Amy D. Bertelson

The effectiveness of three behavioral treatments for different degrees of sleep onset insomnia

This study compared the effectiveness of progressive relaxation, stimulus control, paradoxical intention, and a placebo control treatment for different degrees of sleep onset insomnia (mild, moderate, and severe). Results demonstrated that stimulus control was the most effective intervention regardless of severity level. Individuals with severe insomnia showed at least as much improvement as those with either mild or moderate insomnia, regardless of type of treatment.

Sexual dysfunction in diabetic women.

This study examined sexual dysfunction in diabetic women. Eighty-one insulin-treated diabetic women were interviewed and administered standardized questionnaires. Using criteria derived from the Diagnostic and Statistical Manual of Mental Disorders(3rd ed.) (DSM-III; American Psychiatric Association, Washington, D.C., 1980), 38 (47%) of the women were diagnosed with sexual dysfunction and 43 (53%) did not report sexual problems. The more frequently reported sexual problems were inhibited sexual excitement, inhibited sexual desire, and dyspareunia. Diabetic women with sexual dysfunction were more depressed, more stereotyped in their sex-role definitions, and less satisfied in their sexual relationships than those without sexual dysfunction. The two groups did not differ in metabolic control, insulin dose, duration of diabetes, or frequency of diabetic complications (e.g., neuropathy, etc.). Results suggest that diabetes may be associated with inhibited sexual excitement and dyspareunia in women. Both psychological and physiological concomitants of sexual dysfunction in diabetic women should be considered in diagnostic and treatment programs.

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

Abstract 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.

Is sleep hygiene a sufficient treatment for sleep-maintenance insomnia?

This study compared the effectiveness of meditation, stimulus control, and sleep hygiene treatments for sleep-maintenance insomnia. Subjects were 65 adults who participated in a four-week treatment program. Subjective estimates of wake time after sleep onset (WASO) were obtained at pretest, posttest, and at six-weeks follow-up. Results demonstrated that all three treatments produced comparable reductions in WASO as well as in number and duration of arousals. Despite comparable rates of improvement, subjects in the sleep hygiene condition rated treatment less favorably and, at follow-up, were more likely to consider themselves still insomniac in comparison to subjects in the stimulus control and meditation treatments.

Short-term stimulus control treatment of insomnia in older adults†

A 4-week stimulus control treatment was administered in small groups to 16 ambulatory, noninstitutionalized older adults with sleep onset insomnia. Nine subjects received immediate treatment, and 7 received delayed treatment. Subjective sleep onset latency was collected at baseline, at termination of treatment, and at a 6-week follow-up. Results showed a strong treatment effect which was replicated with the delayed treatment group; both groups maintained their gains through the 6-week follow-up period. The effectiveness of these procedures with the older insomniac is especially encouraging, since it is a much safer intervention than sedative-hypnotic medications.

The effects of gender and response style on depressed mood

Research has shown that gender differences in the rate of depression may be accounted for by different response styles. To examine whether response style affects mood, depressed mood was induced in 31 females and 33 males (all Caucasian) who were then randomly assigned to either a ruminating or a distracting response task. The findings supported the response style theory as the ruminating group remained depressed after the response task, while the distracting group became less depressed. Gender was not a factor in this experiment as both men and women reacted similarly to the mood induction and the experimental tasks. Although clinical implication cannot be determined from a study involving nondepressed subjects, it can be concluded that ruminating about ones depressed mood is not an effective method for overcoming depression.

MMPI-2 clinical scale differences between dysthymia and major depression.

Though dysthymia is considered less severe and more chronic than major depressive disorder, it is unclear whether the two disorders are truly different. In this study, MMPI-2 scales of 21 patients with dysthymia and 30 patients with major depressive disorder were compared. The average scores on Scales 2, 4, 6, 7, and 8 were in the clinical range for both groups. However, sizable differences between the two groups were found for Scale 1 and Scale 3. Smaller but reliable differences were found for Scale 2 and mean clinical scale T score with major depressives scoring higher on all of these measures. Results indicate that not only is major depressive disorder more severe than dysthymia, but also contains more physical/somatic symptoms than dysthymia.