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To establish if insomniacs' underestimation of sleep time is due to reduced ability to discriminate between sleeping and waking states.Two night's home polysomnography were compared to sleep diaries. Five laboratory nights employed a series of recorded questions regarding perception of prior sleep-wake state, which were presented during sustained wake and interrupted Stage 2 and REM sleep.Sleep laboratory and participants' homes.Fourteen insomniacs were compared to 8 good sleepers. Mean age for both groups was 58 years.N/A.A signal detection theory analysis was applied to participants' responses to questions presented overnight in the laboratory concerning judgement of prior sleep-wake state and confidence in their decision. Insomniacs had reduced sleep-wake discriminability in addition to a greater bias toward reporting prior wakefulness in the laboratory compared to good sleepers. These measures correlated significantly with the degree of underestimation of total sleep and overestimation of wake recorded at home.Insomniacs' underestimation of total sleep time is the product of prior sleep being misperceived as wake time upon awakening overnight. This misperception may play a role in the perpetuation of insomnia.

Richard F Kaplan,1 Ying Wang,1 Kenneth A Loparo,1,2 Monica R Kelly,3 Richard R Bootzin3 1General Sleep Corporation, Euclid, OH, USA; 2Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH, USA; 3Department of Psychology, University of Arizona, Tucson, AZ, USA Background: A need exists, from both a clinical and a research standpoint, for objective sleep measurement systems that are both easy to use and can accurately assess sleep and wake. This study evaluates the output of an automated sleep–wake detection algorithm (Z-ALG) used in the Zmachine (a portable, single-channel, electroencephalographic [EEG] acquisition and analysis system) against laboratory polysomnography (PSG) using a consensus of expert visual scorers. Methods: Overnight laboratory PSG studies from 99 subjects (52 females/47 males, 18–60 years, median age 32.7 years), including both normal sleepers and those with a variety of sleep disorders, were assessed. PSG data obtained from the differential mastoids (A1–A2) were assessed by Z-ALG, which determines sleep versus wake every 30 seconds using low-frequency, intermediate-frequency, and high-frequency and time domain EEG features. PSG data were independently scored by two to four certified PSG technologists, using standard Rechtschaffen and Kales guidelines, and these score files were combined on an epoch-by-epoch basis, using a majority voting rule, to generate a single score file per subject to compare against the Z-ALG output. Both epoch-by-epoch and standard sleep indices (eg, total sleep time, sleep efficiency, latency to persistent sleep, and wake after sleep onset) were compared between the Z-ALG output and the technologist consensus score files. Results: Overall, the sensitivity and specificity for detecting sleep using the Z-ALG as compared to the technologist consensus are 95.5% and 92.5%, respectively, across all subjects, and the positive predictive value and the negative predictive value for detecting sleep are 98.0% and 84.2%, respectively. Overall κ agreement is 0.85 (approaching the level of agreement observed among sleep technologists). These results persist when the sleep disorder subgroups are analyzed separately. Conclusion: This study demonstrates that the Z-ALG automated sleep–wake detection algorithm, using the single A1–A2 EEG channel, has a level of accuracy that is similar to PSG technologists in the scoring of sleep and wake, thereby making it suitable for a variety of in-home monitoring applications, such as in conjunction with the Zmachine system. Keywords: EEG, sleep–wake detection, algorithm, Zmachine, automatic sleep scoring, single channel

The aim of this article is to shed more light on the relationship between quality of life and aspects of the psychosocial experience for women with breast cancer. The literature is briefly reviewed, including highlights of the psychosocial consequences of cancer, an exploration of the relationship of psychosocial variables to cancer, and a brief review of psychosocial interventions for cancer. Further, preliminary findings of an on-going NCI study are introduced. Finally, clinical implications are discussed. The purpose of this article is to provide a context and foundation on which future researchers and clinicians can build. Ultimately, we suggest that the biomedical model of disease, though crucial, does not take into account all of the complex factors involved in cancer. The current literature lends support to the argument that a broader, more integrative framework, which includes psychosocial factors, is needed. © 2001 John Wiley & Sons, Inc. J Clin Psychol 57: 501–519, 2001

Publisher Summary This chapter proposes a framework for the assessment of learning outcomes associated with technology. It discusses the kind of expertise that is required for such assessment, the nature of current instructional technologies, and potential mismatches between technologies and human learning. These mismatches occur with respect to four classes of characteristics of human learners: natural learning and memory processes; perception; individual differences in learning styles and other cognitive factors; and individual differences in social and personality factors. The human–machine mismatches occur in each of these domains. The chapter determines the instructional outcomes produced by learning technologies. Educational uses of technology suggest several conclusions that should inform a research agenda. Four options predominate university courses: Web-based instruction, video-delivered distance learning, electronic interactive-learning environments, and simulated environments. Technology-infused instruction poses some fundamental dilemmas for learners that are rooted in mismatches between the capabilities of humans and those of machines.

This paper reviews the evidence regarding the efficacy of nonpharmacological treatments for primary chronic insomnia. It is based on a review of 48 clinical trials and two meta-analyses conducted by a task force appointed by the American Academy of Sleep Medicine to develop practice parameters on non-drug therapies for the clinical management of insomnia. The findings indicate that nonpharmacological therapies produce reliable and durable changes in several sleep parameters of chronic insomnia sufferers. The data indicate that between 70% and 80% of patients treated with nonpharmacological interventions benefit from treatment. For the typical patient with persistent primary insomnia, treatment is likely to reduce the main target symptoms of sleep onset latency and/or wake time after sleep onset below or near the 30-min criterion initially used to define insomnia severity. Sleep duration is also increased by a modest 30 minutes and sleep quality and patient's satisfaction with sleep patterns are significantly enhanced. Sleep improvements achieved with these behavioral interventions are sustained for at least 6 months after treatment completion. However, there is no clear evidence that improved sleep leads to meaningful changes in daytime well-being or performance. Three treatments meet the American Psychological Association (APA) criteria for empirically-supported psychological treatments for insomnia: Stimulus control, progressive muscle relaxation, and paradoxical intention; and three additional treatments meet APA criteria for probably efficacious treatments: Sleep restriction, biofeedback, and multifaceted cognitive-behavior therapy. Additional outcome research is needed to examine the effectiveness of treatment when it is implemented in clinical settings (primary care, family practice), by non-sleep specialists, and with insomnia patients presenting medical or psychiatric comorbidity.

The present study was designed to explore mechanisms of amnesia for meaningful auditory material presented during the sleep onset transition. Thirty undergraduate subjects (17 female, 13 male) were presented with auditory stimuli in an oddball paradigm until sleep onset. Subjects were allowed to accumulate either 30 seconds or 10 minutes of sleep, then awakened and tested on free recall and recognition memory for the meaningful stimuli. After 10 minutes of sleep, but not after 30 seconds of sleep, subjects had profound amnesia on free recall for stimuli presented in the 4-minute window prior to sleep onset. Increased beta electroencephalograph (EEG) power during the sleep period correlated positively with recall of stimuli in the 4-minute presleep window. Event-related potential recordings provided suggestive evidence that subjects continued to process the auditory stimuli to some extent during the sleep onset transition. When allowed to sleep for 10 minutes, subjects evidenced a mixed anterograde and retrograde amnesia for auditory stimuli presented in the 4-minute window prior to sleep onset. The results are discussed in terms of stimulus encoding, consolidation, and retrieval.

This study examined the relationship between alpha sleep and information processing during sleep, perception of sleep, musculoskeletal pain, and arousability in patients with fibromyalgia. Patients (n = 20) were allowed to sleep undisturbed for the first 60 minutes of the study to assess amount of alpha sleep and were classified as high or low alpha generators based on quantitative analyses of alpha activity during this period. The groups were compared for performance on two memory tasks, perceptions of polysomnographically-defined sleep and EEG arousals in response to auditory stimuli. Correlations between symptoms of fibromyalgia and alpha activity were also examined. Alpha activity during sleep in fibromyalgic patients was associated with the perception of shallow sleep and an increased tendency to arouse in relation to auditory stimuli. Alpha activity was not associated with increased memory for auditory stimuli presented during sleep, sleep state misperception, or with myalgia symptoms. Alpha sleep appears to be, electrophysiologically, a shallow form of sleep. Our results suggest that it is perceived as such phenomenologically and that it is also associated with increased arousability.

In this study, we tested the hypothesis that low-level chemical odor intolerance (i.e., "cacosmia") is a manifestation of heightened sensitizability to environmental stimuli. We examined supine heart rate and blood pressure of elderly individuals, who were classified as either having a higher degree of chemical odor intolerance (n = 12) or a lower degree of chemical odor intolerance (n = 13), upon awakening in a sleep research laboratory on 6 different days during an 8-wk protocol. During the 2 initial wk, they consumed a customary baseline diet (including ad lib milk and other dairy products), followed by 3 wk each of nondairy-containing and dairy-containing diets in randomly assigned, counterbalanced order. Measurements were made on 3 pairs of successive days, distributed over a 6-wk period, and on which different diets were consumed. The high-intolerance group had significantly higher mean supine systolic and diastolic blood pressures than did the low-intolerance group. Although subjects consumed milk products during both the initial baseline and subsequent dairy diet periods, the high-intolerance group had significantly higher heart rates and diastolic blood pressures later in the study than at baseline, especially when they were on the dairy diet. In contrast, the cardiovascular measures of the low-intolerance group lowered on average with time. The high-intolerance subjects had an increased mean diastolic blood pressure on the second days versus the first days in the laboratory (averaged across all diets). Collectively, the data suggest that elderly individuals with a high degree of chemical odor intolerance evidence (a) increased sympathetic tone in the cardiovascular system at rest over multiple measurements; and (b) greater sensitizability and/or lesser habituation of heart rate and diastolic blood pressure over time as a function, in part, of repeated environmental stressor exposures (i.e., a novel laboratory contextual setting and/or specific dietary constituents). Consistent with a sensitization model, the findings emphasize the need for two or more identical sessions at least 24 h apart in physiological studies of individuals with a high degree of intolerance for chemical odors versus normal individuals. The results of the blood pressure observations suggest that the possibility of abnormally labile autonomic function and cognitive sequelae in individuals with a high degree of intolerance for chemical odor increases with age.

Heightened psychophysiological reactivity to the novel or unfamiliar is a leading characteristic of sky or behaviorally inhibited individuals. To assess one aspect of the physiological stress response in shyness, the authors compared the morning plasma beta-endorphin levels of 15 extremely sky, healthy elderly individuals with beta-endorphin levels of 15 extremely outgoing persons on three pairs of 2 successive days. The primary finding was that sky participants exhibited significantly higher levels of beta-endorphin on the 1st days of each pair of days, compared with the 2nd days in the laboratory. No main effect for shyness or interaction between shyness and diet on endorphin levels was found. The findings are consistent with a peripheral opioid hyperreactivity to novelty in shy elderly persons. Shyness may constitute a risk factor for panic disorder in younger adults and for nasal allergies and certain cancers in older adults. Experimental design and interpretation of future studies of shy individuals' stress responses may need to consider novelty versus familiarity of the procedures and setting.

Subjective sleep complaints and food intolerances, especially to milk products, are frequent symptoms of individuals who also report intolerance for low-level odors of various environmental chemicals. The purpose of the present study was to evaluate the objective nature of nocturnal sleep patterns during different diets, using polysomnography in community older adults with self-reported illness from chemical odors. Those high in chemical odor intolerance (n = 15) exhibited significantly lower sleep efficiency (p = .005) and lower rapid-eye-movement (REM) sleep percent (p = .04), with a trend toward longer latency to REM sleep (p = .07), than did those low in chemical intolerance (n = 15), especially on dairy-containing as compared with nondairy (soy) diets. The arousal pattern of the chemical odor intolerant group differed from the polysomnographic features of major depression, classical organophosphate toxicity, and subjective insomnia without objective findings. The findings suggest that community elderly with moderate chemical odor intolerance and minimal sleep complaints exhibit objectively poorer sleep than do their normal peers. Individual differences in underlying brain function may help generate these observations. The data support the need for similar studies in clinical populations with chemical odor intolerance, such as multiple chemical sensitivity patients and perhaps certain veterans with "Persian Gulf Syndrome."

This study examined plasma beta-endorphin as a marker of the physiological stress response in community elderly who were either high ( n = 15) or low ( n = 15) in self-rated frequency of illness from environmental chemical odors. Individuals who report nonatopic multiple sensitivities to or intolerances for low levels of environmental chemicals also claim high rates of comorbid food sensitivities or intolerances. Subjects gave 9 am blood samples for plasma beta-endorphin 90 min after ingesting either 1% fat cow's milk or a soy-based nondairy drink, on six different mornings in the laboratory after all-night sleep recordings. The six sessions were divided into three sets of two successive days each, with each set [involving baseline (ad lib milk), nondairy (soy-based), and dairy diets] separated from the next by 3 weeks. In the chemically tolerant subjects, stably lower beta-endorphin levels suggested that milk may have been a physiologically less stressful beverage than was the soy drink. In contrast, the chemical odor intolerant group exhibited a) increased levels of plasma beta-endorphin averaged over the 6 days ( p = .02); and b) marked fiuctuations in endorphin from one laboratory day to the next (Group × Diet × Day interaction, p = .005). The findings were consistent with time-dependent, context-dependent sensitization of beta-endorphin in the chemical odor intolerant individuals.

The report of sleep problems, particularly insomnia, is frequent among older adults. The careful assessment and treatment of sleep problems for older adults is important not only for their sense of well-being but for their physical health and ability to function during the day. A complete understanding of the insomnia experienced by the older adult requires a working knowledge of the structure of sleep and general overview of sleep characteristics, knowledge of how the sleep of the older adult differs from that of younger individuals, and comprehension of the factors that contribute to insomnia. In this chapter, we will provide a brief overview of sleep, with a focus on changes in sleep as one ages. In addition, we will explore the multiple causes of sleep disturbance and report on current behavioral techniques used in the treatment of insomnia. Finally, we will recommend a progression of steps used in the identification of factors impacting on sleep.

The goals of stimulus control instructions are to help the insomniac learn to fall asleep quickly and to maintain sleep. These goals are reached by strengthening the bed as a cue for sleep, weakening it as a cue for activities that might interfere with sleep, and helping the insomniac acquire a consistent sleep rhythm. Although there are many causes of insomnia, poor sleep habits are often an important contributor.

Almost every child experiences a sleep problem at some time while growing up. In many cases the problem is not serious or long-lasting; an occasional poor night of sleep resulting from stress, excitement, or external disturbances is normal and to be expected. In other cases, sleep problems may have significant effects on the child’s normal functioning and general well-being. Furthermore, these problems may have an impact on others as well, notably parents and siblings of the affected child.

We consider Walker's thorough review in the context of thinking about future research on the relation between sleep and memory. We first address methodological issues including type of memory and sleep-stage dependency. We suggest a broader investigation of potential signaling molecules that may be critical to sleep-related consolidation. A brief review of the importance of the stress hormone cortisol illustrates this point.

Nursing homes play an important and controversial role in the community-based care of chronic mental patients. Confronting the reality of this role can help us recognize problems in the rationales for deinstitutionalization and community care. Problems with three concepts that were central to deinstitutionalization are examined--the total institution, institutional neurosis, and social reintegration. Furthermore, two concepts are presented that were overlooked in the haste to initiate deinstitutionalization--custody, asylum, and treatment functions in society; and the role of patient expectations. Finally, suggestions are made about how nursing homes can play a more constructive role in mental health policy.

Studies of deinstitutionalization often use a limited set of criteria by which to judge success. Social integration and recidivism, for example, are particularly popular criteria. Yet such criteria may not reflect the diverse settings in which community care occurs, nor the diverse views of success held by different interest groups. The present study presents a methodology for developing more comprehensive criteria for evaluating social programs, including deinstitutionalization. The methodology is illustrated by analyzing the perceptions of different interest groups about the nature of successful care for mental patients in nursing homes.

Nursing homes play an important role in the community-based care of chronic mental patients, yet there is little research in that setting. The present study gathered and analyzed descriptive data on 20 nursing homes in a large urban area, including data about structure, staffing, policy, treatment, residents, discharge, psychosocial climate, and neighborhood characteristics. Results suggested a clear difference between skilled nursing versus intermediate care facilities, with the latter playing a larger role in caring for mental patients. More important, data suggested such facilities play primarily a custodial rather than treatment role, and that managers expect patients in nursing homes to stay indefinitely. In view of this, our justifications for community care, such as social integration, need to be examined anew.

The character and content of Northwestern's joint program in methodology research and clinical research is described and the subject matter for the core evaluation courses is discussed.

The authors explored self-reports of the social integration of 163 chronically ill psychiatric patients who were admitted to 12 nursing homes over a 1-year period. Results suggest that nursing home care for psychiatric patients is custodial and institutional in character and that the social integration of such patients is generally low. Nursing home patients had lower scores than outpatients but not inpatients on a measure of social participation; they were similar to both these groups on measures of spending and employment. Levels of social integration changed little over 1 year, either for better or for worse.

Forty percent of inpatient psychiatric episodes are treated in general hospitals without psychiatric units, but little is known about these patients and their treatment. A survey of medical records personnel at 452 hospitals without psychiatric units revealed that the hospitals' psychiatric patients typically lived at home, were admitted through the emergency room because of a substance abuse disorder, received active medical treatment, were discharged back home after about four days, and paid with private insurance. The hospitals that treated primarily substance abusers provided a significantly different mix of treatments than did those that treated primarily patients with traditional diagnoses. The data suggest that general hospitals without psychiatric units may provide appropriate treatment for psychiatric patients, especially those with a substance abuse disorder.

Nursing homes play an important role in the care of chronic mental patients, and they could be used as one base on which to build a better system of care. Carling, in his article "Nursing Homes and Chronic Mental Patients: A Second Opinion," appears to question aspects of this contention. His efforts in this regard are interesting but unconvincing, though his thoughtful comments usefully elaborate the problems inherent in trying to incorporate nursing homes into the mainstream of mental health care. He more successfully uses his article to describe the National Plan for the Chronically Mentally Ill, a recent policy proposal of great merit that may some day significantly benefit metal patients. Meanwhile, mental health policy must face the reality that nursing homes are providing useful services to many chronic mental patients who have been inadequately served by current community care programs. This is not likely to change in the foreseeable future. Policy advocates need to attend to practical alternatives, not just to idealized possibilities.

Researchers have become increasingly concerned about problems of the quality of measurement in applied evaluation settings. Of particular importance is change in both the reliability and the validity of a measure that is used in a novel setting. This problem is illustrated by an attempt to use psychiatric rating scales to assess the behavior of chronic mental patients currently residing in nursing homes. Methods for assessing changes in both reliability and validity are presented, along with suggestions for how to deal with these problems.

Contact desensitization, attention placebo, and instructions to simulate the effects of attention placebo were compared in their ability to alleviate fears of rats in college students under brief group therapy conditions. The results were: (a) contact desensitization was highly effective and superior to the groups controlling for expectancy and demand characteristics and to a no-treatment control group; (b) although not performing as well as Ss receiving contact desensitization, role playing Ss effectively simulated improvement on the behavioral approach test; and (c) the expectancy manipulation did not result in significant improvement.

Token economies have been applied in a wide range of settings. While there are several advantages to the use of this procedure, there are obstacles that may impede its implementation and therapeutic efficacy. These include: staff training, client resistance, circumvention of the contingencies, and non-responsiveness of subjects. Studies employing token programs with psychiatric patients, retardates, children in classroom settings, delinquents, and autistic children are reviewed. Although token economies are successful while in operation, the issue of generalization of behavior gains or resistance to extinction has not been given careful consideration. Inasmuch as generalization is perhaps the most crucial issue, several procedures are presented that are designed to facilitate maintenance of performance when reinforcement is withdrawn. Methodological suggestions for investigations on token reinforcement in applied settings are presented.

Two relaxation techniques, progressive relaxation and autogenic training, were evaluated as treatments for insomnia. No-treatment, a baseline control group, and a self-relaxatio n group designed to control for nonspecific therapeutic elements were employed. Subjects were 30 adult insomniacs who had chronic and severe difficulties in falling asleep. As indicated by global measures of improvement and by reduction in time to fall asleep, progressive relaxation and autogenic training were equally effective as treatments and superior to both control groups. At a six-month follow-up, treatment gains had been maintained in time to fall asleep but not in self-reported global improvement, while control subjects showed no spontaneous improvement on either of the measures.

Issues regarding aloneness and loneliness have become increasingly prevalent in recent years as our society has become more urbanized and mobile and as families have become less stable. In this paper, I first discuss some consequences of aloneness, then briefly survey different approaches to loneliness, and finally describe a skill deficit approach and its implications for prevention and treatment.

This article reports a survey of self-reports of well-being by chronic mental patients in nursing homes. Patients reported lower levels of well-being than the general population, but not lower than other socially disadvantaged groups including urban renewal blacks. Nursing home mental patients reported levels of well-being that were generally similar to mental patients in other settings, including day hospital patients, participants in an innovative community care program, and patients receiving traditional hospital and follow-up care. These reports were mostly unrelated to levels of symptomatology or social integration, but were strongly related to patient perceptions of the quality of the environment. Results have important implications concerning the justifications for community care goals like noninstitutional care, reduction of symptomatology, and the fostering of social integration.

The present study attempted a conceptual replication of Valins and Ray (1967), altering certain aspects of their “cognitive desensitization” procedure in order to more closely approximate the systematic desensitization situation. The results failed to replicate Valins and Ray's findings, suggesting that cognitive desensitization may not be a useful model of systematic desensitization.