Self-assessment in clinical health psychology: a model for ethical expansion of practice.

Society expects autonomous professions to ensure the competency of it practitioners, and professions should facilitate the continuing education and training of its members. Given the shift from psychology as a mental health profession to that of a health profession, the authors propose a self-assessment model for the individual practitioner to gauge his or her readiness to provide professional service in expanded areas of practice. This model could also be useful to the American Psychological Association, state psychological associations, and other purveyors of continuing education programs in systematically developing postgraduate experiences. A template for self-assessment that reflects well-accepted core domains of knowledge and skills is presented.

Graduate education in clinical psychology. "We're not in Kansas anymore".

In this article, the author addresses changes impacting graduate education in clinical psychology, including those in technology, the academy, and the marketplace, and discusses implications of these changes for psychology. Significant concerns are raised concerning issues of supply and demand as well as the nature of the product of graduate education and training.

Clinical health psychology: a specialty for the 21st century.

To meet its potential in the 21st century, clinical health psychology must develop an accumulated body of knowledge relevant to practice, disseminate this knowledge, use this knowledge in practice and policy, and provide appropriate education and training for future psychologists. In this Division of Health Psychology Presidential Address, the author articulates issues in each of these areas, highlighting changes in health care and problems in research as well as issues in the development of practice guidelines and policies relevant to organized psychology.

Board certification in health psychology.

As professional practice in health psychology has matured, mechanisms for board certification through the American Board of Professional Psychology have been developed. This article describes the American Board of Health Psychology and its role in the credentialing of practitioners who demonstrate advanced competence in the science and practice of psychology related to health, including the prevention, treatment, and rehabilitation of illness.

Postdoctoral education and training for clinical service providers in health psychology.

It was recommended by the 1983 National Working Conference on Education and Training in Health Psychology (Stone, 1983) that 2 years of postdoctoral education and training be mandated for future licensed health service providers in health psychology. The background for requiring this postdoctoral training, a model for education, criteria for developing programs, issues of funding, and a rationale for accepting this mandate are presented. Highlighted are the stable and consistent growth of health psychology, the need to expand the period of clinical training to meet the many advances in the field, and the challenges that exist for the fully trained clinical health service provider.

Alexithymia and pain in an outpatient behavioral medicine clinic.

Alexithymia is defined as a "lack of words for feelings." This deficiency has been suggested to play a role in the formation and maintenance of somatic symptoms. Prior research has found alexithymia prevalent in "classic" psychosomatic disorders. The present study examines the prevalence of alexithymia and its relationship to patient age, sex, and report of pain. The sample was 208 consecutive outpatients evaluated on a Behavioral Medicine Service and presenting with pain as a primary symptom. Results indicated that the prevalence of alexithymia in this study is consistent with prior research using inpatient pain patients and a similar MMPI alexithymia subscale. Additional analyses of the MMPI clinical and validity scales revealed that alexithymic patients were more defensive and presented themselves in a favorable manner reflecting a "normal" picture of mental health. It is suggested that alexithymia may play a role in chronic pain syndromes. Further research is needed to examine this deficiency and its potential etiological significance in these disorders.

Psychological aspects of essential blepharospasm.

Evaluation of 20 essential blepharospasm patients by using structured interview and psychological testing (MMPI, Rorschach) revealed characteristic pathological personality patterns in all cases. Recent losses or life change, marital conflict, and specific precipitating events were common. Test findings indicated unexpressed hostility, denial, and repression in a majority of women. Three of five men showed evidence of depression. This initial systematic investigation of psychological factors in blepharospasm supports the hypothesis that neurological and psychogenic factors may interact etiologically. The data suggest that personality, recent stress, and precipitating events warrant both clinical assessment and controlled research to determine the specificity and prevalence of these findings.

The relative efficacy of autogenic phrases and autogenic-feedback training in teaching hand warming to children.

There are few well-controlled biofeedback temperature training studies in the literature that have used children as subjects. The purposes of this study were (1) to evaluate whether children can learn to increase hand temperature, controlling for methodological factors that have been overlooked in previous experiments, and (2) to determine whether adding thermal biofeedback to autogenic phrases results in improved ability to produce voluntary increases in hand temperature over the use of autogenic phrases alone. Twenty-six subjects (ages 9-11) were divided into two groups of 13 subjects each. All subjects participated in four 35 to 45-minute sessions consisting of a stabilization phase, a training phase, and a post-training phase on 4 consecutive days. One group was trained to increase finger temperature with autogenic phrases only, and the other was trained with autogenic phrases plus thermal feedback. None of the subjects in either group learned to increase hand temperature significantly within sessions. There was a consistent and reliable decreasing trend within each session; however, finger temperature did increase (.27 degrees F) for the first 8 minutes of the training phase. There was a significant increase in hand temperature from day 1 to days 3 and 4, and there were significant increases in temperature during the stabilization phase alone. There were no differential effects of treatments. Methodological issues concerning stabilization, the potential confounding effect of boredom and fatigue, and different training methods for children are discussed.

The use of EMG feedback and progressive relaxation in the treatment of a woman with chronic back pain.

In this systematic single-case study, a 71-year-old white female with chronic back pain and paravertebral muscle spasm was treated with 17 sessions of electromyographic (EMG) feedback, with recording site just below the right inferior scapular angle. Progressive relaxation practice was also employed. EMG level was monitored during baseline, treatment, and follow-up phases. Backaches were recorded by the subject on a daily basis. There was a marked decrease in both EMG level and frequency of backaches, as well as an increase in activities at home. Improvement was maintained 12 weeks after the last treatment session.

A comment on Silver and Blanchard's (1978) review of the treatment of tension headaches via EMG feedback and relaxation training.

In response to an earlier review by Silver and Blanchard, caution is urged in reaching "premature" conclusions about the relative efficacy of biofeedback vs. relaxation training in the treatment of tension headaches. Additional points are raised concerning subject and procedural variables, data interpretation, and choice of dependent measures in assessing treatment outcome. The need for continued study of this question is emphasized.

Male delusional depressed patients: response to treatment.

In view of the previous finding that female deluded depressed patients do not respond to tricyclic antidepressants, a retrospective review of charts of thirteen male patients with primary depression accompanied by delusions were undertaken. None improved on tricyclics alone, whereas all those treated initially with neuroleptics improved. Twelve out of thirteen patients showed no improvement until neuroleptics were added to the treatment regimen. Implications for classification and treatment are discussed.