Mindsets and Motivation

1. Mindsets and Motivation Claudia Mueller, PhD, MD Division of Pediatric Surgery

2. Framework • Based on work by psychologist Carol Dweck, PhD • Dweck et al have identified a set of “implicit theories” or “mindsets” that individuals use to analyze and interpret the world • These theories are based on two different assumptions that people make about the malleability of personal attributes

3. Implicit theories • “Entity” theory • The belief that a personal attribute is fixed and nonmalleable • “Incremental” theory • The belief that an attribute is a malleable quality that is subject to change and development • Beliefs can be applied in various domains: intelligence, morality, athletics

4. Implicit theories 2 • Entity/incremental category determined by responses to statements • Implicit theories • Intelligence • You can learn new things, but you can’t really change your basic intelligence. • Morality • A person’s moral character is something very basic about them and it can’t be changed very much.

5. Mindset statements • Your intelligence is something very basic about you that you can’t change very much. • You can learn new things, but you can’t really change how intelligent you are. • No matter how much intelligence you have, you can always change it quite a bit. • You can always substantially change how intelligent you are.

6. Implicit theories 3 • Entity vs. Incremental theories influence • Judgments • Entity see failures as indicative of stable, low ability • Goals • Performance (look good, avoid failure) vs. mastery(learn material, may have to fail to do so) • Response to setbacks • Entity give up in face of challenge • Theories create “mindsets” which influence behavior • Independent of actual intelligence, morality, athletic ability

7. Intelligence theory • Entity view of intelligence as fixed stable trait • Intelligence is reflected by individual outcomes • Performance goals: challenge is threatening • Failure is devastating (I’m dumb) • Incremental view of intelligence as able to be developed • Individual outcomes not representative of whole • Learning goals: challenge is informative • Failure is motivating (I need to work harder)

8. Theory development • Likely related to feedback received throughout life • Parents, teachers, peers • Some studies have looked at feedback after failure • My work has focused on feedback after success

9. Feedback studies • Does feedback change how children respond to challenge? • Can different types of praise lead children to develop different goals and theories (mindsets)? • Conventional wisdom • Praise in any form is good • Praise after success • builds self esteem • protects against disappointment after failure

10. Type of praise • Praise for: • Fixed ability = “smartness” • Malleable effort = “hard work” • Would children respond differently based on the type of praise given? • Conventional wisdom: no • Hypothesis: yes

11. Dissertation • Series of 6 studies with fifth-graders assessed for their work on geometric puzzles (Mueller & Dweck) • >500 participants • public and private schools • Midwest, Northeast • Dweck lab, Psychology Dept, Columbia University

12. Experimental Design Puzzle 1 (Success) Praise manipulation Puzzle 2 (Failure) Measures Puzzle Enjoyment Task Persistence Failure Attributions Puzzle 3 (Test)

13. Puzzles • Raven’s Progressive Matrices • John C. Raven, Oxford Psychologists Press

14. Praise • Wow, you did very well on these problems. You got – right. That’s a really high score. • Ability • You must be smart at these problems. • Effort • You must have worked hard at these problems.

15. Failure • Children told they scored “a lot worse” on second set of puzzles • Post-failure assessments • How well they did • Enjoyment • Persistence • Attributions • I didn’t work hard enough • I’m not good enough at the problems • I’m not smart enough • I didn’t have enough time

16. Psychological impact of praise • Children praised for effort • Attributed failure to lack of trying • Enjoyed puzzles more • More likely to persist • Children praised for ability • Attributed failure to lack of ability • Enjoyed the puzzles less • Gave up sooner • Content of praise matters

17. Puzzle Performance

18. Additional findings • Ability praise • Performance goals • Entity belief of intelligence • Sought information on performance not mastery • Misrepresented score to other kids • Effort praise: learning, incremental theory

19. Conclusions • Praise delivers message • Praise for ability after success • Poor performance = low ability • Avoid challenge • Praise for effort after success • Poor performance = work harder • Embrace challenge as opportunity for growth • Feedback leads to “mindset” that determines behavior

20. My research paradigm • Propose psychological framework of children’s illness that uses their theories of health to predict adherence and outcomes • Develop scale to identify these health theories • Test scale in healthy children • Study theories and behaviors in chronically ill adolescents • Develop feedback messages to improve both adherence and outcomes in pediatric populations

21. Response to disease • Little is known about the psychological dimensions of children’s disease • Children respond very differently to stressful hospital settings • Some crumble and regress; others thrive and adapt • “Mindset” of illness • Independent of illness severity • “Mindset” can be created by theory which may determine adherence and, ultimately, response to disease

22. Translation to clinical setting • Illness is a challenge • Hospitalized children behave similarly to children in schools • Do children perceive health as they do intelligence: fixed vs. malleable? • If fixed, less incentive to develop strategies for health promotion • If malleable, more likely to be active in their health care • Studies designed to examine how children think about health and how this affects their behaviors

23. Scale development • Potential statements tested with 500 healthy high school students • Goal to identify cohesive set of items to categorize beliefs • Entity theorists=health is fixed, unchangeable • Incremental theorists=health is malleable, subject to change • Key items • Your body has a certain amount of health, and you really can’t do much to change it. • Your health is something about you that you can’t change very much. • You can try to make yourself feel better, but you can’t really change your basic health.

24. Study 1: Test scale with healthy kids • 100 high school students • Exclude any with chronic medical conditions • Asked to respond to scenarios of kids with specific illnesses • Broken leg • Asthma • Appendicitis

25. Results 1 • Definition of health • Entity attribute to genes • Incremental attribute to behavior • Assessment of health in others • Entity exaggerate illness severity • Entity exaggerate illness duration • Assessment of own health • Incremental theorists believe they are healthier • Entity have higher BMI • Minimal overlap with previous scale of health causation (Locus of control)

26. Study 2 • 250 high school students • Asked to assess health of others (replicate first study) • Also asked to self-report safety behaviors • Hypothesis: Entity theorists might be less mindful of safety • Results confirmed Study 1 • No significant difference in safety precautions

27. Current study: Assessment of beliefs in patients • Chronically ill adolescents: Type 1 Diabetes • Age 12-18 yrs • Implicit theories of health • Dependent measures • Self-report of adherence attitudes • Health outcomes • Meter results • Blood sugar levels

28. Current study 2 • Participants approached at regularly-scheduled clinic visit • Consent from parents • Assent from patients • Participation rate 95% • Questionnaire administered in waiting area • Implicit theory of health scale • Adherence attitudes

29. Results-adherence attitudes • Entity theorists vs incremental theorists • Less likely to believe that adherence matters (p<.05) • Taking the right amount of medication on schedule will help me control my illness. • If I do exactly what my doctor tells me, I can control my illness.

30. Results-actual health • Meter results (previous 3 weeks) • Entity vs. incremental • Highest glucose (p<.05) • Mean glucose (p<.05) • Percent above target (p<.02) • Hgb A1c not significant

31. Overall results • By measuring adolescents’ implicit theories of health, we were able to predict • Reactions to illness in others • Attitudes toward adherence • Actual health outcomes in diabetic patients • Advantages of implicit theory scale (Mueller, Williams, Dweck) • Simple • Easy to administer • Long history of use in various contexts

32. Future investigations • Apply theory framework to other disease populations • Post-transplant, Cystic fibrosis, IBD • Post-op recovery cardiac surgery • Design experimental manipulations in which theories are changed (eg, fixed to malleable) to measure effect on outcomes • Deliver feedback messages targeted at theory change • Via web-based designs, technologies

33. Other ongoing research projects • Implicit theories of body weight (Burnette) • Plan to implement interventions (on-line reading activities that present body weight as malleable) • Measure motivation as well as weight loss over test period • Theories of trauma • Teenagers hospitalized for trauma asked about cause of injury • Use attributions to develop prevention strategies • Children’s perceptions of their surgical scars

34. Summary • Perceptions can change behaviors • In academic setting, children’s beliefs about intelligence influence their performance • In healthcare setting, children’s beliefs about health and illness may affect their responses to disease • My work is an attempt to create a psychological model that explains children’s health behaviors • Encouraging results using implicit theory framework to predict adherence and outcomes in medical setting

35. Thank you • Carol Dweck, PhD • Robert Wright, MA • Ryan Williams, MD • Bruce Buckingham, MD • Marily Oppezzo, MA • David Yeager, PhD • Jeni Burnette, PhD • Lindsey Eliopulos, MA • MetteHoybye, PhD

36. References • Berg et al. (1993). Medication compliance: A health care problem. Annals of Pharmacotherapy, 27, 2-21. • Burnette, J. (2009). Implicit theories of body weight: Fostering beliefs for healthy behavior. NIH grant proposal. • Cimpian,A, Arce, HC, Markman, EM & Dweck, CS. (2007). Subtle linguistic cues affect children’s motivation. Psychological Science, 18, 314-316. • Diener, CI & Dweck, CS. (1978). An analysis of learned helplessness: Continuous changes in performance, strategy and achievement cognitions following failure. Journal of Personality and Social Psychology, 36, 451-462. • Dweck, CS, Chiu, CY & Hong, YY. (1995). Implicit theories and their role in judgments and reactions: A world from two perspectives. Psychological Inquiry, 6, 267-285. • Festa et al. (1992). Therapeutic adherence to oral medication regimens by adolescents with cancer. J of Pediatrics, 120, 807-811. • Heyman, GD, Dweck, CS & Cain, K. (1992). Young children’s vulnerability to self-blame and helplessness. Child Development, 63, 401-415. • Mueller, CM & Dweck, CS. (1998). Intelligence praise can undermine motivation and performance. Journal of Personality and Social Psychology, 75, 33-52. • Shagena, MM, Sandler, HK & Perrin, EC. (1988). Concepts of illness and perception of control in healthy children and in children with chronic illness. Developmental and Behavioral Pediatrics, 9, 252-256. • Tebbi et al. (1986). Compliance of pediatric and adolescent cancer patients. Cancer, 58, 1179-1184. • Zora et al. (1989). Assessment of compliance in children using inhaled beta adrenergic agonists. Annals of Allergy, 62, 406-409.