Insomnia, Hypnotic Ability, Negative Affectivity, and the High Risk Model of Threat Perception

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According to Morin (1993), insomnia is second only to pain in terms of the frequency of health complaints. According to The International Classification of Sleep Disorders Diagnostic and Coding Manual-Revised (American Sleep Disorders Association, 1997), psychophysiological insomnia is defined as "a disorder of somatized tension and learned sleep-preventing associations that results in a complaint of insomnia and associated decreased functioning during wakefulness." Meaning associated with stressful events is generally denied or repressed, manifesting as increased physiological arousal (e.g., muscle tension). Based on the above criteria, psychophysiological insomnia may be regarded as a somatization disorder (American Sleep Disorders Association, 1997). Somatization is diagnosed by exclusion. The High Risk Model of Threat Perception (HRMTP) provides an approach to diagnosis by inclusion (Wickramasekera, 1988, 1993). It identifies specific and quantitative psychosocial and psychophysiological risk factors implicated in the perception of threat that are hypothesized to drive, consciously or unconsciously, somatic symptoms like psychophysiological insomnia (Wickramasekera, 1988, 1992b, 1995). The HRMTP proposes diagnosis of somatoform disorders by inclusion and provides quantitative and relatively modifiable risk factors that can be targeted in therapy. The identification of specific high risk psychosocial factors that unconsciously but independently drive somatic symptoms can have profound implications for diagnostic practice, as well as for therapy and for primary prevention.Hypnosis is defined as a form of information processing in which voluntarily initiated suspension of peripheral awareness and critical analytic cognition can, in some people, readily lead to major changes in perception, memory, and mood that appear involuntary and may have important behavioral and biological consequences (Wickramasekera, 1986, 1988). Hypnotic ability is a normally distributed individual difference variable unrelated to gender (Barber, 1969; Hilgard, 1965), with a stable test-retest reliability of r = .71 after 25 years (Piccione et al., 1989), that is believed to have a partly genetic basis (Morgan, 1973; Morgan et al., 1970). The HRMTP states that people who score high (9 to 12) or low (0 to 4) on hypnotic ability are at risk, but for very different reasons (Wickramasekera 1979, 1986, 1988, 1993, 1995). Generally, patients with high hypnotic ability are at risk because they are hypothesized to be psychologically hypersensitive to the perception of threat and sympathetically hyperactive to threat (Wickramasekera, 1998; Wickramasekera et al., 1996a). In fact, highs (Das, 1958; Wickramasekera, 1970, 1976) condition very rapidly, operantly, and respondently and, hence, are at risk for maladaptive learning (Wickramasekera, 1988, 1993). People low in hypnotic ability are hypothesized to be at risk because they appear to be verbally hyposensitive to emotional threats and prone to parasympathetic dysregulation during chronic threat (Wickramasekera, 1998; Wickramasekera and Price, 1997). A hypothesized deficit in psychological methods of coping may place lows at greater risk, during threat perception, of using external methods of self-soothing (e.g., substance abuse or overeating) or somatization to reduce negative affect (Wickramasekera and Price, 1997). It is also hypothesized that both high and low hypnotic ability are associated with low correlations (incongruence) between verbal report measures of threat perception on one hand and physiological measures of threat perception (e.g., high heart rate, high muscle tension, etc) on the other (Wickramasekera, 1988, 1993, 1998). Hence, paradoxically, people of high or low hypnotic ability are more likely to be able to keep threatening secrets from their mind but not their body (Wickramasekera, 1988, 1998).

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