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.     

Recent Developments in Close-Relationships Theory

A selective review of some recent theoretical developments in the field of close relationships is presented. We describe demographic developments reflecting flux in relationships and the family and what may be viewed as a revolution in gender relations and the family over the past three to four decades. Also reviewed are theories on the development, maintenance, and ending of relationships, as well as the “dark side" of closerelationships. We conclude that the close-relationships field is likely to continue to develop and prosper as people search for answers to daunting relationship problems.     

Antisocial Behavior and the Continuing "Tragedy of the Commons"

The influence of individuals' antisocial tendencies and risk perceptions on a simulated managerial decision are examined in the study. Subjects accepting and rejecting a hypothetical scenario were found to be significantly different in terms of aggression, lack of empathy, and degree of individualism. Situational influences were not significantly related to subjects' decision. Limitations and future research are discussed.     

Choosing and using geospatial displays: effects of design on performance and metacognition

Interactive display systems give users flexibility to tailor their visual displays to different tasks and situations. However, in order for such flexibility to be beneficial, users need to understand how to tailor displays to different tasks (to possess "metarepresentational competence"). Recent research suggests that people may desire more complex and realistic displays than are most effective (Smallman & St. John, 2005). In Experiment 1, undergraduate students were tested on a comprehension task with geospatial displays (weather maps) that varied in the number of extraneous variables displayed. Their metacognitive judgments about the relative effectiveness of the displays were also solicited. Extraneous variables slowed response time and increased errors, but participants favored complex maps that looked more realistic about one third of the time. In Experiment 2, the eye fixations of undergraduate students were monitored as they performed the comprehension task. Complex maps that looked more realistic led to more eye fixations on both task-relevant and task-irrelevant regions of the displays. Experiment 3 compared performance of experienced meteorologists and undergraduate students on the comprehension and metacognitive tasks. Meteorologists were as likely as undergraduate students to prefer geographically complex (realistic) displays and more likely than undergraduates to opt for displays that added extraneous weather variables. However, meteorologists were also slower and less accurate with complex than with simple displays. This work highlights the importance of empirically testing principles of visual display design and suggests some limits to metarepresentational competence.     

Automated assembly of optimally spaced and balanced paired comparisons: Controlling order effects

To control order effects in questionnaires containing paired comparisons, Ross (1934) described an optimal ordering of the pairings. The pairs can also be balanced so that every stimulus appears equal numbers of times as the first and the second member of a pair. First, we describe and illustrate the optimally spaced, balanced ordering of pairings. Then we show how the optimally spaced, balanced order can be used to implement a matrix-sampling design or a fully incomplete design when the number of stimuli n is so large that respondents cannot reasonably be expected to judge all n(n - 1)/2 pairs. The algorithm for balancing and optimally spacing the list of pairs is described.     

A test of the bidirectional association between sleep and mood in bipolar disorder and insomnia

The present study investigates sleep, mood, and the proposed bidirectional relationship between the two in psychiatric disorders. Participants with interepisode bipolar disorder (n = 49), insomnia (n = 34), and no psychiatric history (n = 52) completed seven consecutive days of sleep diaries and mood measures. The interepisode bipolar and insomnia participants exhibited greater sleep disturbance than the healthy control individuals. Negative mood was equally heightened in both interepisode bipolar disorder and insomnia, and there were no differences between the three groups in positive mood. Total wake time was associated with next morning negative mood in bipolar disorder, whereas evening negative mood was associated with subsequent total wake time in both bipolar disorder and insomnia. Additionally, positive mood was associated with subsequent total wake time for the insomnia group. Results support the theory that disruptions in nighttime sleep and daytime mood may be mutually maintaining and suggest the potential importance of transdiagnostic or universal processes.     

Nonword repetition and phoneme elision in adults who do and do not stutter

The purpose of the present study was to explore the phonological working memory of adults who stutter through the use of a non-word repetition and a phoneme elision task. Participants were 14 adults who stutter (M=28 years) and 14 age/gender matched adults who do not stutter (M=28 years). For the non-word repetition task, the participants had to repeat a set of 12 non-words across four syllable lengths (2-, 3-, 4-, and 7-syllables) (N=48 total non-words). For the phoneme elision task, the participants repeated the same set of non-words at each syllable length, but with a designated target phoneme eliminated. Adults who stutter were significantly less accurate than adults who do not stutter in their initial attempts to produce the longest non-words (i.e., 7-syllable). Adults who stutter also required a significantly higher mean number of attempts to accurately produce 7-syllable non-words than adults who do not stutter. For the phoneme elision task, both groups demonstrated a significant reduction in accuracy as the non-words increased in length; however, there was no significant interaction between group and syllable length. Thus, although there appear to be advancements in the phonological working memory for adults who stutter relative to children who stutter, preliminary data from the present study suggest that the advancements may not be comparable to those demonstrated by adults who do not stutter. EDUCATIONAL OBJECTIVES: At the end of this activity the reader will be able to (a) summarize the nonword repetition data that have been published thus far with children and adults who stutter; (b) describe the subvocal rehearsal system, an aspect of the phonological working memory that is critical to nonword repetition accuracy; (c) employ an alternative means to explore the phonological working memory in adults who stutter, the phoneme elision task; and (d) discuss both phonological and motoric implications of deficits in the phonological working memory.     

Contrasting Social Climates of Small Peer-Run Versus a Larger Staff-Run Substance Abuse Recovery Setting

This study compared the social climate of peer‐run homes for recovering substance abusers called Oxford House (OH) to that of a staffed residential therapeutic community (TC). Residents of OHs (N = 70) and the TC (N = 62) completed the Community Oriented Programs Environment Scales. OHs structurally differ on two primary dimensions from TCs in that they tend to be smaller and are self‐run rather than professionally run. Findings indicated significantly higher Involvement, Support, Practical Orientation, Spontaneity, Autonomy, Order and Organization, and Program Clarity scores among the OH compared to TC residents. Additional analyses found the OH condition was higher Support, Personal Problem Orientation, and Order and Organization scores among women compared to men residents. These results suggested that these smaller OH self‐run environments created a more involving and supportive social milieu than a larger staff‐run TC. These findings are interpreted within Moos' ( 2007 ) four theoretical ingredients (i.e., social control, social learning, behavioral economics, and stress and coping), which help account for effective substance abuse treatment environments.