Dimensions Relevant to the Health Care and Therapeutic Use of Self-Control Strategies: A System Model for Applied Research

DIMENSIONS RELEVANT TO THE HEALTH CARE AND THERAPEUTIC USE OF SELF-CONTROL STRATEGIES: A SYSTEM MODEL FOR APPUED RESEARCH DEANE H. SHAPIRO, JR.* Introduction: Historical Background, Current Plateau One of the promising areas within both psychotherapy and the health sciences has been the efforts directed toward the development and refinement of self-control strategies. These strategies enable clients and patients to observe, monitor, and alter (if desired) physiological, cognitive , and overt behavior patterns in ways which are more adaptable and health giving. As such, these techniques provide clinicians, physicians, and other practitioners in these fields the ability to begin to bridge the gap between theory, research, and clinical practice, and, in Stunkard's words, to go "from explanation to action" [I]. A plethora of research studies has shown the clinical effectiveness of these strategies with a variety of affective and physical disorders, including obesity [1], stress [2], hypertension [3], pain [4], depression [5], insomnia [6], etc. Broadly subsumed under the label self-control strategies , these techniques include, but are not limited to, behavioral selfcontrol [7, 8]; cognitive behavior modification [9] and cognitive therapies [10]; meditation [11, 12]; biofeedback [13]; self-hypnosis [14]; progressive relaxation [15]; guided daydreams and imagery [16]. However, although the late 1960s and most of the 1970s were filled with excitement regarding the development, refinement, and utility of self-control or self-regulation strategies, such efforts appear to have reached a plateau. Recent studies have had almost no success in differentiating efficacies of competing self-regulation techniques as a treatment of choice for * Department of Psychiatry and Human Behavior, California College of Medicine, University of California Irvine Medical Center, 101 City Drive South, Orange, California 92651.© 1983 by The University of Chicago. AU rights reserved. 0031-5982/83/2604-0349$01 .00 568 I Deane H. Shapiro,Jr. ¦ Self-Control Strategies a particular dependent variable. For example, Shapiro, in an extensive review of the literature comparing meditation with biofeedback , hypnosis, and progressive relaxation on a variety of physiological and clinical measures, concluded that there were no significant differences among these various strategies [17]—a finding supported by other reviews and more recent studies. In addition, there are difficulties in long-term maintenance and problems of adherence and compliance —and sometimes conflicting results. Thus, although self-control strategies abound, and there are isolated studies showing the efficacy of different self-regulation techniques with diverse clinical, psychotherapeutic, and health care problems, the question ofwhich particular self-control strategy is a treatment of choice for which client or patient with what type of clinical problem remains, for the most part, elusive and uncharted territory [18]. Stepping BachReassesnng and Re-Posing Critical Questions Given this state of affairs, it may be an appropriate time to take a step back from isolated empirical investigations, obtain a precise overview of where we are, and posit where we might profitably proceed with respect to applied biobehavioral, psychotherapeutic, and health science research on self-control strategies. This is not to challenge in any way the need for empirical research. Rather, it is to suggest that further research at this point in our knowledge ofself-control strategies might be best guided by efforts involving a broad reassessment and reposing ofthe questions that need to be asked. Appropriate topics and issues range from a macro to a micro level and include the following: (1) making a concerted effort to develop and formulate a unifying construct (or, if necessary, constructs) of selfcontrol so that the construct ofself-control provides a way for organizing and interpreting empirical research rather than a priori and tautologically being assumed and/or embedded with the self-control strategy itself [19]; (2) understanding and grounding self-control strategies within the theoretical and philosophical context and backgrounds from which the techniques arise and within which they are used [20, 21]; (3) exploring value and ethical questions, including a construct of psychological health toward which these self-control strategies might be directed so that we have more than technical and technician knowledge and application and so that unexamined cultural values and mores, as well as the techniques themselves, do not determine the goal and clinical outcome [22, 23]; (4) sensitivity to political, social, organizational, and environmental...