A controlled comparative investigation of psychological treatments for chronic sleep-onset insomnia

A sample of physician-referred chronic insomniacs was randomly allocated to either progressive relaxation, stimulus control, paradoxical intention, placebo or no treatment conditions. Treatment process and outcome were investigated in terms of mean and standard deviation (night to night variability) measures of sleep pattern and sleep quality. Only active treatments were associated with significant improvement, but the nature of treatment gains varied. In particular, stimulus control improved sleep pattern, whereas relaxation affected perception of sleep quality. All improvements were maintained at 17 month follow-up. Results are discussed with reference to previous research and guidelines are given for clinical practice.     

Spelunking as a manifestation of a counterclaustrophobia

Material is presented from the case history of a patient whose interest in spelunking (cave exploration) was found to be an unconscious expression of a type of counterclaustrophobia. Both oedipal and preoedipal determinants of the claustrophobic anxieties are delineated. Of particular note in this instance is the testicular element in the genesis of the patient's claustrophobia. His confusion of the movements of his testicles into his inguinal canals during childhood defecation with the movements of the feces themselves lent an special intensity to his fear of being flushed away from the mother by an expulsive anal birth from the claustrum. Childhood anxiety aroused when his testicles would become trapped in the inguinal canals was an important forerunner of the adult fear of being trapped in confined spaces. A counterphobic element of the spelunking per se was his enjoyment in hanging suspended by a rope in caves. In this manner, he was able to act out (by virtue of his body-testicle equation) his identification with, and control over, the disappearing testicles in the setting of a claustrophilic union with the mother.     

Risk behaviors and health. Contrasting individual and population perspectives

This article discusses risk behaviors, seemingly voluntary actions of individuals that have adverse health consequences. The central theme is to examine these behaviors from two contrasting perspectives, that of the individual and that of the population as a whole. It is argued that distinguishing between individual and population views is important for understanding and interpreting health risk data, for developing conceptual and theoretical models for explaining these behaviors, and for devising intervention strategies to modify them. It is argued that an appreciation of both the individual and the population perspectives is important to developing effective action strategies for reducing these behaviors as public health problems.     

Private-sector care for chronically mentally ill individuals. The more things change, the more they stay the same

Two profit-making industries, nursing homes and board-and-care homes, care for about one million chronic mental patients. This care is primarily custodial and probably not very different from the care patients received in the public sector prior to deinstitutionalization. Moreover, certain characteristics of privately owned facilities encourage poor patient care so as to maximize profit. The problem could be ameliorated if chronic mental patients were strong and informed consumers or if the public sector strongly regulated proprietary care. However, neither of these two conditions now hold. Perhaps the apparent difficulties in significantly improving care for chronically mentally ill individuals despite seemingly major changes in policy reflect a fundamental problem in overall social policy--a reluctance to care for chronically indigent individuals of all kinds.     

The Social Phobia and Anxiety Inventory: concurrent validity with a clinic sample

The Social Phobia and Anxiety Inventory (SPAI) is an empirically derived self-report inventory developed as a specific measure of social phobia. The current investigation included two studies. The first examined the correlation of the SPAI with daily social behavior of a clinic sample of social phobics. The results indicated that the SPAI provides a reasonable indication of the distress experienced during daily social encounters in three dimensions: behavior, cognitions, and overall distress. The second study examined the validity of the SPAI with reference to the somatic response and avoidance behavior of social phobics. The results indicated that the somatic items of the SPAI are related to the somatic response of social phobics and that performance on the SPAI is associated with avoidance behavior in an anxiety-producing task.     

Testing between the TRACE model and the fuzzy logical model of speech perception

The TRACE model of speech perception (McClelland & Elman, 1986) is contrasted with a fuzzy logical model of perception (FLMP) (Oden & Massaro, 1978). The central question is how the models account for the influence of multiple sources of information on perceptual judgment. Although the two models can make somewhat similar predictions, the assumptions underlying the models are fundamentally different. The TRACE model is built around the concept of interactive activation, whereas the FLMP is structured in terms of the integration of independent sources of information. The models are tested against test results of an experiment involving the independent manipulation of bottom-up and top-down sources of information. Using a signal detection framework, sensitivity and bias measures of performance can be computed. The TRACE model predicts that top-down influences from the word level influence sensitivity at the phoneme level, whereas the FLMP does not. The empirical results of a study involving the influence of phonological context and segmental information on the perceptual recognition of a speech segment are best described without any assumed changes in sensitivity. To date, not only is a mechanism of interactive activation not necessary to describe speech perception, it is shown to be wrong when instantiated in the TRACE model.     

The composition of imaginal transformations

Three experiments examine the performance of composite imaginal spatial transformations using tasks in which people perform pairs of distinct imaginal transformations either in close succession or simultaneously. The principal aim of the investigation is to determine, for both modes of composition, whether imaginal transformations combine interactively or noninteractively to determine the temporal course of imaging performance. Specifically, does the time to imagine a given composite transformation reflect the independent contributions of its component transformations, or do component transformations have different effects within different composites? Results obtained under a number of distinct task conditions are most consistent with the proposal of noninteractive composition. However, the temporal effects of particular imaginal transformations are neither consistent nor readily predictable across different task conditions. Implications of these results for analogue-spatial models, task demand, and procedural accounts of imaging are discussed.     

Effect of depression on processing interactions in group psychotherapy

Two studies were conducted to investigate the possibility of individual differences in the ability of inpatients to process interactions in group psychotherapy. The first was a pilot study conducted on groups of major depressive patients and matched normal subjects. Subjects were asked to give process comments after viewing simulations of typical group therapy interactions. These comments were later rated on the extent to which they reflected process qualities and accuracy. These data led to a more rigorous and extensive study that included more appropriate control groups as well as measures of potential confounding factors, such as simulation realism, verbal ability, and interaction comprehension. Results indicated that major depressives suffer from deficits in the ability to process group interactions, relative to three types of control groups, including normals. These differences in processing were not significantly positively correlated with any of the potential confounding factors. The implications for understanding interactional processing and group psychotherapy are discussed.