Effects of Alprazolam on Complex Human Functioning1

Benzodiazepines can reduce anxiety, can have favorable effects upon sleep, and may diminish problems that interfere with patients' quality of life. On the other hand, these drugs can generate transient anterograde amnesia and may diminish aspects of task performance. Research on the impact of alprazolam and other “tranquilizing” drugs has generally focused on tasks that remain below the complex efforts of managerial or professional personnel. Alprazolam-induced reduction of anxiety under challenging conditions might aid complex task performance, yet anterograde amnesia might interfere. In the present research, managers participated in validated complex simulation tasks. In a double-blind, dual crossover design, placebo, 0.5 mg, or 1.0 mg alprazolam was administered on 2 occasions during the task day. Drug treatment diminished performance on measures that require sequential actions but improved performance on measures less subject to short term memory but more determined by long-term style of functioning. Thus, depending on task requirements, positive or negative alteration of performance might occur.     

Alexithymia and insomnia

The purpose of the present study was (1) to investigate the association between insomnia and alexithymia, as measured by the Toronto Alexithymia Scale (TAS-20) and its subscales, and (2) to test if the TAS-20 and its subscales show the same correlational pattern with anxiety, depression and perfectionism in insomnia patients as has previously been found in non-clinical samples. A consecutive series of 259 insomnia patients were compared with a community sample. Although the insomnia patients scored significantly higher on the TAS-20, this difference disappeared when trait anxiety was controlled for, and was primarily due to patients who suffered from insomnia associated with another psychiatric disorder. All insomnia groups, however, showed elevated scores on the TAS-20 subscale Externally Oriented Thinking (EOT). The correlational analysis showed moderate to high correlations between the TAS-20 (and its subscales Difficulties Identifying Feelings and Difficulties Describing Feelings, although not the EOT) and measures of depression, anxiety and perfectionism, thus replicating a pattern from non-clinical samples. The results are discussed in terms of externally oriented thinking being an interesting dimension of alexithymia, which is (a) not confounded by negative emotion and standards of performance, and (b) shows generally elevated scores in insomnia patients.     

Quantitative criteria for insomnia

Formal diagnostic systems (DSM-IV, ICSD, and ICD-10) do not provide adequate quantitative criteria to diagnose insomnia. This may not present a serious problem in clinical settings where extensive interviews determine the need for clinical management. However, lack of standard criteria introduce disruptive variability into the insomnia research domain. The present study reviewed two decades of psychology clinical trials for insomnia to determine common practice with regard to frequency, severity, and duration criteria for insomnia. Modal patterns established frequency (> or =3 nights a week) and duration (> or =6 months) standard criteria. We then applied four versions of severity criteria to a random sample and used sensitivity-specificity analyses to identify the most valid criterion. We found that severity of sleep onset latency or wake time after sleep onset of: (a) > or =31 min; (b) occurring > or =3 nights a week; (c) for > or =6 months are the most defensible quantitative criteria for insomnia.     

Socioeconomic status and insomnia

This investigation compared the likelihood of insomnia and insomnia-related health consequences among individuals of different socioeconomic status. A random-digit dialing procedure was used to recruit at least 50 men and 50 women in each age decade from 20 to 80+ years old. Participants completed 2 weeks of sleep diaries as well as questionnaires related to fatigue, sleepiness, and psychological distress. Socioeconomic status was measured by education status assessed at 3 different levels: individual, household, and community. Results indicated that individuals of lower individual and household education were significantly more likely to experience insomnia even after researchers accounted for ethnicity, gender, and age. Additionally, individuals with fewer years of education, particularly those who had dropped out of high school, experienced greater subjective impairment because of their insomnia.     

Psychological treatment of secondary insomnia

Psychological treatment of insomnia has focused on primary insomnia (i.e., having a psychological origin). Secondary insomnia, sleep disturbance caused by a psychiatric or medical disorder, although it is more common than primary insomnia, has received very little attention as a result of the belief that it would be refractory to treatment. The present study randomly assigned older adults with secondary insomnia to a treatment group, 4 sessions composed of relaxation and stimulus control, or a no-treatment control group. Self-report assessments conducted at pretreatment, posttreatment, and a 3-month follow-up revealed that treated participants showed significantly greater improvement on wake time during the night, sleep efficiency percentage, and sleep quality rating. The authors hypothesize that treatment success was probably due in part to difficulty in diagnostic discrimination between primary and secondary insomnia.     

A cognitive model of insomnia

Insomnia is one of the most prevalent psychological disorders, causing sufferers severe distress as well as social, interpersonal, and occupational impairment. Drawing on well-validated cognitive models of the anxiety disorders as well as on theoretical and empirical work highlighting the contribution of cognitive processes to insomnia, this paper presents a new cognitive model of the maintenance of insomnia. It is suggested that individuals who suffer from insomnia tend to be overly worried about their sleep and about the daytime consequences of not getting enough sleep. This excessive negatively toned cognitive activity triggers both autonomic arousal and emotional distress. It is proposed that this anxious state triggers selective attention towards and monitoring of internal and external sleep-related threat cues. Together, the anxious state and the attentional processes triggered by it tricks the individual into overestimating the extent of the perceived deficit in sleep and daytime performance. It is suggested that the excessive negatively toned cognitive activity will be fuelled if a sleep-related threat is detected or a deficit perceived. Counterproductive safety behaviours (including thought control, imagery control, emotional inhibition, and difficulty problem solving) and erroneous beliefs about sleep and the benefits of worry are highlighted as exacerbating factors. The unfortunate consequence of this sequence of events is that the excessive and escalating anxiety may culminate in a real deficit in sleep and daytime functioning. The literature providing preliminary support for the model is reviewed and the clinical implications and limitations discussed.     

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.     

Distinguishing rumination from worry in clinical insomnia

Research has found that repetitive thought processes, such as worry and rumination, play an important role in several disorders; however, these cognitive processes have not yet been examined in insomnia. This study explores rumination and worry in insomnia by examining: 1) whether those high and low on rumination and worry differ on subjective sleep measures, and 2) whether rumination and worry are distinct processes in insomnia. Participants (N = 242) were diagnosed with an insomnia disorder by sleep experts. Participants completed measures of worry and rumination and maintained a 2-week daily sleep log. Results of a multivariate analysis of variance found no main effect of worry; although high and low ruminators differed on several sleep log indices, including sleep efficiency, wakefulness after sleep onset and sleep quality. Factor analysis supported the idea that rumination and worry are separate constructs. Whereas previous research has focused on worry in insomnia, these findings suggest that rumination is important for understanding sleep disturbance. Further, although rumination and worry are both repetitive thought processes, these results indicate that they are distinct processes within insomnia and should be treated as such. The results are discussed with respect to treatment implications for Cognitive Behavioural Therapy for Insomnia.     

Clinical management of alcohol withdrawal

It has been well known for a number of years that abrupt withdrawal from alcohol following chronic use is associated with adverse consequences, ranging from mild tremors to withdrawal seizures. The overall purposes of treating alcohol withdrawal (AW) are to relieve patient discomfort, to prevent the development of more serious withdrawal symptoms, and to initiate long-term alcohol rehabilitation. Several areas of controversy exist in the clinical management of AW, including the optimal treatment setting, the need for pharmacologic management, and the most appropriate agent to prescribe when medication is deemed necessary. This article reviews the clinical features, general management, and treatment of AW.     

Articulatory suppression and the treatment of insomnia

The prominence of intrusive thoughts in insomnia suggests the relevance of cognitive techniques to control them. It is suggested that the technique of Articulatory Suppression derived from Baddeley's model of Working Memory provides a relevant approach. The technique is presented as it was developed with a preliminary uncontrolled case series. A single-case experiment is then reported in which Articulatory Suppression was compared with other techniques. The preliminary indications are that it may be particularly helpful for sleep maintenance problems.     

一例运用催眠疗法治疗失眠症的案例报告

本次案例主要采用催眠疗法,并结合行为疗法和认知疗法对个案进行了心理问题的矫正,尤其是将系统脱敏和认知疗法融入到催眠疗法之中,在对求助者的心理进行整合式治疗后,其睡眠状况明显改善,精神状况得到提高,抑郁情绪消除,焦虑程度显著降低。再次进行问卷自测后分数明显下降,该咨询取得了较好的效果。