The effectiveness of treatment programs based on progressive relaxtion, stimulus control, and paradoxical intention was assessed in the context of sleep difficulties. The results indicated that each of the therapeutic procedures significantly reduced sleep complaints in contrast to placebo and waiting list control groups. No differences were observed among the three active techniques.The prescription of sedative hypnotics is the most frequently used treatment for primary or nonphysiologically based insomnia. The popularity of this procedure is due to the rapidity with which these compounds ameliorate difficulties of sleep (American Medical Association, 1977;Williams & Karacan, 1976). Because the resultant transitory improvement has detrimental psychological and physiological concomitants nondrug alternatives have been sought. Of these, behavioral techniques seem especially promising, since they offer relatively rapid amelioration of sleep disturbance devoid of the complications of medication (
Sleep onset insomnia seems often to be based on performance anxiety associated with a client's fears of being able to fall asleep; in some cases, a therapeutic program might actually exacerbate this performance anxiety by focusing on the client's efforts to voluntarily control the sleep onset process. Five cases of sleep onset difficulty, unusually resistant to a conventional behavioral program for this problem (i.e., deep muscle relaxation and systematic desensitization), were exposed to paradoxical intention suggestions requiring that they try to remain awake as long as possible, rather than attempt to fall asleep. A rapid reduction of sleep onset latency occurred following the shift from the conventional program to the paradoxical intention instructions.
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