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.     

Development of cognitive averaging: when light and light make dark

In two experiments we studied developmental changes in reasoning about intensive quantities. In contrast to previous studies, color--an intensive quantity that is readily perceivable--was chosen as stimulus material. Children between 6 and 12 years of age and adults predicted the mixture intensity of pairs of liquids with different intensities of red color, the liquid volumes in the two source glasses either being the same (Experiment 1) or different (Experiment 2). The data show that cognitive averaging in this domain develops late and slowly. An extensitivity bias, a strong tendency to use rules (adding in particular) that hold for extensive but not for intensive quantities, predominated up to the age of 12 years and was not totally absent in adults. Contrary to common expectation, children's use of the correct averaging rule became more likely when an extensive quantity, volume, was also varied and thus the task increased in complexity.     

The predictive strength of personal constructs versus conventional constructs: self-image disparity and neuroticism

Idiographic personal construct (PC) measures of self-image disparity were hypothesized to be stronger than nonidiographic conventional construct (CC) measures in predicting neuroticism. Ninety-six college students completed PC and CC measures of real self, ideal self, social self, and ideal social self; the NEO Five-Factor Inventory; and the Marlowe-Crowne Social Desirability Scale. Content analysis showed that individuals' PC measures were unique. The disparity between real self and ideal self and the disparity between social self and ideal social self were computed for PC and CC; test-retest reliabilities were .76 to .81. Results of simultaneous multiple regression analyses supported the hypothesis. Also, the two-variable PC self-image disparity scores were stronger than one-variable PC esteem scores in predicting neuroticism. Implications were discussed for research method, self-concept theory, personal construct theory, neuroticism, and psychotherapy.     

Personality profiles and the prediction of categorical personality disorders

Personality disorders (PDs) are usually construed as psychiatric categories characterized by a unique configuration of traits and behaviors. To generate clinical hypotheses from normal personality trait scores, profile agreement statistics can be calculated using a prototypical personality profile for each PD. Multimethod data from 1,909 psychiatric patients in the People's Republic of China were used to examine the accuracy of such hypotheses in the Interpretive Report of the Revised NEO Personality Inventory. Profile agreement indices from both self-reports and spouse ratings were significantly related to PD symptom scores derived from questionnaires and clinical interviews. However, accuracy of diagnostic classification was only modest to moderate, probably because PDs are not discrete categorical entities. Together with other literature, these data suggest that the current categorical system should be replaced by a more comprehensive system of personality traits and personality-related problems.     

Re-examining the general positivity model of subjective well-being: the discrepancy between specific and global domain satisfaction

Three studies were conducted to examine the role of global life satisfaction in the discrepancy between specific and global domain satisfaction. Participants rated both global (e.g., education) and the corresponding, specific domain (e.g., professors, textbooks) satisfactions. In 3 studies, we found that individuals with higher life satisfaction evaluated global domain as a whole as more satisfying than those with lower life satisfaction, given the same level of satisfaction with specific domains. In Study 3, we also found that, given the same level of satisfaction during the previous 2 weeks, individuals with higher life satisfaction rated the global domains in general as more satisfying than those with lower life satisfaction. Overall, the association between globallife satisfaction and evaluative enhancement of global domains was most consistent in "self" and "social relationships." Finally, the effect of global life satisfaction on evaluative enhancement remained significant, controlling for extraversion and neuroticism.     

Drawing Movements as an Outcome of the Principle of Least Action

According to the two-thirds power law the cube of the speed of a drawing movement is proportional to the radius of curvature of the trajectory, and the coefficient of proportionality has the meaning of mechanical power. We derive this empirical law from the variational principle known in physics as the principle of least action. It states that if a movement between two points of a given path obeys the two-thirds law, then the amount of work required to execute a trajectory in a fixed time is minimal. In this strict sense one may say that among infinitely many ways to execute a given path, the central nervous system chooses the most economical. We show that the kinematic equations for all drawing movements are solutions of a certain differential equation with a single (time-variable) coefficient. We consider several special cases of drawing movements corresponding to simplest forms of this coefficient. Copyright 2001 Academic Press.     

The contributions of memory and attention processes to cognitive abilities

In two experiments, the contributions of memory and attention processes to the cognitive abilities of reasoning and perceptual speed were investigated. Two measures of speed of information retrieval from long-term and short-term memory (Posner paradigm, Sternberg paradigm) and two attention measures (continuous attention test, attention switching test) were included in the first experiment (N = 220). The memory tests led to correlations with the measures of cognitive abilities, whereas the attention test did not. The same tests as well as one additional memory test and one attention test (working memory test, test of covert orientation) were administered in the second experiment (N = 116). Again, the memory tests led to the larger correlations with the measures of cognitive abilities. Two components were obtained in components analysis, of which the first was characterized by high loadings of the memory tests and the second by high loadings of the attention tests. Only the memory component contributed to the prediction of cognitive abilities.     

The influence of learning style and cognitive ability on recall of names and faces in an older population

The present study examined whether, for older adults, a verbal or imagery cognitive style is associated with recall of names and faces learned in an experimental condition. Cognitive abilities that are represented in current models of face recognition and name recall were also examined. Those abilities included picture naming, verbal fluency (i.e., naming items within a given category), vocabulary comprehension, visual memory, and the learning of unassociated word pairs. Fifty older adults attempted to learn first and last names of 20 student actors and actresses pictured on videotapes (40 names total). On average, participants learned the most first names, followed by last names, and the fewest full names. The greater the number of responses on a questionnaire associated with an imagery cognitive style, the more the names of faces were correctly identified by participants. There was no significant relationship between a verbal cognitive style and the number of names and faces recalled. As for cognitive abilities, all of the abilities measured--with the exception of vocabulary comprehension--were significantly associated with the number of names and faces learned. A regression analysis indicated that the best predictor of successful name-face learning was the participants' ability to learn and recall 5 unrelated word pairs. When that cognitive measure was deleted from the regression analysis, delayed visual memory and verbal fluency were the next best predictors of the older adults' ability to learn names and faces.     

Use of the survey of elementary education students' reading instructional beliefs

29 undergraduate majors in elementary education reading instructional beliefs were measured at the beginning and the conclusion of a 15-wk. course on reading methods. Analysis indicated a positive change in the students' beliefs.     

Effects of an early intervention group program for anxious and depressed adolescents: a pilot study

The Resourceful Adolescent Program is an early intervention program designed to enhance psychological resilience in adolescents with emotional problems. Eight adolescents with high anxious and/or depressive symptoms were treated with this 11-session group program. Treatment effects were examined by means of self-report questionnaires of anxiety, depression, and self-efficacy. Pre- and postintervention data showed reductions in anxiety and depression scores and a concomitant increase in adolescents' self-efficacy.