CASE HISTORIES
AND SHORTER
COMMUNICATIONS
Effects of metronome-conditioned relaxation. metronome-induced relaxation. and progressive muscle relaxation on insomnia
(Rrcricrd
7 April
1975)
Although several controlled studies have indicated that relaxation can be effectively employed in the treatment of insomnia (Borkovec and Fowles, 1973; Steinmark and Borkovec. 1974; Haynes et al.. 1974). the relaxation training procedures thus far utilized have typically necessitated several hours of therapistclient contact. The possibility of a more efficient relaxation procedure for treating insomniacs suggests an attractive alternative to the tense-relax instructions of progressive muscle relaxation (Jacobson. 1938). Brady (1973) has reported that the sound of a metronome set at 60 beats per min is inherently relaxing. and. although he has only reported on the effects of the metronome when paired with verbally-induced relaxation (both general suggestions of relaxation and instructions to tense and relax successive muscle groups). he has successfully employed this technique in the treatment of borborygmi (rumbling noises in the abdomen) and essential hypertension (Brady. 1973; Brady. Luborsky and Kron. 1974). If the sound of the metronome alone. which would require minimal therapistxlient contact. is sufficient to induce relaxation. the efficiency with which relaxation can be achieved in the treatment of insomnia. as well as other tension-related disorders. may be greatly enhanced. The present study was designed to assess the relaxation-inducing properties of (a) Brady’s metronomeconditioned relaxation (metronome plus verbal relaxation instructions). (b) progressive muscle relaxation and (c) metronome-induced relaxation (the sound of a metronome alone) in the treatment of insomnia. In order to provide an evaluation of the effectiveness of relaxation techniques with a broader population than was sampled in previous investigations of this nature, this study included employed adults as well as college students in the sub.ject pool. In addition to its implications for treating insomnia. this study was designed to yield an independent test of the hypothesis that a 60 beat per min metronome sound has the capacity by itself to induce relaxation. METHOD
Twenty-nine subjects (16 undergraduate students. 8 faculty members. and 5 nonacademic staff members at Colorado State University) who had suffered from insomnia for at least a year and who reported more than 30 min average latency of sleep onset were involved in the study. They were asked to keep a daily record of latency of sleep onset for 2 weeks prior to treatment. during the 2 weeks of treatment. and for Based on an average latency of sleep onset for the I-week baseline period. the 2 weeks following treatment. subjects were ranked and randomly assigned within severity blocks to one of four conditions: (a) metronomeconditioned relaxation. (b) progressive muscle relaxation. (c) metronome-induced relaxation. and (d) no-treatment control. The ,,letrorlnrllc,-corlditiorled rela.xarim group met twice weekly in 45-min sessions for 2 weeks (four sessions total). This group received an abbreviated form of muscle relaxation instructions (Wolpe and Lazarus. 1966) with a standard Olympian metronome set at 60 beats per min sounding in the background. Two minutes of suggestions to ‘relax’ and ‘let-go’ paced to the metronome beat followed relaxation instructions (Brady. 1973). As an ad.junct to the treatment sessions, each subject was issued a metronome and instructed to practice progressive muscle relaxation with the metronome beating every night upon retirmg. The pro~/rcssrrc~ rinrscle rcla.wtio~l qraup also met for four 45-min sessions spaced over a 2-week period. and received relaxatton instructions identical to those given to the metronome-conditioned relaxation group. minus the metronome. These subjects were also instructed to practice the technique they learned every night upon retiring. Subjects m the rtlcrro,~o,~lr-irldl~c~d rrla.sarim group were issued a metronome identical to those used by metronome-conditioned relaxation subjects and were given instructions to use it every night upon retiring. These subjects had no further contact with the therapist. Subjects in the waiting-list cmtrol group were informed by telephone that current treatment groups were filled but that they would be contacted in 4 weeks when new groups would be formed. Six months after treatment had terminated. a letter was sent to all treated subjects asking them to monitor and record latency of sleep onset for a 2-week period. No attempt was made to contact control subjects since they had undergone treatment at the conclusion of the experiment. RESULTS
Pre and post treatment means were derived by averaging the _T-week baseline period before and immediately after treatment. Analysis of variance indicated that pretreatment group means did not differ signilicantly F(3.25) = 0.22. but posttreatment group means did, F(3.25) = 6.79. p < 0.01. Scheffe’s method of posi hoc comparisons (Kirk. 1968) showed that the posttreatment means of the three treated groups did not differ among themselves but all three significantly differed from the mean of the control group. r-Tests of differences between means of employed adults compared to those of students showed no significant differences on either pretreatment or posttreatment data. I (21) = 0.57 for pretreatment data. I (21) = 0.74 165
CASEHISTORIES Ah’D
166
SHORTER COMMUNICATIONS
Fig. 1. Mean latency of sleep onset for the four treatment conditions at pretreatment. ment, and follow-up periods.
posttreat-
for posttreatment data. It was possible to obtain 6-month follow-up data (in the form of sleep latency estimates recorded nightly over a 2-week period) for 12 of the 23 treated subjects and these data are illustrated in Fig. 1. DISClISSION
The results of the present study offer further support to the effectiveness of progressive muscle relaxation in the treatment of insomnia, and indicate that two new treatment approaches may be equally effective. Since adding the metronome to. progressive muscle relaxation instructions, as is done in metronome-conditioned relaxation, does not seem to increase treatment efficacy, there is no obvious advantage of metronomeconditioned relaxation in the treatment of insomnia. However, metronome-induced relaxation might prove a useful innovation in insomnia treatment since it does not differ significantly from progressive muscle relaxation in effectiveness yet is much more efficient in eliminating the necessity for therapist contact. Results suggest further that relaxation techniques may be effective in treating sleep-disturbed adults as well as college students. Previous controlled studies of relaxation techniques in the treatment of insomnia have sampled college student populations only (Borkovec and Fowles. 1973; Steinmark and Borkovec. 1974; Haynes et al., 1974). Nearly half of the subjects (13 of 29) in this study were employed adults. whose scores on the dependent variable (latency of sleep onset) were not significantly different from those of students either before or after treatment. Thus, this study demonstrates that the effectiveness of relaxation methods in the treatment of insomnia is generahzable beyond the college population. Department q/Psychology, Colorado State University, Ft. Collins. CO 80523. U.S.A.
LINVA R. PENDLETON
DONALDL. TASTO*
REFERENCES BORKOVEC T. D. and FOWLESD. C. (1973) Controlled investigation of the effects of progressive and hypnotic relaxation on insomnia. J. ahnorm. Psychol. 82. 153-158. BRADY J. P. (1973) Metronome-conditioned relaxation: A new behavioural procedure. Br. J. Psychiat. 122.
729-730. BRADY J. P.. LUBORSKY L. and
KRONR. E. (1974) Blood pressure reduction in patients with essential hypertension through metronome-conditioned relaxation: A preliminary report. Behar. ‘771erap~,5. 203-209. HAYNESS. N., WO~DWARDS., MORANR. and ALEXANDER D. (1974) Relaxation treatment of insomnia. Erhau. 7herapy 5. 555-558.
(1938) Progressive Relaxation. University of Chicago Press. Chrcago. KIRK R. E. (1968) E.~perimotta/ Design: Precedures :for the kkhatioral Scicruxx BrookstCole. Belmont. Calif. STEINMARK S. W. and BORKOVEC T. D. (1974) Actrve and placebo treatment effects on moderate insomnia under counterdemand and positive demand instructions. J. ahnorm. Psvcho/. 83. I57- 163. WOLPE J. and LAZARUS A. A. (1966) Behavior Therapy Techtliques: A Guide to the fieatmrnt of Neuroses. Pergamon Press. Oxford. JACOBSON E.
* Reprint requests should be directed to: Donald L. Tasto. Stanford Research Institute. Menlo Park. CA 94025, U.S.A.
AND SHORTER
COMMUNICATIONS
Effects of metronome-conditioned relaxation. metronome-induced relaxation. and progressive muscle relaxation on insomnia
(Rrcricrd
7 April
1975)
Although several controlled studies have indicated that relaxation can be effectively employed in the treatment of insomnia (Borkovec and Fowles, 1973; Steinmark and Borkovec. 1974; Haynes et al.. 1974). the relaxation training procedures thus far utilized have typically necessitated several hours of therapistclient contact. The possibility of a more efficient relaxation procedure for treating insomniacs suggests an attractive alternative to the tense-relax instructions of progressive muscle relaxation (Jacobson. 1938). Brady (1973) has reported that the sound of a metronome set at 60 beats per min is inherently relaxing. and. although he has only reported on the effects of the metronome when paired with verbally-induced relaxation (both general suggestions of relaxation and instructions to tense and relax successive muscle groups). he has successfully employed this technique in the treatment of borborygmi (rumbling noises in the abdomen) and essential hypertension (Brady. 1973; Brady. Luborsky and Kron. 1974). If the sound of the metronome alone. which would require minimal therapistxlient contact. is sufficient to induce relaxation. the efficiency with which relaxation can be achieved in the treatment of insomnia. as well as other tension-related disorders. may be greatly enhanced. The present study was designed to assess the relaxation-inducing properties of (a) Brady’s metronomeconditioned relaxation (metronome plus verbal relaxation instructions). (b) progressive muscle relaxation and (c) metronome-induced relaxation (the sound of a metronome alone) in the treatment of insomnia. In order to provide an evaluation of the effectiveness of relaxation techniques with a broader population than was sampled in previous investigations of this nature, this study included employed adults as well as college students in the sub.ject pool. In addition to its implications for treating insomnia. this study was designed to yield an independent test of the hypothesis that a 60 beat per min metronome sound has the capacity by itself to induce relaxation. METHOD
Twenty-nine subjects (16 undergraduate students. 8 faculty members. and 5 nonacademic staff members at Colorado State University) who had suffered from insomnia for at least a year and who reported more than 30 min average latency of sleep onset were involved in the study. They were asked to keep a daily record of latency of sleep onset for 2 weeks prior to treatment. during the 2 weeks of treatment. and for Based on an average latency of sleep onset for the I-week baseline period. the 2 weeks following treatment. subjects were ranked and randomly assigned within severity blocks to one of four conditions: (a) metronomeconditioned relaxation. (b) progressive muscle relaxation. (c) metronome-induced relaxation. and (d) no-treatment control. The ,,letrorlnrllc,-corlditiorled rela.xarim group met twice weekly in 45-min sessions for 2 weeks (four sessions total). This group received an abbreviated form of muscle relaxation instructions (Wolpe and Lazarus. 1966) with a standard Olympian metronome set at 60 beats per min sounding in the background. Two minutes of suggestions to ‘relax’ and ‘let-go’ paced to the metronome beat followed relaxation instructions (Brady. 1973). As an ad.junct to the treatment sessions, each subject was issued a metronome and instructed to practice progressive muscle relaxation with the metronome beating every night upon retirmg. The pro~/rcssrrc~ rinrscle rcla.wtio~l qraup also met for four 45-min sessions spaced over a 2-week period. and received relaxatton instructions identical to those given to the metronome-conditioned relaxation group. minus the metronome. These subjects were also instructed to practice the technique they learned every night upon retiring. Subjects m the rtlcrro,~o,~lr-irldl~c~d rrla.sarim group were issued a metronome identical to those used by metronome-conditioned relaxation subjects and were given instructions to use it every night upon retiring. These subjects had no further contact with the therapist. Subjects in the waiting-list cmtrol group were informed by telephone that current treatment groups were filled but that they would be contacted in 4 weeks when new groups would be formed. Six months after treatment had terminated. a letter was sent to all treated subjects asking them to monitor and record latency of sleep onset for a 2-week period. No attempt was made to contact control subjects since they had undergone treatment at the conclusion of the experiment. RESULTS
Pre and post treatment means were derived by averaging the _T-week baseline period before and immediately after treatment. Analysis of variance indicated that pretreatment group means did not differ signilicantly F(3.25) = 0.22. but posttreatment group means did, F(3.25) = 6.79. p < 0.01. Scheffe’s method of posi hoc comparisons (Kirk. 1968) showed that the posttreatment means of the three treated groups did not differ among themselves but all three significantly differed from the mean of the control group. r-Tests of differences between means of employed adults compared to those of students showed no significant differences on either pretreatment or posttreatment data. I (21) = 0.57 for pretreatment data. I (21) = 0.74 165
CASEHISTORIES Ah’D
166
SHORTER COMMUNICATIONS
Fig. 1. Mean latency of sleep onset for the four treatment conditions at pretreatment. ment, and follow-up periods.
posttreat-
for posttreatment data. It was possible to obtain 6-month follow-up data (in the form of sleep latency estimates recorded nightly over a 2-week period) for 12 of the 23 treated subjects and these data are illustrated in Fig. 1. DISClISSION
The results of the present study offer further support to the effectiveness of progressive muscle relaxation in the treatment of insomnia, and indicate that two new treatment approaches may be equally effective. Since adding the metronome to. progressive muscle relaxation instructions, as is done in metronome-conditioned relaxation, does not seem to increase treatment efficacy, there is no obvious advantage of metronomeconditioned relaxation in the treatment of insomnia. However, metronome-induced relaxation might prove a useful innovation in insomnia treatment since it does not differ significantly from progressive muscle relaxation in effectiveness yet is much more efficient in eliminating the necessity for therapist contact. Results suggest further that relaxation techniques may be effective in treating sleep-disturbed adults as well as college students. Previous controlled studies of relaxation techniques in the treatment of insomnia have sampled college student populations only (Borkovec and Fowles. 1973; Steinmark and Borkovec. 1974; Haynes et al., 1974). Nearly half of the subjects (13 of 29) in this study were employed adults. whose scores on the dependent variable (latency of sleep onset) were not significantly different from those of students either before or after treatment. Thus, this study demonstrates that the effectiveness of relaxation methods in the treatment of insomnia is generahzable beyond the college population. Department q/Psychology, Colorado State University, Ft. Collins. CO 80523. U.S.A.
LINVA R. PENDLETON
DONALDL. TASTO*
REFERENCES BORKOVEC T. D. and FOWLESD. C. (1973) Controlled investigation of the effects of progressive and hypnotic relaxation on insomnia. J. ahnorm. Psychol. 82. 153-158. BRADY J. P. (1973) Metronome-conditioned relaxation: A new behavioural procedure. Br. J. Psychiat. 122.
729-730. BRADY J. P.. LUBORSKY L. and
KRONR. E. (1974) Blood pressure reduction in patients with essential hypertension through metronome-conditioned relaxation: A preliminary report. Behar. ‘771erap~,5. 203-209. HAYNESS. N., WO~DWARDS., MORANR. and ALEXANDER D. (1974) Relaxation treatment of insomnia. Erhau. 7herapy 5. 555-558.
(1938) Progressive Relaxation. University of Chicago Press. Chrcago. KIRK R. E. (1968) E.~perimotta/ Design: Precedures :for the kkhatioral Scicruxx BrookstCole. Belmont. Calif. STEINMARK S. W. and BORKOVEC T. D. (1974) Actrve and placebo treatment effects on moderate insomnia under counterdemand and positive demand instructions. J. ahnorm. Psvcho/. 83. I57- 163. WOLPE J. and LAZARUS A. A. (1966) Behavior Therapy Techtliques: A Guide to the fieatmrnt of Neuroses. Pergamon Press. Oxford. JACOBSON E.
* Reprint requests should be directed to: Donald L. Tasto. Stanford Research Institute. Menlo Park. CA 94025, U.S.A.
