اضطراب خصلتی و بی خوابی زمان شروع خواب: بررسی درمان با استفاده از آموزش مدیریت اضطراب

Objectives: This study was initially designed to test the notion that generalized anxiety is a predominant factor in the maintenance of psychologically determined sleep-onset insomnia and that a trait anxiety reducing technique can provide significant therapeutic gains. Methods: Twenty participants (age 19–63) with moderate to severe sleep-onset chronic insomnia were first asked to monitor their sleep-onset latency (SOL) for a 3-week baseline period at home using a SOL clock device. Then, 10 received anxiety management training (AMT) for 9 weeks, while the remaining 10 were trained in the use of progressive relaxation (PR). All participants were measured before and after therapy using sleep laboratory recordings (three nights each), the Spielberger Trait Anxiety Inventory and the Beck Depression Inventory. Daily home sleep-onset measures with the SOL clock device were also taken during therapy. Results: There was no change in SOL over the 3-week baseline period. However, both groups experienced a significant improvement in SOL from pretreatment (end of baseline) to posttreatment periods. In the laboratory, both groups experienced a reduction in Stage 1 sleep as well as an increase in slow wave sleep (SWS) and sleep satisfaction. On the personality measures, both groups experienced a significant reduction in trait anxiety and a decrease in depression. Overall, there was no indication that one of the therapies was significantly better than the other in effecting changes. Conclusion: These results suggest that both PR and AMT are efficient therapies for sleep onset insomnia and overall sleep quality. Improvements in the application of the AMT technique are proposed to maximize its usefulness.

Research on the nonpharmacological treatment of insomnia has confirmed the short and long term benefits of several behavioural techniques. Such therapies have taken a wide variety of forms. Indeed, progressive and autogenic relaxation [1], [2] and [3], systematic desensitization [4], paradoxical intention [5], [6] and [7], sleep restriction therapy [8], [9] and [10], stimulus control [11] and [12] and biofeedback [13] and [14] are all examples of successful techniques to alleviate symptoms of sleep-onset insomnia. They have become preferred alternatives to drug therapies [15] and [16]. Several reviews are available (e.g., [17] and [18]). More recently, their combination with new hypnotics appears most successful [19]. These approaches focus on eliminating competing behaviours and reducing levels of anxiety present at bedtime. Several studies have linked insomnia with the presence of increased general trait anxiety [20], [21] and [22]. It appears that, at least in certain conditions, life-stress factors are prevalent and cause or exacerbate chronic insomnia. Learning to cope with these life-stress events would contribute to a more global solution for the treatment of insomnia. More specifically, it would follow that treatment, which includes a reduction of trait anxiety, would be even more efficacious in alleviating symptoms associated with sleep-onset insomnia than therapies that focus only on bedtime conditions. In this study, such a treatment, anxiety management training (AMT) [23] and [24] which has been shown to reduce trait anxiety, was compared to Jacobson's [25] progressive relaxation (PR). It was predicted that AMT would lead to a greater reduction in trait anxiety, sleep-onset latency (SOL) and negative psychological correlates of insomnia than PR.