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. 2010 Jan 20;2010(1):CD003974. doi: 10.1002/14651858.CD003974.pub3

Ascher 1979.

Methods Design: three group parallel trial 
 Purpose: examine the effect of paradoxical intention on insomnia
Participants Patients: out‐patients suffering from insomnia 
 Baseline comparability: yes (sleep parameters)
Interventions Placebo: sessions of 'quasi‐desensitization' (neutral images paired with bedtime activity) 
 Untreated: no sessions 
 Experimental: paradoxical intention: (instructed to remain awake as long as possible and presented with the true theoretical background) 
 (Co‐intervention: NS)
Outcomes Sleep latency (minutes) 
 Awakenings 
 Restedness rating 
 Difficulty falling asleep
Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Adequate sequence generation? Unclear risk NS
Allocation concealment? Unclear risk NS
Blinding? 
 Treatment provider High risk Not described as double‐blind (placebo/paradoxical intention)
Blinding? 
 Outcome assessor Unclear risk Not relevant as patient reported outcome
Incomplete outcome data addressed? 
 All outcomes High risk Drop out > 15% or NS
Free of selective reporting? Unclear risk No protocol available
Free of other bias? Low risk  
No signs of variance inequality or skewness? High risk Either variance inequality (F‐test statistically significant) or skewness (1.64 standard deviations exceeds the mean)
Trial size > 49? High risk N = 17
Clearly concealed allocation + trial size > 49 + drop‐out max 15% High risk Trial size < 49