Patricia Lacks

Knowledge and practice of sleep hygiene techniques in insomniacs and good sleepers

Abstract An instrument was developed to assess sleep hygiene knowledge and practice in 44 sleep-onset insomniacs, 49 sleep-maintenance insomniacs and 50 good sleepers. Multivariate ANOVAs revealed that insomniacs had more general sleep hygiene knowledge than good sleepers, but practiced it less often. Sleep-onset and sleep-maintenance insomniacs had equivalent hygiene awareness, but the former group had less healthy hygiene practices. Hygiene knowledge was most deficient regarding the effects of nicotine, sleep medication, alcohol and exercise; hygiene practice needed most improvement in the areas of regular exercise, prebedtime relaxation and managing prebedtime worry. The results suggest that poor sleep hygiene is not a primary cause of insomnia; however, behavior therapists should continue to include this element in treatment to help insomniacs avoid exacerbation cycles.

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.

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.

Improvement following behavioral treatment for insomnia: Clinical significance, long-term maintenance, and predictors of outcome

Data from seven outcome studies (n=216) of various brief behavioral treatments for chronic insomnia were reanalyzed to determine individual rates of statistically and clinically significant improvement. Results were also assessed for long-term maintenance of treatment gains and for predictors of favorable outcome. Overall, 39% of participants showed statistically significant improvement after 4 weeks of treatment, 47% at short-term follow-up (1 to 3 months posttreatment), and 49% by a year follow-up. Deterioration rates were low: less than 1% at each of the same time periods. About 23% of insomniacs showed clinically significant improvement, that is they became good sleepers by end of treatment, with 33% attaining this status by short-term follow-up, a figure which was maintained at 1 year. Younger individuals with a later original age of onset and longer current duration, who showed less psychopathology and received stimulus control treatment had an initial treatment advantage which disappeared sometime during the short-term follow-up period.

Bender Gestalt performance of normal older adults.

With increased numbers of older adults in the population, psychologists are faced frequently with diagnostic questions that concern the neuropsychological functioning of an older client. The need for a brief screening measure of organicity can be filled by the Bender Gestalt Test (BGT), a measure widely used by psychologists. This report provides normative data on the BGT with a sample of 334 normal older adults aged 60 and above who are residing in the community. Using the Hutt-Briskin scoring criteria, it is shown that these older adults, as a group, do not perform on the BGT in a manner that can be called brain-damaged. Use of the cut-off score developed with younger persons appears to be appropriate even with older adults.

Learned Helplessness A Function of Attribution Style and Comparative Performance Information

This study examined the mediating influence of internal-external attribution style and comparative performance information on responses to task success and failure. Subjects classified as exhibiting either an internal or external attribution style were induced to either succeed or fail on an initial task and then attempted a second, solvable task. In addition, the initial task was performed either alone or in the presence of a confederate who succeeded on the task. Results indicated that subjects with an external attribution style were little influenced by the task success manipulation or by the presence of a successful co-participant. By contrast, internal subjects who failed on the first task in the presence of a successful confederate performed better on the second task than did subjects who performed the first task alone. These results complement previous research, which indicates that internally oriented individuals are more responsive to control contingencies, and under certain conditions, respond to failure with enhanced subsequent performance.