The effectiveness of various treatment techniques on different degrees and durations of sleep-onset insomnia

Mild and moderate insomniacs were randomly assigned to one of five group therapy conditions: relaxation without muscle-tension, stimulus control plus relaxation without muscletension, placebo, self-monitoring, and waiting list. Mild insomniacs were differentiated according to the duration of their sleep disturbance. Insomniacs were told that improvement would not be noticeable until after the final therapy session. During this counterdemand period, the two relaxation groups showed significantly greater decreases in sleep onset latency than the control conditions. In addition, it appeared that duration affected treated outcome. The effectiveness of treatment packages and self-monitoring in alleviating insomnia is briefly discussed.     

Trait-anger enhances effects of caffeine on psychomotor vigilance performance

This study examined the combined effects of caffeine and the personality attribute of trait-anger on the speed of psychomotor vigilance performance during sleep deprivation. 23 young adult soldiers (19 male) were administered the State-Trait Anger Expression Inventory-2 when well-rested. Participants were then sleep deprived for three consecutive nights (77 hours total) during which they completed repeated psychomotor vigilance testing. Half of the participants received four doses of oral caffeine (200 mg every 2 hr.; 800 mg total) each night, while the other half were administered a placebo. For the first night, higher scores on trait-anger, outward anger expression, and intensity of anger expression predicted better sustained overnight vigilance performance, but only for those volunteers receiving caffeine. These correlations were not significant for the subsequent nights. Findings suggest a possible synergistic effect between personality traits associated with arousal of the central nervous system and vigilance-promoting effects of caffeine.     

Is dissonance phenomenologically aversive?

This study examined whether dissonance is, phenomenologically, an aversive state. Experimental subjects were induced to write counterattitudinal essays under a high-choice condition. One group of subjects was led to believe that a pill, which they had just taken in the context of a separate experiment, would cause them to feel pleasantly excited. A second group was led to believe that the pill would make them feel tense. A third group was given no information about the pill's potential side effects, while a fourth group expected to have no side effects at all. In this last condition, the results yielded the usual dissonance effect: subjects stated attitudes more congruent with the essay than did subjects in a survey control condition. When subjects were given an opportunity to attribute their arousal to an arousing, but nonaversive pill (i.e., the pleasant excitement condition), this effect was unchanged. In contrast, when subjects could attribute their arousal to an aversive pill (i.e., in the tensè and the no information conditions), this effect was virtually eliminated. These results are consistent with the notion that dissonance is an aversive state and that subjects will seize, when possible, an external attribution for this state.     

Criterion Development and Validity of the CQT in Field Application

Two experiments evaluated the competing interpretations of cognitive dissonance and impression management theories regarding the pill and misattribution studies of attitude change in the forced compliance situation. Attitude change was eliminated when subjects were told about the tension side effects of taking a placebo, replicating the usual effect. Attitude change was also eliminated, however, when subjects took the pill following counterattitudinal behavior. In one condition of the second experiment, subjects were given instructions about tension side effects but were also told that the drug would not affect their moral judgment or behavior. These instructions eliminated attitude change in a standard pill condition. The typical finding of attitude change was manifested in the misattribution/no-excuse condition. The primary and secondary data from both studies provided more support for the impression management interpretation of the standard misattribution manipulations than for a theory of misattribution of dissonance-produced arousal.     

Changes in Subjective-Objective Sleep Discrepancy Following Inpatient Cognitive Behavior Therapy for Insomnia

Discrepancy between objective and subjective sleep parameters is a frequent symptom in persons suffering from insomnia. Since it has an impairing effect on daytime well-being and neglects possible positive objective improvements, it would be useful if it was treated. Apart from hypnotics, cognitive behavior therapy (CBT-I) is the therapy of choice for chronic forms of insomnia. However, there is limited information about whether CBT-I can also improve subjective-objective sleep discrepancy. We investigated a large sample of patients showing chronic forms of insomnia regarding their subjective-objective sleep discrepancy pre and post CBT-I. Objective sleep data were obtained from 3 nights (2 baseline nights and 1 night after therapy) using polysomnography in our sleep laboratory. All 92 patients participated in a 14-day inpatient program with CBT-I including psychoeducation about subjective-objective sleep discrepancy. Repeated measures analyses showed an improvement in subjective-objective sleep discrepancy parameters after CBT-I. Those parameters were also correlated with perceived quality of sleep. We conclude that CBT-I is a useful tool to improve subjective-objective sleep discrepancy in patients showing chronic forms of insomnia.     

Sleep deprivation and naps

It is important for military commanders to know the likely effects of a small amount of sleep under conditions of sustained operations. To this end, two laboratory-based experiments on naps were carried out. The first examined the effect of 2 h of sleep following 90 h of wakefulness. Ten infantrymen subjects were not told the scheduled length of their vigil, or that they would be allowed a nap at some stage, until a few hours before the 2-h nap. After 3 nights without sleep, the subjects’ average cognitive performance was 55% of the control values. During a test session immediately before the 2-h nap, performance improved by 30%, to 85% of control values, indicating the considerable effect that the incentive of knowing that a nap is imminent can have on even severely sleep-deprived subjects. In the second experiment, two groups, each of six infantrymen, took part in a 5-day trial; for one group, 4 h of uninterrupted sleep was scheduled and for the other, four l-h naps in each 24-h period. There were no significant differences in cognitive test scores or mood between the two groups. On the last experimental day, cognitive test and mood scores were not significantly different from baseline values for either group, indicating the utility of 4 h of sleep, either in one uninterrupted block or in four scheduled 1-h naps per 24 h.     

Pills and attitude change: misattribution of arousal or excuses for negative actions?

Two experiments evaluated the competing interpretations of cognitive dissonance and impression management theories regarding the pill and misattribution studies of attitude change in the forced compliance situation. Attitude change was eliminated when subjects were told about the tension side effects of taking a placebo, replicating the usual effect. Attitude change was also eliminated, however, when subjects took the pill following counterattitudinal behavior. In one condition of the second experiment, subjects were given instructions about tension side effects but were also told that the drug would not affect their moral judgment or behavior. These instructions eliminated attitude change in a standard pill condition. The typical finding of attitude change was manifested in the misattribution/no-excuse condition. The primary and secondary data from both studies provided more support for the impression management interpretation of the standard misattribution manipulations than for a theory of misattribution of dissonance-produced arousal.     

Is Emotion Perception Relative? Evaluating Sleep Effects on Relativity of Emotion Perception

The present study examines whether valence strength causes relativistic shifts in emotion perception form faces across sleep (filled vs deprived) nights. A group of twelve volunteers participated twice (sleep/no-sleep) with fourteen days gap between participation. Subjects evaluated low valenced facial expressions (targets) in the presence on high valence facial expressions (anchors) before sleep/no sleep nights and again the following morning. Analysis of results using 2?×?2?×?2 (groups, anchor, sessions) split plot analysis of variance suggest that larger relativistic shifts were apparent in the no-sleep group. Also post sleep relativistic shifts in emotion perception were the least (p?相似文献   

MMPI differences among mild and severe insomniacs and good sleepers

Past research has attempted to delineate personality differences between insomniacs and good sleepers but has failed to control for type of insomnia or severity of the disorder. The purpose of this study was to compare MMPI scores of mild and severe sleep onset insomniacs with a control group of noninsomniacs . Results demonstrated that sleep onset insomniacs, regardless of degree of severity, differed significantly from noninsomniacs ; and that mild and severe insomniacs differed from each other on only one MMPI scale.     

Sleep Increases Susceptibility to the Misinformation Effect

When individuals witness an event and are exposed to misleading postevent information, they often incorporate the misleading information into their memory for the original event, a phenomenon known as the misinformation effect. The present study examined the role of sleep in the misinformation effect. Participants (N = 177) witnessed two events; were exposed to misleading postevent information immediately, 12 hours later the same day, 12 hours later the next day, or 24 hours later; and then took a recognition test. All groups demonstrated the misinformation effect, and this effect was larger in groups with an overnight retention interval. Signal detection analyses revealed that sleep decreased sensitivity. These results suggest that sleep increases susceptibility to the misinformation effect, which may occur because sleep results in gist‐based representations of original events or because sleep improves learning of postevent information. Implications for interviewing eyewitnesses are discussed. Copyright © 2016 John Wiley & Sons, Ltd.     

Memory performance after arousal from different sleep stages.

Learning material was presented to independent groups of subjects either after arousal from non-Rapid Eye Movement (non-REM) sleep, after arousal from REM sleep, or under conditions of no prior sleep. Measures of immediate and subsequent free recall were taken. Memory performance was found to be impaired where learning took place after non-REM arousal. This was manifest in the number of categories recalled, over both immediate and subsequent recall, and in the number of items recalled per category over subsequent recall. It was suggested that the memory performance decrement after non-REM arousal may be understood in terms of a retrieval deficit as well as a coding deficit. It is possible that the former is consequent upon a lower general level of arousal, whereas the latter is specific to memory.     

The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: implementation and evaluation of a sleep clinic in general medical practice

Chronic insomnia is a very common clinical condition which may respond well to non-pharmacological treatment. Indeed, the literature supports the efficacy of cognitive behaviour therapy (CBT). However, there has been no substantial study of clinical effectiveness. Since insomniacs typically present in general medical practice this is a crucial gap in the outcome research. This study, therefore, specifically investigated the clinical effectiveness of CBT delivered by Health Visitors (primary care nurses) trained as therapists. One hundred and thirty-nine insomniacs (mean age 51 yr) were randomised to CBT or Self-Monitoring Control (SMC) in a controlled trial. CBT comprised six group sessions (n=4 to 6 patients). After the controlled phase, SMC patients entered deferred treatment (CBT-DEF), allowing both treatment replication and long-term outcome to be investigated for a sizeable, treated sample. Repeated measures ANOVAs demonstrated superiority of CBT over SMC in substantially reducing sleep latency and wakefulness during the night. CBT-DEF replicated similar effects and maintained improvement was observed in both groups one year later. Furthermore, total sleep increased significantly during follow-up and 84% of patients initially using hypnotics remained drug-free. Results suggest that CBT administered by Health Visitors offers a clinically effective treatment for insomnia.     

Sleep patterns of 7‐week‐old infants at familial risk for attention deficit hyperactivity disorder

Sleep patterns of 26 seven‐week‐old boys at familial risk for attention deficit hyperactivity disorder (ADHD) and 18 control infants were compared by objective (actigraph) and subjective (maternal sleep diary) measures, over five consecutive 24‐hr periods. Actigraph findings indicated that the groups differed on stability (SD) of quiet sleep only during the day. Reports in maternal sleep diaries indicated that they also differed on stability of waking and stability of sleep duration, again only during the day. No group differences were found in terms of average scores, whether calculated for the entire 24‐hr periods, for nights, or for days. Mothers in the risk group reported that fathers were less involved in infant care than did those in the control group. These findings suggest that as early as 7 weeks of age, infants at risk for ADHD differ from controls only on stability of their sleep patterns during the day, when environmental regulatory factors are more intensive.     

Clinical validation of a sleep assessment device

We have previously reported on the use of a sleep assessment device (SAD) with non-insomniac subjects. The SAD works by generating a brief, soft tone about every 10 min throughout the night and tape recording verbal responses to these cues. The sleep patterns reconstructed from the night's tape recordings proved highly concordant with EEG records. The present study tested the SAD against the EEG standard in 20 nights of monitoring chronic insomniacs. No significant differences were found between the SAD and EEG records with respect to sleep latency, duration of awakenings during the night, total sleep time and sleep efficiency percentage. The EEG detected many more very brief awakenings during the night than did the SAD due to the continuous monitoring by the former. The SAD proved to be a non-intrusive measure of sleep according to three independent measures. The usefulness of the SAD as a measure of sleep in the natural environment was discussed.     

Psychological mechanisms in the maintenance of insomnia: arousal, distress, and sleep-related beliefs

The purpose of this study was to examine whether arousal, distress, and sleep-related beliefs are related to the maintenance of insomnia. From a randomly selected sample from the general population (n=3600), 1936 participants filled out a baseline and 1-year follow-up survey. Logistic regressions were used to investigate whether arousal, distress, and beliefs were related to sleep status (insomnia: n=116; poor sleep: n=222; normal sleep: n=529; good sleep: n=234) over 1 year. Cluster analysis was employed to assess whether it was possible to classify the participants based on their profiles of psychological functioning. The results showed that beliefs in the long-term negative consequences of insomnia, anxiety, depression, and arousal were significantly related to the maintenance of insomnia (18-72% of the variance). Of the individuals with persistent insomnia, 91% belonged to a cluster characterized by high scores on sleep-related beliefs, anxiety, depression, and arousal, and 9% to a cluster defined by low scores on the mechanisms. This study shows that sleep-related beliefs, anxiety, depression, and arousal are related to the maintenance of persistent insomnia, but also that these mechanisms often co-occur in individuals with insomnia.     

Belief in an Unjust World: When Beliefs in a Just World Fail

Past research has attempted to delineate personality differences between insomniacs and good sleepers but has failed to control for type of insomnia or severity of the disorder. The purpose of this study was to compare MMPI scores of mild and severe sleep onset insomniacs with a control group of noninsomniacs. Results demonstrated that sleep onset insomniacs, regardless of degree of severity, differed significantly from noninsomniacs; and that mild and severe insomniacs differed from each other on only one MMPI scale.     

Misattribution of arousal and the effects of self-threatening information

Two experiments are reported on the effects of misattributing arousal. In both experiments, subjects took an intelligence test and received fictitious negative results about their performance. In the first experiment, subjects before receiving feedback were given a pill labeled as arousing; however, the ostensible effectiveness of the pill was varied. The greater the alleged strength of the pill, the less the test was derogated following feedback about performance on it and the more effort subjects reported expending on the test. In the second experiment, subjects were told that the pill was either arousing or relaxing and that its effect lasted for either a short or a long period of time. Initial test evaluations were more positive and estimates of effort expended were greater when the pill was described as arousing than when it was described as relaxing. However, whereas these differences were maintained over time when the pill's effects were described as of long duration, they disappeared over time when the pill's effects were described as of short duration.     

Super Pill is Less Effective than an Ordinary Mint in Altering Subjective Psychological Feeling States within a Few Minutes

Expectations shape human behavior. Initial drug use might be associated with information-based expectations. In this study, we presumed that changes in affect and perceived physical wellbeing will be stronger after receiving an active placebo (Tic Tac mint; n = 40), than a pure placebo (inert pill; n = 40) given as a mood-enhancing “super pill.” After baseline measures, participants completed a treatment-expectancy scale, ingested the mint/super pill, and attended to the effects over 3-minutes. Subsequently, they completed again the psychological tests. Expectancy scores were positive and did not differ between the groups. The pure placebo group increased in physical wellbeing but less than the active placebo group, which also showed an increase in positive affect. Negative affect decreased in both groups. The Tic Tac produced greater affective changes than the pure placebo. Since these are new findings on the ultra-short placebo effects on affect, the results might have relevance for drug-use studies.     

The treatment of sleep-maintenance insomnia with stimulus-control techniques

Sleep-maintenance insomniacs received either a stimulus-control (n = 7) or a credible placebo treatment (n = 8), administered in small groups for 4 weeks. Self-reports of time awake after sleep onset, total number of arousals and number of arousals exceeding 10 min were collected at baseline, at termination of treatment (post-treatment), and at a 3-month follow-up. Results showed a statistically- and clinically-significant reduction on all three dependent measures from baseline to post-treatment for both groups; these gains were maintained through the follow-up period. However, the results achieved with stimulus-control procedures were not significantly different from reductions found with a credible placebo condition. These findings compare favorably with other reports of behavioral treatments of both onset and maintenance insomnia.     

The impact of pre-sleep arousal state and strategy to control unwanted thoughts on sleep quality

Objective: It has been questioned whether elevated pre-sleep cognitive arousal contributes to poor sleep or whether it is the use of maladaptive thought control strategies, used to manage this cognitive arousal, that are responsible. The study aimed to examine how these factors – cognitive arousal (with and without anxiety) and maladaptive thought control strategies contribute to perceived sleep quality (SQ). Design: 129 “healthy adults” (46 males, 83 females) were exposed to picture-stimuli eliciting either anxious cognitive arousal or non-anxious cognitive arousal at bedtime. The groups were then randomly split and briefed to use either a cognitive distraction or cognitive suppression thought control strategy or no instructions were given (controls). Subjective SQ was measured immediately on waking. Results: Induced anxious cognitive arousal was associated with lower SQ compared to non-anxious cognitive arousal. Analyses revealed a significant interaction between arousal and the strategies used to control unwanted thoughts on SQ. When experiencing anxious cognitive arousal, the strategy of distraction was associated with poorer sleep outcomes. Conclusion: The findings suggest that the efficacy of differing thought control strategies vary depending upon whether cognitive arousal elicits anxiety or not. With that in mind, clinical implications in terms of augmenting the treatment of insomnia are discussed.