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A Comparison of Stimulus Control and Symptom Prescription Procedures for the Treatment of Sleep-Onset Latency Insomnia

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A Comparison of Stimulus Control and Symptom Prescription Procedures for the Treatment of Sleep-Onset Latency Insomnia Chadian Theses Sewke Sewice des theses eanadiennes -$ Ottawa. Canada KIA ON4 . *. d NOTICE The quality of this microformis heavily dependent upon the La qualit6 de cette microforme dep& grandement de la quality of the original thesis submitted for microfilmiog. qualit6 de la these soum'ise au microfilmage. Nous avons , Every effort has been made to ensure the highest quality of tout fait pour assurer une qualit6 sup6rieure de reproduc- reproduction possible. tion. ., 11 pages are missing, contact the university which granted S'il manque des pages, veuillez communiquer avec the degree. I'universitd qui a confer6 le grade. Some pages may have indistipct print especially if fhe La qualit6 d'impression de certaines pages peut laisser A original pages w-ere typed with a poor typewriter ribbon or desirer, surtout si les pages originales ont kt6 dactylogra- if the university gent us an inferior photocopy. phi6es a I'aide d'un mban us6 ou si I'universit6 nous a fait . parvenir une photmpie de qualit6 inf6rieure.: - Reproduction in full or in part of this microformis ovemed La reproduction, meme partielle, de cette microforme est by the Canadian Copyright Act, F4.S.C. 1970, c. 2-30, and soumise a la Loi canadienne sur le droit d'auteur, SRC subsequent-amendments. 1970, c. C-30, et ses amendements subs&quents. ' A COMPARISON OF STIMULUS CONTROL AND SYMPTOM PRESCRIPTION , - PROCEDURES FOR THE TREATMENT OF SLEEP-ONSET LATENCY INSOMNIA Mark D. Goheen B.A. (Hons.), Simon Fraser University, 1984 i -3 ,b -*. A THESIS SUBMllTED IN PARTIAL FULFILLMENT OF 1 .F- a THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS (EDUCATION) / I a i C Mark D. Goheen I988 0 * SIMON f RASER UNIVERSITY August 1988 All rights reserved. This work may not be reproduced in whole or in part, by photocopy or other means, without permission of the author. t * National Library . Bibliotmue nationale 1+1 of Canada du Canada Service des theses canadiennes 1 Ottawa. Canada KIA ON4 The author ha.s granted an irrevocable noin- L'auteur a accorde une licence irrevacable et exclusive licence allowing the National Library non exclusive permettant a la Bibliolht3que ' of Canada to reproduce, ban, distribute or sen - nationale du Canada reproduire, prdter, de " copies of hislher thesis by any means and TI distribuer ou vendre des copies de sa these any form or format, making this thesis avalaMe de quelque maniere et sous quelque forme to interested persons. - que ce soit pour mettre des exemplaires de cette th$se a la disposition des personnes interessees. The author retains ownership of thacopyrigflt L'auteur qnserve la propti&& du droit d'auteur in hidher thesis. Neither the thesis nor qui prot&e sa Wse: Ni la these ni des extraits substantial extracts from it may be printed or substantiels de celled ne doivent &re otherwise reproduced without hislher per- imprimes ou autrement reproduits sans son mission. autorisation. ISBN 0-315-59340-7 Departmentpf Physical Medicine Dodd Hall 471 Dodd Drive ~olurnbus,OW 43210-1299.; ' Phone 614-293-3801 /' December 13,1988 Mark Goheen ' . Faculty of Education Simon Fraser University Burnaby, B.C. Canada V5A 1S6 Dezw Mr. Goheen: This letter is to reanfirm my earlier permissim for you to vs'bthe W-Sfor your research. I congratulate you on the completion of your thesis. and I am more than happy to grant permission to the National Library to copy the CRF-S as they see fit. ', Again, congratulations. b I Sincerely, John B'Corrigan, PhJ). Associate Professor Depart f cdu& t~ona~~sychology STATE uNlvMsm _ and ~eallershrpSfurlres * bP=Kent 0th 44242-0001 . Mark Goheen Facul ty of Education Simon Fraser University Burnaby, B.C. Canada V5A156 - 0 Dear Mr. Goheen: As you requested, I am providing yod yi th this letter giving you my permissioF to clse the Therapeutic Reactance Scale for your research. I would appreciate receiving a copy o+ your article when it, is ready. In fact, if you have a copy of the abstract of your thesis that you could send me now, I would appreciate it. Sihcerel y, E. Thomas Dowd, Ph. D. Professor and Director of Counsel'i ng Psycho1 ogy DNIVERSITY OF WASHINGTON . S~TTLE,WASHINGTON 98 195 . 9 s&w/ v~urrin~,SCL~G~ * Department of Psychosorial Nursing 006)343-6960 Mark Goheen " ~aculty~ofg ducati ion * Simon Fpser University Buraaby, B.C. CANADA V5A 1S6 Dear Mark:- Ypu haye our permission to allow the National Library to copy the Symptoms of Stress Inventory as needed. Congratulations on the completion of your thesis. Good luck for Yhe future. Helen Nakagawa-Kogan, ld.,Ph.D. Profes~or,~Psychosocial~ursing HNK: ts Name: Mark D. Goheen Degree: , Master of Arts (Education) Title of Project: A Com.parison Of Stimulus Control And Symptom Prescription Procedures For:The Treatment Of Sleep-Onset Latency lnsmmnia - Examining Committee: . Chair: Cornel M. Hamm -- -- -- - Adam Horvath Senior Supervisor - / " ~on\ldW. Mary Professor Dr. Varda S4hoham-Salomon Departmerit of Psychology University of Arizona Tucson, Arizona 85721 External Examiner Date Approved . 2 5-/ /'Pkd PARTIAL^ COPYRl GHT L l CENSE I herdby grant to Simon Fraser University the right to lend my thisis, probqt/or extended essay (the title of which is shown below) to users of tde $ipon,~raser univeisity Library, and to make partial or J '_ i- single copies .only/ for such' users or in response to a request from the . I ibrary of any other _university, or .other educat iopl institdiion, on - % .. its own behalf or for oneJof its users. I further agree that permission I for mu1 tiple copyi(ng of this work foi scholarly purposes may be granted I * by me or the Dean of Graduate Studi.es.- It is understood that copying or publication of this work for finapcial gain, shall not be'allohed without my written permission. Title of,Thesis/Project/Extended Essay / L- . A Comparison of Stimulus ~.ontroland Symptom ~rescr~~t~on. _ 6 Procedures for the Treatment of Sleep-O~setLatency Insomnia AU t hor : , , (signLture) Mark D. Goheen (name) -, - 1 * ' (date) Abstract 0 . ' . I - . ~aradoxi&lstrategies, such as symptom pre&ription, are claimed to be the .' treatment of choice with clients who tend not-to comply with intervention-instructions. I i. I This study investigated the relationshp between psycbdogical. reactance and . w intervention outcome using writt~,selfhelp symptom prescription and stimulus 0 - control procedures for difficulties falling asleep. Psychological reactance is described a; a predisposition to respond to threats ti one's freedom or autonomy * with non-compliant or "resistant" betiaviour. lnbaddition, levels of stress, levels of 6 . * client's perception*of the social influence qualities,of the counsellar, and levels of . ,counsellor-client alliance were each correlated with intervention outcome. .. Forty-one subjects.participatecl in three, seven-day experimental phases , A (baseline, two treatment phasbs). Twenty of the subjects keceived a one-hour counselling interview plus &her $written symptom prescription procedure or a written stimulus control procedure. Twenty-one of the subjects received one of the' two written interventions, but no co,unselling interview. ; ' * Six research predictions were formulafed: One, psychological reactance would be less negatively related to treatment outcome in the symptom prescription condition than in the stimulus control condition. Two, irrespective of intervention . type, there would be sbnificant overall reductions in time to sleep onset. Three, there would not be reliable differences in magnitude of treatment effect between the 'L two interventions. Four, the client's perception of social influence quallaies of the counsellor and tAe level of counsellor-client alliance. would each be*more positively related tontreatment outcome:in the symptom prescription condition than in the ,Y stimulus control condition. Five, regardless Of interventiondype, level of stress would be negatively associated with reduction in time to sleep-onset. Six, stress would be 1, less negatively related to-treatment outcome in the symptom prescription condition . , relative to the stimulus control condition. t - r d third The results suhort the first, second, and predictions.- Significant - reductionsr& time to sleep onset were observed for all conditions, however reactance was positively associated with reductions in time to sleep onset-in the * syrqptom prescription-condition, but reactance was negatively associated with - reductions in the ~timuluscontrol conditioTi, There-were, except in terms of K A' reactance, no reliable treatment effect differences between the two interventions. -0 These findings suggest that both interventions facilitate reductions in time to sleep P 6r 6 onset, yet syAptom prescription iisuperior for reactant clientele. The fou?h, fifth, and i sixth predictions we're not supported. Neither stiess nor quality of the copnseltor- . client relationship were significantly associated with treatment- effect. ,, I am indebted to the entire committee -- Adam Horvath, Ron Man, and Varda - < .- ,/ . ~hohark~olomon-- for-their time and ekpertise. Particular appreciation is extended & . to Adam Hqrvath who devoted untold hours gJiding me towards some semblance of o* '9 - clarity. I thank avid Lingley for ihe-stimulating ideas and discussion which were 0 0 -+ - in-strumental in the developmegt of this study. Glen Grunau and Suzanne Kyra, . -thank you! Your suhort and humour, and the interviews that you performed made t. t. the difference. Evelyn, love'and tolerance-are just two of the many diamonds.in your 1 * -. universe. " -. ' .. Title Page - -:i Approval Page ii Abstract I i ii Acknowledgements v I - Table of Contents List of Tables - ,. 4 ix ..I->. List of ~i~ires X Chapter I: Introduction .. 1 w Organizer - I \ 1 \ Th-e Problem x~ * 1 *. Issue 1 ,4 " Issue 2 , 6 Issue 3 7 * Issue 4 .8 ~~potheses Chapter II: Review of the Literature 10 Towards a definition of paradoxical Interventions - 10 Mechanisms Accounting for Paradoxical Phenomenon 14 9 Anticipatory anxiety .I5 Attributions 16 Double binds 17 3 (\ = Qeframing/Decontextua!ization 18 ~xperi6entallnvestigations of Paradoxical Interventions .,.
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