Treating Primary Insomnia: A Comparative Study of Self-Help Methods and Progressive Muscle Relaxation
Alexandru, Bogdan Vasile, Róbert, Balázsi, Viorel, Lupu, Vasile, Bogdan, Journal of Evidence-Based Psychotherapies
Insomnia is one of the most prevalent psychological disorders worldwide. Some of the deficiencies of the current treatments of insomnia are: side effects in the case of sleeping pills and high costs in the case of psychotherapeutic treatment. Some suggest that self-help treatments could be a viable alternative, with certain advantages such as low cost, and wide accessibility to a large number of people. In our study we used a modified Latin square experimental design for single subject research to verify the effect of multi-component treatment efficiency in primary insomnia. Another goal of our study was to compare the effects of the three treatment techniques (progressive muscle relaxation, sleep hygiene, binaural beats) included in the multi-component intervention package. Our results reflect the efficiency of the multi-component treatment. Significant differences were found only between muscle relaxation and binaural beat. Based on effects size measures we can say that muscle relaxation and sleep hygiene have a very similar effect. The effect of binaural beat treatment is lower than that of the other two types of intervention.
Keywords: insomnia, single subject experiment, progressive muscular relaxation, sleep hygiene, binaural beats
Insomnia is a disorder characterized by the qualitative reduction of the sleep duration and efficacy (Morin, Hauri, Espie, Spielman, Buysse, & Bootzin, 1999; Pallesen, 2003). Out of all psychological disorders, insomnia displays some of the highest prevalence rates, epidemiological data reporting frequencies as high as 22% (Stinson et al., 2006) and even 33% (Harvey, 2001). Insomnia causes severe distress, social, interpersonal and professional dysfunction (Harvey, 2002). It affects well-being and the quality of life (Espie, 1991) and is often associated with affective disorders, such as irritability and dysphoria (Morin, 2003). The impredictibility and incontrolability of the sleeping pattern can lead to feelings of helplessness and to the onset of depressive and anxiety disorders (Morin, 2003; Neckelmann, 2007). Longitudinal studies conducted by Ford & Kamerow (1989) showed that persistent untreated insomnia can be a risk factor in the development of the major depressive disorder.
The global expenses for the treatment of insomnia and its consequences rise to several billion dollars. For example, in the United States, the cost of insomnia treatments in 2004 rose to over 2.1 billion dollars, and it is estimated to reach 3.2 billion dollars in 2009 (Gershell, 2006). A cost harder to quantify is due to the decrease of daytime performance of people affected by insomnia, due to the reduction of the cognitive and motor performances (Mendelson, Garnett, Gillin & Weingartner, 1984), as well as to the high rates of work absence (Johnson & Spinveber, 1983).
Theoretical models in the literature generally attribute insomnia to certain activating factors that interfere with the sleeping pattern. These factors can be organized along two dimensions: a. physiological, emotional and cognitive activation; b. the general level of activation of the person and the person's tendency to respond with activation to aversive life events. These models only consider certain factors in isolation, such as psychological, emotional and cognitive hyperactivity, level of arousal, excitability and habituation to stimuli, and the role of the activating events.
According to the integrative model of insomnia recently proposed by Lundh and Broman (2000), an essential component in the development and maintenance of insomnia is the physiological and cognitive arousal before sleep. The physiological processes of sleep interference are those that influence a person's sleeping pattern, independently of the way the person interprets the sleeping pattern and of daytime events (traumatic or stressful events, emotional conflicts, depression, worries). Psychological insomnia processes influence the way the person interprets sleep fluctuations, difficulties and daytime events (personal standards, beliefs and attitudes). …