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Shi Y, Ren R, Zhang Y, Vitiello MV, Tang X. Factors influencing the effectiveness of digital cognitive behavioural therapy for chronic insomnia in clinical practice. J Sleep Res 2024; 33:e14077. [PMID: 37897204 DOI: 10.1111/jsr.14077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
Digital cognitive behavioural therapy for chronic insomnia (D-CBT-I) has been shown to be as efficacious as traditional CBT-I. However, not all patients achieve insomnia remission after treatment. We explored the factors influencing the effectiveness of D-CBT-I in a clinical practice. A total of 414 Asian chronic insomniacs were studied during a 6 week D-CBT-I intervention. All patients were assessed at baseline and posttreatment and were determined to be remitters or non-remitters, responders or non-responders by posttreatment criteria; Insomnia Severity Index (ISI <8) or ISI reduction ≥8, to examine whether remission and response status were associated with patient baseline characteristics. The average baseline ISI score in all subjects was 16.29 points. At posttreatment, 192 (46.4%) patients achieved ISI remission and 218 (52.7%) patients demonstrated an ISI response. An increased baseline early morning awakening time and ISI score were independently associated with a lower odds for remission (OR, 0.995 and 0.991, respectively). Increased baseline Patients Health Questionnaire-9 score was independently associated with higher odds for response (OR, 1.114). Our results suggest that D-CBT-I can be recommended as the first-line treatment for chronic insomnia, particularly in insomniacs with milder insomnia symptoms and more severe depressive symptoms. Meanwhile, the effectiveness of D-CBT-I was adversely affected by longer early morning awakening time and higher insomnia severity at pretreatment, which may be improved by more intense intervention and greater therapeutic support or by traditional CBT-I.
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Affiliation(s)
- Yuan Shi
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Zhang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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2
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Jansson-Fröjmark M, Sunnhed R, Carney CE, Rosendahl I. Conceptual overlap of negative thought processes in insomnia: A focus on catastrophizing, worry, and rumination in a student sample. Behav Sleep Med 2024:1-16. [PMID: 38949088 DOI: 10.1080/15402002.2024.2374264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
OBJECTIVES The association and overlap between different forms of negative thought processes in insomnia is largely unknown. The purpose of the current investigation was to examine conceptual overlap between three insomnia-specific negative thought processes; catastrophizing, worry, and rumination, identify the underlying factors, and explore their associations with insomnia symptoms. METHODS A total of 360 students completed three insomnia-related negative thought process scales (Catastrophic Thoughts about Insomnia Scale, Anxiety and Preoccupation about Sleep Questionnaire, Daytime Insomnia Symptom Response Scale) and two insomnia symptoms measures (the Insomnia Severity Index and Sleep Condition Indicator). RESULTS The three scales and their subscales displayed acceptable reliabilities. Further, confirmatory factor analysis was supportive of the notion of catastrophizing, worry, and rumination measures as distinct. The catastrophizing and worry constructs were significantly associated with insomnia symptoms, but the rumination factor was not. CONCLUSIONS The findings indicate that catastrophizing, worry, and rumination might be viewed as distinct constructs. Although more research is warranted on the topic of conceptual overlap, the current results might have implications for the development of models of insomnia, clinical research, and practice.
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Affiliation(s)
- Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Rikard Sunnhed
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Colleen E Carney
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Ingvar Rosendahl
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Stockholm, Sweden
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3
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Nyhuis CC, Fernandez-Mendoza J. Insomnia nosology: a systematic review and critical appraisal of historical diagnostic categories and current phenotypes. J Sleep Res 2023; 32:e13910. [PMID: 37122153 DOI: 10.1111/jsr.13910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/02/2023]
Abstract
Insomnia nosology has significantly evolved since the Diagnostic and Statistical Manual (DSM)-III-R first distinguished between 'primary' and 'secondary' insomnia. Prior International Classification of Sleep Disorders (ICSD) nosology 'split' diagnostic phenotypes to address insomnia's heterogeneity and the DSM nosology 'lumped' them into primary insomnia, while both systems assumed causality for insomnia secondary to health conditions. In this systematic review, we discuss the historical phenotypes in prior insomnia nosology, present findings for currently proposed insomnia phenotypes based on more robust approaches, and critically appraise the most relevant ones. Electronic databases PsychINFO, PubMED, Web of Science, and references of eligible articles, were accessed to find diagnostic manuals, literature on insomnia phenotypes, including systematic reviews or meta-analysis, and assessments of the reliability or validity of insomnia diagnoses, identifying 184 articles. The data show that previous insomnia diagnoses lacked reliability and validity, leading current DSM-5-TR and ICSD-3 nosology to 'lump' phenotypes into a single diagnosis comorbid with health conditions. However, at least two new, robust insomnia phenotyping approaches were identified. One approach is multidimensional-multimethod and provides evidence for self-reported insomnia with objective short versus normal sleep duration linked to clinically relevant outcomes, while the other is multidimensional and provides evidence for two to five clusters (phenotypes) based on self-reported trait, state, and/or life-history data. Some approaches still need replication to better support whether their findings identify true phenotypes or simply different patterns of symptomatology. Regardless, these phenotyping efforts aim at improving insomnia nosology both as a classification system and as a mechanism to guide treatment.
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Affiliation(s)
- Casandra C Nyhuis
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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4
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Wang Y, Li X, Zhang Y, Ma Y, Xu S, Shuai Z, Pan F, Cai G. Association of Sleep Disturbance With Catastrophizing and Knee Pain: Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2023; 75:2134-2141. [PMID: 37038964 PMCID: PMC10524285 DOI: 10.1002/acr.25127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 02/15/2023] [Accepted: 04/04/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To investigate the relationship between sleep disturbance, catastrophizing, and knee pain in middle-aged and older individuals. METHODS Data from the Osteoarthritis Initiative cohort from months 48 to 96 were used, where month 48 was treated as baseline. Knee pain (Western Ontario and McMaster Universities Osteoarthritis Index pain scale score ≥5 [range 0-20]), catastrophizing (extracted from Coping Strategies Questionnaire score ≥3 [range 0-6]), and sleep quality (extracted from Center for Epidemiologic Studies Depression Scale [range 1-4]) were assessed annually. We described the association of sleep disturbance with the presence and risk of knee pain and catastrophizing. The mediation effect of knee pain and catastrophizing on the sleep-catastrophizing and sleep-pain association was evaluated, respectively. RESULTS Catastrophizing and knee pain were reported in 346 (10%) and 917 (24%) of the 3,813 participants (mean 64.9 years, 58% female) at baseline. Participants with worse sleep disturbance were more likely to have knee pain (prevalence ratio [PR] 1.4-2.0, P for trend <0.001) and catastrophizing (PR 1.4-3.1, P for trend <0.001). Sleep disturbance at baseline predicted the risk of knee pain (risk ratio [RR] 1.1, P for trend <0.001) and catastrophizing (RR 1.2-1.7, P for trend <0.001) during follow-up. No statistically significant interactions between sleep disturbance and knee pain or catastrophizing were observed. Knee pain and catastrophizing mediated the sleep-catastrophizing and sleep-pain association, respectively, at baseline, and knee pain negatively mediated the sleep-catastrophizing association longitudinally. CONCLUSION Sleep disturbance was associated with the presence and risk of catastrophizing and knee pain. Sleep interventions may have a universal and independent effect in preventing incident knee pain.
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Affiliation(s)
- Yining Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China
| | - Xiaoxi Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China
| | - Youyou Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China
| | - Shengqian Xu
- Department of Rheumatism and Immunity, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Zongwen Shuai
- Department of Rheumatism and Immunity, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China
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5
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Wilson D, Driller M, Johnston B, Gill N. Healthy Nutrition, Physical Activity, and Sleep Hygiene to Promote Cardiometabolic Health of Airline Pilots: A Narrative Review. J Lifestyle Med 2023; 13:1-15. [PMID: 37250274 PMCID: PMC10210965 DOI: 10.15280/jlm.2023.13.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/17/2022] [Accepted: 12/21/2022] [Indexed: 05/31/2023] Open
Abstract
Background Airline pilots experience unique occupational demands that may contribute to adverse physical and psychological health outcomes. Epidemiological reports have shown a substantial prevalence of cardiometabolic health risk factors including excessive body weight, elevated blood pressure, poor lifestyle behaviors, and psychological fatigue. Achieving health guidelines for lifestyle behavior nutrition, physical activity, and sleep are protective factors against the development of noncommunicable diseases and may mitigate the unfavorable occupational demands of airline pilots. This narrative review examines occupational characteristics for sleep, nutrition, and physical activity and outlines evidence-based strategies to inform health behavior interventions to mitigate cardiometabolic health risk factors among airline pilots. Methods Literature sources published between 1990 and 2022 were identified through electronic searches in PubMed, MEDLINE (via OvidSP), PsychINFO, Web of Science, and Google Scholar databases, and a review of official reports and documents from regulatory authorities pertaining to aviation medicine and public health was conducted. The literature search strategy comprised key search terms relating to airline pilots, health behaviors, and cardiometabolic health. The inclusion criteria for literature sources were peer-reviewed human studies, meta-analyses, systematic reviews, and reports or documents published by regulatory bodies. Results The results of the review show occupational factors influencing nutrition, sleep, and physical activity behaviors and delineate evident occupational disruptions to these lifestyle behaviors. Evidence from clinical trials demonstrates the efficacy of nutrition, sleep, and physical activity interventions for enhancing the cardiometabolic health of airline pilots. Conclusion This narrative review suggests that implementing evidence-based interventions focused on nutrition, physical activity, and sleep could help mitigate cardiometabolic health risk factors among airline pilots, who are particularly susceptible to adverse health outcomes due to unique occupational demands.
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Affiliation(s)
- Daniel Wilson
- Te Huataki Waiora School of Health, The University of Waikato, Hamilton, New Zealand
- Faculty of Health, Education and Environment, Toi Ohomai Institute of Technology, Tauranga, New Zealand
| | - Matthew Driller
- Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Ben Johnston
- Aviation and Occupational Health Unit, Air New Zealand, Auckland, New Zealand
| | - Nicholas Gill
- Te Huataki Waiora School of Health, The University of Waikato, Hamilton, New Zealand
- New Zealand Rugby, Wellington, New Zealand
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6
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Perlis ML, Posner D, Riemann D, Bastien CH, Teel J, Thase M. Insomnia. Lancet 2022; 400:1047-1060. [PMID: 36115372 DOI: 10.1016/s0140-6736(22)00879-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/03/2022] [Accepted: 05/05/2022] [Indexed: 12/30/2022]
Abstract
Insomnia is highly prevalent in clinical practice, occurring in up to 50% of primary care patients. Insomnia can present independently or alongside other medical conditions or mental health disorders and is a risk factor for the development and exacerbation of these other disorders if not treated. In 2016, the American College of Physicians recommended that insomnia be specifically targeted for treatment. The recommended first-line treatment for insomnia, whether the underlying cause has been identified or not, is cognitive behavioural therapy for insomnia (CBT-I). Currently, there is no global consensus regarding which pharmacological treatment has the best efficacy or risk-benefit ratio. Both CBT-I and pharmacological intervention are thought to have similar acute effects, but only CBT-I has shown durable long-term effects after treatment discontinuation. Administering a combined treatment of CBT-I and medication could decrease the latency to treatment response, but might diminish the durability of the positive treatment effects of CBT-I.
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Affiliation(s)
- Michael L Perlis
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Donn Posner
- Department of Psychiatry and Behavioral Science, Stanford University, Stanford, CA, USA
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | | | - Joseph Teel
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Thase
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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7
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Scott H, Cheung JM, Muench A, Ivers H, Grandner MA, Lack L, Morin CM, Perlis M. Does total sleep time substantially increase after cognitive behavioral therapy for insomnia? J Clin Sleep Med 2022; 18:1823-1829. [PMID: 35404226 PMCID: PMC9243283 DOI: 10.5664/jcsm.10004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES In most standardized approaches to cognitive behavioral therapy for insomnia, it is commonly the case that total wake time is reduced substantially during sleep restriction, but self-reported total sleep time (TST) is minimally affected. By follow-up, however, TST increases by almost 1 hour on average. A secondary analysis was undertaken to assess what percentage of participants meet or appreciably exceed baseline TST after cognitive behavioral therapy for insomnia. METHODS Data were drawn from a randomized controlled trial assessing acute and maintenance therapies for chronic insomnia (n = 80). The present analyses assessed the percentage of participants that 1) reached (≥ 0 minute increase) and 2) appreciably exceeded (≥ 30 minutes increase) baseline TST as assessed via daily sleep diaries at posttreatment and 3, 6, 12, and 24 months following treatment. RESULTS By the end of acute treatment, 45% of participants reached or exceeded baseline TST. By 24 months follow-up, this percentage had increased to 86%. Only 17% of participants achieved a 30-minute increase in TST by the end of acute treatment, and this proportion only increased to 58% over time. CONCLUSIONS These findings suggest that cognitive behavioral therapy for insomnia in its current form does not appreciably increase self-reported TST in a significant proportion of patients with insomnia. Whether participants would benefit from further increases in TST warrants investigation. The further titration of sleep opportunity may be useful to accelerate increases in TST, to extend the effect to a larger subset of patients, and/or to increase the magnitude of the TST gain. CITATION Scott H, Cheung JMY, Muench A, et al. Does total sleep time substantially increase after cognitive behavioral therapy for insomnia? J Clin Sleep Med. 2022;18(7):1823-1829.
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Affiliation(s)
- Hannah Scott
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Janet M.Y. Cheung
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alexandria Muench
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hans Ivers
- School of Psychology and BRAIN Research Center, Université Laval, Quebec City, Canada
| | | | - Leon Lack
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Charles M. Morin
- School of Psychology and BRAIN Research Center, Université Laval, Quebec City, Canada
| | - Michael Perlis
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
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8
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Duraccio KM, Simmons DM, Beebe DW, Byars KC. Relationship of overweight and obesity to insomnia severity, sleep quality, and insomnia improvement in a clinically referred pediatric sample. J Clin Sleep Med 2022; 18:1083-1091. [PMID: 34879901 PMCID: PMC8974392 DOI: 10.5664/jcsm.9806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Children with overweight or obesity are more likely to experience sleep disorders, although the role of weight in pediatric insomnia treatment has not been examined. The current study examined the relationships of high body mass with pretreatment insomnia severity and global sleep problems and the potential moderating impact of weight on changes in insomnia severity following insomnia treatment. METHODS Participants included 1,133 youth ages 2-18 years clinically referred for insomnia treatment. The Pediatric Insomnia Severity Index was collected at the initial assessment and throughout treatment as part of routine clinical care. Treatment status was coded as no treatment, early termination, and completed treatment. Secondary measures of global sleep problems at the initial assessment included the Adolescent Sleep Wake Scale, Adolescent Sleep Hygiene Scale, and Children's Sleep Habits Questionnaire. Medical chart review of visits within ± 3 months of baseline was used to obtain age-adjusted and sex-adjusted body mass index Z-score. RESULTS Among adolescents, regression analyses found that higher body mass index Z-score modestly predicted baseline insomnia severity (P = .021) and worse sleep hygiene (P < .001). For children, higher body mass index Z-score was modestly associated with baseline total sleep problems (P = .006) but not insomnia severity (P = .792). Across ages, body mass index Z-score predicted neither treatment status nor insomnia improvement (P > .05). Findings were similar in categorical analyses comparing patients with overweight/obesity to healthy weight. CONCLUSIONS Although there is evidence that children of higher body mass present for insomnia treatment with greater sleep concerns, body mass does not predict treatment completion or insomnia improvement. Data suggest insomnia treatment is effective irrespective of weight status. CITATION Duraccio KM, Simmons DM, Beebe DW, Byars KC. Relationship of overweight and obesity to insomnia severity, sleep quality, and insomnia improvement in a clinically referred pediatric sample. J Clin Sleep Med. 2022;18(4):1083-1091.
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Affiliation(s)
| | - Danielle M. Simmons
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Dean W. Beebe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kelly C. Byars
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Walker J, Muench A, Perlis ML, Vargas I. Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer. KLINICHESKAIA I SPETSIAL'NAIA PSIKHOLOGIIA = CLINICAL PSYCHOLOGY AND SPECIAL EDUCATION 2022; 11:123-137. [PMID: 36908717 PMCID: PMC10002474 DOI: 10.17759/cpse.2022110208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a multi-component treatment for insomnia that targets difficulties with initiating and/or maintaining sleep and is delivered over the course of six to eight sessions. The primary focus of CBT-I is to address the perpetuating factors (according to the three-factor model of insomnia) that contribute to the development of chronic insomnia. Chronic insomnia is the most prevalent sleep disorder, occurring in approximately 6-10% of the population, and is a risk factor for multiple medical and psychiatric disorders. Despite its prevalence and morbidity, the widespread dissemination of CBT-I is not commensurate with insomnia's overall public health impact. This is particularly surprising given its large evidence base and recent recommendation as the first line intervention for insomnia. The primary goal of this article is to provide a primer or brief introduction to CBT-I that is intended to be accessible to all clinicians and researchers, including non-sleep experts. Core components of CBT-I (i.e., Sleep Restriction Therapy, Stimulus Control Therapy, Sleep Hygiene, and Cognitive Therapy), relapse prevention strategies, multicultural considerations, adjuvants to traditional interventions, treatment adherence issues, efficacy, and further training options are described. A session-by-session outline is also provided.
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Affiliation(s)
| | | | | | - Ivan Vargas
- University of Arkansas, Fayetteville, AR, USA
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10
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Cho JH, Kremer S, Young J. Who to Refer to a Behavioral Insomnia Clinic? - Recommendations Based on Treatment Rationale and Response Prediction. CURRENT SLEEP MEDICINE REPORTS 2021; 7:213-220. [PMID: 34804765 PMCID: PMC8596854 DOI: 10.1007/s40675-021-00220-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
Purpose of Review Response to cognitive-behavioral therapy for insomnia (CBT-I) is variable across individuals, and specialty insomnia clinics that provide CBT-I are few. To personalize insomnia treatments and maximize the cost-effectiveness of CBT-I, this paper reviews the conceptual model and content of CBT-I and the predictors of adherence/response to CBT-I as the basis for understanding who is most likely to benefit from CBT-I. Recent Findings Specific patient-related attributes that predict benefit from CBT-I include (1) presence of maladaptive behaviors that serve as perpetuating factors of insomnia; (2) greater motivation to pursue therapy and higher treatment expectancies regarding CBT-I; (3) reduced use of hypnotics; (4) longer sleep duration; and (5) adequately treated psychiatric comorbidities. Summary People presenting with chronic insomnia and these attributes may warrant prioritization in referral to behavioral insomnia clinics. Conversely, those who do not have such favorable characteristics may require interventions that address modifiable factors associated with poor adherence/response to CBT-I.
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Affiliation(s)
- Joshua H Cho
- UCLA Insomnia Clinic, Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, 300 UCLA Medical Plaza, Suite 3200A, Los Angeles, CA 90095 USA
| | - Stephanie Kremer
- UCLA Insomnia Clinic, Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, 300 UCLA Medical Plaza, Suite 3200A, Los Angeles, CA 90095 USA
| | - Jeffrey Young
- UCLA Insomnia Clinic, Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, 300 UCLA Medical Plaza, Suite 3200A, Los Angeles, CA 90095 USA
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11
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Sultana M, Campbell K, Jennings M, Montero-Odasso M, Orange JB, Knowlton J, St George A, Bryant D. Virtual Reality Experience Intervention May Reduce Responsive Behaviors in Nursing Home Residents with Dementia: A Case Series. J Alzheimers Dis 2021; 84:883-893. [PMID: 34602467 DOI: 10.3233/jad-210010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with advanced dementia often exhibit responsive behaviors such as apathy, depression, agitation, aggression, and psychosis. Non-pharmacological approaches (e.g., listening to music, watching television, doing arts and crafts) are now considered as a first-line strategy to manage responsive behaviors in clinical practice due to the potential risks associated with the antipsychotic medications. To date, no evaluations of immersive non-head mounted virtual reality (VR) experience as a non-pharmacologic approach for people with advanced dementia living in nursing homes have been reported. OBJECTIVE To evaluate the feasibility (acceptance and safety) of VR experience. METHODS A single site case series (nonrandomized and unblinded) with a convenience sample (N = 24; age = 85.8±8.6 years; Cognitive Performance Scale score = 3.4±0.6) measuring depression and agitation before and after the intervention. The intervention was a 30-min long research coordinator- facilitated VR experience for two weeks (10 sessions). RESULTS The intervention was feasible (attrition rate = 0% ; adverse events = 0). A reduction in depression and in agitation was observed after the intervention. However, we suggest extreme caution in interpreting this result considering the study design and small sample size. CONCLUSION This study provides the basis for conducting a randomized controlled trial to evaluate the effect of VR experience on responsive behaviors in nursing homes. Since our intervention uses a smart remote-controlled projector without a headset, infectious exposure can be avoided following the COVID-19 pandemic-induced physical distancing policy in care homes.
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Affiliation(s)
- Munira Sultana
- Health and Rehabilitation Sciences, Western University, London, ON, Canada.,Gait & Brain Lab, Parkwood Institute, London, ON, Canada
| | - Karen Campbell
- International Skin Tear Advisory Panel, Ottawa, ON, Canada.,Primacare Living Solutions Inc.TM, Toronto, ON, Canada.,Master of Clinical Science - Advanced Health Care Practice, Western University, London, ON, Canada
| | - Morgan Jennings
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Manuel Montero-Odasso
- Gait & Brain Lab, Parkwood Institute, London, ON, Canada.,Department of Medicine and Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,Geriatric Medicine, St. Joseph's Health Care, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - J B Orange
- Lawson Health Research Institute, London, ON, Canada
| | - Jill Knowlton
- Primacare Living Solutions Inc.TM, Toronto, ON, Canada
| | | | - Dianne Bryant
- Lawson Health Research Institute, London, ON, Canada.,School of Physical Therapy and Schulich School of Medicine & Dentistry (Orthopaedic Surgery), Western University, London, ON, Canada.,Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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12
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Zavalko IM. [Options to enhance the efficacy of cognitive-behavior therapy of insomnia]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:36-40. [PMID: 34078858 DOI: 10.17116/jnevro202112140236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cognitive-behavior therapy of insomnia (CBT-I) is first-line treatment for insomnia, but it produces a clinical significant result only in 60-80% of patients. Addition reason of reduction of CBT-I efficacy is a relatively low adherence: the attrition rate is 10-39%. The authors discuss options to enhance efficacy of the therapy by usage of complex approach, individualized choice of technics, motivating a patient and his relatives, and combination of CBT-I with hypnotics.
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Affiliation(s)
- I M Zavalko
- State Research Center Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
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Wilson D, Driller M, Johnston B, Gill N. The effectiveness of a 17-week lifestyle intervention on health behaviors among airline pilots during COVID-19. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:333-340. [PMID: 33221534 PMCID: PMC7957121 DOI: 10.1016/j.jshs.2020.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/24/2020] [Accepted: 10/15/2020] [Indexed: 06/01/2023]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy of a 17-week, 3-component lifestyle intervention for enhancing health behaviors during the coronavirus disease 2019 (COVID-19) pandemic. METHODS A parallel-group (intervention and control) study was conducted amongst 79 airline pilots over a 17-week period during the COVID-19 pandemic. The intervention group (n = 38) received a personalized sleep, dietary, and physical activity (PA) program. The control group (n = 41) received no intervention. Outcome measures for sleep, fruit and vegetable intake, PA, and subjective health were measured though an online survey before and after the 17-week period. The changes in outcome measures were used to determine the efficacy of the intervention. RESULTS Significant main effects for time × group were found for International Physical Activity Questionnaire-walk (p = 0.02) and for all other outcome measures (p < 0.01). The intervention group significantly improved in sleep duration (p < 0.01; d = 1.35), Pittsburgh Sleep Quality Index score (p < 0.01; d = 1.14), moderate-to-vigorous PA (p < 0.01; d = 1.44), fruit and vegetable intake (p < 0.01; d = 2.09), Short Form 12v2 physical score (p < 0.01; d = 1.52), and Short Form 12v2 mental score (p < 0.01; d = 2.09). The control group showed significant negative change for sleep duration, Pittsburgh Sleep Quality Index score, and Short Form 12v2 mental score (p < 0.01). CONCLUSION Results provide preliminary evidence that a 3-component healthy sleep, eating, and PA intervention elicit improvements in health behaviors and perceived subjective health in pilots and may improve quality of life during an unprecedented global pandemic.
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Affiliation(s)
- Daniel Wilson
- Te Huataki Waiora School of Health, The University of Waikato, Hamilton 3216, New Zealand; Faculty of Health, Education and Environment, Toi Ohomai Institute of Technology, Tauranga 3112, New Zealand.
| | - Matthew Driller
- Sport and Exercise Science, Human Services and Sport, La Trobe University, Melbourne 3086, Australia
| | - Ben Johnston
- Aviation and Occupational Medicine Unit, Wellington School of Medicine, Otago University, Wellington 6242, New Zealand
| | - Nicholas Gill
- Te Huataki Waiora School of Health, The University of Waikato, Hamilton 3216, New Zealand; New Zealand Rugby, Wellington 6011, New Zealand
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Short NA, Uhde TW, Paquet C, Milanak M, Rheingold AA, Wilkerson A. An Investigation of the Rate and Predictors of Initiating and Attending Group Cognitive Behavioral Therapy for Insomnia After Referral. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Efficacy of a sleep health intervention to optimize standard smoking cessation treatment response: results from a pilot randomized controlled trial. J Smok Cessat 2020. [DOI: 10.1017/jsc.2020.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AbstractBackgroundWe tested if an adjunctive sleep health (SH) intervention improved smoking cessation treatment response by increasing quit rates. We also examined if baseline sleep, and improvements in sleep in the first weeks of quitting, were associated with quitting at the end of treatment.MethodsTreatment-seeking smokers (N = 29) aged 21–65 years were randomized to a SH intervention (n = 16), or general health (GH) control (n = 13) condition. Participants received six counseling sessions across 15-weeks: SH received smoking cessation + SH counseling; GH received smoking cessation + GH counseling. Counseling began 4-weeks before the target quit date (TQD), and varenicline treatment began 1-week prior to TQD. Smoking status and SH were assessed at baseline (week 1), TQD (week 4), 3 weeks after cessation (week 7), week 12, and at the end of treatment (EOT; week 15).ResultsSH versus GH participants had higher Carbon Monoxide (CO) -verified, 7-day point prevalence abstinence at EOT (69% vs. 54%, respectively; adjusted odds ratio (aOR) = 2.10, 95% confidence interval (CI) = 0.40–10.69, P = 0.77). Higher baseline sleep efficiency (aOR = 1.42, 95% CI = 1.03–1.96, P = 0.03), predicted higher EOT cessation. Models were adjusted for age, sex, education, and baseline nicotine dependence.ConclusionsImproving SH in treatment-seeking smokers prior to cessation warrants further examination as a viable strategy to promote cessation.
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Cognitive behavioural treatment for insomnia in primary care: a systematic review of sleep outcomes. Br J Gen Pract 2019; 69:e657-e664. [PMID: 31358494 DOI: 10.3399/bjgp19x705065] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/11/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Practice guidelines recommend that chronic insomnia be treated first with cognitive behavioural therapy for insomnia (CBT-I), and that hypnotic medication be considered only when CBT-I is unsuccessful. Although there is evidence of CBT-I's efficacy in research studies, systematic reviews of its effects in primary care are lacking. AIM To review the effects on sleep outcomes of CBT-I delivered in primary care. DESIGN AND SETTING Systematic review of articles published worldwide. METHOD Medline, PsycINFO, EMBASE, and CINAHL were searched for articles published from January 1987 until August 2018 that reported sleep results and on the use of CBT-I in general primary care settings. Two researchers independently assessed and then reached agreement on the included studies and the extracted data. Cohen's d was used to measure effects on sleep diary outcomes and the Insomnia Severity Index. RESULTS In total, 13 studies were included. Medium-to-large positive effects on self-reported sleep were found for CBT-I provided over 4-6 sessions. Improvements were generally well maintained for 3-12 months post-treatment. Studies of interventions in which the format or content veered substantially from conventional CBT-I were less conclusive. In only three studies was CBT-I delivered by a GP; usually, it was provided by nurses, psychologists, nurse practitioners, social workers, or counsellors. Six studies included advice on withdrawal from hypnotics. CONCLUSION The findings support the effectiveness of multicomponent CBT-I in general primary care. Future studies should use standard sleep measures, examine daytime symptoms, and investigate the impact of hypnotic tapering interventions delivered in conjunction with CBT-I.
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Jan YW, Yang CM, Huang SH, Lee HC. Treatment effect of cognitive-behavior therapy for insomnia combined with usual medication. Sleep Biol Rhythms 2019. [DOI: 10.1007/s41105-019-00218-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Buenaver LF, Townsend D, Ong JC. Delivering Cognitive Behavioral Therapy for Insomnia in the Real World: Considerations and Controversies. Sleep Med Clin 2019; 14:275-281. [PMID: 31029193 DOI: 10.1016/j.jsmc.2019.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cognitive-behavioral therapy for insomnia (CBT-I) has emerged as the first-line treatment for chronic insomnia but remains massively underused relative to the prevalence of insomnia disorder. This article focuses on 3 key issues in the delivery of CBT-I in the real world. First, where and how should CBT-I be delivered and who should deliver it? Second, who is an appropriate candidate for CBT-I? Third, how do you measure quality care with CBT-I? These issues give rise to targets for future research aimed at improving the implementation science of CBT-I in the real world.
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Affiliation(s)
- Luis F Buenaver
- Departments of Psychiatry and Behavioral Sciences, and Neurology, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 100, Baltimore, MD 21224, USA.
| | - Donald Townsend
- Arizona School of Professional Psychology at Argosy University, 3322 West Dunlap Avenue, Phoenix, AZ 85021, USA
| | - Jason C Ong
- Department of Neurology, Northwestern University Feinberg School of Medicine, Abbott Hall Suite 1004, 710 North Lake Shore Drive, Chicago, IL 60611, USA
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Jansson-Fröjmark M, Harvey AG, Flink IK. Psychometric properties of the Insomnia Catastrophizing Scale (ICS) in a large community sample. Cogn Behav Ther 2019; 49:120-136. [PMID: 30896297 DOI: 10.1080/16506073.2019.1588362] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose was to investigate the psychometric properties of the Insomnia Catastrophizing Scale (ICS) including factorial validity and internal consistency as well as discriminative and convergent validity. Associations with sleep parameters and daytime impairment are also examined. Drawn from a randomly selected sample of the general population, 1615 participants completed a survey on insomnia-related nighttime and daytime symptoms, health outcomes and psychological processes, including the ICS. A one-factor solution was supported for both the nighttime catastrophizing (11 items) and daytime catastrophizing (6 items) subscales. Both subscales displayed high internal consistencies (α > 0.90) and accounted for 59.1-70.1% of the variance. The insomnia disorder group had significantly higher scores than participants without insomnia on the two subscales and on the individual items. Cutoffs were established for both subscales with acceptable sensitivity and specificity. Both subscales displayed adequate convergent validity with measures indexing worry, cognitive pre-sleep arousal and anxiety. The two subscales were also significantly associated with nighttime and daytime insomnia symptoms. The ICS is a reliable and valid scale for the assessment of insomnia-related catastrophizing. Future research is needed to examine the test-retest reliability and treatment sensitivity of the ICS.
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Affiliation(s)
- Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Ida K Flink
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
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Galbiati A, Sforza M, Fasiello E, Castronovo V, Ferini-Strambi L. Impact Of Phenotypic Heterogeneity Of Insomnia On The Patients' Response To Cognitive-Behavioral Therapy For Insomnia: Current Perspectives. Nat Sci Sleep 2019; 11:367-376. [PMID: 31819690 PMCID: PMC6890191 DOI: 10.2147/nss.s198812] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/22/2019] [Indexed: 11/23/2022] Open
Abstract
Insomnia is one of the most common mental disorders and the most frequent sleep disorder encountered in clinical practice, with a prevalence of about 7% in the European population. Insomnia Disorder (ID) is defined as a disturbance of sleep initiation or maintenance, followed by a feeling of non-restorative sleep and several diurnal consequences ranging from occupational and social difficulties to cognitive impairment. Cognitive-Behavioral Therapy for Insomnia (CBT-I) is considered the first-choice therapy for this disorder because its effectiveness has been proven to be greater in the long term with fewer side effects in comparison to pharmacotherapy. Although its effectiveness has been well established, it has been reported that nearly 40% of patients do not achieve remission after treatment. This finding could be the consequence of heterogeneity of ID between patients. It has been proposed that this heterogeneity might be ascribable to indices that are not related to sleep quality and quantity, such as comorbidities, life events, and personality traits. However, several works focused on the role of sleep markers, in particular objective total sleep time, for the phenotypization of ID and treatment response. The aim of this work is to summarize the available scientific literature regarding the impact of ID subtype on CBT-I response.
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Affiliation(s)
- Andrea Galbiati
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Marco Sforza
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Elisabetta Fasiello
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Vincenza Castronovo
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Luigi Ferini-Strambi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
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Pulantara IW, Parmanto B, Germain A. Clinical Feasibility of a Just-in-Time Adaptive Intervention App (iREST) as a Behavioral Sleep Treatment in a Military Population: Feasibility Comparative Effectiveness Study. J Med Internet Res 2018; 20:e10124. [PMID: 30530452 PMCID: PMC6303679 DOI: 10.2196/10124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/22/2018] [Accepted: 09/10/2018] [Indexed: 01/23/2023] Open
Abstract
Background Although evidence-based cognitive behavioral sleep treatments have been shown to be safe and effective, these treatments have limited scalability. Mobile health tools can address this scalability challenge. iREST, or interactive Resilience Enhancing Sleep Tactics, is a mobile health platform designed to provide a just-in-time adaptive intervention (JITAI) in the assessment, monitoring, and delivery of evidence-based sleep recommendations in a scalable and personalized manner. The platform includes a mobile phone–based patient app linked to a clinician portal. Objective The first aim of the pilot study was to evaluate the effectiveness of JITAI using the iREST platform for delivering evidence-based sleep interventions in a sample of military service members and veterans. The second aim was to explore the potential effectiveness of this treatment delivery form relative to habitual in-person delivery. Methods In this pilot study, military service members and veterans between the ages of 18 and 60 years who reported clinically significant service-related sleep disturbances were enrolled as participants. Participants were asked to use iREST for a period of 4 to 6 weeks during which time they completed a daily sleep/wake diary. Through the clinician portal, trained clinicians offered recommendations consistent with evidence-based behavioral sleep treatments on weeks 2 through 4. To explore potential effectiveness, self-report measures were used, including the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI), and the PSQI Addendum for Posttraumatic Stress Disorder. Results A total of 27 participants completed the posttreatment assessments. Between pre- and postintervention, clinically and statistically significant improvements in primary and secondary outcomes were detected (eg, a mean reduction on the ISI of 9.96, t26=9.99, P<.001). At posttreatment, 70% (19/27) of participants met the criteria for treatment response and 59% (16/27) achieved remission. Comparing these response and remission rates with previously published results for in-person trials showed no significant differences. Conclusion Participants who received evidence-based recommendations from their assigned clinicians through the iREST platform showed clinically significant improvements in insomnia severity, overall sleep quality, and disruptive nocturnal disturbances. These findings are promising, and a larger noninferiority clinical trial is warranted.
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Affiliation(s)
- I Wayan Pulantara
- Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bambang Parmanto
- Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anne Germain
- Sleep and Behavioral Neuroscience Center, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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Abstract
In this study the authors evaluated how a consistent sleep schedule would result in the participant’s being able to demonstrate a shorter latency between retiring for bed and sleep. A 44-year-old female went to bed within the same 15-minute time period at night and arose within the same 15-minute time period in the morning. A single-subject reversal design was used. During treatment, the average latency between going to bed and sleeping was 46 minutes (111 minutes before treatment), with the last 5 nights averaging 9 minutes of latency. The participant established consistency in her bedtime schedule by going to bed at the same time every night and by arising in the morning at the same time. This intervention resulted in the participant’s demonstrating a shorter latency between the onset of bedtime and going to sleep. This intervention and measuring procedure was used with little expense to the participant and yet captured the behavior change intended.
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23
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Thomas A, Grandner M, Nowakowski S, Nesom G, Corbitt C, Perlis ML. Where are the Behavioral Sleep Medicine Providers and Where are They Needed? A Geographic Assessment. Behav Sleep Med 2016; 14:687-98. [PMID: 27159249 PMCID: PMC5070478 DOI: 10.1080/15402002.2016.1173551] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although it is widely acknowledged that there are not enough clinicians trained in either Behavioral Sleep Medicine (BSM) in general or in Cognitive Behavioral Therapy for Insomnia (CBT-I) in specific, what is unclear is whether this problem is more acute in some regions relative to others. Accordingly, a geographic approach was taken to assess this issue. Using national directories as well as e-mail listservs (Behavioral Sleep Medicine group and Behavioral Treatment for Insomnia Roster), the present study evaluated geographic patterning of CBSM and BSM providers by city, state, and country. Overall, 88% of 752 BSM providers worldwide live in the United States (n = 659). Of these, 58% reside in 12 states with ≥ 20 providers (CA, NY, PA, IL, MA, TX, FL, OH, MI, MN, WA, and CO), and 19% reside in just 2 states (NY and CA). There were 4 states with no BSM providers (NH, HI, SD, and WY). Of the 167 U.S. cities with a population of > 150,000, 105 cities have no BSM providers. These results clearly suggest that a targeted effort is needed to train individuals in both the unserved and underserved areas.
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Affiliation(s)
- Arthur Thomas
- Department of Biology, University of Pennsylvania, Philadelphia, Pennsylvania, Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Grandner
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, Arizona
| | - Sara Nowakowski
- Department of Obstetrics & Gynecology, Department of Psychiatry & Behavioral Sciences, The University of Texas (Medical Branch), Galveston, Texas
| | - Genevieve Nesom
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles Corbitt
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael L. Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Yeung WF, Chung KF, Ho FYY, Ho LM. Predictors of dropout from internet-based self-help cognitive behavioral therapy for insomnia. Behav Res Ther 2015. [PMID: 26226091 DOI: 10.1016/j.brat.2015.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dropout from self-help cognitive-behavioral therapy for insomnia (CBT-I) potentially diminishes therapeutic effect and poses clinical concern. We analyzed the characteristics of subjects who did not complete a 6-week internet-based CBT-I program. Receiver operator characteristics (ROC) analysis was used to identify potential variables and cutoff for predicting dropout among 207 participants with self-report insomnia 3 or more nights per week for at least 3 months randomly assigned to self-help CBT-I with telephone support (n = 103) and self-help CBT-I (n = 104). Seventy-two participants (34.4%) did not complete all 6 sessions, while 42 of the 72 (56.9%) dropped out prior to the fourth session. Significant predictors of non-completion are total sleep time (TST) ≥ 6.82 h, Hospital Anxiety and Depression Scale depression score ≥ 9 and Insomnia Severity Index score < 13 at baseline in this ranking order. Only TST ≥ 5.92 h predicts early dropout. Longer TST and less severe insomnia predict dropout in this study of self-help CBT-I, in contrast to shorter TST as a predictor in 2 studies of face-to-face CBT-I, while greater severity of depression predicts dropout in both this study and a study of face-to-face CBT-I. Strategies for minimizing dropout from internet-based CBT-I are discussed.
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Affiliation(s)
- Wing-Fai Yeung
- School of Chinese Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Ka-Fai Chung
- Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Fiona Yan-Yee Ho
- Department of Psychology, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Lai-Ming Ho
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region
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Taylor HL, Rybarczyk BD, Nay W, Leszczyszyn D. Effectiveness of a CBT Intervention for Persistent Insomnia and Hypnotic Dependency in an Outpatient Psychiatry Clinic. J Clin Psychol 2015; 71:666-83. [DOI: 10.1002/jclp.22186] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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26
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A History of Nonpharmacological Treatments for Insomnia. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Germain A, Richardson R, Stocker R, Mammen O, Hall M, Bramoweth AD, Begley A, Rode N, Frank E, Haas G, Buysse DJ. Treatment for insomnia in combat-exposed OEF/OIF/OND military veterans: preliminary randomized controlled trial. Behav Res Ther 2014; 61:78-88. [PMID: 25194223 DOI: 10.1016/j.brat.2014.07.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Chronic insomnia is highly prevalent among military personnel returning from Iraq and Afghanistan. We evaluated the effects of a military version of a brief behavioral treatment of insomnia (BBTI-MV) compared to an information only control (IC) condition in combat-exposed Veterans of Operations Enduring/Iraqi Freedom or Operation New Dawn (OEF/OIF/OND) on insomnia, sleep quality, and daytime symptoms of anxiety and depression. Forty OEF/OIF/OND Veterans (Mean age = 38.4 years old, s.d. = 11.69; 85% men; 77.5% white) were randomized to one of two conditions. BBTI-MV consisted of two in-person sessions and two telephone contacts delivered over four weeks, and included personalized recommendations to reduce insomnia. The IC condition also consisted of 2 in-person sessions two telephone contacts delivered over four weeks, and Veterans were encouraged to read written information about sleep-promoting behaviors. The Insomnia Severity Index, Pittsburgh Sleep Quality Index, PTSD Checklist, and Beck Depression and Anxiety Inventories were completed at baseline, post-treatment, and at the six-month follow-up. Both interventions were associated with clinically significant improvements in insomnia, although the magnitude of improvements in sleep and rates of treatment response and remission were greater for BBTI-MV compared to IC from pre- to post-treatment. Both BBTI-MV and the provision of information were associated with clinically significant improvements in insomnia among Veterans. Despite the preliminary nature of the findings and limitations inherent to small controlled trials, the findings suggest that both approaches may provide viable options in a stepped-care approach to the treatment of insomnia in retuning combat-exposed Veterans. Larger, confirmatory effectiveness trials are required. CLINICALTRIALSGOV IDENTIFIER NCT00840255.
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Affiliation(s)
- Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA.
| | | | | | - Oommen Mammen
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
| | - Martica Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
| | - Adam D Bramoweth
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA; VISN4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, USA
| | - Amy Begley
- University of Pittsburgh Medical Center, USA
| | - Noelle Rode
- University of Pittsburgh Medical Center, USA
| | - Ellen Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
| | - Gretchen Haas
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA; VISN4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA
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Altering Unhelpful Beliefs About Sleep with Behavioral and Cognitive Therapies. COGNITIVE THERAPY AND RESEARCH 2011. [DOI: 10.1007/s10608-011-9417-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Van Houdenhove L, Buyse B, Gabriëls L, Van den Bergh O. Treating Primary Insomnia: Clinical Effectiveness and Predictors of Outcomes on Sleep, Daytime Function and Health-Related Quality of Life. J Clin Psychol Med Settings 2011; 18:312-21. [DOI: 10.1007/s10880-011-9250-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Siebern AT, Manber R. New developments in cognitive behavioral therapy as the first-line treatment of insomnia. Psychol Res Behav Manag 2011; 4:21-8. [PMID: 22114532 PMCID: PMC3218784 DOI: 10.2147/prbm.s10041] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Insomnia is the most common sleep disorder. Psychological, behavioral, and biological factors are implicated in the development and maintenance of insomnia as a disorder, although the etiology of insomnia remains under investigation, as it is still not fully understood. Cognitive behavioral therapy for insomnia (CBTI) is a treatment for insomnia that is grounded in the science of behavior change, psychological theories, and the science of sleep. There is strong empirical evidence that CBTI is effective. Recognition of CBTI as the first-line treatment for chronic insomnia (National Institutes of Health consensus, British Medical Association) was based largely on evidence of its efficacy in primary insomnia. The aim of this article is to provide background information and review recent developments in CBTI, focusing on three domains: promising data on the use of CBTI when insomnia is experienced in the presence of comorbid conditions, new data on the use of CBTI as maintenance therapy, and emerging data on the delivery of CBTI through the use of technology and in primary care settings.
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Affiliation(s)
- Allison T Siebern
- Sleep Medicine Center, Stanford University School of Medicine, Redwood City, California, USA
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31
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Cognitive–behavioral therapy of insomnia: A clinical case series study of patients with co-morbid disorders and using hypnotic medications. Behav Res Ther 2010; 48:321-7. [DOI: 10.1016/j.brat.2009.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 12/03/2009] [Accepted: 12/07/2009] [Indexed: 10/20/2022]
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32
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Riemann D. Does effective management of sleep disorders reduce depressive symptoms and the risk of depression? Drugs 2010; 69 Suppl 2:43-64. [PMID: 20047350 DOI: 10.2165/11531130-000000000-00000] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The link between co-morbid insomnia and depression has been demonstrated in numerous groups. Insomnia has been associated with: (1) an increased risk of developing subsequent depression; (2) an increased duration of established depression; and (3) relapse following treatment for depression. In addition, specific insomnia symptoms, such as nocturnal awakening with difficulty resuming sleep, are more strongly associated with depression than classic symptoms of insomnia. Participants of a workshop, held at the 6th annual meeting of The International Sleep Disorders Forum: The Art of Good Sleep in 2008, evaluated whether the effective management of sleep disorders could reduce both concurrent depressive symptoms and the risk of developing subsequent depression. Following the workshop, a targeted literature review was conducted. Initial evidence demonstrated that in patients with insomnia and co-morbid depression either pharmacological treatment of insomnia or psychological treatment in the form of cognitive behavioural therapy for insomnia improved both insomnia and depressive symptoms. Although these appeared to be promising treatment strategies, however, of the 27 identified treatment studies, only one large well-designed randomized controlled trial comparing the efficacy of eszopiclone plus fluoxetine with placebo plus fluoxetine demonstrated unequivocal evidence that improvements in insomnia symptoms conferred additive benefits on depressive outcomes. In addition, it was unclear whether any differences exist in efficacy between sedating versus non-sedating pharmacotherapies for insomnia in this patient group. Further studies of sufficient sample size and duration are needed to evaluate combinations of pharmacological (either sedating or non-sedating) and psychological interventions in co-morbid insomnia and depression. This article reviews the level of evidence, recommendations and areas of particular interest for further study and discussion arising from this workshop.
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Affiliation(s)
- Dieter Riemann
- Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Freiburg, Germany.
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Staner L. Comorbidity of insomnia and depression. Sleep Med Rev 2009; 14:35-46. [PMID: 19939713 DOI: 10.1016/j.smrv.2009.09.003] [Citation(s) in RCA: 303] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 09/08/2009] [Accepted: 09/09/2009] [Indexed: 12/18/2022]
Abstract
During the last decade, several studies have shown that insomnia, rather than a symptom of depression, could be a medical condition on its own, showing high comorbidity with depression. Epidemiological research indicates that insomnia could lead to depression and/or that common causalities underlie the two disorders. Neurobiological and sleep EEG studies suggest that a heightened level of arousal may play a common role in both conditions and that signs of REM sleep disinhibition may appear in individuals prone to depression. The effects of antidepressant drugs on non-REM and REM sleep are discussed in relation to their use in insomnia comorbid with depression. Empirical treatment approaches are behavioral management of sleep combined with prescription of a sedative antidepressant alone, co-prescription of two antidepressants, or of an antidepressant with a hypnotic drug.
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Affiliation(s)
- Luc Staner
- Sleep Laboratory, Forenap, Centre Hospitalier de Rouffach, 27 rue du 4ème R.S.M. F-68250 Rouffach, France.
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Vincent N, Lewycky S. Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia. Sleep 2009; 32:807-15. [PMID: 19544758 DOI: 10.1093/sleep/32.6.807] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Despite effective cognitive behavioral treatments for chronic insomnia, such treatments are underutilized. This study evaluated the impact of a 5-week, online treatment for insomnia. DESIGN This was a randomized controlled trial with online treatment and waiting list control conditions. PARTICIPANTS Participants were 118 adults with chronic insomnia. SETTING Participants received online treatment from their homes. INTERVENTION Online treatment consisted of psychoeducation, sleep hygiene, and stimulus control instruction, sleep restriction treatment, relaxation training, cognitive therapy, and help with medication tapering. MEASUREMENT AND RESULTS From pre- to post-treatment, there was a 33% attrition rate, and attrition was related to referral status (i.e., dropouts were more likely to have been referred for treatment rather than recruited from the community). Using a mixed model analysis of variance procedure (ANOVA), results showed that online treatment produced statistically significant improvements in the primary end points of sleep quality, insomnia severity, and daytime fatigue. Online treatment also produced significant changes in process variables of pre-sleep cognitive arousal and dysfunctional beliefs about sleep. CONCLUSIONS Implications of these findings are that identification of who most benefits from online treatment is a worthy area of future study.
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Affiliation(s)
- Norah Vincent
- Department of Clinical Health Psychology, University of Manitoba, Manitoba, Canada
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Manber R, Edinger JD, Gress JL, San Pedro-Salcedo MG, Kuo TF, Kalista T. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep 2008; 31:489-95. [PMID: 18457236 DOI: 10.1093/sleep/31.4.489] [Citation(s) in RCA: 560] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY OBJECTIVE Insomnia impacts the course of major depressive disorder (MDD), hinders response to treatment, and increases risk for depressive relapse. This study is an initial evaluation of adding cognitive behavioral therapy for insomnia (CBTI) to the antidepressant medication escitalopram (EsCIT) in individuals with both disorders. DESIGN AND SETTING A randomized, controlled, pilot study in a single academic medical center. PARTICIPANTS 30 individuals (61% female, mean age 35 +/- 18) with MDD and insomnia. INTERVENTIONS EsCIT and 7 individual therapy sessions of CBTI or CTRL (quasi-desensitization). MEASUREMENTS AND RESULTS Depression was assessed with the HRSD17 and the depression portion of the SCID, administered by raters masked to treatment assignment, at baseline and after 2, 4, 6, 8, and 12 weeks of treatment. The primary outcome was remission of MDD at study exit, which required both an HRSD17 score < or =7 and absence of the 2 core symptoms of MDD. Sleep was assessed with the insomnia severity index (ISI), daily sleep diaries, and actigraphy. EsCIT + CBTI resulted in a higher rate of remission of depression (61.5%) than EsCIT + CTRL (33.3%). EsCIT + CBTI was also associated with a greater remission from insomnia (50.0%) than EsCIT + CTRL (7.7%) and larger improvement in all diary and actigraphy measures of sleep, except for total sleep time. CONCLUSIONS This pilot study provides evidence that augmenting an antidepressant medication with a brief, symptom focused, cognitive-behavioral therapy for insomnia is promising for individuals with MDD and comorbid insomnia in terms of alleviating both depression and insomnia.
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Affiliation(s)
- Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA 94305, USA.
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Ong JC, Kuo TF, Manber R. Who is at risk for dropout from group cognitive-behavior therapy for insomnia? J Psychosom Res 2008; 64:419-25. [PMID: 18374742 PMCID: PMC2435302 DOI: 10.1016/j.jpsychores.2007.10.009] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 07/18/2007] [Accepted: 10/16/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the present study was to identify characteristics of patients who are at risk for dropout from a seven-session group cognitive-behavior therapy for insomnia (CBT-I) in a clinical setting using the receiver operating characteristic curve (ROC) approach. METHODS Two separate ROC analyses were conducted using predictor variables taken from questionnaire packets and sleep diaries collected at baseline including age, gender, Beck Depression Inventory (BDI), Morningness-Eveningness Questionnaire, Beliefs and Attitudes about Sleep, use of sleep medication, sleep onset latency, wake time after sleep onset, and total sleep time (TST). RESULTS The first ROC analysis was conducted on the entire sample of 528 patients with treatment completion vs. dropout (noncompletion) as the outcome variable. No significant predictor variables were found in this analysis. The second ROC analysis was conducted on the 211 patients who did not complete treatment with early termination (prior to fourth session) vs. late termination (at or after fourth session) as the outcome variable. The results revealed that patients who reported an average baseline TST <3.65 h were at greatest risk for early termination. Sixty percent of patients in this group terminated early compared to 9.3% of patients with TST > or =3.65 h. Among patients with TST > or =3.65 h, 22% of those with BDI scores > or =16 were early dropouts compared to 4.3% of those who reported BDI <16. CONCLUSION These findings indicate that short sleep duration and elevated symptoms of depression at baseline are associated with increased risk of early termination from CBT-I.
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Abstract
Primary insomnia (PI) is a prevalent form of sleep difficulty that impairs diurnal functioning, reduces quality of life and enhances health care utilization/costs for millions worldwide. Whereas the underlying pathophysiology of PI remains poorly understood, it is widely accepted that a host of cognitive and behavioral factors play important roles in perpetuating this condition. As such, a multi-factorial, cognitive-behavioral therapy (CBT) has emerged as a "treatment of choice" for managing the sleep/wake complaints of PI sufferers. This article considers the nature and relative merits of CBT for treating PI patients. In addition, this article reviews studies supporting the general efficacy and clinical effectiveness of CBT for treating PI complaints. Issues related to treatment implementation as well as factors that mediate patients' responses to CBT and predict treatment acceptance/outcome are also considered. Finally, remaining questions regarding CBT's application to PI are considered, and suggestions for future research are provided.
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Affiliation(s)
- Jack D Edinger
- Department of Veterans Affairs and Duke University Medical Centers, Durham, NC, USA.
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Abstract
Cognition is a broad term that refers to all mental activities and encompasses attention, perception, memory, reasoning, beliefs, attributions and expectations. The aim of the present paper is to draw together the major research findings relating to the importance of cognition in insomnia. Although the research to date has tended to focus on the role of unwanted intrusive thought (also known as worry or cognitive arousal), there is evidence that a broad range of cognitive processes are important for a full understanding of insomnia. These include beliefs, attributions, expectations, perception and attention. The treatment implications of this evidence are discussed, as are priorities for future research.
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Affiliation(s)
- Allison G Harvey
- Department of Psychology, University of California, Berkeley 94720-1650, USA.
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40
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Smith MT, Perlis ML, Chengazi VU, Soeffing J, McCann U. NREM sleep cerebral blood flow before and after behavior therapy for chronic primary insomnia: preliminary single photon emission computed tomography (SPECT) data. Sleep Med 2005; 6:93-4. [PMID: 15680307 DOI: 10.1016/j.sleep.2004.10.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Revised: 10/12/2004] [Accepted: 10/14/2004] [Indexed: 11/28/2022]
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Jaffe SE, Patterson DR. Treating Sleep Problems in Patients with Burn Injuries: Practical Considerations. ACTA ACUST UNITED AC 2004; 25:294-305. [PMID: 15273471 DOI: 10.1097/01.bcr.0000124793.99886.6a] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sleep disorders are a frequent but under-addressed complication of burn injuries. Burn injuries can potentially disrupt sleep for a variety of reasons, including the physiological effects of trauma as well as ramifications of treatment (ie, intensive care unit environment, pain, itching, medications). The literature on sleep disorders and burn injuries is reviewed, and suggestions for treatment are provided. Treatment is divided into two major types: nonpharmacologic and pharmacologic. Nonpharmacologic treatment, also referred to as behavioral techniques, may include any one or combination of the following: sleep hygiene, stimulus control, sleep restriction, relaxation techniques, cognitive, and light therapy. Pharmacologic therapies may include hypnotics (benzodiazepine, nonbenzodiazepine, or benzodiazepine receptor agonists), antidepressants, over-the-counter preparations, hormone replacement therapy, herbs, and melatonin.
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Abstract
Significant efforts have been made in the last decade to develop evidence-based guidelines for the treatment of insomnia and other sleep disorders. Despite such progress, there are still no standard assessment methods to document outcome and no accepted criteria to define what should be a successful outcome in the treatment of insomnia. This paper reviews methodological and conceptual issues related to the measurement of outcomes in clinical trials of insomnia. Selected studies of behavioral and pharmacological therapies of insomnia are summarized to illustrate the types of dependent variables and assessment instruments used to document treatment efficacy. Additional outcome variables and assessment methods of potential interest are discussed, and criteria for interpreting and reporting outcomes are summarized. As most studies have relied on fairly narrow criteria to define an effective treatment, the need to broaden the scope of outcome assessment is highlighted. For instance, it is essential to document treatment efficacy beyond the simple reduction of insomnia symptoms and to incorporate additional indicators of success. Given that insomnia is associated with significant morbidity, an effective treatment should not only improve sleep parameters, but it should also produce clinically meaningful changes in daytime functioning, fatigue, mood, and quality of life. The need to evaluate outcome from multiple perspectives and to develop a core-assessment battery that would consider efficacy, clinical significance, and cost-effectiveness are discussed.
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Abstract
The present study aimed to provide an empirical test of the proposal that catastrophic worry about the consequences of not sleeping is common among patients with primary insomnia and serves to maintain the sleep disturbance. It was predicted that relative to good sleepers, patients with primary insomnia would catastrophize more and that catastrophizing would be associated with increased negative affect and increased perception of threat. A 'catastrophizing interview' was administered to 30 patients with primary insomnia and 30 good sleepers. Consistent with the predictions, the insomnia patients generated more catastrophes about the consequences of not sleeping and gave higher likelihood ratings than good sleepers. For the insomnia group, but not the good sleepers, the catastrophizing interview was associated with increased anxiety and discomfort. The limitations of the study, possibilities for future research, and clinical implications of these findings are discussed.
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Affiliation(s)
- Allison G Harvey
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
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44
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Morin CM. Primary insomnia. Sleep 2003. [DOI: 10.1007/978-1-4615-0217-3_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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45
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Martin JL, Ancoli-Israel S. Assessment and diagnosis of insomnia in non-pharmacological intervention studies. Sleep Med Rev 2002. [DOI: 10.1053/smrv.2001.0208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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46
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Currie SR, Wilson KG, Curran D. Clinical significance and predictors of treatment response to cognitive-behavior therapy for insomnia secondary to chronic pain. J Behav Med 2002; 25:135-53. [PMID: 11977435 DOI: 10.1023/a:1014832720903] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We examined individual responses to cognitive-behavior therapy for insomnia in 51 persons with chronic pain to determine the rate of clinically significant change and to identify predictors of successful treatment response. Outcome measures consisted of the Pittsburgh Sleep Quality Index (PSQI) and diary measures of sleep latency and sleep continuity. Using reliable change indices, 57% of participants were statistically improved on the PSQI after 7 weeks of treatment, but only 18% were considered fully recovered from their sleep problems. No demographic variables predicted treatment response but persons who reliably improved on the PSQI had a lower sleep self-efficacy at baseline. Improvers showed a significant increase in sleep self-efficacy ratings and a decrease in self-reported levels of distress and pain-related disability. These results suggest that patients with insomnia secondary to chronic medical conditions can be helped with cognitive-behavior therapy, although most individuals continue to have mild or subthreshold sleep problems at posttreatment.
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Affiliation(s)
- Shawn R Currie
- University of Ottawa, School of Psychology, Addiction Centre, Foothills Medical Centre, Calgary, Alberta, Canada.
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47
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Perlis ML, Sharpe M, Smith MT, Greenblatt D, Giles D. Behavioral treatment of insomnia: treatment outcome and the relevance of medical and psychiatric morbidity. J Behav Med 2001; 24:281-96. [PMID: 11436547 DOI: 10.1023/a:1010770807823] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Recently, we undertook a case series study and found that behavior therapy for insomnia was effective as plied in the clinic setting and that the findings were similar to those in the "clinical trial" literature. In the present study, we evaluate a second set of case series data to assess (1) the replicability of our original findings, (2) if our treatment outcomes are statistically comparable to those in the literature, and (3) if medical and psychiatric morbidity influence treatment outcome. It was found that patients who completed four or more sessions of cognitive behavioral therapy for insomnia (CBT) were, on average, 33% improved. This average corresponded to a 56% reduction in wake time after sleep onset, a 34% reduction in sleep latency, a 29% increase in total sleep time, and a 13% decrease in number of awakenings per night. These findings are not significantly different from those reported in literature for both CBT and pharmacotherapy interventions. Medical and psychiatric comorbidity did not influence treatment outcome.
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Affiliation(s)
- M L Perlis
- Sleep Disorders Center, Behavioral Sleep Medicine Clinic, Rochester, New York, USA.
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