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Goodhines PA, Svingos AM, Gerish S, Park A, Gellis LA. Randomized controlled trial of cognitive refocusing versus stimulus control treatment for college insomnia: feasibility of a brief, electronic-based, and peer-led approach. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:2229-2241. [PMID: 35943968 PMCID: PMC9908774 DOI: 10.1080/07448481.2022.2109031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 05/27/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Performance of Cognitive Refocusing Treatment for Insomnia (CRT-I) relative to stimulus control treatment (SCT) remains unknown among college students. This pilot trial compared single-session, electronic-based, peer-led CRT-I to SCT, and as well as awareness-based (AC) and no-treatment (NTC) controls. PARTICIPANTS College students (N = 82; Mage=18.59 [SD = 0.78]; 58% female; 61% White; 16% Hispanic) with insomnia symptoms were randomly assigned to CRT-I (n = 12), SCT (n = 14), and AC (n = 14) conditions, or non-randomly recruited to NTC (n = 42). METHODS All participants completed baseline and one-month follow-up surveys, and reported daily task enactment (except NTC). RESULTS Feasibility ratings were comparable across conditions. Within-group treatment effects revealed greater improvements in (a) insomnia symptom severity among CRT-I (d = 1.13) and SCT (d = 1.66) groups relative to AC (d = 0.90) and (b) pre-sleep cognitive arousal among CRT-I (d = 0.94) and SCT (d = 1.42) groups relative to AC (d = 0.75). CONCLUSIONS Brief, electronic-based, peer-led CRT-I and SCT interventions appear feasible and potentially efficacious for college insomnia.
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Affiliation(s)
| | - Adrian M Svingos
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Samantha Gerish
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Aesoon Park
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Les A Gellis
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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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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Wright ID, Jensen CD, Duraccio KM. Predictors of adherence to a brief sleep extension protocol in emerging adults. J Pediatr Psychol 2024; 49:442-447. [PMID: 38578604 DOI: 10.1093/jpepsy/jsae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVES This study examined how mental health symptoms (i.e., depression, anxiety, stress) and baseline sleep characteristics (i.e., sleep quality and levels of daytime sleepiness) predicted adherence to and initial success of a brief sleep extension research protocol in emerging adults. METHODS 184 emerging adults (ages 18-25; M = 20.96, SD = 2.04) were asked to extend their nightly sleep opportunity to 8 hr for 1 week and to anchor bedtime and waketime. Sleep outcomes (adherence and initial protocol success) were tracked using actigraphy. Baseline sleep quality, daytime sleepiness, depression, anxiety, and stress were assessed using self-report questionnaires. RESULTS Poorer baseline sleep quality predicted better adherence to the protocol (p = .002). Other baseline sleep characteristics and mental health were not predictive of adherence (ps>.50). Lower levels of baseline daytime sleepiness approached significance in predicting greater initial protocol success following the protocol (p = .05). Baseline sleep quality and mental health did not predict initial protocol success (ps > 0.34). CONCLUSIONS Mental health symptoms did not significantly predict adherence to or the success of a sleep extension protocol. Surprisingly, individuals with poor baseline sleep quality were more likely to adhere to the extension protocol, perhaps suggesting heightened motivation for change or increased risk for sleep problems. This research provides valuable insight into factors that predict adherence to sleep extension protocols in emerging adults.
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Affiliation(s)
- Isabella D Wright
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Chad D Jensen
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Kara M Duraccio
- Department of Psychology, Brigham Young University, Provo, UT, United States
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Pickett SM, Kozak AT, Lanni DJ, Warnke AS, Gaillard P, Jarrett NL. The comparison of brief, online mindfulness and relaxation interventions to reduce stress and improve sleep-related outcomes in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1085-1093. [PMID: 35709245 DOI: 10.1080/07448481.2022.2066979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 02/24/2022] [Accepted: 04/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The current study aimed to examine whether brief online stress reduction exercises supplemented with sleep improvement strategies would reduce stress, arousal, and sleep difficulties in college students who were not required to use the sleep improvement strategies for participation. PARTICIPANTS A sample of 114 college student participants were enrolled because they were experiencing stress and/or wanted to improve their sleep. METHODS Participants were randomized into an abbreviated progressive muscle relaxation, a mindful breathing, or a self-monitoring control condition for the 4-week intervention. Measures of physical relaxation, mindfulness, perceived stress, pre-sleep arousal, and insomnia symptom severity were collected. RESULTS The APMR group improved on five of the six dependent measures and was significantly different than the SM group at posttest, but not different than the MB group. CONCLUSION The results suggests promise for brief, online, scaled back stress reduction interventions to reduce stress, arousal, and sleep difficulties in college students.
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Affiliation(s)
- Scott M Pickett
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Andrea T Kozak
- Department of Psychology, Oakland University, Rochester, Michigan, USA
| | - Daniel J Lanni
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Andrew S Warnke
- Department of Psychology, Oakland University, Rochester, Michigan, USA
| | - Philippe Gaillard
- Office of Clinical Research Advancement, Florida State University, Tallahassee, Florida, USA
| | - Nicole L Jarrett
- Department of Psychology, Oakland University, Rochester, Michigan, USA
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Shao Y, Li Y, Wang N, Xue Y, Wang T, Qiu F, Lu Y, Lan D, Wu H. Effect of daily light exposure on sleep in polar regions: A meta-analysis. J Sleep Res 2024:e14144. [PMID: 38253963 DOI: 10.1111/jsr.14144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Although studies have shown that light affects sleep in polar populations, the sample size of most studies is small. This meta-analysis provides the first systematic review of the effects of summer glare, spring and fall moderate daylight, and artificial lighting on general sleep problems (sleep duration, efficiency, and delay). This analysis included 18 studies involving 986 participants. We calculated the random effect size via an evidence-based meta-analysis that analysed the effect of bright/auxiliary light on sleep and the effect of three different types of light on sleep compared with conventional light. There was no significant correlation between specific light types and sleep duration. Intense summer light has a negative effect on sleep time and efficiency. Moderate, natural light in spring and autumn effectively delayed sleep but could not improve sleep efficiency. For artificial fill light, neither blue light nor enhanced white light has been found to have a significant effect. In summary, summer light has a detrimental effect on sleep in polar populations, and moderate natural light may be superior to conventional light. However, specific strategies to improve sleep and artificial lighting in polar populations must be explored further.
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Affiliation(s)
- Yingqi Shao
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yao Li
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Nan Wang
- Department of Traditional Chinese Medicine, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yan Xue
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Tongyue Wang
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Fengxi Qiu
- Department of Traditional Chinese Medicine, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yi Lu
- Department of Neurology and Neurological Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Danmei Lan
- Department of Neurology and Neurological Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Hengjing Wu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
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Tougas M, Rigney G, Chambers C, Smith I, Mugford J, Keeler L, Rajda M, Corkum P. Focus Groups to Inform User-Centered Development of an eHealth Sleep Intervention for Adolescents: Perspectives of Youth with Insomnia Symptoms, with and without Pain. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1692. [PMID: 37892355 PMCID: PMC10605192 DOI: 10.3390/children10101692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Adolescence is a developmental stage that often coincides with increasing sleep problems. Focus groups were conducted to inform development of an adolescent eHealth sleep intervention by exploring opinions about (1) healthy sleep practices, and (2) using an eHealth intervention. METHODS Adolescents 14-18 years old experiencing symptoms of insomnia based on the Insomnia Sleep Index, with and without recurrent pain, and associated stakeholders (i.e., parents, school personnel, and health care providers) were recruited. Across six online focus groups, 24 adolescents with insomnia participated (14 pain-free, 10 with recurrent pain; 10 male, 14 female). Across seven online focus groups, 22 stakeholders participated, including 8 parents, 9 school professionals, and 5 health care providers (10 male, 8 female). Using a content analysis, subthemes were induced from transcripts. RESULTS Most healthy sleep practices were perceived as reasonable for adolescents to implement, except avoiding technology before bed and using bedrooms only for sleep. Three primary barriers to sleep practices were identified, including a variable schedule due to lifestyle factors, technology at night, and academics interfering with sleep, and only in the pain group, the barrier related to pain was identified. Content addressing adolescent-specific barriers was considered important to include in a sleep intervention. Desirable eHealth components included interactive features, videos, audio, and pictures to present information. A common barrier to using an eHealth sleep intervention was the program feeling too academic, with accessibility of the sleep information and strategies as a common facilitator. CONCLUSIONS This research represents the first step in a user-centered approach to developing an adolescent eHealth sleep intervention. These results provide insights from a range of perspectives on guiding adolescents to follow healthy sleep practices. Next, these findings will be integrated in the development of an eHealth intervention for adolescents with and without recurrent pain.
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Affiliation(s)
- Michelle Tougas
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
| | - Gabrielle Rigney
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
- Appleton Institute, School of Health, Medical and Applied Sciences, CQUniversity, Adelaide, SA 5034, Australia
| | - Christine Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
- Department of Pediatrics, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Isabel Smith
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
- Department of Pediatrics, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Joshua Mugford
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
| | - Laura Keeler
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
| | - Malgorzata Rajda
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
- Department of Pediatrics, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada;
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Edinger JD, Wamboldt FS, Johnson RL, Simmons B, Tsai S, Morin CM, Holm KE. Adherence to behavioral recommendations of cognitive behavioral therapy for insomnia predicts medication use after a structured medication taper. J Clin Sleep Med 2023; 19:1495-1503. [PMID: 37086054 PMCID: PMC10394369 DOI: 10.5664/jcsm.10616] [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: 11/06/2022] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
STUDY OBJECTIVES Cognitive behavioral therapy for insomnia (CBTI) has been paired with supervised medication tapering to help hypnotic-dependent individuals discontinue their hypnotics. This study examined the hypothesis that higher participant adherence to behavioral recommendations of CBTI will predict lower odds of using sleep medications 3 months after completion of a combined CBTI/sleep medication tapering protocol. METHODS Fifty-eight individuals who used sedative hypnotics completed four CBTI sessions followed by sleep medication tapering. Logistic regression was used to examine the association of stability of time in bed and stability of rise time (measured as the within-person standard deviation) at completion of CBTI with two outcomes at 3-month follow-up: use of sedative hypnotics and use of any medication/substance for sleep. RESULTS Participants with more stability in their rise time after CBTI than at baseline (ie, a decrease in their within-person standard deviation) had 69.5% lower odds of using sedative hypnotics at follow-up (odds ratio = 0.305, 95% confidence interval = 0.095-0.979, P = .046) than individuals who had no change or a decrease in the stability of their rise time. Results were similar for time in bed: participants with more stability in their time in bed after CBTI than at baseline had 83.2% lower odds of using sedative hypnotics (odds ratio = 0.168, 95% confidence interval = 0.049-0.580, P = .005). Increase in stability of rise time and stability of time in bed was also associated with reduced odds of using any medication/substance for sleep at follow-up. CONCLUSIONS Participants who implement behavioral recommendations of CBTI appear to have more success with discontinuing use of sleep medications. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: The Role of Tapering Pace and Selected Traits on Hypnotic Discontinuation; URL: https://clinicaltrials.gov/ct2/show/NCT02831894; Identifier: NCT02831894. CITATION Edinger JD, Wamboldt FS, Johnson RL, et al. Adherence to behavioral recommendations of cognitive behavioral therapy for insomnia predicts medication use after a structured medication taper. J Clin Sleep Med. 2023;19(8):1495-1503.
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Affiliation(s)
- Jack D. Edinger
- National Jewish Health, Denver, Colorado
- Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | | | - Kristen E. Holm
- National Jewish Health, Denver, Colorado
- Colorado School of Public Health, Denver, Colorado
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Fretz KM. Recommendations to bolster adherence in cognitive behavioral therapy for insomnia: a self-efficacy approach. Transl Behav Med 2023; 13:206-211. [PMID: 36688474 PMCID: PMC10105881 DOI: 10.1093/tbm/ibac104] [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] [Indexed: 01/24/2023] Open
Abstract
Lay SummaryThe safest and most effective treatment for chronic insomnia is Cognitive Behavioural Therapy for Insomnia (CBT-I). People sometimes struggle to adhere to, or follow the steps, involved in CBT-I because they are challenging (i.e., restricting time in bed to induce sleepiness, getting out of bed when not sleeping). These steps are based on sleep science and research shows that more closely adhering to them relates to better sleep improvements. One way that clinicians can help patients completing CBT-I improve their adherence to the difficult treatment steps is to promote their self-efficacy, or belief that they can effectively complete the treatment steps. Inspired by tried-and-true health promotion techniques rooted in Social Cognitive Theory, this paper describes concrete recommendations that clinicians can use to improve their patients’ self-efficacy when completing CBT-I. These recommendations include suggestions such as setting positive treatment expectations, discussing with patients how to set up for success when completing the treatment steps at home, and how to work with potential barriers to treatment. If clinicians can help boost patients’ self-efficacy, they may be able to carry out the treatment steps of CBT-I more effectively, and ultimately experience more benefits.
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Cheng P, Casement MD, Kalmbach DA, Cuamatzi Castelan A, Drake CL. Self-efficacy in Insomnia Symptom Management after Digital CBT-I Mediates Insomnia Severity during the COVID-19 Pandemic. Behav Sleep Med 2022; 20:638-648. [PMID: 34511016 PMCID: PMC8917241 DOI: 10.1080/15402002.2021.1976780] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVES Digital cognitive behavioral therapy for insomnia (dCBT-I) can reduce acute insomnia and depressive symptoms and prevent symptom recurrence. The current study evaluated self-efficacy in managing insomnia symptoms as a potential mediator of the relationship between prior dCBT-I and subsequent insomnia and depressive symptoms assessed during the coronavirus 2019 (COVID-19) pandemic. METHOD Participants were 208 adults who completed a randomized controlled trial of dCBT-I versus sleep education in 2016-2017 and also completed self-report assessments of insomnia, depression, and self-efficacy in managing insomnia symptoms. Data were collected in May 2020, five weeks into state-wide COVID-19 stay-at-home orders. Regression and mediation analyses were used to evaluate the extent to which self-efficacy accounted for the relationship between treatment condition and improvement in insomnia and depressive symptoms from pre-treatment to COVID-19 follow-up. RESULTS Prior dCBT-I predicted greater self-efficacy in managing insomnia symptoms. Self-efficacy accounted for 49% and 67% of the protective effect of dCBT-I against COVID-era insomnia and depressive symptoms, respectively. CONCLUSIONS This study affirms the importance of self-efficacy as a key intervention outcome and potential mechanism by which dCBT-I predicts future sleep and mental health. Future studies that evaluate the role of self-efficacy in treatment effectiveness and resilience can provide additional clues about how to optimize dCBT-I for maximum benefit to public health.
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Affiliation(s)
- Philip Cheng
- Sleep Disorders and Research Center, Henry Ford Health
System, 2779 West Grant Blvd, Detroit, MI, USA
| | - Melynda D. Casement
- Department of Psychology, University of Oregon, 1451 Onyx
Street, Eugene, OR 97403 USA
| | - David A. Kalmbach
- Sleep Disorders and Research Center, Henry Ford Health
System, 2779 West Grant Blvd, Detroit, MI, USA
| | - Andrea Cuamatzi Castelan
- Sleep Disorders and Research Center, Henry Ford Health
System, 2779 West Grant Blvd, Detroit, MI, USA
| | - Christopher L. Drake
- Sleep Disorders and Research Center, Henry Ford Health
System, 2779 West Grant Blvd, Detroit, MI, USA
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Mellor A, Kavaliotis E, Mascaro L, Drummond SP. Approaches to the assessment of adherence to CBT-I, predictors of adherence, and the association of adherence to outcomes: A systematic review. Sleep Med Rev 2022; 63:101620. [DOI: 10.1016/j.smrv.2022.101620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
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Mukherjee D, Weissenkampen JD, Wasserman E, Krishnamurthy VB, Millett C, Conway S, Saunders EF. Dysregulated Diurnal Cortisol Pattern and Heightened Night-Time Cortisol in Individuals with Bipolar Disorder. Neuropsychobiology 2022; 81:51-59. [PMID: 34320487 PMCID: PMC8795243 DOI: 10.1159/000517343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 05/17/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Hypothalamic-pituitary-adrenal (HPA) axis dysregulation may contribute to the symptom burden in bipolar disorder (BD). Further characterization of cortisol secretion is needed to improve understanding of the connection between mood, sleep, and the HPA axis. Here, we observe diurnal cortisol patterns in individuals with BD and healthy controls (HCs) to determine time points where differences may occur. METHODS Salivary cortisol was measured at 6 time points (wake, 15, 30, and 45 min after wake, between 2:00 and 4:00 p.m. and 10:00 p.m.) for 3 consecutive days in individuals with symptomatic BD (N = 27) and HC participants (N = 31). A general linear model with correlated errors was utilized to determine if salivary cortisol changed differently throughout the day between the 2 study groups. RESULTS A significant interaction (F = 2.74, df = 5, and p = 0.02) was observed between the time of day and the study group (BD vs. HC) when modeling salivary cortisol over time, indicating that salivary cortisol levels throughout the day significantly differed between the study groups. Specifically, salivary cortisol in BD was elevated compared to HCs at the 10:00 p.m. time point (p = 0.01). CONCLUSION Significantly higher levels of cortisol in participants with BD in the night-time suggest that the attenuation of cortisol observed in healthy individuals may be impaired in those with BD. Reregulation of cortisol levels may be a target of further study and treatment intervention for individuals with BD.
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Affiliation(s)
- Dahlia Mukherjee
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - J. Dylan Weissenkampen
- Neural and Behavioral Sciences, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Venkatesh Basappa Krishnamurthy
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Caitlin Millett
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America,Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Stephen Conway
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Erika F.H. Saunders
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
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Agnew S, Vallières A, Hamilton A, McCrory S, Nikolic M, Kyle SD, Fleming L, Crawford MR. Adherence to Cognitive Behavior Therapy for Insomnia. Sleep Med Clin 2021; 16:155-202. [DOI: 10.1016/j.jsmc.2020.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Predictors of Adherence to Psychological Treatment for Insomnia and Pain: Analysis from a Randomized Trial. Clin J Pain 2019; 34:375-382. [PMID: 28915152 DOI: 10.1097/ajp.0000000000000546] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Poor adherence to psychological treatment for insomnia is common and limits treatment gains. Very little is known about predictors of adherence among patients with chronic pain, although adherence is theorized to be more critical and more challenging for these patients. This secondary data analysis examines predictors of drop-out and therapy nonattendance in an osteoarthritis population receiving psychological treatment for insomnia and pain. METHODS Data were analyzed from the "Lifestyles" trial, a randomized controlled trial of a 6-week group cognitive behavioral pain coping skills intervention (CBT-P), group cognitive-behavioral therapy for pain and insomnia (CBT-PI), and an education only attention control group (EOC). The current analysis focuses on 122 participants randomized to CBT-PI from 6 primary care clinics. Measures of treatment acceptability, demographics, and symptoms were collected at baseline. Factor analysis was used to clarify the boundaries of these domains, and hierarchical regression was used to examine the incremental predictive power of these patient characteristics on therapy attendance. RESULTS Ratings of treatment acceptability were distinct from demographic and medical variables and baseline symptoms. Treatment acceptability was significantly related to session attendance and drop-out (rs ranging from 0.24 to 0.32) and was also one of the strongest predictors of session attendance (β=0.20; P<0.05). DISCUSSION Perceptions of treatment acceptability early in treatment represent a potentially modifiable target to enhance adherence to psychological treatment for insomnia and pain among patients with chronic pain. This work represents an important step towards understanding how to best maximize sleep treatments for this patient population.
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Barnes GL, Lawrence V, Khondoker M, Stewart R, Brown JSL. Participant Experiences of Attending a Community CBT Workshop for Insomnia: A Qualitative Six-Year Follow-Up. Behav Sleep Med 2019; 17:156-173. [PMID: 28388220 DOI: 10.1080/15402002.2017.1301942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective/Background: Our aim was to qualitatively explore the experiences of people who attended a one-day sleep workshop six years previously. Participants: Of the 95 people who originally attended the workshop and a three-month follow-up, 14 individuals (mean age = 63.6 years) participated. Methods: Semi-structured interviews were used to explore: participants' experiences of insomnia since the workshop, memories of the techniques and information provided and the perceived impact of the workshop on their lives. Qualitative data were analyzed using the principles of Framework Analysis. Results: Interviews produced rich accounts of attributions of changes in sleep, the application of taught strategies and general experiences of the workshop. Conclusions: This research highlights which aspects of a large-scale intervention may be most helpful for individuals experiencing sleep difficulties and what factors may contribute to changes in sleep over time.
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Affiliation(s)
- Georgina L Barnes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Vanessa Lawrence
- Department of Health Sciences and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Mizanur Khondoker
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - June S L Brown
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
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15
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Ludwin BM, Bamonti P, Mulligan EA. Program Evaluation of Group-based Cognitive Behavioral Therapy for Insomnia: a Focus on Treatment Adherence and Outcomes in Older Adults with Co-morbidities. Clin Gerontol 2018; 41:487-497. [PMID: 29252112 DOI: 10.1080/07317115.2017.1399190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe a program evaluation of the interrelationship of adherence and treatment outcomes in a sample of veteran older adults with co-morbidities who participated in group-based cognitive behavioral therapy for insomnia. METHODS Retrospective data extraction was performed for 14 older adults. Adherence measures and sleep outcomes were measured with sleep diaries and Insomnia Severity Index. Demographic and clinical information was extracted through chart review. RESULTS Adherence with prescribed time in bed, daily sleep diaries, and maintaining consistent time out of bed and time in bed was generally high. There were moderate, though not significant, improvements in consistency of time in bed and time out of bed over time. Adherence was not significantly associated with sleep outcomes despite improvements in most sleep outcomes. CONCLUSIONS The non-significant relationship between sleep outcomes and adherence may reflect the moderating influence of co-morbidities or may suggest a threshold effect beyond which stricter adherence has a limited impact on outcomes. CLINICAL IMPLICATIONS Development of multi-method adherence measures across all treatment components will be important to understand the influence of adherence on treatment outcomes as monitoring adherence to time in bed and time out of bed had limited utility for understanding treatment outcomes in our sample.
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Affiliation(s)
- Brian M Ludwin
- a VA Boston Healthcare System , Brockton , Massachusetts, USA
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16
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Koffel E, Bramoweth AD, Ulmer CS. Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review. J Gen Intern Med 2018; 33:955-962. [PMID: 29619651 PMCID: PMC5975165 DOI: 10.1007/s11606-018-4390-1] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/26/2018] [Accepted: 02/15/2018] [Indexed: 01/22/2023]
Abstract
The American College of Physicians (ACP) recently identified cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment for insomnia. Although CBT-I improves sleep outcomes and reduces the risks associated with reliance on hypnotics, patients are rarely referred to this treatment, especially in primary care where most insomnia treatment is provided. We reviewed the evidence about barriers to CBT-I referrals and efforts to increase the use of CBT-I services. PubMed, PsycINFO, and Embase were searched on January 11, 2018; additional titles were added based on a review of bibliographies and expert opinion and 51 articles were included in the results of this narrative review. Implementation research testing specific interventions to increase routine and sustained use of CBT-I was lacking. Most research focused on pre-implementation work that revealed the complexity of delivering CBT-I in routine healthcare settings due to three distinct categories of barriers. First, system barriers result in limited access to CBT-I and behavioral sleep medicine (BSM) providers. Second, primary care providers are not adequately screening for sleep issues and referring appropriately due to a lack of knowledge, treatment beliefs, and a lack of motivation to assess and treat insomnia. Finally, patient barriers, including a lack of knowledge, treatment beliefs, and limited access, prevent patients from engaging in CBT-I. These findings are organized using a conceptual model to represent the many challenges inherent in providing guideline-concordant insomnia care. We conclude with an agenda for future implementation research to systematically address these challenges.
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Affiliation(s)
- Erin Koffel
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA. .,University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Adam D Bramoweth
- Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Christi S Ulmer
- Durham VA Health Services Research and Development, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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17
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de Zambotti M, Goldstone A, Colrain IM, Baker FC. Insomnia disorder in adolescence: Diagnosis, impact, and treatment. Sleep Med Rev 2018; 39:12-24. [PMID: 28974427 PMCID: PMC5931364 DOI: 10.1016/j.smrv.2017.06.009] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 11/26/2022]
Abstract
Insomnia disorder is very common in adolescents; it is particularly manifest in older adolescents and girls, with a prevalence comparable to that of other major psychiatric disorders (e.g., depressive disorders). However, insomnia disorder in adolescence is poorly characterized, under-recognized, under-diagnosed, and under-treated, and the reason for the female preponderance for insomnia that emerges after puberty is largely unknown. Insomnia disorder goes beyond an individual complaint of poor sleep or a sleep state misperception, and there is emerging evidence supporting the association of insomnia symptoms in adolescents with alterations in several bio-systems including functional cortical alterations and systemic inflammation. Insomnia disorder is associated with depression and other psychiatric disorders, and is an independent risk factor for suicidality and substance use in adolescents, raising the possibility that treating insomnia symptoms in early adolescence may reduce risk for these adverse outcomes. Cognitive behavioral treatments have proven efficacy for adolescent insomnia and online methods seem to offer promising cost-effective options. Current evidence indicates that insomnia in adolescence is an independent entity that warrants attention as a public health concern in its own right.
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Affiliation(s)
| | - Aimee Goldstone
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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18
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Schlarb A, Lutchen U, Brenner T, Faber J. Arbeitsverhalten und Schlaf. SOMNOLOGIE 2018. [DOI: 10.1007/s11818-017-0135-3] [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]
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19
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Friedrich A, Schlarb AA. Let's talk about sleep: a systematic review of psychological interventions to improve sleep in college students. J Sleep Res 2017; 27:4-22. [DOI: 10.1111/jsr.12568] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Anja Friedrich
- Faculty of Psychology and Sport Science; Bielefeld University; Bielefeld Germany
| | - Angelika A. Schlarb
- Faculty of Psychology and Sport Science; Bielefeld University; Bielefeld Germany
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20
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Reed DL, Sacco WP. Measuring Sleep Efficiency: What Should the Denominator Be? J Clin Sleep Med 2017; 12:263-6. [PMID: 26194727 DOI: 10.5664/jcsm.5498] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/05/2015] [Indexed: 11/13/2022]
Abstract
ABSTRACT Inconsistency in operationally defining sleep efficiency (SE) creates confusion with regard to the conceptualization and use of the construct by researchers and clinicians. The source of the inconsistency is the denominator of the widely published operational definition of SE: ratio of total sleep time (TST) to time in bed (TIB) (multiplied by 100 to yield a percentage). When taken literally, TIB includes non-sleep-related activity (e.g., reading, texting, conversing with a partner, watching television) both prior to initiating sleep and after the final awakening. However, the construct of SE refers to TST compared to the amount of time spent attempting to initially fall asleep and sleep discontinuity. Non-sleep related activities in bed do not reflect that construct. Also, time out of bed during nighttime awakenings, a manifestation of sleep discontinuity, should be included in the SE denominator. Using TIB as the denominator can also create a methodological problem when SE is an outcome measure in sleep intervention research. It is proposed that research and practice would benefit by clarifying and adopting a consistent operational definition that more accurately captures the construct of SE. An alternate denominator, duration of the sleep episode (DSE), is suggested, where DSE = sleep onset latency (SOL) + TST + time awake after initial sleep onset but before the final awakening (WASO) + time attempting to sleep after final awakening (TASAFA). The proposed formula for SE would be: SE = TST / DSE (× 100). DSE can be easily calculated using standard sleep diary entries along with one item from the Expanded Consensus Sleep Diary. Implications for insomnia research and practice are discussed.
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Affiliation(s)
- David L Reed
- CBTMaine and Director of Somniskills Insomnia Program, Portland, ME
| | - William P Sacco
- Department of Psychology, University of South Florida, Tampa FL
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21
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Behavioral economics strategies for promoting adherence to sleep interventions. Sleep Med Rev 2015; 23:20-7. [DOI: 10.1016/j.smrv.2014.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 11/04/2014] [Accepted: 11/11/2014] [Indexed: 12/28/2022]
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