Treating insomnia with a self-administered muscle relaxation training program: a follow-up.

22 subjects seeking psychological help for problems of insomnia were trained to use a self-administered treatment package which contained a booklet explaining the problem and outlining the training program in detail and a tape with three versions of progressive relaxation training. A follow-up study one year later indicated that 90% of the subjects had trained according to the instructions and that 82% experienced a positive effect on sleep both with respect to falling asleep, staying asleep, and consumption of sleeping pills. It was concluded that self-administered relaxation training seems a cheap, convenient, and effective means of treating insomnia.     

The treatment of tension headache—II. EMG ‘normality’ and relaxation

A selected group of patients complaining of severe and chronic tension headache (without muscular abnormality) were given a short 3-week course of relaxation treatment. Half of the subjects received progressive relaxation instructions, while the other half received relaxation plus calming imagery. Both groups showed substantial improvements in pain behaviour and in pain experience. The improvements were synchronous and still present at the 6–8 week follow-up assessment. Although no significant differences were found between the groups, the addition of imagery appeared to produce larger improvements on a number of measures. These results were compared with those reported obtained in a previous biofeedback study and the implications of both the studies were discussed with respect to tension headache and its treatment.     

Effects of relaxation instructions on the electromyographic responses of abstinent alcoholics to drinking-related stimuli

Viewed from a behavioral perspective alcoholism is a behavioral disorder which should be influenced by the same range of environmental and historical variables which affect other operant behaviors. Therefore, environmental stimulus circumstances should play a significant role in influencing alcoholics' disposition to drink. In particular, stimuli which have previously been associated with drinking behavior should come to exert some controlling influence over subsequent disposition to drink. Relapse to substance abuse is often believed to be precipitated by exposure to stimulus circumstances previously associated with the drug or its use. This hypothesis has received its greatest emphasis in the area of narcotics abuse (Wikler, 1965). but presumably it is relevant also to the case of alcohol abuse. Research concerning abusers' reactions to alcohol-related or drinking-related stimuli has been minimal. Ludwig et al. (1974) have presented data suggesting that alcohol-related stimuli interact with priming doses of ethanol to increase alcoholics' disposition to drink. Miller et al. (1974), however, failed to observe a significant effect of drinking-related stimuli upon alcoholics' disposition to drink.

In the field of behavior therapy, relaxation and stimulus-exposure techniques (e.g. systematic desensitization) are often recommended as techniques for reducing the effect of environmental stimuli upon an individual's behavior. However, data are lacking concerning the effect of relaxation training upon alcoholics. The present study uses psychophysiological procedures to investigate three issues concerning the effect of drinking-related stimuli and relaxation instructions upon alcoholics: (1) the effect of a single session of systematic relaxation instructions upon the electromyographic tension levels of abstinent alcoholics; (2) the effect of drinking-related auditory stimuli upon the electromyographic tension levels of abstinent alcoholics; and (3) the influence of prior relaxation instructions upon the EMG responses of abstinent alcoholics exposed to drinking-related stimuli.     

The role of mental relaxation in experimental desensitization

Certain evidence indicates that training in peripheral muscle relaxation is not an essential factor in the successful experimental desensitization of phobias. Rachman (1968) has suggested that a sense of calmness or mental relaxation is the necessary component and that all the preliminary training techniques leading to successful desensitization, have, as the basis for their success, the inadvertent induction of this state of mental calmness. The direct induction of mental relaxation then, ought to be at least as effective an adjunct to desensitization as training in muscle relaxation. Using spider phobia as the target behaviour, the present study compared the effectiveness of (a) hierarchy presentation paired with deep muscle relaxation; (b) hierarchy presentation paired with instructions to feel calm and relaxed and alternated with imagining a pleasant scene; (c) a combination of these two procedures paired with hierarchy presentation; and (d) a placebo control procedure. The treatment groups all improved significantly more than controls and there there were no differences between treatments. The results were seen as offering strong support of Rachman's position. Both theoretical and practical implications of the results are discussed with consideration being given to the nature of “mental calmness”.     

The effects of instructional set on physiological response to stressful imagery

Centrally mediated or cognitive variables have received considerable attention in clinical research. With the establishment of the effectiveness of such specific treatment techniques as systematic desensitization (Paul. 1969a. 1969b). a question arises as to the influence of cognitions on process and outcome variables in such learning based treatments (Lang. 1971). Research investigating the influence of demand characteristics and subject expectancies has demonstrated such centrally mediated variables can significantly influence overt, behavioral and self-report measures of fear, stress, or anxiety (cf. Borkovec. 1972: Marcia. Rubin and Efran. 1969; McGlynn. Maelia and Nawas. 1969: McGlynn. Reynolds and Linder. 1971: Oliveau. Agras. Leitenberg and Wright. 1969; Rappaport. 1972: Rosen. 1974).However. Borkovec (1972) and Rappaport (1972) failed to obtain expectancy effects on physiological measures of anxiety. Neither investigation provided for an independent assessment of subjects' actual expectancies, or belief in the instructions, as recommended by Davison and Wilson (1973). Borkovec administered clinical procedures over four sessions and varied the information communicated about the ‘purpose’ of the treatments (physiological versus therapeutic instructions). Differential rationales for differential expectancies of physiological reactivity were not provided. After each session, subjects reviewed the same false physiological records depicting reductions in fear responses. Although these changes were explained either physiologically or therapeutically. the fact that such reductions were emphasized should have attenuated differences between groups. Rappaport (1972) exposed subjects to a fearful stimulus and varied the suggestion and rationale for the pseudotreatment: no expectancy (stress research): therapeutic expectancy (fear reduction); and negative expectancy (fear increase). The lack of an independent assessment of the expectancy manipulation, as well as the exclusion of a specific therapeutic procedure, make it impossible to interpret the results in relation to expectancy effects on physiological fear responses during the administration of therapeutic procedures. There is other evidence, however, that suggestion and instructional set can significantly influence somatic and autonomic response systems (Barber. 1961. 1965; Sternbach. 1964. 1965).The primary purpose of this study was to evaluate the effects of instructional set on physiological responses to stressful imagery. This was an early step in a research program investigating the effects of instructional and informational variables on physiological responses of clinical interest. One half of the subjects received abbreviated live relaxation training (R) as described m a manual by Bernstein and Borkovec (1972) and based upon the original work of Jacobson (1938). The other half received an inert placebo pill and undertook a target detection task (P). The latter procedure was similar to that used by Paul (1966). Although both procedures had previously been shown to have relaxing effects, the P task was included as an additional control for any potential effects specific to the tension-release procedure of R. In order to evaluate the effects of instructional set, one half of each of the above two groups received instructions designed to lead to an expectancy of response inhibition to stressful imagery by the respective procedure (Decrease Stress Response. DSR). while the other half received instructions designed to lead to an expectancy of an increased response to stressful imagery by the respective procedure (Increase Stress Response. ISR). Each subject visualized three individually specified items that were the most frightening scenes imaginable prior to training and four times after training visualized the scene producing the largest response. Considerable effort was devoted to eliciting from each subject the most frightening items possible for her. and it was clear from subject comments that the items did elicit negative emotional responses.Since previous research (Barber. 1961. 1965; Sternbach. 1964. 1965) indicated that instructional set can influence physiological reactivity, it was hypothesized the DSR) subjects should exhibit a greater reduction in emotional response from pre- to posttraining than ISR subjects.     

Electrode placement,EMG feedback,and relaxation for tension headaches

Fifteen tension headache subjects were allocated to one of three groups: direct EMG feedback (from a site corresponding to the source of pain), indirect EMG feedback (from a site not corresponding to the source of the pain) and relaxation instructions. There were two base-line, six treatment and one post-treatment sessions. No significant differences were found between base-line and post-treatment EMG levels, for any of the groups; however, some significant reductions in levels were obtained within sessions. EMG levels recorded during headache attacks did not differ significantly from levels recorded during base-line. Frequency and intensity of headaches were significantly reduced, particularly in the relaxation group. At follow-up this improvement was maintained for subjects with forehead pain, but differences between the groups had disappeared.     

Therapist factor in the treatment of insomnia

This quasi-experiment attempted to replicate the finding of Turner and Ascher (1979) in contrasting progressive relaxation, stimulus control and paradoxical intention therapies for the treatment of insomnia using clinicians-in-training as therapists. Progressive relaxation and stimulus control were again shown to be effective, paradoxical intention instructions were not. A significant therapist effect was found which is discrepant with previous findings in the field.     

Self-versus drug-produced relaxation and the effects of instructional set in standardized systematic desensitization

Snake fearful college students underwent Standardized Systematic Desensitization (SSD) treatment in which they received instructions designed to induce cognitions of either self- or drug-produced relaxation. Half of the subjects in each of these conditions were also given high expectancy therapy instructions and low expectancy therapy instructions respectively. All four SSD groups showed significantly greater improvement than a no-treatment control group on both the behavior avoidance test (BAT) and the self-report measure of fear. No differences between self- and drug-attributions of relaxation were found on any measure. Subjects' high expectancy ratings were significantly correlated with improvement on self-report measures but not related to BAT performance.     

Effects of massed practice and meprobamate on spasmodic torticollis: an experimental analysis

In recent years a variety of behavioral techniques have been used in the treatment of spasmodic torticollis including negative practice (Agras and Marshall, 1965). faradic aversion (Brierly, 1967). instructions and negative feedback (Bernhardt et al., 1972). and systematic desensitization (Meares. 1973). However, in most of the aforementioned reports the controlling effects of the particular technique over dependent measures (voluntary and/or involuntary evocations of the tic) have not been demonstrated experimentally (see Hersen and Eisler, 1973 for review). In the present single case experimental analysis (Barlow and Hersen. 1973; Hersen and Barlow, 1974). the effects of massed practice (see Yates. 1958) and meprobamate on a subject exhibiting spasmodic torticollis were systematically examined. Following Bernhardt. Hersen and Barlow (1972). treatment efficacy was evaluated by monitoring rate of involuntary torticollis movements per 10-min videotaped recording sessions.     

The effects of progressive relaxation on stress and diabetic control

Four insulin-requiring diabetic Ss were followed in single-S designs to measure the impact of progressive muscle relaxation training on blood glucose and stress levels. Measures of blood glucose, stress, activity and caloric intake were taken four times a day, along with a daily measure of anxiety. Two of the 4 Ss showed a significant decrease in blood glucose during treatment periods as compared to baseline measures. Similarly, 2 of the 4 Ss showed a significant decrease in stress levels during treatment. A multiple regression analysis revealed some significant relationships between blood glucose, stress, activity level and caloric intake. The results support previous studies that show relaxation techniques to be a viable aid in establishing greater diabetic control.     

Evaluation of content and vocal style in relaxation instructions

The relative contributions of content and vocal style in relaxation instructions were studied in vivo. Eighty adult dental patients, 40 males and 40 females, who required two amalgam dental restorations were randomly assigned to four conditions (10 males and 10 females in each): a control group in which the restorations were completed in the typical fashion; a group who listened to standard relaxation instructions during the dental procedure; a group who listened to relaxation instructions presented in a conversational tone and pace: and a group who listened to a travelogue presented in a calm, quiet voice at a slow pace. Several cognitive self-rating measures and electrodermal response measures were obtained. The pattern of results suggested that content may be somewhat more important than style in relaxation instructions. However, both appear to be necessary to produce effective relaxation.     

A note on the effects of anonymity,response consequence information,and sex on the self-assessment of fear

Despite an increasing emphasis on the direct observation and measurement of behavior in the assessment of fear (e.g. Bernstein, 1973. Goldfried and Sprafkin, 1974: Hersen, 1973). the Fear Survey Schedule (FSS; Geer, 1965: Wolpe and Lang, 1964) has remained popular as a paper-and-pencil instrument for screening large populations of potential treatment subjects prior to behavior avoidance tests (BATs; e.g. Bernstein and Nietzel, 1973). The utility of the FSS for this purpose is largely dependent upon its ability accurately to predict avoidance behavior in the presence of specific fear targets (Hersen, 1973) but. unfortunately, correlations between self-reported fear intensity on the FSS and overt behavior during BATs usually range from low to moderate (Lang, 1968; Schroeder and Craine, 1971). There is evidence that this disparity between FSS reports of fear and subsequent avoidance behavior are due in part to the operation of situational and contextual variables within the BAT which affect overt responses (Bernstein, 1973). and it seems reasonable to suspect that procedural variations in the self-assessment situation (e.g. method of test administration, instructions regarding the nature and purpose of testing, test form. and physical/interpersonal context) could modify FSS responses in a similar fashion. While research on projective and other assessment instruments has clearly established the influence of such variables on test responses (e.g. Azrin, Holz and Goldiamond, 1961; Henry and Rotter, 1956; Page and Yates, 1975). it is presently unknown to what extent ‘impression management’ strategies (Braginsky, Grosse and Ring, 1966) based upon cues in the testing situation bias verbal reports of fear. Preliminary investigation of this problem was undertaken in the present experiment by directly manipulating (a) the degree to which subjects could be identified with and held ‘accountable’ for their reported levels of fear and (b) the amount of information provided about the probable consequences of their responses.     

An examination of methods for producing relaxation during short-term laboratory sessions

Reductions in psychological and physiological correlates of tension produced by various muscle relaxation training techniques were examined during a short-term laboratory session. Two studies are described involving a combined total of one hundred subjects receiving either abbreviated progressive relaxation, visual, auditory, or tactile electromyographic (EMG) biofeedback procedures. The Anxiety Differential was administered before and after the laboratory session. Heart rate, respiratory rate, skin conductance, systolic blood pressure, and frontalis and dominant forearm extensor EMG measures were obtained before, during, and after administration of relaxation training. Results indicated feedback in the tactile modality to produce overall reductions in tension comparable to those produced by progressive relaxation. Overall reductions in tension displayed by both progressive relaxation and tactile feedback were generally greater than reductions shown by visual or auditory feedback procedures. Interpretations suggest that certain forms of EMG feedback may offer an alternative to progressive relaxation techniques for producing short-term reductions in tension. Feedback modality is further indicated as a potentially important variable during relaxation training using the EMG feedback technique.     

Therapeutic rationale,monetary incentive and fear behavior: a methodological note on analogue research

Analogue research has been questioned as a means of evaluating clinical procedures (e.g. Cooper, Furst and Bridger, 1969). A major criticism has been the failure to include adequate controls. Placebo conditions have varied markedly in their similarity to active treatment procedures (Caputo, Nau and Borkovec, 1973), have not provided equally credible therapeutic rationales (Borkovec and Nau, 1972), and have thus generated differing expectancies and demands for improvement.To evaluate a therapy procedure, a comparison condition is needed in which no treatment intervenes between pre- and post-test measures, yet which provides adequate incentive for improvement. Rimm and Mahoney (1969) used a ‘contingent reinforcement’ placebo condition in which tokens, exchangeable for money, were dispensed for improvement in a graded approach to a feared stimulus. Little improvement occurred, suggesting a lack of effectiveness of money alone in improving approach behavior. However, as no therapeutic rationale was presented, it is likely that little expectancy for improvement occurred.The present study provided a ‘no treatment’ condition in which Ss participated in three test sessions with no intervening treatment procedure. Unlike Rimm and Mahoney (1969), two conditions provided a rationale explaining why Ss had maintained their fear and why no real therapy was needed to eliminate it. Also, monetary reward (a $5.00 bill rather than tokens) was dispensed only upon picking up the feared object. A follow-up session assessed the lasting effects of rationale and monetary incentive in the absence of extrinsic reinforcement. Thus, the present study attempted to determine the effect of therapeutic rationale and/or the possibility of receiving money, in the absence of ‘therapy’, on subclinical fear.     

Systematic desensitization, muscle relaxation and visual imagery in the counterconditioning of four-year-old phobic child

A four-year-old boy with a severe phobia for loud sudden noises was successfully treated with behavior modification utilizing muscle relaxation and in vivo conditioning in six sessions. The question of theoretical importance was whether muscle relaxation and systematic desensitization by imagining feared stimuli could successfully be employed to treat a phobia in a child this young. The literature does not, to the author's knowledge, contain any reports of the combined use of muscle relaxation and imagination of fear-producing stimuli for treating phobic children of such a young age.     

The role of physiological attention-focusing in the relaxation treatment of sleep disturbance,general tension,and specific stress reaction

Three experiments comparing the effects of muscle tension-release relaxation with vs without physiological attention-focusing and no-treatment on (a) sleep disturbance, (b) general tension, and (c) a variety of time estimation, heart rate perception, and stress reaction measures, are reported. The two relaxation conditions produced equivalent reductions in latency to sleep onset reports, suggesting the importance of tension-release in the relaxation treatment of sleep disturbance. Relaxation without physiological attention-focusing was unexpectedly superior to the other relaxation condition in reducing reported daily tension, supporting Denny's (1976) hypothesis that pervasive anxiety may be a function of anxiety conditioned to relaxation-produced cues. Sleep disturbed subjects over-estimated elapsed time, and relaxation training improved accuracy of time estimation. Several additional differences between sleep and tension subjects and among the three treatment conditions on physiological activity during stress are reported and discussed.     

Linear Phase-Correction in Synchronization: Predictions, Parameter Estimation, and Simulations

A stochastic model for synchronization with a metronome is analyzed which generalizes Wing and Kristofferson's (1973a, 1973b) two-level model for tapping. The model includes a motor component, a timekeeper component, and a linear phase error correction mechanism. The model's predictions of the asymptotic dependence structure of the synchronization errors and interresponse intervals are derived. Problems of identifiability and estimation of parameters are discussed.     

A comparison of two methods for the administration of paradoxical intention

Recent research in the treatment of insomnia by paradoxical intention has utilized two different methods of instruction. Studies utilizing the random assignment of subjects to treatment groups employ a procedure in which clients are provided with a straight-forward explanation based on the present authors' understanding of the use of paradoxical intention with insomnia (type A administration). In contrast, controlled case studies have employed reframing, a procedure which explains the need for the paradoxical intention in a manner which best suits the specific understanding of the individual client (type B administration). The present study employed the type B method in a design employing the random assignment of clients to groups. Three additional groups (type A administration, placebo control, no-treatment control) completed the design. The results indicated that the type A method was superior to the type B procedure when the same method for administering paradoxical intention was applied to a randomized group of individuals.     

Heterosexual anxiety: Stable multichannel assessment for therapy outcome research

Thirty-six shy males participated in two interpersonal performance tests with attractive female confederates. Between the two interpersonal performances, each was exposed either to one of three elaborate placebo treatments or to no treatment. During and after each performance, heterosexual anxiety was measured with instruments recommended for research purposes by Borkovec et al. (1974). Results showed that the recommended shyness measures were immune to unwanted changes either from repeated assessments or from any of the three multisession placebo procedures. Hence the experiment partially replicated and substantially extended previous research, suggesting the feasibility of using the Borkovec et al. shyness-assessment package in behavioral fear-therapy research.     

Progressive and imaginal relaxation training for elderly persons with subjective anxiety.

Elders exposed to either progressive or imaginal relaxation procedures reported significant relaxation effects and showed improvement on measures of personal functioning. The results of the Physical Assessment Scale of the Relaxation Inventory indicated that relaxation responses were acquired within and across sessions. Large, consistent changes in relaxation occurred in all 4 sessions. The Symptom Checklist-90-R, which measures self-reported personal adjustment, showed significant positive changes following relaxation training and at 1-month follow-up. Elders who imagined muscle tension release profited as much as those engaged in actual muscle tension-release activities. This finding is of importance for older adults who may experience physical limitations that contraindicate muscle-tension-release procedures.