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Perceived benefits in a behavioral-medicine insomnia program: A clinical report

  • Gregg D. Jacobs
    Correspondence
    Requests for reprints should be addressed to Gregg D. Jacobs, PhD, Division of Behavioral Medicine, 110 Francis Street, Suite 1A, Boston, Massachusetts 02215.
    Affiliations
    From the Division of Behavioral Medicine (GDJ, HB), Department of Medicine, Deaconess Hospital/Harvard Medical School, Boston, Massachusetts, USA
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  • Herbert Benson
    Affiliations
    From the Division of Behavioral Medicine (GDJ, HB), Department of Medicine, Deaconess Hospital/Harvard Medical School, Boston, Massachusetts, USA
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  • Richard Friedman
    Affiliations
    From and the Division of Behavioral Medicine (RF), Department of Psychiatry, State University of New York at Stony Brook, New York, USA
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      Purpose

      This clinical replication series assessed the perceived outcome of individuals with chronic insomnia who spontaneously sought treatment at a hospital behavioral-medicine insomnia program. patients and methods: Chronic insomnia patients who were treated with a group multifactor behavioral intervention completed posttreatment (n = 102) and 6-month follow-up (n = 70) questionnaires that assessed improvement.

      Results

      All patients reported improved sleep at posttreatment, with the majority (58%, 59) reporting significant improvement. Of sleep medication users, 91% (62/68) either eliminated or reduced medication use. At 6-month follow-up, 90% (63/70) of respondents rated improvement in sleep as either maintained or enhanced.

      Conclusion

      These results suggest that patients spontaneously seeking treatment for insomnia, including sleep medication users and those with psychological comorbidity, derive significant benefit from a group multifactor behavioral intervention. Several factors, including maintenance of therapeutic gains at long-term follow-up, the average pretreatment duration of insomnia, previous unsuccessful treatment with psychotherapy and pharmacotherapy, and previous research, argue against nonspecific effects playing a significant role in these results.
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      References

      1. Executive Summary and Executive Report submitted to the United States Congress and to the Secretary, Department of Health and Human Services. A Report of the National Commission on Sleep Disorders Research. Wake Up America! A National Sleep Alert. Vol. 1. NCSDR, Washington, DC1993
        • Kales JD
        • Kales A
        • Bixler E
        • et al.
        Biopsychobehavioral correlates of insomnia, V: clinical characteristics and behavioral correlates.
        Am J Psychiatry. 1984; 141: 1371-1376
        • Pollack C
        • Perlick D
        • Linsner J
        • et al.
        Sleep problems in the community elderly as predictors of death in nursing home placement.
        J Community Health. 1990; 15: 123-135
        • Lacks P
        Behavioral Treatment for Persistent Insomnia. Pergamon, New York1987
        • Ford D
        • Kamerow D
        Epidemiologic study of sleep disturbances and psychopathology. An opportunity for prevention?.
        JAMA. 1989; 262: 1479-1484
        • Morin C
        • Kwentus J
        Behavioral and pharmacological treatments for insomnia.
        Ann Behav Med. 1988; 10: 91-100
        • Gillin J
        • Byerley W
        Diagnosis and management of insomnia.
        NEJM. 1990; 322: 239-248
        • Hauri P
        The Steep Disorders.
        Upjohn, Kalamazoo, Michigan1982
        • Roy-Byrne D
        • Hommer D
        Benzodiazepine withdrawal: overview and implications for treatment of anxiety.
        Am J Med. 1988; 84: 1041-1052
        • Greenblatt D
        • Hormatz J
        • Zinny M
        • Shader R
        Effect of gradual withdrawal on the rebound sleep disorder after discontinuation of Triazolam.
        NEJM. 1987; 317: 722-728
        • Consensus Conference
        Drugs and insomnia: the use of medications to promote sleep.
        JAMA. 1984; 251: 2410-2414
        • Lacks P
        • Morin C
        Recent advance in the assessment and treatment of insomnia.
        J Consult Clin Psychol. 1992; 60: 586-594
        • Lichstein K
        • Fischer S
        Insomnia.
        in: Hersen M Bellack A Handbook of Clinical Behavior Therapy With Adults. Plenum, New York1985
        • Morin C
        • Culbert J
        • Schwartz S
        Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy.
        Am J Psychiatry. 1994; 151: 1172-1180
        • Jacobs GD
        • Benson H
        • Friedman R
        Home-based central nervous system assessment of a multifactor behavioral intervention for chronic sleep-onset insomnia.
        Behavior Therapy. 1993; 24: 159-174
        • Stepanski E
        • Koshorek G
        • Zorick F
        • et al.
        Characteristics of individuals who do or do not seek treatment for chronic insomnia.
        Psychosom. 1989; 30: 421-427
        • American Sleep Disorders Association
        International Classification of Sleep Disorders (ICSD): Diagnostic and Coding Manual. ASDA, Rochester, Minnesota1990
        • Morin C
        Insomnia: Psychological Assessment and Management. Guilford, New York1993
        • Morin C
        • Stone J
        • Trinkle D
        • et al.
        Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints.
        Psychol Aging. 1993; 8: 463-467
        • Coyle K
        • Watts F
        The factorial structure of sleep dissatisfaction.
        Behav Res Ther. 1991; 29: 513-520
        • Derogatis LR
        SCL-90R Revised Version Manual. Leonard Derogatis, Baltimore, Maryland1977
        • Espie CA
        • Lindsay WR
        • Brooks DN
        Substituting behavioural treatment for drugs in the treatment of insomnia: an exploratory study.
        J Behav Ther Exper Psychiatry. 1988; 19: 51-56
        • Benson H
        • Epstein MD
        The placebo effect—a neglected asset in the care of patients.
        JAMA. 1975; 232: 1225-1227
        • Wickramasekera I
        A conditioned response model of the placebo effect: predictions from the model.
        in: White L Tursky B Schwartz G Placebo: Theory, Research and Mechanisms. Guilford, New York1985
        • Morin C
        • Gaulier B
        • Barry T
        • Kowatch RA
        Patients' acceptance of psychological and pharmacological therapies for insomnia.
        Sleep. 1992; 15: 302-305
        • Jacobs GD
        Improving your sleep.
        in: Benson H Stuart E The Wellness Book. Simon & Schuster, New York1992