***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Patients with primary insomnia overestimate their sleep onset latency ( SOL ) and underestimate their total sleep time ( TST ) . The present study aim ed to test the utility of a novel behavioural experiment design ed to correct distorted perception of sleep among patients diagnosed with primary insomnia . Individuals with primary insomnia were asked to wear an actigraph and keep a sleep diary for three nights . On the following day , half were shown the discrepancy between the data recorded on the actigraph and their sleep diary ( Shown-Discrepancy Group ) , the other half were not shown the discrepancy ( No-Demonstration Group ) . Participants were then asked to wear the actigraph and keep a sleep diary for three further nights . Following the behavioural experiment , the Shown-Discrepancy Group estimated their SOL more accurately and reported less anxiety and preoccupation about sleep compared to the No-Demonstration Group . The theoretical and clinical implication s of these findings are discussed Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Abstract Recent research in the treatment of insomnia by paradoxical intention has utilized two different methods of instruction . Studies utilizing the r and om assignment of subjects to treatment groups employ a procedure in which clients are provided with a straight-forward explanation based on the present authors ' underst and ing of the use of paradoxical intention with insomnia ( type A administration ) . In contrast , controlled case studies have employed reframing , a procedure which explains the need for the paradoxical intention in a manner which best suits the specific underst and ing of the individual client ( type B administration ) . The present study employed the type B method in a design employing the r and om assignment of clients to groups . Three additional groups ( type A administration , placebo control , no-treatment control )  completed the design . The results indicated that the type A method was superior to the type B procedure when the same method for administering paradoxical intention was applied to a r and omized group of individuals This investigation assessed the efficacy of a technique specifically design ed to change the style and content of presleep thoughts in order to reduce nighttime cognitive arousal and decrease insomnia severity . This investigation , termed " cognitive refocusing treatment for insomnia " ( CRT-I ) , previously improved sleep in a small sample of veterans with primary insomnia . In this investigation , university students with poor sleep were r and omly assigned to attend either one session of CRT-I and sleep hygiene education ( SH : n=27 ) or one session of only SH ( n=24 ) . Insomnia severity ( assessed by the Insomnia Severity Index ) and nighttime arousal ( assessed by the Pre-Sleep Arousal Scale ) were measured at baseline and 1month posttreatment . A significant Group × Time interaction for insomnia severity suggested more improved sleep over time for those receiving CRT-I+SH . A trend for a Group × Time interaction showed decreased cognitive arousal over time among those receiving CRT-I. These findings provide preliminary support for the efficacy of CRT-I for insomnia treatment among college students . Continued study of CRT-I in a community-based sample appears warranted It seems sensible to tailor treatments of  insomnia  in relation to the presenting characteristics of the sleeper and of the complaint . This report describes the first study formally to examine the comparative effectiveness of tailored and untailored ( r and omly allocated ) treatments . We developed a question naire to facilitate the design ing of individualized programmes . Results indicated that statistical analysis may underestimate the benefits of tailoring . Measures of clinical ly significant change , however , suggested that  tailored treatment though it may be highly effective , is no more so than stimulus control therapy We describe the development of a cognitive therapy intervention for  chronic insomnia .  The therapy is based on a cognitive model which suggests that the processes that maintain insomnia include : ( 1 ) worry and rumination , ( 2 ) attentional bias and monitoring for sleep-related threat , ( 3 ) unhelpful beliefs about sleep , ( 4 ) misperception of sleep and daytime deficits and ( 5 ) the use of safety behaviors that maintain unhelpful beliefs . The aim of cognitive therapy for insomnia is to reverse all five maintaining processes during both the night and the day . In an open trial 19 patients meeting diagnostic criteria for primary insomnia were treated with cognitive therapy for insomnia . Assessment s were completed pretreatment , posttreatment and at 3- , 6- and 12-month followup . The significant improvement in both nighttime and daytime impairment evident at the posttreatment assessment was retained up to the 12 month followup Objective : To examine the mediators and the potential of treatment matching to improve outcome for cognitive behavior therapy ( CBT ) for insomnia . Method : Participants were 188 adults ( 117 women ; Mage = 47.4 years , SD = 12.6 ) meeting the Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . ; text rev . ; DSM – IV – TR ; American Psychiatric Association [ APA ] , 2000 ) diagnostic criteria for chronic insomnia ( M duration : 14.5 years , SD : 12.8 ) . Participants were r and omized to behavior therapy ( BT ; n = 63 ) , cognitive therapy ( CT ; n = 65 ) , or CBT ( n = 60 ) . The outcome measure was the Insomnia Severity Index ( ISI ) . Hypothesized BT mediators were sleep-incompatible behaviors , bedtime variability ( BTv ) , risetime variability ( RTv ) and time in bed ( TIB ) . Hypothesized CT mediators were worry , unhelpful beliefs , and monitoring for sleep-related threat . Results : The behavioral processes mediated outcome for BT but not CT . The cognitive processes mediated outcome in both BT and CT . The subgroup scoring high on both behavioral and cognitive processes had a marginally significant better outcome if they received CBT relative to BT or CT . The subgroup scoring relatively high on behavioral but low on cognitive processes and received BT or CBT did not differ from those who received CT . The subgroup scoring relatively high on cognitive but low on behavioral processes and received CT or CBT did not differ from those who received BT . Conclusion : The behavioral mediators were specific to BT relative to CT . The cognitive mediators were significant for both BT and CT outcomes . Patients exhibiting high levels of both behavioral and cognitive processes achieve better outcome if they receive CBT relative to BT or CT alone Insomniacs commonly complain that they are unable to get to sleep at night due to unwanted thoughts , worries and concerns . The present study investigated whether brief training in identifying and elaborating an interesting and engaging imagery task for use during the pre-sleep period can reduce unwanted pre-sleep cognitive activity and sleep onset latency .  Forty one people with insomnia were given one of three instructional sets to follow on the experimental night ; instructions to distract using imagery , general instructions to distract , or no instructions . Based on previous findings reported by Salkovskis & Campbell ( 1994 ) ' Behaviour Research and Therapy 32 ( 1994 ) 1 ' and ironic control theory ( Wegner , 1994 ) ' Psychological Review 101 ( 1994 ) 34 ' , it was predicted that ( 1 ) " imagery distraction " would be associated with shorter sleep onset latency and less frequent and distressing pre-sleep cognitive activity compared to the " no instruction " group and that ( 2 ) " general distraction " would be associated with longer sleep onset latency and more frequent and distressing pre-sleep cognitive activity compared to the " no instruction " group . Support was found for the first but not the second prediction . The success of the " imagery distraction " task is attributed to it occupying sufficient " cognitive space " to keep the individual from re-engaging with thoughts , worries , and concerns during the pre-sleep period . In addition , " imagery distraction " involved a very specific alternative cognitive task hence the operating process was given a feature positive search , conditions where mental control is likely to be achieved This study considers the role of pre-sleep cognitive arousal , worry , and inhibition in sleep onset difficulties . The Pennebaker writing task , which promotes emotional processing by asking people to write about their thoughts , worries , and emotions , has proven effective in several areas of health . Here , the paradigm 's ability to reduce pre-sleep cognitive arousal ( PSCA ) and sleep onset latency ( SOL ) in people with insomnia was tested . Twenty-eight people with insomnia were r and omized to three nights of Pennebaker writing or a control condition , following a one-night baseline . The outcomes of change over baseline at Day 4 in pre-sleep cognitive arousal and SOL were compared . Writing significantly reduced pre-sleep cognitive arousal on one out of two measures , but did not significantly reduce SOL A new cognitive therapy ( CT ) program was compared with an established behavioral treatment .  Sixty-two patients meeting Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . ; American Psychiatric Association , 1994 ) criteria for social phobia were r and omly assigned to CT , exposure plus applied relaxation ( EXP = AR ) , or wait-list ( WAIT ) . CT and EXP = AR were superior to WAIT on all measures . On measures of social phobia , CT led to greater improvement than did EXP = AR . Percentages of patients who no longer met diagnostic criteria for social phobia at posttreatment-wait were as follows : 84 % in CT , 42 % in EXP = AR , and 0 % in WAIT . At the 1-year follow-up , differences in outcome persisted . In addition , patients in EXP = AR were more likely to have sought additional treatment . Therapist effects were small and nonsignificant . CT appears to be superior to EXP = AR in the treatment of social phobia STUDY OBJECTIVES To compare the efficacy of problem-solving therapy ( PST ) combined with behavioral sleep strategies to st and ard cognitive therapy ( CT ) combined with behavioral sleep strategies in the treatment of insomnia . DESIGN A six-week r and omized controlled trial with one month follow-up . SETTING The Australian National University Psychology Clinic , Canberra , Australia . PARTICIPANTS Forty-seven adults aged 18 - 60 years recruited from the community meeting the Research Diagnostic Criteria for insomnia . INTERVENTIONS Participants received 6 weeks of treatment including one group session ( sleep education and hygiene , stimulus control instructions and progressive muscle relaxation ) followed by 5 weeks of individual treatment of PST or CT . MEASUREMENTS AND RESULTS Primary outcomes included sleep efficiency ( SE ) from sleep diaries , the Insomnia Severity Index ( ISI ) , and the Pittsburgh Sleep Quality Index ( PSQI ) . Secondary measures assessed dysfunctional sleep beliefs , problem-solving skills and orientations , and worry . Both treatments produced significant post therapy improvements in sleep which were maintained at 1 month follow-up ( on SE Cohen d = 1.42 , 95 % CI 1.02 - 1.87 for PST ; d = 1.26 , 95 % CI 0.81 - 1.65 for CT ; on ISI d = 1.46 , 95 % CI 1.03 - 1.88 for PST ; d = 1.95 , 95 % CI 0.52 - 2.38 for CT ; for PSQI d = 0.97 , 95 % CI 0.55 - 1.40 for PST and d = 1.34 , 95 % CI 0.90 - 1.79 for the CT ) . There were no differences in PST and CT in the size or rate of improvement in sleep although CT produced a significant faster rate of decline in negative beliefs about sleep than PST and there was a trend ( P = 0.08 ) for PST to produce a faster rate of improvement in negative problem orientation than CT . CONCLUSIONS The results provide preliminary support for problem solving treatment as an equally efficacious alternative component to cognitive therapy in psychological interventions for insomnia This study compared the effectiveness of paradoxical intention , stimulus control , information and a control group on  severe sleep onset insomnia .  Results showed that paradoxical intention and stimulus control were equally effective but significantly better than the information and control groups . It is suggested that treatment be adapted for each individual according to data collected from the intensive behavioral analysis of each case Patients with insomnia commonly complain that they are unable to get to sleep because of unwanted thoughts and worries . One account given of this excess cognitive activity is that it results from the incomplete processing of daytime stressors and hassles . Previous research has demonstrated the benefits of writing about emotional experiences as a method to facilitate emotional processing . This pilot study tested the hypothesis that writing about worries and concerns , with an emphasis on the expression and processing of emotion , will reduce sleep onset latency among an analogue sample of poor sleepers . Forty-two poor sleepers were r and omly allocated to 1 of 3 groups for 3 nights ; the instructions for the " problems " writing group emphasized the expression and processing of worries and concerns , the instructions for the " hobbies " writing group emphasized distraction from worries and concerns by writing about hobbies and interests , the " no writing " group were not given a writing task . The " problems " writing group reported shorter sleep onset latency compared to the " no writing " group . The results of this pilot study highlight the potential of research exploring the utility of a Pennebaker-style writing intervention for improving sleep Abstract A study by Turner and Ascher ( 1978 ) compared the efficacy of progressive relaxation , stimulus control , and paradoxical intention in ameliorating  sleep onset insomnia .  Results indicated that the three were equally effective . The present study is a partial replication of Turner and Ascher ( 1978 ) and focuses on the use of paradoxical intention in reducing sleep difficulties .  Twenty-five individuals complaining of sleep discomfort were r and omly assigned to three groups : paradoxical intention , 
    Output:
    
It is concluded that there is support for paradoxical intention and cognitive therapy .
There are also other cognitive interventions that appears promising , such as cognitive refocusing and behavioral experiments .
We conclude that several cognitive treatment components and therapies can be viewed as efficacious or promising interventions for patients with insomnia disorder .