This article was downloaded by: [Australian National University] On: 21 January 2015, At: 00:08 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
Relaxation and Hypnosis in the Treatment of Insomnia a
a
Dr. Kenneth R. Graham Ph.D. , Gail W. Wright , Wendy J. a
Toman & Charles B. Mark
a
a
Muhlenberg College , USA Published online: 20 Sep 2011.
To cite this article: Dr. Kenneth R. Graham Ph.D. , Gail W. Wright , Wendy J. Toman & Charles B. Mark (1975) Relaxation and Hypnosis in the Treatment of Insomnia, American Journal of Clinical Hypnosis, 18:1, 39-42, DOI: 10.1080/00029157.1975.10403769 To link to this article: http://dx.doi.org/10.1080/00029157.1975.10403769
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
THE AMERICAN JOURNAL OF CLINICAL HYPNOSIS
Volume 18, Number I, July 1975 Printed in U.S.A.
Relaxation and Hypnosis in the Treatment of Insomnia 1.2
Downloaded by [Australian National University] at 00:08 21 January 2015
KENNETH R. GRAHAM, Ph.D., GAIL W. WRIGHT, WENDY J. TOMAN and CHARLES B. MARK Muhlenberg College The study compared the effectiveness of hypnosis and relaxation training in the treatment of insomnia among 22 student volunteers. Using a subjective rating scale, subjects in both the hypnosis and relaxation conditions reported substantial improvement in their sleep problem following training, but objective records showed that only subjects in the relaxation condition achieved a significant reduction in the actual incidence of insomnia. The difference between conditions may have been the result of lower expectation of success on the part of hypnosis subjects.
Although many persons report occasional difficulty in getting to sleep, and some suffer from severe and frequent insomnia, there have been few reports in the psychological literature of attempts to understand or treat the problem. Several studies suggest that procedures involving relaxation may be effective. Geer and Katkin (1966) reported improvement in one case using a variant of systematic desensitization, and Kahn, et al, (1968) employed relaxation training successfully with a group of patients. More recently, Nicassio and Bootzin (1974) compared the effectiveness of two relaxation techniques: progressive relaxation and autogenic training. They found both methods were effective in reducing the time required for subjects to fall asleep. There is a long historical association between hypnosis and sleep. The term itself is derived from the Greek word for sleep, and suggestions to "go to sleep" are often a
part of trance induction techniques. Although electroencephalographic recordings have shown the two states to be distinct (Loomis, et al., 1936), the sleep metaphor of hypnosis is still accepted as useful. Considering this long relationship, the present study was designed to see whether relaxation combined with hypnosis would be a more effective treatment than relaxation alone in cases of insomnia. METHOD
The 5s were 22 Muhlenberg College undergraduate volunteers chosen on the basis of reporting that they required an hour or more to get to sleep at least once a week. Fourteen students participated during the academic year 1972-73, and eight during the year 1973-74. None of the Ss reported using sleeping drugs on a regular basis. The procedure used during the two years was the same. The 5s were enlisted for participation during the fall semester and were asked to keep careful records of their sleep habits during the last 20 school nights of the semester. During the first half of the second semester each 5 participated in four, half-hour training sessions, patterned after autogenic training procedures, that were
1 This paper was presented at the 17th Annual Scientific Meeting of the American Society of Clinical Hypnosis, New Orleans, 1974. 2 Requests for reprints should be sent to: Dr. Kenneth R. Graham, Muhlenberg College, Allentown, Pa. 18104.
39
Downloaded by [Australian National University] at 00:08 21 January 2015
40
GRAHAM ET AL.
defined either as hypnosis or relaxation group. The sessions for all Ss were identical except that half were told the procedure training. Prior to each session, Ss in the hypnosis involved systematic relaxation and the condition were told: "This is the (first, sec- others that it involved self-hypnosis. The ond, third, fourth) of four training sessions tape recorded sessions were administered designed to help you to go to sleep more individually by an experimenter who did quickly through the use of self-hypnosis. not know how severe the S' s insomnia was Several case studies reported by prominent nor his hypnotic susceptibility. At the end of the second semester the S therapists have shown hypnosis to be an effective tool in the treatment of insomnia. was asked to complete another sleep data Indeed, the name 'hypnosis' comes from card for the final 20 school nights of the the Greek word for sleep, and at least one year. About four months after training a important theory regards hypnosis as a state follow-up questionnaire was mailed to each of partial sleep. In the session(s) to follow, S in which he was asked to report on the reyou will practice entering a deep state of sults of the study and present state of his hypnosis which in turn will enable you to sleep problem. Ss were assigned to either the hypnosis relax and go to sleep." Ss in the relaxation condition received or relaxation condition by means of a the following introduction: "This is the matching procedure using ratings of the (first, second, third, fourth) of four training severity of insomnia and the subject's hypsessions designed to help you to go to sleep notic susceptibility as measured by the more quickly through the use of systematic Harvard Group Scale of Hypnotic relaxation. Several published research re- Susceptibility: Form A (Shor and Orne, ports have shown systematic relaxation to 1962). The study by Kahn, et al. (1968) was be an effective tool in the treatment of insomnia. The procedure we will be using is criticized by Eisenman (1970) on the not a form of hypnosis, and you will not grounds that it did not adequately account become hypnotized during any of the train- for S demand characteristics and relied ening. Rather, it involves concentrated re- tirely on the S s' self reports. An attempt laxation in a state of relaxed wakefulness. was made in the present study to meet those In the session(s) to follow you will practice objections by using both subjective ratings systematic relaxation which in turn will en- and more objective sleep records. The S was also asked to estimate how much he able you to relax and go to sleep." Each training session consisted of 10-15 expected to improve before and after the minutes of general relaxation instructions first training session. followed by instructions to concentrate on RESULTS one part of the body: the right arm, left On the post-training questionnaire eachS arm, right leg, and left leg. The S was instructed to practice the relaxation exercises was asked to rate the severity of his sleep at home, between sessions, and after train- problem prior to training, immediately after ing for the remainder of the semester. The training, and after six months. The ratings general instructions for relaxation were were made by circling a number on a ten adapted from the Stanford Hypnotic Suscep- point scale with 10 representing maximum tibility Scale: Form C (Weitzenhoffer and severity. Analysis of the subjective ratings Hilgard, 1962). Sugge stions to "go to revealed that S s in both conditions reported sleep" or become hypnotized were substantial improvement in their sleep probchanged to "relax" for the relaxation lem. (Table 1) On the average, the rated
41
TREATMENT OF INSOMNIA
TABLE 1 IMPROVEMENT OF INSOMNIA ACCORDING TO OBJECTIVE AND SUBJECTIVE MEASURES
Downloaded by [Australian National University] at 00:08 21 January 2015
Treatment Condition
Objective Scores (Proportion of nights insomnia occurred, N = 16) Pre-Training Post-Training t test
Subjective Scores (Subjects ratings of insomnia severity on 10 point scale, (N = 21) t test Pre-Training Post-Training
Hypnosis mean S. D.
.23 .21
.12 .12
ns.
5.9 1.9
3.1 1.7
P
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
Relaxation and Hypnosis in the Treatment of Insomnia a
a
Dr. Kenneth R. Graham Ph.D. , Gail W. Wright , Wendy J. a
Toman & Charles B. Mark
a
a
Muhlenberg College , USA Published online: 20 Sep 2011.
To cite this article: Dr. Kenneth R. Graham Ph.D. , Gail W. Wright , Wendy J. Toman & Charles B. Mark (1975) Relaxation and Hypnosis in the Treatment of Insomnia, American Journal of Clinical Hypnosis, 18:1, 39-42, DOI: 10.1080/00029157.1975.10403769 To link to this article: http://dx.doi.org/10.1080/00029157.1975.10403769
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
THE AMERICAN JOURNAL OF CLINICAL HYPNOSIS
Volume 18, Number I, July 1975 Printed in U.S.A.
Relaxation and Hypnosis in the Treatment of Insomnia 1.2
Downloaded by [Australian National University] at 00:08 21 January 2015
KENNETH R. GRAHAM, Ph.D., GAIL W. WRIGHT, WENDY J. TOMAN and CHARLES B. MARK Muhlenberg College The study compared the effectiveness of hypnosis and relaxation training in the treatment of insomnia among 22 student volunteers. Using a subjective rating scale, subjects in both the hypnosis and relaxation conditions reported substantial improvement in their sleep problem following training, but objective records showed that only subjects in the relaxation condition achieved a significant reduction in the actual incidence of insomnia. The difference between conditions may have been the result of lower expectation of success on the part of hypnosis subjects.
Although many persons report occasional difficulty in getting to sleep, and some suffer from severe and frequent insomnia, there have been few reports in the psychological literature of attempts to understand or treat the problem. Several studies suggest that procedures involving relaxation may be effective. Geer and Katkin (1966) reported improvement in one case using a variant of systematic desensitization, and Kahn, et al, (1968) employed relaxation training successfully with a group of patients. More recently, Nicassio and Bootzin (1974) compared the effectiveness of two relaxation techniques: progressive relaxation and autogenic training. They found both methods were effective in reducing the time required for subjects to fall asleep. There is a long historical association between hypnosis and sleep. The term itself is derived from the Greek word for sleep, and suggestions to "go to sleep" are often a
part of trance induction techniques. Although electroencephalographic recordings have shown the two states to be distinct (Loomis, et al., 1936), the sleep metaphor of hypnosis is still accepted as useful. Considering this long relationship, the present study was designed to see whether relaxation combined with hypnosis would be a more effective treatment than relaxation alone in cases of insomnia. METHOD
The 5s were 22 Muhlenberg College undergraduate volunteers chosen on the basis of reporting that they required an hour or more to get to sleep at least once a week. Fourteen students participated during the academic year 1972-73, and eight during the year 1973-74. None of the Ss reported using sleeping drugs on a regular basis. The procedure used during the two years was the same. The 5s were enlisted for participation during the fall semester and were asked to keep careful records of their sleep habits during the last 20 school nights of the semester. During the first half of the second semester each 5 participated in four, half-hour training sessions, patterned after autogenic training procedures, that were
1 This paper was presented at the 17th Annual Scientific Meeting of the American Society of Clinical Hypnosis, New Orleans, 1974. 2 Requests for reprints should be sent to: Dr. Kenneth R. Graham, Muhlenberg College, Allentown, Pa. 18104.
39
Downloaded by [Australian National University] at 00:08 21 January 2015
40
GRAHAM ET AL.
defined either as hypnosis or relaxation group. The sessions for all Ss were identical except that half were told the procedure training. Prior to each session, Ss in the hypnosis involved systematic relaxation and the condition were told: "This is the (first, sec- others that it involved self-hypnosis. The ond, third, fourth) of four training sessions tape recorded sessions were administered designed to help you to go to sleep more individually by an experimenter who did quickly through the use of self-hypnosis. not know how severe the S' s insomnia was Several case studies reported by prominent nor his hypnotic susceptibility. At the end of the second semester the S therapists have shown hypnosis to be an effective tool in the treatment of insomnia. was asked to complete another sleep data Indeed, the name 'hypnosis' comes from card for the final 20 school nights of the the Greek word for sleep, and at least one year. About four months after training a important theory regards hypnosis as a state follow-up questionnaire was mailed to each of partial sleep. In the session(s) to follow, S in which he was asked to report on the reyou will practice entering a deep state of sults of the study and present state of his hypnosis which in turn will enable you to sleep problem. Ss were assigned to either the hypnosis relax and go to sleep." Ss in the relaxation condition received or relaxation condition by means of a the following introduction: "This is the matching procedure using ratings of the (first, second, third, fourth) of four training severity of insomnia and the subject's hypsessions designed to help you to go to sleep notic susceptibility as measured by the more quickly through the use of systematic Harvard Group Scale of Hypnotic relaxation. Several published research re- Susceptibility: Form A (Shor and Orne, ports have shown systematic relaxation to 1962). The study by Kahn, et al. (1968) was be an effective tool in the treatment of insomnia. The procedure we will be using is criticized by Eisenman (1970) on the not a form of hypnosis, and you will not grounds that it did not adequately account become hypnotized during any of the train- for S demand characteristics and relied ening. Rather, it involves concentrated re- tirely on the S s' self reports. An attempt laxation in a state of relaxed wakefulness. was made in the present study to meet those In the session(s) to follow you will practice objections by using both subjective ratings systematic relaxation which in turn will en- and more objective sleep records. The S was also asked to estimate how much he able you to relax and go to sleep." Each training session consisted of 10-15 expected to improve before and after the minutes of general relaxation instructions first training session. followed by instructions to concentrate on RESULTS one part of the body: the right arm, left On the post-training questionnaire eachS arm, right leg, and left leg. The S was instructed to practice the relaxation exercises was asked to rate the severity of his sleep at home, between sessions, and after train- problem prior to training, immediately after ing for the remainder of the semester. The training, and after six months. The ratings general instructions for relaxation were were made by circling a number on a ten adapted from the Stanford Hypnotic Suscep- point scale with 10 representing maximum tibility Scale: Form C (Weitzenhoffer and severity. Analysis of the subjective ratings Hilgard, 1962). Sugge stions to "go to revealed that S s in both conditions reported sleep" or become hypnotized were substantial improvement in their sleep probchanged to "relax" for the relaxation lem. (Table 1) On the average, the rated
41
TREATMENT OF INSOMNIA
TABLE 1 IMPROVEMENT OF INSOMNIA ACCORDING TO OBJECTIVE AND SUBJECTIVE MEASURES
Downloaded by [Australian National University] at 00:08 21 January 2015
Treatment Condition
Objective Scores (Proportion of nights insomnia occurred, N = 16) Pre-Training Post-Training t test
Subjective Scores (Subjects ratings of insomnia severity on 10 point scale, (N = 21) t test Pre-Training Post-Training
Hypnosis mean S. D.
.23 .21
.12 .12
ns.
5.9 1.9
3.1 1.7
P
