associated with sustained top-down attention, and on motor performance.

Methods

We recruited thirty-four professional golfers to perform 60 putts, during which their electroencephalographic activity was monitored. SE levels were assessed using a visual analog scale from 0 to 10 before each putt, with scores categorized into higher or lower SE based on each golfer's individual average score.

Results

Paired t-tests indicated that trials with higher SE scores had a higher putting success rate than those with lower SE scores (53.3% vs. 46.7%). Furthermore, trials associated with higher SE scores exhibited lower Fmθ activity compared to those with lower SE scores (4.49 vs. 5.18).

Discussion

Our results suggest that higher SE is associated with reduced top-down attentional control, leading to improved putting performance. These findings support Bandura's theory of SE, which suggests that the effects of efficacy beliefs are mediated by cognitive, motivational, emotional, and decision-making processes. This study sheds light on the intermediate processes of SE by examining its impact on the anticipation of outcomes, sports performance, and attentional control prior to putting.

Work Engagement and Well-being Study (SWELL): a randomised controlled feasibility trial evaluating the effects of mindfulness versus light physical exercise at work

BACKGROUND

Mindfulness-based programmes (MBPs) are increasingly offered at work, often in online self-guided format. However, the evidence on MBPs' effect on work performance (WP) is inconsistent.

OBJECTIVE

This pragmatic randomised controlled feasibility trial assessed procedural uncertainties, intervention acceptability and preliminary effect sizes of an MBP on WP, relative to an alternative intervention.

METHODS

241 employees from eight employers were randomised (1:1) to complete a 4-week, self-guided, online MBP or a light physical exercise programme (LE)(active control). Feasibility and acceptability measures were of primary interest. WP at postintervention (PostInt) was the primary outcome for preliminary assessment of effect sizes. Secondary outcomes assessed mental health (MH) and cognitive processes hypothesised to be targeted by the MBP. Outcomes were collected at baseline, PostInt and 12-week follow-up (12wFUP). Prospective trial protocol: NCT04631302.

FINDINGS

87% of randomised participants started the course. Courses had high acceptability. Retention rates were typical for online trials (64% PostInt; 30% 12wFUP). MBP, compared with the LE control, offered negligible benefits for WP (PostInt (d=0.06, 95% CI -0.19 to 0.32); 12wFUP (d=0.02, 95% CI -0.30 to 0.26)). Both interventions improved MH outcomes (ds=-0.40 to 0.58, 95% CI -0.32 to 0.18); between-group differences were small (ds=-0.09 to 0.04, 95% CI -0.15 to 0.17).

CONCLUSION

The trial is feasible; interventions are acceptable. Results provide little support for a later phase trial comparing an MBP to a light exercise control. To inform future trials, we summarise procedural challenges.

CLINICAL IMPLICATIONS

Results suggest MBPs are unlikely to improve WP relative to light physical exercise. Although the MBP improved MH, other active interventions may be just as efficacious.

TRIAL REGISTRATION NUMBER

NCT04631302.

Assessing the potential conditioning effects of mis and disinformation self-efficacy on the relationship between general social media use and political knowledge

Prior work on the relationship between general social media use and political knowledge has yielded mixed findings. One recent meta-analysis on the topic concluded that the literature, when assessed as a whole, fails to indicate a direct and statistically identifiable between relationship general social media use and political knowledge. Considering these findings, the present work sought to assess the extent to which general social media use might be conditionally related to political knowledge. To do so, we explored the moderating effect of information-related self-efficacy beliefs. Specifically, building upon general self-efficacy theory and the idea that there exists considerable concern over the extent to which information on social media is factually incorrect, misleading, or biased, we predicted that mis and disinformation self-efficacy (MDSE) beliefs would positively condition the relationship between general social media usage and political knowledge. Contrary to our expectations, the results of three studies indicated that the combination of MDSE and frequent social media use was negatively related to political knowledge.

Cognitive self-efficacy in schizophrenia: Questionnaire construction and its relation with social functioning

Background

Social functioning or social adjustment is a general term used to refer to the ability of individuals to meet socially defined roles such as homemaker, worker, student, spouse, family member, or friend. In schizophrenia, the patient's social functioning is impaired. Social functioning tends to worsen due to impairment in cognitive functions, and it is a primary target for various rehabilitation programs for schizophrenia. In cognitive remediation therapies, much attention is paid to cognitive skill development rather than cognitive self-efficacy, possibly due to a dearth of systematic studies in this area. The objective of the current study was to explore cognitive self-efficacy in association with verbal working memory and demographic variables as predictors of social functioning.

Materials and Methods

The research was classified into two studies: Phase-I dealt with construction of a questionnaire measuring cognitive self-efficacy (CSE). Psychometric properties of the questionnaire were tested on 100 patients with schizophrenia. In phase II, 150 patients diagnosed with schizophrenia according to ICD-10 were taken from the department of psychiatry of different postgraduate hospitals in Kolkata. CSE questionnaire, positive and negative symptoms scale for schizophrenia (PANSS), Schizophrenia Research Foundation (SCARF) India-Social Functioning Index (SCARF-SFI), and backward digit span test were administered.

Results

Linear regression analysis showed that CSE was a strong predictor in predicting social functioning.

Conclusion

Cognitive Self-efficacy questionnaire was developed and validated.

Changes in dual-task cognitive performance elicited by physical exertion vary with motor task

Background

Integrated movement and cognitive load paradigms are used to expose impairments associated with concussion and musculoskeletal injury. There is currently little information on the discriminatory nature of dual-task complexity and the relative influence of physical exertion on cognitive outcomes.

Purpose

Assess cognitive performance while under motor conditions of increasing complexity before and after a standardized exercise protocol.

Methods

34 participants were recruited (17 male and 17 female; 24 ± 1.4 yrs). A modified Eriksen flanker test was used to assess cognitive performance under four conditions (seated, single-leg stance, walking, and lateral stepping) before and after a 20-min moderate-to vigorous intensity treadmill protocol. The flanker test consisted of 20 sets of 5-arrow configurations, appearing in random order. To complete the response to cognitive stimulus, participants held a smartphone horizontally and were instructed to respond as quickly and as accurately as possible by tilting the device in the direction corresponding to the orientation of the middle arrow. The metrics used for analysis included average reaction time (ms), inverse efficiency index (average reaction time penalized for incorrect responses), and conflict effect (the average time cost of responding to an incongruent repetition vs. a congruent repetition). Mixed effects (condition by time) RMANOVAs were conducted to examine the effects of motor task complexity and physical exertion on cognitive performance.

Results

There was a condition by time interaction for inverse efficiency index (p < 0.001), in which participants displayed higher cognitive efficiency for the pre-activity lateral stepping condition compared to the other three conditions (Cohen's d = 1.3–1.6). For reaction time and conflict effect, there were main effects for condition (p = 0.004 and 0.006, respectively), in which performance during lateral stepping was improved in relation to the seated condition (reaction time Cohen's d = 0.68; conflict effect Cohen's d = 0.64).

Conclusion

Participants tended to display better dual-task cognitive performance under more stimulating or complex motor tasks before physical exertion, likely associated with the inverted-U arousal-performance relationship. When using dual-task assessments, clinicians should be mindful of the accompanying motor task and baseline exertion levels and their potential to disrupt or optimize cognitive performance.

Determining Counseling Self-efficacy of Indian Students of Speech Language Pathology

Purpose

Counseling self-efficacy is the view that counselors have of their capability to practice certain abilities that contribute to good clinical service. Speech Language Pathologists (SLPs) require to possess strategic counseling skills for effective service delivery. Although counseling is mostly considered an essential component during rehabilitation, many SLPs receive no explicit training on the same. The current study aims to explore self-efficacy measures in counseling among Indian students of speech-language pathology.

Methods

The Counselor Activity Self-Efficacy Scales (CASES), which is a 6-point Likert rating scale developed by Victorino and Hinkle (2019) was adopted to assess the self-efficacy of 105 student clinicians (undergraduates and graduates) of speech-language pathology. The study comprised of two phases. Phase one included the administration of the CASES questionnaire on the target population, and Phase two included performing frequency-based analysis on Helping Skills (HS), Emotional Support Skills (ESS), and Session Management Skills (SMS) domains.

Results

The majority of participants felt somewhat confident over questions in the HS and ESS domain, while a large proportion felt very confident over the questions in the SMS domain. Although the student clinicians felt somewhat confident and very confident in most of the domains, none of the participants were completely confident in any of the domains.

Conclusion

Having a counseling self-efficacy tool will help estimate the level of counseling competency one may possess. The results of the study can be used to design effective counseling-based training programs for student clinicians and practicing professionals, to achieve productive therapeutic connections with patients and caregivers.

Inhibition modulated by self-efficacy: An event-related potential study

Inhibition, associated with self-efficacy, enables people to control thought and action and inhibit disturbing stimulus and impulsion and has certain evolutionary significance. This study analyzed the neural correlates of inhibition modulated by self-efficacy. Self-efficacy was assessed by using the survey adapted from the Motivated Strategies for Learning Questionnaire. Fifty college students divided into low and high self-efficacy groups participated in the experiments. Their ability to conduct inhibitory control was studied through Go/No-Go tasks. During the tasks, we recorded students’ brain activity, focusing on N2 and P3 components in the event-related potential (ERP). Larger No-Go N2 amplitudes for the high self-efficacy group were found compared with the low self-efficacy group. Conflict detection as represented by N2 was modulated by self-efficacy, whereas conflict inhibition as represented by P3 was not modulated by self-efficacy. The highly self-efficacious students were more capable of detecting conflicts but not necessarily more capable of inhibiting action given that conflict was detected. Taken together, these findings offer neurophysiological evidence of the important regulatory role of self-efficacy in inhibitory control ability development.

Investigating the relationship between online information seeking and translation performance among translation students: The mediating role of translation self-efficacy

The widespread use of online information resources by translation students has motivated an increasing number of researchers to investigate the relationship between online information seeking and translation performance. However, these studies mainly address the direct effect of online information seeking on translation performance, thus failing to explore and identify the internal psychological mechanisms. This study, therefore, explores the mediating role of translation self-efficacy in the relationship between online information seeking and translation performance. A total of 314 translation students in China completed questionnaires on online information seeking and translation self-efficacy, and translation performance was measured by assessing the quality of a translation task given to them. Results showed that translation self-efficacy partially mediated the association between online information seeking and students’ translation performance. These findings can contribute to our understanding of the role that translation self-efficacy plays in information seeking behaviors and the emotional states of translation students in translator training.

Mindset as a resilience resource and perceived wellness of first responders in a South African context

The global increase in frequency and intensity of disasters and emergency situations has a major disruptive effect on societies that is especially visible in Africa, where conflict, poverty, diseases and social unrest are some of the biggest factors contributing to societal vulnerability. Developing countries such as South Africa are vulnerable to the impact of disaster situations that strain the society’s ability to deal with these emergencies. First responders play an important function responding to disasters but are exposed to work-related stressors that could impact their performance. Several international studies make a link between wellness, performance and resilience and the use of resilience resources in the development and enhancement of wellness, indicating that resilience resources such as a resilient mindset are an indicator of good mental health and performance amongst first responders, despite being exposed to traumatic situations. However, very little research has been carried out on first responders in South Africa, making this study an important stepping stone towards gaining an understanding of the relationship between mindset as a resilience resource and perceived wellness of first responders in a South African context. Data were collected from 52 first responders using a structured questionnaire. The results indicate a statistically significant relationship between mindset and perceived wellness, with all the wellness factors indicating that the mindset of first responders plays a crucial role in their resilience and perception of wellness, necessitating additional research in this specialised field of disaster response.

Factors influencing adherence to antiretroviral therapy among HIV/AIDS patients in the Ga West Municipality, Ghana

OBJECTIVES

Antiretroviral therapy (ART) is used to suppress the HIV viral load but requires optimal adherence to be effective. This study examined the factors influencing ART adherence among HIV-positive clients in the Ga West Municipality, Ghana using the Health Belief Model (HBM).

METHODS

A facility-based cross-sectional design was adopted among 397 HIV clients aged 18 years and above. Data were collected using an interviewer-administered questionnaire and analysed using Stata version 16.0. Binary logistic regression was performed at the P < 0.05 level.

RESULTS

Adherence to ART was 44.6%. Clients who took less than 30 minutes to reach ART sites were 59% less likely to adhere to ART (odds ratio (OR) 0.41, 95% confidence interval (CI) 0.20-0.82). Clients who thought they lost income when they went to obtain their ART refill were more likely to adhere to ART (OR 1.71, 95% CI 1.04-2.83), as were those who developed side effects (OR 1.74, 95% CI 1.05-2.89) (perceived barriers). Clients who had confidence in their ability to take their medications (self-efficacy) (OR 1.86, 95% CI 1.05-3.31) and those who received reminders from health workers (cues to action) (OR 1.91, 95% CI 1.04-3.53) were more likely to adhere to ART.

CONCLUSIONS

Interventions should focus on increasing client confidence in adhering to ART. Providers should be empowered to provide reminders to patients.

A Novel Approach to Assessment of Perceptual-Motor Efficiency and Training-Induced Improvement in the Performance Capabilities of Elite Athletes

Standard clinical assessments of mild traumatic brain injury are inadequate to detect subtle abnormalities that can be revealed by sophisticated diagnostic technology. An association has been observed between sport-related concussion (SRC) and subsequent musculoskeletal injury, but the underlying neurophysiological mechanism is not currently understood. A cohort of 16 elite athletes (10 male, 6 female), which included nine individuals who reported a history of SRC (5 male, 4 female) that occurred between 4 months and 8 years earlier, volunteered to participate in a 12-session program for assessment and training of perceptual-motor efficiency. Performance metrics derived from single- and dual-task whole-body lateral and diagonal reactive movements to virtual reality targets in left and right directions were analyzed separately and combined in various ways to create composite representations of global function. Intra-individual variability across performance domains demonstrated very good SRC history classification accuracy for the earliest 3-session phase of the program (Reaction Time Dispersion AUC = 0.841; Deceleration Dispersion AUC = 0.810; Reaction Time Discrepancy AUC = 0.825, Deceleration Discrepancy AUC = 0.794). Good earliest phase discrimination was also found for Composite Asymmetry between left and right movement directions (AUC = 0.778) and Excursion Average distance beyond the minimal body displacement necessary for virtual target deactivation (AUC = 0.730). Sensitivity derived from Youden's Index for the 6 global factors ranged from 67 to 89% and an identical specificity value of 86% for all of them. Median values demonstrated substantial improvement from the first 3-session phase to the last 3-session phase for Composite Asymmetry and Excursion Average. The results suggest that a Composite Asymmetry value ≥ 0.15 and an Excursion Average value ≥ 7 m, provide reasonable qualitative approximations for clinical identification of suboptimal perceptual-motor performance. Despite acknowledged study limitations, the findings support a hypothesized relationship between whole-body reactive agility performance and functional connectivity among brain networks subserving sensory perception, cognitive decision-making, and motor execution. A complex systems approach appears to perform better than traditional data analysis methods for detection of subtle perceptual-motor impairment, which has the potential to advance both clinical management of SRC and training for performance enhancement.

The Role of the Observers' Perception of a Model's Self-Confidence in Observationally Induced Placebo Analgesia

The aim of this study was to investigate the effect of a model's self-confidence as well as the observer's self-esteem and self-efficacy on observationally acquired placebo analgesia. In addition, we aimed to verify the stability of the placebo effect induced by observational learning. Participants (n = 60) were randomly assigned to one of three groups: a self-confident model, an unself-confident model, and a control group. In the experimental groups, participants watched a videotaped model who rated the intensity of electrocutaneous pain stimuli applied in the placebo condition as lower than those applied in the non-placebo condition. The different levels of self-confidence in these groups were manifested in the body posture and facial expressions of the model as well as in specific behavior that accompanied the assessment of pain. Then, 16 electrocutaneous pain stimuli of the same intensity, preceded by the placebo or non-placebo, were applied to participants. In both experimental groups, in contrast to the control group, participants experienced less pain in the placebo than in the non-placebo condition. Although the magnitude of placebo analgesia did not differ between the experimental groups, multiple regression analysis revealed that the perceived self-confidence of the model, but not the self-efficacy or self-esteem of the observer, was a significant predictor of the placebo effect. Moreover, placebo analgesia induced by observational learning did not extinguish over the course of the experiment. These results support the premise that the observers' perception of a model's self-confidence plays a significant role in placebo effects. PERSPECTIVE: The results of this study open the discussion on the role of model's features in the effectiveness of observational learning in the induction of placebo effects. The study provides the very first suggestion that the perceived self-confidence of the model may be related to the magnitude of the observationally induced placebo analgesia. It suggests that self-confidence of other patients and medical staff might affect individual pain experiences.

From the simulation center to the bedside: Validating the efficacy of a dynamic haptic robotic trainer in internal jugular central venous catheter placement

BACKGROUND

The objective of this study was to validate the transfer of ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) placement skills from training on a Dynamic Haptic Robotic Trainer (DHRT), to placing US-IJCVCs in clinical environments. DHRT training greatly reduces preceptor time by providing automated feedback, standardizes learning experiences, and quantifies skill improvements.

METHODS

Expert observers evaluated DHRT-trained (N = 21) and manikin-trained (N = 36) surgical residents on US-IJCVC placement in the operating suite using a US-IJCVC evaluation form. Performance and errors by DHRT-trained residents were compared to traditional manikin-trained residents.

RESULTS

There were no significant training group differences between unsuccessful insertions (p = 0.404), assistance on procedure (p = 0.102), arterial puncture (p = 0.998), and average number of insertion attempts (p = 0.878). Regardless of training group, previous central line experience significantly predicted whether residents needed assistance on the procedure (p = 0.033).

CONCLUSION

The results failed to show a statistical difference between DHRT- and manikin-trained residents. This study validates the transfer of skills from training on the DHRT system to performing US-IJCVC in clinical environments.

The Development of a Self-Efficacy Measurement Tool For Counseling in Speech-Language Pathology

Purpose This study aimed to develop and administer an adapted survey tool to measure counseling skills in graduate students and early-career speech-language pathologists, focusing on the concept of counselor self-efficacy. Method An online survey, adapted from the Counselor Activity Self-Efficacy Scales ( Lent, Hill, & Hoffman, 2003 ), was administered. Two hundred ninety-four surveys were completed. An exploratory factor analysis was conducted, along with measures of reliability and validity, in order to determine the psychometric properties of the tool. Results Factor analysis supported a 5-factor solution, with subscales reflecting Emotional Support Skills, Session Management Skills, and Helping Skills in 3 domains: Exploration, Insight, and Action. Strong internal consistency was found for each subscale and for the total scale scores. Significant intercorrelations between subscale scores were expected and confirmed. Construct validity was examined with reference to American Speech-Language-Hearing Association and Council for Academic Accreditation in Audiology and Speech-Language Pathology practice guidelines and clinical competencies. Preliminary comparative data were analyzed to demonstrate utility of the tool in measuring effects of experience on self-efficacy ratings. Conclusion The adapted Counselor Activity Self-Efficacy Scales for speech-language pathologists is psychometrically sound; factor analysis, reliability, and validity were in line with reported values for the original survey tool. Potential uses for the survey tool within the field of speech-language pathology are discussed, along with implications for graduate education and clinical supervision related to counseling skills.

Investigating the Effect of Simulator Functional Fidelity and Personalized Feedback on Central Venous Catheterization Training

OBJECTIVE

To compare the effect of simulator functional fidelity (manikin vs a Dynamic Haptic Robotic Trainer [DHRT]) and personalized feedback on surgical resident self-efficacy and self-ratings of performance during ultrasound-guided internal jugular central venous catheterization (IJ CVC) training. In addition, we seek to explore how self-ratings of performance compare to objective performance scores generated by the DHRT system.

DESIGN

Participants were randomly assigned to either manikin or DHRT IJ CVC training over a 6-month period. Self-efficacy surveys were distributed before and following training. Training consisted of a pretest, 22 practice IJ CVC needle insertion attempts, 2 full-line practice attempts, and a posttest. Participants provided self-ratings of performance for each needle insertion and were presented with feedback from either an upper level resident (manikin) or a personalized learning system (DHRT).

SETTING

A study was conducted from July 2016 to February 2017 through a surgical skills training program at Hershey Medical Center in Hershey, Pennsylvania.

PARTICIPANTS

Twenty-six first-year surgical residents were recruited for the study. Individuals were informed that IJ CVC training procedures would be consistent regardless of participation in the study and that participation was optional. All recruited residents opted to participate in the study.

RESULTS

Residents in both groups significantly improved their self-efficacy scores from pretest to posttest (p < 0.01). Residents in the manikin group consistently provided higher self-ratings of performance (p < 0.001). Residents in the DHRT group recorded more feedback on errors (228 instances) than the manikin group (144 instances). Self-ratings of performance on the DHRT system were able to significantly predict the objective score of the DHRT system (R2 = 0.223, p < 0.001).

CONCLUSION

Simulation training with the DHRT system and the personalized learning feedback can improve resident self-efficacy with IJ CVC procedures and provide sufficient feedback to allow residents to accurately assess their own performance.

Costs and benefits of self-efficacy: Differences of the stress response and clinical implications

Encounters with stressors induce diverse idiosyncratic neuroendocrine, behavioral and psychological reactions across people. Perceived self-efficacy can alter autonomic responses and their effects on mental health. The beneficial effects of self-efficacy in buffering physiological arousal, enhancing performance, and diminishing psychopathological symptoms have been observed in diverse contexts. We show that the role of self-efficacy is not uniformly beneficial, and that higher levels of self-efficacy can sometimes lead to increases in neuroendocrine and psychological stress responses and decreases in performance, a phenomenon that has been widely neglected. We discuss specific conditions under which self-efficacy effects do not uniformly ameliorate or prevent the consequences of stress. These conditions suggest that therapeutic interventions need not always promote self-efficacy in principal. Simultaneously, they to do suggest that keeping self-efficacy high might be disadvantageous or detrimental.

Side effects, adherence self-efficacy, and adherence to antiretroviral treatment: a mediation analysis in a Chinese sample

Antiretroviral therapy (ART) is a lifelong treatment. To date, ART adherence is suboptimal for most patients in resource-poor settings. Previous research indicates that medication side effects are perceived to be a significant barrier of high ART adherence. Data regarding the role of adherence self-efficacy in mediating the relationship between side effects from ART and adherence to ART are limited; thus, this study examines this potential mediational role of self-efficacy. A cross-sectional survey of 2987 people living with HIV aged ≥18 years was conducted in 2012-2013 in Guangxi Autonomous Region (Guangxi) which has one of the fastest-growing HIV rates in China. Of the total sample, 2146 (72.1%) participants had initiated ART. Participants reported the number of days of completing the daily dose of ART in the past month; adherence was defined as completing the daily dose at least 28 days in the last month (≥90%). Side effects were significantly negatively related to adherence to ART. Mediation analyses indicated that adherence self-efficacy significantly mediated the side effects-adherence relationship. Future interventions to increase adherence self-efficacy and effective coping with side effects among HIV patients are needed in order to improve their ART adherence.

Does Self-Efficacy Affect Cognitive Performance in Persons with Clinically Isolated Syndrome and Early Relapsing Remitting Multiple Sclerosis?

In persons with multiple sclerosis (MS) a lowered self-efficacy negatively affects physical activities. Against this background we studied the relationship between self-efficacy and cognitive performance in the early stages of MS. Thirty-three patients with Clinically Isolated Syndrome (CIS) and early Relapsing Remitting MS (eRRMS) were assessed for self-efficacy (MSSES-18), cognition (CDR System), fatigue (MFIS-5), depressive symptoms (BDI), disease impact (MSIS-29), and disability (EDSS). Correlative analyses were performed between self-efficacy and cognitive scores, and stepwise regression analyses identified predictors of cognition and self-efficacy. Good correlations existed between total self-efficacy and Power of Attention (r= 0.65; P< 0.001), Reaction Time Variability (r= 0.57; P< 0.001), and Speed of Memory (r= 0.53; P< 0.01), and between control self-efficacy and Reaction Time Variability (r= 0.55; P< 0.01). Total self-efficacy predicted 40% of Power of Attention, 34% of Reaction Time Variability, and 40% of Speed of Memory variabilities. Disease impact predicted 65% of total self-efficacy and 58% of control self-efficacy variabilities. The findings may suggest that in persons with CIS and eRRMS self-efficacy may positively affect cognitive performance and that prevention of disease activity may preserve self-efficacy.