Perceived Control

There are two primary mechanisms through which perceived control may produce beneficial outcomes: direct (main-effect model), or indirect, through a reduction in stress (stressbuffering model; see Cohen).

The main-effect model suggests that having a strong sense of control has a direct positive effect on health through various mediators, or mechanisms. These mediators include cognitive, behavioral, and physiological factors. For example, control may lead to positive psychological states, such as high self-esteem and positive affect. This in turn may lead to favorable physiological responses as well as to participation in health-promoting behaviors. Together, these produce health-relevant biological influences (e.g., immune effects) resulting in good health. This model does not explicitly include alternative paths, which also likely exist. For example, it is plausible that a health-promoting behavior like exercise would influence health, physiological responses, and subsequent feelings of control.

There is evidence for a main-effect model. For example, an internal health locus of control has been related to the importance placed on good health, and both of them are predictors of engaging in preventive health behaviors. Thus, control beliefs can help explain why some people abstain from risky behaviors (e.g., smoking) and participate in healthy ones (e.g., exercise).

In the psychological domain, perceived control has been associated with increased levels of self-esteem, optimism, vigor, and social support, and decreased levels of depression and anxiety. While many of the studies in this area are correlational, growing numbers of experimental manipulations of objective control and interventions enhancing efficacy beliefs have produced beneficial results, suggesting that the causal direction is from feelings of control to health and wellbeing.

While the main-effect model assumes that there are effects of control on health and wellbeing (through cognition, behaviors, and/or physiology), an alternative and equally plausible view suggests that a strong sense of control may aid in the buffering of stress. Stress is assumed to have negative effects on health and well-being. In the stress-buffering model, a potentially stressful event is tempered by feelings of control at multiple points. For example, control may lead a potentially stressful event to be appraised as less so, or, once a stressful event is perceived, control may ward off feelings of helplessness.

Studies in which outcomes depend upon an interaction between stress and control support a stress-buffering model (e.g., control moderates the effects of stress on physical and mental health). Research also supports interactions between control and physiological aspects of stress; physiological responses to stressful events are lessened in those with strong control beliefs. For example, when people believe they have control over an aversive event like noise, or that they can successfully overcome a stressor, they show lower levels of stress-related hormones.