Treatment of insomnia by relaxation training.

16 undergraduates with chronic insomnia were given 2-wk training in a relaxation technique called autogenic training, in an attempt to determine whether this alone would relieve the insomnia. It was hypothesized that tension in large skeletal muscles is the necessary and sufficient condition for insomnia, whatever its origin. 13 Ss were available for the posttreatment interview. Of these, 11 reported improvement. 2 follow-ups, covering a period of almost 1 yr., showed approximately the same results. With 1 discussed exception, no symptom substitution could be found. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of insomnia using a variant of systematic desensitization.

Describes the treatment of a case of severe insomnia. The treatment, a variant of systematic desensitization, was short and apparently quite successful. The primary difference between usual desensitization procedures and those employed in this case was the absence of a fear hierarchy. A trainee-O was present during several training and early therapy sessions. He observed 2 therapy sessions and then became the therapist. He was directly supervised for 2 more therapy sessions and then continued treatment singly. The case illustrates the flexibility of behavior therapy in both procedural variations and in training of therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Two occult causes of insomnia and their therapeutic problems

Insomnia may be associated with a sleep-induced apnea syndrome in nonobese patients who snore. The "central" type of apnea appears to be predominant in this population, in opposition to Pickwickian and nonobese hypersomniacs. An abnormal "swallowing reflex syndrome," also induced by sleep, may be a differential diagnosis. Sleeping pills that are central nervous system depressants should be cautiously prescribed for patients with such syndromes.     

Getting out of the box.

Like an actor who is typecast, each of us has probably experienced the frustration of becoming over identified by a client with one service or product. Often a first, or highly visible, piece of successful work becomes the exclusive way in which our client defines our services. This in turn becomes a limitation and obstacle to broadening our impact. Getting out of the box is important to building a practice. This is particularly true in the service industry where the cost of finding a new client far exceeds the cost of maintaining a current one. While most consultants caution against devoting more than 25% of billable time to one client, selling multiple services to an existing client is a useful way to leverage your business development efforts in those situations where you want to increase your time. There are many tactics for getting out of the box, but one of the simplest is based on good quality practice—asking your client for feedback on your work. The payoff will be apparent in an improved client relationship that will translate quickly to a stronger practice and steadier revenue stream. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The association of distress and sleeping problems with physicians’ intentions to change profession: The moderating effect of job control.

The present study examined whether job control moderated the association between stress indicators (distress and sleeping problems) and intentions to change profession among 2,650 Finnish physicians. Ordinal logistic regression analysis was applied. The authors found that high levels of distress and sleeping problems were associated with higher levels of intentions to change profession, whereas high job control was associated with lower levels of intentions to change profession even after adjusting for the effects of gender, age, and employment sector. In addition, high job control was able to mitigate the positive association that distress and sleeping problems had with intentions to change profession. Our findings highlight the importance of offering more job control to physicians to prevent unnecessary physician turnover. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical factors contributing to the differential diagnosis of primary insomnia and insomnia related to mental disorders

OBJECTIVE: Primary insomnia and insomnia related to mental disorders are the two most common DSM-IV insomnia diagnoses, but distinguishing between them is difficult in clinical practice. This analysis was performed to identify clinical factors used by sleep specialists to distinguish primary insomnia from insomnia related to mental disorders. METHOD: Clinicians evaluated 216 patients referred for insomnia at five clinical sites, rated a list of clinical factors judged to contribute to each patient's presentation, and assigned diagnoses. Analysis of variance was performed, with contributing factors as the dependent variable and diagnostic group and clinic location as independent variables. RESULTS: Sleep specialists rated a psychiatric disorder as a stronger factor for insomnia related to mental disorders and rated negative conditioning and sleep hygiene as stronger factors for primary insomnia. However, a psychiatric disorder was rated as a contributing factor for 77% of patients who received a first diagnosis of primary insomnia. CONCLUSIONS: While neither sleep hygiene nor negative conditioning is a diagnostic criterion in DSM-IV, these results support the face validity of these clinical factors distinguishing between primary insomnia and insomnia related to mental disorders. The use of a psychiatric disorder as an inclusion criterion for insomnia related to mental disorders and an exclusion criterion for primary insomnia reinforces a categorical distinction between the two diagnoses, but the contribution of psychiatric symptoms in primary insomnia appears to be a clinically relevant one. These findings suggest the need for studies on the validity of negative conditioning and sleep hygiene in the etiology of primary insomnia, as well as on the significance of psychiatric disorders, especially depression, in primary insomnia.     

Early intervention in the path to alcohol problems through conduct problems: Treatment involvement and child behavior change.

A program for the prevention of conduct problems among preschool-age sons of alcoholic fathers was implemented to interrupt what is likely to be a major mediating factor in the development of alcoholism in later years. A population-based sample of 42 families participated in a 10-month intervention involving parent training and marital problem solving. Differences in treatment outcome were examined, with the expectation that level of treatment involvement—entailing both level of participation and level of investment—would account for variability in child outcome at termination. Significant changes in positive and negative child behaviors were observed only within the group of families who completed the program and where the mothers demonstrated a higher level of treatment investment. When pretreatment child, parent, and family predictors of child behavior change were accounted for, subsequent analyses identified maternal treatment investment as a significant predictor of child outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Countercontrol treatment of sleep-maintenance insomnia in relation to age.

Administered countercontrol behavioral therapy for sleep-maintenance insomnia to 34 insomniacs (aged 35–78 yrs) in small groups. 22 Ss received immediate and 12 received delayed treatment. Three self-report measures of sleep disruption were collected on daily sleep diaries at baseline, termination of treatment, 1-mo follow-up, and 12-mo follow-up. Although amount of time awake at night was correlated with age, response to treatment was not. Even though older Ss experienced more time awake after sleep onset prior to treatment, they were able to profit from therapy as well as the younger insomniacs. Countercontrol therapy reduced the sleep complaint for the total group by about 30% at the end of treatment, with gradual improvement continuing through a 4-wk follow-up. It is suggested, however, that sleep-maintenance insomnia may be more difficult to treat than sleep-onset problems. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of a horizontal root fracture by vital root submergence

Cervical third horizontal root fractures in immature permanent teeth often present complicated and unpredictable treatment options. This case report describes the successful management of a horizontal root fracture in an open apex tooth by vital root submergence and subsequent nonsurgical root canal therapy.     

Cognitive–behavioral treatment of insomnia secondary to chronic pain.

Sixty participants with insomnia secondary to chronic pain were assigned randomly to either a cognitive–behavioral therapy (CBT) or a self-monitoring/waiting-list control condition. The therapy consisted of a multicomponent 7-week group intervention aimed at promoting good sleep habits, teaching relaxation skills, and changing negative thoughts about sleep. Treated participants were significantly more improved than control participants on self-report measures of sleep onset latency, wake time after sleep onset, sleep efficiency, and sleep quality, and they showed less motor activity in ambulatory recordings of nocturnal movement. At a 3-month follow-up assessment, treated participants showed good maintenance of most therapeutic gains. These results provide the 1st evidence from a randomized controlled trial that CBT is an effective treatment for insomnia that is secondary to chronically painful medical conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological treatment of secondary insomnia.

Psychological treatment of insomnia has focused on primary insomnia (i.e., having a psychological origin). Secondary insomnia, sleep disturbance caused by a psychiatric or medical disorder, although it is more common than primary insomnia, has received very little attention as a result of the belief that it would be refractory to treatment. The present study randomly assigned older adults with secondary insomnia to a treatment group, 4 sessions composed of relaxation and stimulus control, or a no-treatment control group. Self-report assessments conducted at pretreatment, posttreatment, and a 3-month follow-up revealed that treated participants showed significantly greater improvement on wake time during the night, sleep efficiency percentage, and sleep quality rating. The authors hypothesize that treatment success was probably due in part to difficulty in diagnostic discrimination between primary and secondary insomnia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Getting the picture: The use of imagery to clarify therapeutic impasses.

Contends that imagery can be used to disclose the nature of the client–therapist relationship and to resolve therapeutic impasses. The most common forms of impasses in the relationship are the result of therapist's misperceptions, the pacing of therapy dealing with acting-out behavior, difficulties induced by transference and countertransference, and difficulties in making alliances with severely disturbed patients. To uncover latent images in the therapist–client interaction, therapists imagine a metaphoric meeting place with a client, what they become to each other there or what other forms they take, the activity both might be engaged in, what a dance between the 2 might look like, what might be done differently, and what translations can be made from the imaginal to the actual therapeutic relationship. Case illustrations with 4 female and 2 male clients are given. It is suggested that images clarify the symbolic and affective elements of the internal world. (45 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Jealousy and the threatened self: Getting to the heart of the green-eyed monster.

Several theories specifying the causes of jealousy have been put forth in the past few decades. Firm support for any proposed theory, however, has been limited by the difficulties inherent in inducing jealousy and examining any proposed mediating mechanisms in real time. In support of a theory of jealousy centering on threats to the self-system, 2 experiments are presented that address these past limitations and argue for a model based on context-induced variability in self-evaluation. Experiment 1 presents a method for evoking jealousy through the use of highly orchestrated social encounters and demonstrates that threatened self-esteem functions as a principal mediator of jealousy. In addition to replicating these findings, Experiment 2 provides direct evidence for jealousy as a cause of aggression. The ability of the proposed theory of jealousy to integrate other extant findings in the literature is also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is handwriting causally related to learning to write? Treatment of handwriting problems in beginning writers.

The contribution of handwriting to learning to write was examined in an experimental training study involving beginning writers with and without an identified disability. First-grade children experiencing handwriting and writing difficulties participated in 27 fifteen-min sessions designed to improve the accuracy and fluency of their handwriting. In comparison to their peers in a contact control condition receiving instruction in phonological awareness, students in the handwriting condition made greater gains in handwriting as well as compositional fluency immediately following instruction and 6 months later. The effects of instruction were similar for students with and without an identified disability. These findings indicate that handwriting is causally related to writing and that explicit and supplemental handwriting instruction is an important element in preventing writing difficulties in the primary grades. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic issues in the behavioral treatment of insomnia.

The problem of insomnia is likely to affect many of the patients seen by practicing clinicians. At present, a number of effective behavioral strategies are available for the treatment of patients with chronic insomnia. However, the literature on behavioral insomnia treatment has traditionally focused on the application of specific techniques, giving little attention to the therapeutic issues that may be important to the success of a comprehensive insomnia treatment program. This article discusses those aspects of treatment that are unique to the complaint of insomnia within the context of several basic problems common to most behavioral treatment programs, including compliance, patient cognitions, and the tailoring of treatment to maximize therapeutic effectiveness. Hypotheses regarding the etiology of insomnia complaints are also presented, along with recommendations for further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ten errors to avoid in managing type 2 diabetes. Getting back to the basics

It is important to remember the basics when treating patients with diabetes. Follow current diagnostic criteria, and clearly communicate findings to patients. Set target glucose levels, and encourage patients to take an active role in controlling their disease. Set time limits for therapy effectiveness, and use combination therapy with caution. Recommend use of home glucose monitors and regular monitoring of glucose levels throughout the day. For more flexibility, adapt insulin dosages to patient needs and use basal insulin, rather than sliding-scale insulin. Finally, remember that early detection and intervention can delay or even prevent complications.     

Clinical assessment and treatment of insomnia.

Insomnia is characterized by problems initiating and maintaining sleep—problems that often go unrecognized by psychotherapists as well as physicians. This article addresses central questions related to the diagnosis, assessment, and treatment of this problem. Differential diagnosis is focused upon as well as the comorbidity with psychiatric and organic disorders. The Assessment of Insomnia section covers different subjective measures of sleep: sleep diaries, sleep questionnaires, and sleep interview. Additionally, central objective sleep measures are included. In the Treatment of Insomnia section, the 6 most common behavioral interventions are presented together with the most current pharmacological approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)