Relaxation Training and Attention Placebo in the Treatment of Severe Insomnia

This study compared the effectiveness of progressive relaxation training with and without a supplementary relaxation recording, which the subjects played at home, and an attention placebo manipulation in the modification of severe insomnia in adult volunteers. The results indicated that the relaxation training procedures were significantly more effective than placebo and no-treatment controls in modifying several parameters of sleeping behavior, in reducing consumption of sleep-inducing medication, and in influencing a self-report anxiety measure. The supplementary relaxation tape did not increase the effectiveness of relaxation training conducted in the clinic, and there was no difference in the efficacy of the placebo and no-treatment conditions. Physiological data gathered during the last treatment session indicated few significant correlations between reductions in arousal associated with relaxation training and treatment outcome. Recent years have witnessed increasing interest in the treatment of insomnia from a behavioral framework. Case studies and uncontrolled group investigations suggesting the effectiveness of relaxation training techniques and stimulus control procedures (Bootzin, 1972; Geer & Katkin, 1966; Jacobson, 1964; Kahn, Baker, & Weiss, 1968) have given rise to controlled studies. Thus far this research has indicated that relaxation training procedures are effective in modifying several parameters of sleeping behavior in volunteer insomniacs. However, the mechanism(s) by which this training operates have not been clearly identified. One possibility is that this technique works because of its placebo value. Relaxation training would seem to have high face validity for the treatment of insomnia, and the impressive proprioceptive muscle feedback often associated with the technique may add to its credibility, Although a number of studies have attempted to investigate this issue (Borkovec & Fowles, 1973; Borkovec, Kaloupek, & Slama, 197S; Borkovec, Steinmark, & Nan, 1973; Haynes, Woodward, Moron, & Alex