Clinical psychology: individual methods

Learned helplessness at work

The development of theory and research on learned helplessness is reviewed and criticized on some points, e.g., for its reliance on artificial laboratory experiments. Some empirical findings are presented, indicating a connection between certain work characteristics and learned helplessness. Other research traditions have emphasized the importance of job qualifications, freedom of action, and development possibilities for well-being and health. There is, however, hardly and research on learned helplessness at work. Learned helplessness hypotheses should be tested on data from real life; if applied to work environment research, the theory of learned helplessness could generate important results.

EMG feedback in the treatment of myofascial pain dysfunction syndrome

The effect of electromyographic (EMG) biofeedback on frontalis and masseter muscle activity was compared with control conditions in two groups of patients with a diagnosis of myofascial pain dysfunction (MPD) syndrome. Patients were selected on the basis of clinical symptoms, radiographic evaluation, and a clinical examination. Depressed patients and patients with signs of a pathological condition in the temporomandibular joint were excluded. Both the experimental (EXP) and the control (CON) group went through two base-line screening sessions before treatment of the EXP group was started. Treatment consisted of eight biofeedback sessions, given twice a week for 4 weeks. Feedback was presented visually on a monitor. Treatment did not include any relaxation training. Control evaluations of both groups took place 1 week, 3 months, and 6 months after the end of treatment. The EXP group was able to reduce EMG levels in frontalis and masseter muscles significantly during training sessions. Follow-up data showed significantly reduced frontalis EMG levels in the EXP group after 3 and 6 months but not in the CON group. Both groups improved subjectively, as judged by reports on pain intensity and duration, but this improvement was significantly more pronounced in the EXP group. Objective clinical indices recorded throughout the study were uncorrelated with EMG changes or subjective reports. It is concluded that biofeedback training facilitated muscular relaxation and self-regulation in the EXP group and that visual EMG feedback, consisting of a patterning of frontalis and masseter muscle activity, can be recommended as an integrated part of MPD syndrome treatment.

Behavioural assessment of disturbed, institutionalized retardates

While behavioural assessment has had wide application in a number of educational and treatment settings, relatively little has been done to develop programmes specifically for use with retardates who have been institutionalized for the treatment of disturbed behaviour. As a result, the development of appropriate procedures for the latter group requires extrapolation from the use of behavioural techniques in other settings. The current literature on behavioural assessment stresses the importance of identifying meaningful response units and their controlling variables, if efficacious treatment programmes are to be mounted. To be maximally useful, assessment must provide a relatively simple description in objective, non-inferential terms of how a patient responds to the demands of daily living. While many reports of treatment programmes focus on the assessment of a single, narrowly defined variable, the occurrence of which can be readily counted, this is not appropriate for the initial assessment procedures of a residential treatment centre. What is required is an omnibus approach which samples the patient's responses to a broad array of environmental situations which are relevant to the centre and its population. A review of available behavioural scales reveals that there are very few reliable omnibus scales available for use with retardates and none which adequately assesses the behavioural concommitants of disturbed retardates. To deal with this group of patients, it is proposed that, initially, two scales be used to sample both normal and maladaptive behaviour. A number of suggestions have been made for implementing behavioural assessment procedures in residential treatment centres, especially for disturbed retardates.

Efficacy and emerging trends in the psychotherapy 'industry'

It has been suggested that psychotherapy is facing a crisis of confidence, as it is subjected to increasing scrutiny by policy-makers, funding agencies and the general public. This review outlines present knowledge of psychotherapeutic efficacy, examines some of the socio-economic arguments with which the psychotherapy 'industry' is involved, and suggests that emerging trends towards eclecticism and specificity in psychotherapy have considerable merit. It is concluded that outcome and process research has so far failed to convince psychotherapy's critics of its essential roles in a comprehensive health-care system. Further, it is clear that cost-containment policies need to be countered by research which provides credible evidence of psychotherapy being both clinically effective and cost effective.