Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions.

Fifty-five insomniacs, 60 years or above, participated in a behavioral treatment program, comparing two interventions (sleep hygiene+stimulus control vs sleep hygiene+relaxation tape). Half of the subjects were randomized to a waiting-list condition prior to treatment. No significant changes were observed during the waiting-list period. During the treatment period however, the subjects improved on several sleep parameters, and treatment gains were maintained at a 6-month follow-up. The effects of treatment were greater for nocturnal measures (e.g. sleep onset latency and total sleep time) as compared to daytime measures (e.g. life satisfaction, daytime alertness) and not-targeted behavior (medication use). There were no differences in treatment effects for the two interventions.

Prevalence of insomnia in the adult Norwegian population.

A representative adult sample (18 years and above) of the Norwegian population, comprising 2001 subjects, participated in telephone interviews, focusing on the one-month point prevalence of insomnia and use of prescribed hypnotics. Employment of DSM-IV inclusion criteria of insomnia yielded a prevalence rate of 11.7%. Logistic regression analysis performed on the different insomnia symptoms revealed that somatic and psychiatric health were the strongest predictors of insomnia, whereas gender, age, and socioeconomic status showed a more inconsistent relationship. Use of prescribed hypnotic drugs was reported by 6.9% and was related to being female, elderly, and having somatic and emotional problems. Sleep onset problems and daytime impairment were more common during winter compared to summer. Use of hypnotics was more common in the southern (rather than the northern) regions of Norway. For sleep onset problems a Season x Region interaction was found, indicating that the prevalence of sleep onset problems increased in southern Norway from summer to winter, while the opposite pattern was found in the northern regions. The importance of clinically adequate criteria and seasonal variation in the evaluation of insomnia is briefly discussed.

The effects of group psychological debriefing on acute stress reactions following a traffic accident: a quasi-experimental approach.

The purpose of this study was to evaluate the effects of a Group Psychological Debriefing (GPD) on acute stress reactions and perceptions following a traumatic situation. A group of military personnel (N = 9) and a group of voluntary civilian firefighters (N = 9) were exposed to severe stress during rescue work in a tunnel following a fatal traffic accident. Both groups participated in an operational debriefing and received brief stress management counseling after the incident. In addition the military personnel also participated in a structured 2.5 hour GPD after the accident. Two weeks later both groups completed the Coping Style Questionnaire (CSQ-30), the Impact of Event Scale (IES), the Post Traumatic Symptom Scale (PTSS-10), the General Health Questionnaire (GHQ-30) and questions about stress and coping after the incident. Lower frequency of symptoms were found in the GPD compared to the non-debriefed group measured by the PTSS-10. Single item analyzes of the scale revealed lower levels of symptoms related to emotional arousal in the GPD participants. Furthermore, the GPD participants revealed more positive personal outcomes than the non-debriefed group after the accident. The total PTSS-10 score and mental preparedness were the two variables that were best able to classify participants as belonging to the two groups, thus indicating significant clinical differences between the debriefed and non-debriefed group and the potential usefulness of PTSS-10 scale as a brief screening inventory after traumatic events.

Sex differences in judgement of facial affect: a multivariate analysis of recognition errors.

The present paper investigated recognition errors in affective judgement of facial emotional expressions. Twenty-eight females and sixteen males participated in the study. The results showed that in both males and females emotional displays could be correctly classified, but females had a higher rate of correct classification; males were more likely to have difficulty distinguishing one emotion from another. Females rated emotions identically regardless of whether the emotion was displayed by a male or female face. Furthermore, the two-factor structure of emotion, based on a valence and an arousal dimension, was only present for female subjects. These results further extend our knowledge about gender differences in affective information processing.

Phasic heart period reactions to cued threat and nonthreat stimuli in generalized anxiety disorder.

The hallmark of generalized anxiety disorder (GAD) is chronic uncontrollable worry. A preattentive bias toward threat cues and hypervigilance may support this ongoing state of apprehension. A study was conducted to bridge the attentional and physiological underpinnings of GAD by examining phasic heart period (HP) responses to cued threat and nonthreat stimuli. Thirty-three GAD clients and 33 nonanxious control participants engaged in an S1-S2 procedure that employed cued threat and nonthreat word stimuli, during which phasic HP reactions were recorded. As compared with the control group, the GAD group showed (1) smaller cardiac orienting responses and impaired habituation of cardiac orienting to neutral words, (2) HR acceleration in response to threat words, and (3) a conditioned anticipatory HR deceleration to threat words over repeated trials. The cardiac-autonomic underpinnings of GAD appear to rigidly maintain precognitive defensive responses against threat. This portrayal is discussed in the context of an integrative model that depicts diminished global adaptive variability in GAD.

Measuring post-traumatic stress: a psychometric evaluation of symptom--and coping questionnaires based on a Norwegian sample.

The purpose of this study was to evaluate the psychometric characteristics of the Norweigian versions of the Impact of Event Scale, the Post Traumatic Stress Scale-10 item version and General Coping Questionnaire-30 item version. A group of 40 male and 56 female medical students was tested one week and four months after having started dissection of cadavers for the first time. The results showed that all scales had good internal consistency and test-retest reliability. The student sample scored lower on the IES and PTSS-10 than comparable groups of traumatized subjects. A gender difference emerged, with female subjects scoring higher than male subjects. The factor analysis of the instruments indicated good construct validity for the symptom scales. The analysis of content validity related to DSM IV criteria indicated that the IES and PTSS-10 may have some limitations in their predictive validity of PTSD. Taken together, the three scales have shown good psychometric properties and could be used in future research and clinical work.

Coping strategies and mental health problems in a military unit.

The aim of the present study was to investigate the effect of different coping styles on the development of self-reported mental health problems in a radically changing context. This was investigated, using a longitudinal design, by following soldiers from before entering service to 8 months of service. Based on their scores on the 30-item General Coping Questionnaire, soldiers were allocated to one of three groups: those whose coping styles were emotional, avoidance, or task focused. These three groups were assessed four times. The General Health Questionnaire (30-item version), Ursin's Health Inventory, and the Alcohol Use Disorders Identification Test (AUDIT) were used as dependent measures. Avoidance-focused soldiers reported an increase in General Health Questionnaire scores over time. Furthermore, the avoidance-focused copers revealed higher scores on the AUDIT questionnaire as well as an increase in AUDIT scores over time. The present study showed that there was an interaction of personality variables and contextual factors involved. More specifically, young subjects with a preference for an avoidance-focused coping strategy are at greater risk of experiencing symptoms of mental health problems compared with task-focused and emotion-focused subjects when exposed to a radically changing environment.

Posttraumatic stress symptoms in nonexposed, victims, and spontaneous rescuers after an avalanche.

A company from the Norwegian Army was investigated 2 weeks and 4 months after they were hit by an avalanche during a winter exercise. The subjects were divided into victims, spontaneous rescuers, and nonexposed subjects. The results showed that exposed subjects (victims and rescuers) reported higher levels of symptoms compared to nonexposed subjects. No differences were found among exposed subjects. The level of symptoms was also higher than comparable previous research both on victims and professional rescuers or nonprofessionals assigned a role as rescuers. All groups showed decrement in symptoms on the 4-month follow-up.

Attentional bias in active smokers, abstinent smokers, and nonsmokers.

Attentional bias was studied with a modified version of the Stroop test in active smokers, abstinent smokers, and nonsmokers. The task was color-naming of incongruent color-words, smoking-related words, and neutral words. The results showed that the active smokers used longer verbal reaction time (VRT) to smoking-related words compared to abstinent smokers, i.e., indicating stronger attentional bias in the active smokers. Furthermore, longer VRTs to the Stroop words compared to the smoking words and the neutral words were found only in nonsmokers and abstinent smokers. Finally, a significant negative correlation was found between attitudes against smoking and VRTs to the smoking-related words. Taken together the main finding was that the active smokers showed no differential response to the stimuli. This could be caused by a lack of ability to modulate attentional processes in active smokers.

[Organisation of psychosocial support--experiences from two accidents in the Norwegian Armed Forces]. / Organisering av psykososialt støttearbeid--erfaringer fra to ulykker i Forsvaret.

Military units are designed and trained to operate under stress, crisis and combat. In peacetime conditions the military organization can be subject to unforeseen crisis situations, including fatal accidents during training and exercises. Such critical incidents will affect personnel, leadership, morale and organizational performance. It may also affect the relationship between the military unit and the civilian community. Recent experience has shown that good leadership, personnel support and organizational restructuring are essential elements in the recovery after critical incidents and peacetime disasters. The present study outlines a systematic approach to crisis management in formal organizations. This includes a descriptive analysis of individual and organizational interventions in two military organizations; an army unit of 150 men and a naval unit of 114 men.

Brain asymmetry and autonomic conditioning: sensitization control.

In the present experiment we report effects of cerebral asymmetry, or laterality, during classical conditioning to facial emotional stimuli. Twenty-five female subjects were presented with slides of a happy face in one visual half-field (VHF), and simultaneously a slide of an angry face in the other VHF, followed by shock as the unconditioned stimulus (UCS). To control for effects of sensitization, a new stimulus, never associated with the UCS, was introduced in the extinction phase. Dependent measures were phasic heart rate responses (HR) and skin conductance responses (SCR). The HR results showed a significant right hemisphere effect for the CS-UCS association, that was not attributable to UCS sensitization. No significant effects were found for the SCRs. The basic HR finding was a right hemisphere superiority for learning of a conditioned association.

Hemispheric asymmetry and human associative learning: interactions with attention.

In a previous study (Hugdahl & Brobeck, 1986) it was shown that Pavlovian conditioning to an auditory verbal conditioned stimulus (CS) initially presented only to the left cerebral hemisphere was stronger than when the same CS was presented to the right hemisphere. This was followed up in the present study by controlling for the possibility that the effect was caused by laterally biased attention. The study was performed using the "dichotic extinction paradigm," which consists of three different phases. During the habituation phase, the CS+ and CS- were presented binaurally and separated in time. During the acquisition phase, the CS+ was followed by a white-noise unconditioned stimulus (UCS). During the dichotic extinction phase, the CS+ and CS- were presented dichotically, i.e., simultaneous presentations on each trial. Half of the subjects had the CS+ in the right ear, and half had the CS+ in the left ear. Each group was further divided into two subgroups, with one subgroup instructed to attend only to the right ear input, and the other subgroup to attend only to the left ear input. During acquisition, larger electrodermal responses were obtained to the CS+ than to the CS-. During dichotic extinction, the CS+ right ear group showed superior resistance to extinction compared to the CS+ left ear group, with no effect of the manipulation of attention. The effect was, however, attenuated when levels of acquisition was used as covariates in an analysis of covariance. There were overall larger responses from the left hand recording.

Cerebral asymmetry in autonomic conditioning to facial expressions: sex differences.

In the present experiment, sex differences in hemispheric asymmetry during classical conditioning to emotional stimuli are reported. 125 subjects (62 females and 63 males) were shown a slide of a happy face in the right (or left) visual half field (VHF), and simultaneously a slide of an angry face in the left (or right) VHF. Eight groups were formed by the combination of male and female subjects; left and right VHF positions of the angry/happy faces; and the administration/omission of the shock unconditioned stimulus (UCS). Dependent measures were skin conductance responses recorded from both hands. The results during extinction showed a significant larger SCR magnitude to the shock compared to the no-shock groups only for the female subjects. CS position during conditioning was also important in revealing differential responding to either the happy or angry faces. A right hemisphere effect was found for the angry face CS for both the male and female subjects, however with a greater difference for the females.

Laterality for facial expressions: does the sex of the subject interact with the sex of the stimulus face?

Seventy right-handed subjects (35 males and 35 females) were shown lateralized pictures of negative, neutral, and positive facial emotional expressions. For each emotional category, half of the pictures were of a male face showing the emotion, half were of a female face. The pictures were shown in the left visual half-field for half of the trials and in the right half-field for the other half of the trials. The question addressed was whether the sex of the stimulus face interacts with the sex of the subject for hemisphere differences in perception of facial emotions. Response accuracy and reaction time were measured. The pictures were shown from a slide projector with a high-speed shutter mounted to the lens to allow for tachistoscopic presentations. The results showed that the right hemisphere was more accurate and faster than the left in recognizing the stimulus faces, and that positive emotions were overall more easily recognized. The lack of a significant interaction between sex of the stimulus and sex of the subject indicates that these two factors are not interrelated or confounded in laterality research.

Right hemisphere representation of autonomic conditioning to facial emotional expressions.

In this experiment, a lateralized right hemisphere effect was found for electrodermal associative learning to facial emotional expressions. Sixty-two subjects were presented simultaneously with a slide of a happy face in the right or left visual half field (VHF) and a slide of an angry face in the opposite VHF. Four groups were formed by the combination of the two VHF positions of angry/happy faces and the administration/omission of shock unconditioned stimuli. The results showed that simultaneous presentation of the angry face to the right hemisphere and the happy face to the left hemisphere, together with shock, resulted in a strong conditioned association with the angry face and a relatively weak association with the happy face. Furthermore, simultaneous presentation of the angry face to the left hemisphere and the happy face to the right hemisphere, together with shock, resulted in a relatively weak association with both stimuli. No significant differences were found for the no-shock control groups. The present results confirm previous findings of a right hemisphere advantage for representation of associative learning.

Hemispheric asymmetry in conditioning to facial emotional expressions.

In the present experiment, we report a right hemisphere advantage for autonomic conditioning to facial emotional expressions. Specifically, angry, but not happy, facial expressions showed significantly more resistance to extinction when presented initially to the right as compared to the left hemisphere. Slides of happy and angry faces were used as conditioned stimuli (CS+ and CS-) with shock as the unconditioned stimulus (UCS). Half of the subjects (n = 15) had the angry face as CS+ (and the happy face as CS-), the other half had the happy face as CS+ (and the angry face as CS-). During acquisition, the CSs were presented foveally. During extinction, using the Visual Half-Field (VHF) technique, half of the CS+ and CS- trials were randomly presented in the right visual half-field (initially to the left hemisphere), and half of the trials were presented in the left half-field (initially to the right hemisphere). Stimuli were presented for 210 ms during acquisition, and for 30 ms during extinction. Bilateral skin conductance responses (SCRs) were recorded. The results showed effects of acquisition only for the angry CS+ group. During extinction, there was a significant Conditioning X Half-field interaction which was due to greater SCRs to the CS+ angry face when it was presented in the left half-field. It is concluded that the present results reveal hemisphere asymmetry effects in facial emotional conditioning.

Brain asymmetry and human electrodermal conditioning.

Two experiments are reviewed that demonstrate effects of brain laterality on human classical conditioning. Pictures of facial emotional expressions were used as conditioned stimuli (CSs) together with shock as unconditioned stimulus (UCS). Bilateral electrodermal responses were recorded as dependent measures. In the first experiment, one group was conditioned to an angry face, and one group to a happy face. During extinction, the face-CSs were presented to the right hemisphere on half of the trials and to the left hemisphere on the other half of the trials. Results showed that the right hemisphere was superior in showing persisting effects of learning, and especially to the angry CS+. In the second experiment, lateralized presentations of the angry and happy faces were made during acquisition, with foveal presentations during extinction. Once again, the angry face elicited greater skin conductance responses (SCRs) during extinction in the group that had this stimulus presented to the right hemisphere during acquisition. It is concluded that emotional conditioning is differentially regulated by the two hemispheres of the brain.

Fear questionnaires for simple phobias: psychometric evaluations of a Norwegian sample.

The present study presents psychometric data for four different phobic fear questionnaires in a Norwegian sample of 284 subjects. The questionnaires concerned fear of flying, snakes, spiders and a questionnaire of general phobic complaints. The results showed a high estimate of internal consistency, and a very high test-retest reliability for all questionnaires. A low to moderate degree of intercorrelation between the questionnaires appeared. A clear sex difference emerged in responding to all four questionnaires. In addition, a clinical sample of phobics with fear of flying as the main symptom was compared to the larger sample on a fear of flying scale. The results showed a clear difference in responding between the samples. The present study concludes that the four different fear questionnaires yielded a high degree of reliability, and their use in clinical practice is encouraged.

Preparedness and electrodermal fear-conditioning: ontogenetic vs phylogenetic explanations.

In a review of existing theories of learning, Seligman (Psychol. Rev. 77, 406-418, 1970) suggested that humans should have an evolutionary derived preparedness to associate fear-relevant (e.g. snakes) events with aversive reinforcers. The preparedness hypothesis has been extensively tested by Ohman and his colleagues. One argument against a non-preparedness explanation for the Ohman findings has been that culturally aversive stimuli, like pictures of guns have not shown the same resistance towards extinction as pictures of snakes. However, the effect of pointing a gun directly towards the S vs pointing it to the side has not been tested. Therefore both slides of guns and snakes, directed both towards and aside from the subject, were used as conditioned stimuli (CSs) in the present study. A second question that has been discussed in the preparedness-literature is the quality of the unconditioned stimulus (UCS), i.e. if only shock can act as UCS for prepared CSs. Thus, both shock and noise UCSs were used in the present study. Skin conductance responses (SCRs) were recorded as dependent measures. The results showed conditioned acquisition, i.e. larger SCRs to CS+ than to CS-, in all groups except for the shock and noise UCS groups with the gun pointing aside as CS+ (where actually larger responses were observed to the CS-, i.e. the gun pointing towards). The extinction data showed significantly larger SCRs to CS+ than to CS- for both snakes and guns directed towards the S. Strongest resistance to extinction was observed for the group with the gun pointed towards as CS+ and with noise as UCS. The gun with noise as UCS pointed towards the S was not different from the snake with shock as UCS. Taken together, the results have shown three things; (a) directing a fear-relevant CS towards the S was a potent manipulation, and especially directing a gun with noise as UCS; (b) shock was overall not superior to noise as UCS, and especially not for snake CSs; (c) a weak form of unique belongingness was demonstrated.