Cognitive-behavioural Analysis and 1 reatment ot Insomnia

Abstract

Insomnia is a condition characterized by subjective complaints of insufficient sleep and poor daytime functioning. Objective measures of sleep and daytime functioning, however, seldom show evidence of a similar degree of dysfunction. Most insomniacs, for example, do not suffer from sleep deprivation or daytime sleepiness. This discrepancy between subjective and objective measures of sleep and daytime functioning suggests that cognitive factors may play a central role in persistent insomnia. In particular, it is argued that fears about insufficient sleep and its adverse daytime consequences tend to interfere with sleep, thereby causing a vicious cycle which serves to maintain the insomnia. It is also argued that perfectionist standards and other dysfunctional beliefs may predispose people to these kinds of fears. Finally, existing models for cognitive-behavioural treatment of insomnia are criticized for being almost exclusively focused on the night-time aspects of insomnia. If insomnia is maintained by various kinds of vicious cycles involving fears, beliefs, and standards with regard to daytime functioning, these daytime aspects of insomnia should receive more attention in cognitive-behavioural treatment.     

Is Acoustic Startle a Viable Exposure Protocol for Posttraumatic Stress Disorder? A Clinical Case Study

Exaggerated startle is a common symptom (based on Diagnostic and Statistical Manual of Mental Disorders [fourth edition] Criterion D) for many patients with posttraumatic stress disorder (PTSD). Findings from previous studies suggest that exaggerated startle may be due to trauma exposure or pretrauma vulnerability factors for PTSD development. The present clinical case study reports on a patient with PTSD characterized by a very prominent startle response and preference against standard trauma-related exposure strategies. On the basis of recent findings that interoceptive exposure exercises (e.g. shaking head side to side, hyperventilation) elicit trauma-related memories (Wald & Taylor, 2008), the authors sought to determine whether repeated application of an acoustic startle stimulus would serve to diminish the prominent startle response and facilitate exposure and overall symptom reduction by eliciting trauma-related memories. The protocol was successful in eliciting vivid and distressing trauma-related memories. Over the course of seven exposure trials, the patient demonstrated a decrease in distress elicited during the protocol, improved mood, and reduced general anxiety and trauma-related distress. He also reported significantly decreased startle response to loud noises encountered during activities of daily living. Although preliminary, these finding suggest that the acoustic startle protocol may be a viable (interoceptive) exposure strategy for individuals with PTSD, particularly those with exaggerated startle responses and those who are not amenable to standard trauma-related exposure strategies.     

Experimental and Behavioral Approaches to Alcoholism: Kongressrapport

Hypochondriasis is highly prevalent in medical settings, has detrimental effects for affected individuals, and is associated with high societal costs. Although cognitive behavior therapy (CBT) has been shown to be effective in the treatment of hypochondriasis, it is not widely available because of a lack of properly trained therapists. Therefore, it is essential to evaluate therapy forms that require less therapist time. The authors investigated the effect and economic impact of group CBT delivered in a psychiatric setting among 24 people with hypochondriasis. A within-group design with prolonged baseline was used, and all participants received 10 weeks of group-based treatment. The primary outcome measures were the Health Anxiety Inventory and the Illness Attitude Scales. Results indicate significant improvement on both measures at posttreatment and 6-month follow-up (Cohen's d = 1.03–1.72). Medical and nonmedical costs were substantially lowered. The authors conclude that group-based CBT delivered in a psychiatric setting is an effective and potentially highly cost-effective treatment for hypochondriasis.     

Disentangling the Impact of Resistance and Ambivalence on Therapy Outcomes in Cognitive Behavioural Therapy for Generalized Anxiety Disorder

Resistance and ambivalence about change are increasingly recognized as important determinants of treatment outcomes. Moreover, resistance and ambivalence are thought to be theoretically related in that clients who are more ambivalent about change are more likely to demonstrate resistance to the process and tasks of treatment. In the context of cognitive behavioural therapy (CBT) for generalized anxiety disorder, the present study simultaneously examined early resistance and ambivalence using two observer-based coding systems in order to determine their inter-relationship and, importantly, to investigate their relative contributions to outcome. Resistance was also coded during mid-treatment in order to investigate possible mediation pathways. Early ambivalence (clients’ arguments against change or counter-change talk) was found to be no longer related to outcomes when early resistance was taken into account, suggesting that disharmony in the therapeutic relationship is more important to outcomes than ambivalence per se. Moreover, mid-treatment resistance partially mediated the relationship between early resistance and post-treatment worry severity. That is, higher early opposition to therapist direction is related to poorer outcomes, in part because it is associated with greater resistance during the working phase of CBT. The findings underscore the critical need for therapists to be sensitive to identifying resistance early and throughout treatment.     

Quantitative work demands,emotional demands,and cognitive stress symptoms in surgery nurses

In surgery, cognitive stress symptoms, including problems in concentrating, deciding, memorising, and reflecting are risks to patient safety. Recent evidence points to social stressors as antecedents of cognitive stress symptoms in surgery personnel. The current study tests whether cognitive stress symptoms are positively associated with emotional abuse, emotional- and task-related demands and resources in surgery work. Forty-eight surgery nurses from two hospitals filled out the Copenhagen Psychosocial Questionnaire in its German version. Task-related and emotional demands were positively related to cognitive stress symptoms. In a stepwise, multiple, linear regression of cognitive stress symptoms on task-related and emotional demands, emotional abuse and emotional demands were unique predictors (p < .05). Efforts to increase patient safety should address emotional abuse, emotional demands, and, therefore, communication and cooperation team climate in surgery personnel.     

Identity Horizons Among Finnish Postsecondary Students: A Comparative Analysis

This article examines the identity horizons of postsecondary students in Finland—a country in which social welfare provisions buffer education-to-work transitions—comparing their identity horizons to those previously reported for U.S. and Japanese students. Confirmatory factor analyses revealed scalar invariance of the Finnish version of the Identity Horizons Scales with the English and Japanese versions. Latent mean comparisons found that Finnish students had the broadest educational and work horizons, and the lowest education-to-work identity anxiety. Finnish men reported lower levels of educational horizons and higher levels of identity anxiety than Finnish women, replicating previous findings. Social class differences were also detected, with higher levels of identity anxiety and narrower educational horizons among those whose parents had no postsecondary education. Based on the apparent impacts on identity development of the different educational policies in the three countries, results are discussed in terms of policy implications supporting more effective education-to-work transitions.     

From Resistance to Buy-In: Experiences of Clinicians in Training Using Feedback-Informed Treatment

In this qualitative research study, the authors use grounded theory analysis to examine the experiences of clinicians in training and use client feedback to inform treatment. Twenty-six marriage and family therapy graduate students in their first or second semester of clinical practicum participated in this study. Participants were trained in eliciting and responding to client feedback at the end of every therapy session. At the end of the semester, participants reflected on their learning experience. Participant experiences reflected a developmental learning process beginning with significant challenges followed by positive clinical changes and positive clinician changes, culminating in overall buy-in regarding the importance of client feedback for nearly all clinicians. The results support the literature that client feedback directly informs the therapeutic process while suggesting important recommendations for training new clinicians in learning to use client feedback.     

Evaluating the Effects of Creative Journal Arts Therapy for Survivors of Domestic Violence

The authors implemented a small series (N = 3) single-case research design to assess the effectiveness of a 9-session creative arts therapy treatment program for adult survivors of domestic violence. Analysis of participants’ scores on the Outcome Questionnaire (OQ-45.2) and Brief Resilience Scale using the percentage of nonoverlapping data procedure yielded treatment effects indicating that a creative arts therapy treatment program may be effective for reducing mental health symptoms and improving resiliency. It is recommended that this body of research continue for other educational, work, and health settings.     

Observed Attachment and Self-Report Affect Within Romantic Relationships

Adult attachment provides unique insights that help researchers and clinicians understand the complexities of individuals and relationships. In romantic relationships, individual attachment can explain partners' abilities for closeness and autonomy as well as how they experience affect within the relationship. These affective experiences during couple interactions have been shown to influence both proximal and distal relationship outcomes. Thus, the authors explore the impact of partners' observed attachment behaviors—coded using the AABQ—on continuous reports of their affective experiences during both difficult and positive marital conversations. Variables examining couple affective negativity and flexibility were developed using state space grids, and data were analyzed using GridWare. Results showed that observed female attachment behaviors significantly impacted a couple's affective experiences of negativity and flexibility during conversations, while there were no significant associations between male observed attachment behaviors and the couple affective experience. Clinical implications and suggestions for future research are discussed.