Treatment of Sleep Onset Insomnia by Paradoxical Instruction

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Abstract
Four adult outpatients suffering from severe, chronic sleep onset insomnia participated in a five-session paradoxical instruction treatment program. A multiple baseline design across subjects was utilized with major dependent measures consisting of eight behaviorally-specific daily sleep indices. Counterdemand manipulations were applied so as to evaluate and control for change attributable to expectancy and therapeutic demand. Results indicated significant improvement on five of the daily sleep chart measures, with treatment gains maintained at 4-, 8-, and 12-week follow-up. These findings are discussed with regard to interruption of hypothesized exacerbation cycle phenomenon.