often lead to that very state of affair of symptom reduction. People suffering from a significant amount of stress and tension often feel at the mercy of this aversive emotional state, with no effective means of alleviating or personally controlling it. One of the chief attractions of tranquilizers, besides the reduction of the physiological components of stress, is that they allow individuals the comforting perception that they have a means of actively controlling the ingestion of a drug.
Indeed, this same perception of control factor can be seen in nonpharmacological treatments. For example, Goldfried and Trier (1974) demonstrated the effectiveness of muscle relaxation training in reducing anxiety when presented as an active self-control coping skill. This self-control concept has been reviewed as an important component of behavioral treatment techniques (e.g., Goldfried & Merbaum, 1973). Goldfried and Trier found that subjects who were given relaxation training presented as an active coping skill over which they exerted personal control demonstrated a significantly greater reduction in anxiety than subjects who were given identical muscle relaxation training, but that was presented as an “automatic” procedure for passively reducing anxiety.
Of course, the concept of personal or perceived control is not the entire reason why techniques such as muscle relaxation and biofeedback work. The techniques are still effective when relaxation is passively induced. There is little doubt, however, that the psychological or cognitive factor of perceived controllability plays a significant role in the stress reduction process. Indeed, the concept of self-eficacy in the treatment of maladaptive or emotional behavior has been emphasized (e.g., Bandura, 1986). A sense of self-efficacy greatly contributes to the reduction of emotional distress. Thus, direct volitional control of physiology may not only impact on the physiological component of stress, but may also simultaneously affect the other more psychological concomitants of this complex psychophysiological process.
Physiological self-regulation techniques such as biofeedback have an important place in the rapidly growing field of health psychology. To date, there is a great deal of research demonstrating the efficacy of these techniques in helping to manage a wide array of medically related disorders. It should again be emphasized, however, that more controlled research is needed to unequivocally document effectiveness for many of the disorders. Moreover, these techniques should be viewed merely as important adjunctive treatment modalities to be used as part of a more comprehensive treatment program. Many disorders are far too complex psychophysiologically, and will not be totally responsive to a single treatment modality. Finally, the therapeutic effects of these techniques are not only due to the direct link to physiological activity, but also the psychological process of perceived control. The further investigation of the complex psychophysiological mechanisms underlying the therapeutic efficacy of self-regulation techniques should lead to a greater refinement of training methods and a resultant more effective overall treatment strategy.
Some research reported in this chapter was supported by grants from the National Institutes of Health (MH46452, MHO1107, and DE10713).
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