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In addition, all hypnotics carry some risk of dependence, particularly with prolonged usage The primary indication for hypnotic medications is for situational sleep dif culties; their role in the clinical management of recurrent or chronic insomnia is still controversial Psychological Therapies More than a dozen psychological interventions (mostly cognitive-behavioral in content) have been used for treating insomnia Treatment modalities that have been adequately evaluated in controlled clinical trials include stimulus control therapy, sleep restriction, relaxation-based interventions, cognitive therapy, and sleep hygiene education The main focus of these treatments is to alter the presumed perpetuating factors of chronic insomnia As such, they seek to modify maladaptive sleep habits, reduce autonomic and cognitive arousal, alter dysfunctional beliefs and attitudes about sleep, and educate patients about healthier sleep practices (see Table 143) As for most cognitive-behavioral interventions, the format of insomnia treatment is structured, short-term, and sleep-focused.



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Treatment duration typically lasts 4 to 6 hours and is implemented over a period of 4 to 8 weeks A summary of these treatments is provided below; more extensive descriptions are available in other sources (Espie, 1991; Hauri, 1991; Lichstein & Morin, 2000; Morin, 1993) Relaxation-Based Interventions Relaxation is the most commonly used nondrug therapy for insomnia Among the available relaxation-based interventions, some methods (eg, progressive-muscle relaxation, autogenic training, biofeedback) focus primarily on reducing somatic.

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Neo-Analytic Models Following Freud s 1909 Clark University lectures, psychoanalysis attracted large numbers of adherents from within the medical and lay communities. At rst, these adherents followed Freud s ideas with little questioning and minimal resistance. By the early 1920s, however, competing schools of psychoanalytic thought were beginning to emerge both in Europe and in America. At rst, the growth of these alternative psychodynamic frameworks was inhibited by Freud s strong personality and by the immense international popularity of psychoanalytic theory (Hilgard, 1987; Torrey, 1992). It was only upon Freud s death in 1939 that competing psychoanalytic perspectives blossomed into full- edged theories in their own right. By the mid-1940s, the discipline had splintered into an array of divergent theoretical perspectives. This splintering process, which has continued (albeit in a somewhat abated form) to the present day, is summarized graphically in Figure 5.2. As Figure 5.2 shows, each post-Freudian psychodynamic model was rooted in classical psychoanalytic theory, but each drew upon ideas and ndings from other areas of psychology as well.

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SOCIAL RELATIONSHIPS AND PSYCHONEUROIMMUNOLOGY Psychoneuroimmunology research focusing on social relationships originated from a larger literature on the relationships between social support and health. Cassel (1976) and Cobb (1976) provided important theoretical and empirical integration of social support and health research, concluding that social support was positively associated with health outcomes. Following the publication of these reviews, research on social support and health experienced geometric growth (House, Landis, & Umberson, 1988). In particular, epidemiological studies showed that lower social integration (lower number of social relationships and activities) was consistently associated with higher risk of mortality, independent of age, physical health, and a number of other health behavior risk factors (Berkman & Syme, 1979; House, Robbins, & Metzner, 1982; Schoenbach, Kaplan, Fredman, & Kleinbaum, 1986). In their seminal review of this work, House et al. (1988) concluded that social relationships, or the relative lack thereof, constitute a major risk factor for health rivaling the effects of well-established health risk factors such as cigarette smoking, blood pressure, blood lipids, obesity, and physical activity (p. 541). The underlying theme of psychoneuroimmunology and social support research is that positive support

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, & Johnson, M A (1992) Personality, life events and coping in the oldestold International Journal of Aging and Human Development, 34, 19 30 Matthews, K A, & Cauley, J A (1999) Menopause and midlife health changes In W R Hazzard, J P Blass, W H Ettinger, J B Halter, & J G Ouslander (Eds), Principles of geriatric medicine and gerontology (pp 179 189)New York: McGraw-Hill Matthews, K A, Wing, R R, Kuller, L H, Meilahn, E N, & Owens, J F (2000) Menopause as a turning point in midlife In S B Manuck, R Jennings, B S Rabin, & A Baum (Eds), Behavior, health and aging (pp 43 56) Mahwah, NJ: Erlbaum McArdle, J J, & Hamagami, F (1991) Modeling incomplete longitudinal and cross-sectional data using latent growth structural equation models In L M Collins & J L Horn (Eds.

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