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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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Eakman AM, Schmid AA, Henry KL, Rolle NR, Schelly C, Pott CE, Burns JE. Restoring effective sleep tranquility (REST): A feasibility and pilot study. Br J Occup Ther 2017. [PMID: 28626295 PMCID: PMC5458872 DOI: 10.1177/0308022617691538] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction The purpose of this pilot study was to establish the feasibility of completing a future controlled trial of a multi-component cognitive behavioral therapy for insomnia program for military veterans with sleep disturbance. Method This was a single-arm feasibility and pilot study. Participants were United States post-9/11 veterans with service-connected injuries, university students, and had self-reported sleep disturbances. Restoring Effective Sleep Tranquility was a multi-component cognitive behavioral therapy for insomnia intervention consisting of seven sessions of group therapy and eight 1:1 sessions delivered by occupational therapists. Feasibility and pilot indicators were process, resources, management, and scientific, including pre–post-assessments of sleep difficulties, dysfunctional sleep beliefs, participation, and pain interference. Findings Indicators were supportive of feasibility, including reduced sleep difficulties (for example Medical Outcomes Study Sleep Measure [t = 3.29, p = .02]), reduced nightmares: t = 2.79, p = .03; fewer dysfunctional sleep beliefs: t = 3.63, p = .01, and greater ability to participate in social roles: t = –2.86, p = .03, along with trends towards improved satisfaction with participation and reduced pain interference. Conclusion The Restoring Effective Sleep Tranquility program may reduce sleep difficulties and improve participation in US veterans with service-connected injuries, and evidence indicates a controlled trial would be feasible to deliver.
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Affiliation(s)
- Aaron M Eakman
- Assistant Professor, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
| | - Arlene A Schmid
- Associate Professor, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kimberly L Henry
- Associate Professor, Department of Psychology, College of Natural Sciences, Colorado State University & The Colorado School of Public Health, Fort Collins, CO, USA
| | - Natalie R Rolle
- Occupational Therapist and Student Veteran Coordinator, Center for Community Partnerships, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
| | - Catherine Schelly
- Assistant Professor and Director, Center for Community Partnerships, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO
| | - Christine E Pott
- Graduate Student, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
| | - Joshua E Burns
- Student Veteran Coordinator, Center for Community Partnerships, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
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Zhou ES, Partridge AH, Recklitis CJ. A pilot trial of brief group cognitive-behavioral treatment for insomnia in an adult cancer survivorship program. Psychooncology 2016; 26:843-848. [PMID: 26872123 DOI: 10.1002/pon.4096] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/17/2015] [Accepted: 01/18/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cognitive-behavioral therapy for insomnia (CBT-Insomnia) is effective, yet rarely available for cancer survivors. This is unfortunate because survivors are at elevated risk for insomnia, which is associated with significant health consequences in this already at-risk population. Barriers to delivering CBT-Insomnia in oncology settings include a lack of trained providers, distance to cancer centers, and treatment duration. PURPOSE To address insomnia treatment barriers, we adapted standard CBT-Insomnia treatment and evaluated a pilot group-based approach for feasibility and efficacy in an adult cancer survivorship program. METHODS Thirty-eight cancer survivors (mean age = 52.2 years) enrolled in our three-session program delivered over 1 month. They were primarily diagnosed with breast cancer (58.6%) and were an average of 6.0 years post-diagnosis and 3.6 years post-treatment. Participants completed sleep logs throughout the study and measures of sleep at baseline and week 4. RESULTS Participants reported experiencing insomnia symptoms an average of 2.4 years, with 89.7% indicating that the cancer experience had caused/exacerbated symptoms. Significant pre/post-intervention group improvements in sleep efficiency (77.3% to 88.5%), sleep quality, and insomnia symptoms were reported (all ps < .01). Less than 1 in 3 had discussed insomnia symptoms with their oncology providers in the prior year. CONCLUSIONS Pilot data indicate that a brief, group-based CBT-Insomnia intervention in a survivorship setting is both feasible and efficacious. There is a need to increase awareness about insomnia and its treatment among both cancer survivors and oncology providers. If validated in future studies, this novel approach can improve cancer survivors' access to much needed insomnia treatment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Eric S Zhou
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Alliger-Horn C, Zimmermann P, Mitte K. Prädiktoren für den Behandlungsverlauf kognitiv-behavioraler Gruppentherapie einsatzbedingter Erkrankungen deutscher Bundeswehrsoldaten. VERHALTENSTHERAPIE 2014. [DOI: 10.1159/000369303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Giosan C, Malta LS, Wyka K, Jayasinghe N, Evans S, Difede J, Avram E. Sleep disturbance, disability, and posttraumatic stress disorder in utility workers. J Clin Psychol 2014; 71:72-84. [PMID: 25099348 DOI: 10.1002/jclp.22116] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of the present study was to examine the associations between sleep disturbance, posttraumatic stress disorder (PTSD), and functional disability in a population exposed to a singular traumatic event. METHOD The participants were a population of 2,453 predominantly male utility workers who were deployed to the World Trade Center site in the aftermath of the 9/11 attack. They underwent psychiatric screenings comprising measures of sleep disturbance, PTSD, and functional disability. RESULTS Analyses indicated that (a) rates of sleep disturbances were significantly higher among participants diagnosed with PTSD than those without, (b) PTSD severity was significantly associated with sleep disturbance, and (c) sleep disturbance moderated the relationship between PTSD and disability. CONCLUSION Sleep disturbance is associated with occupational, social functioning, and PTSD severity, suggesting that ameliorating sleep may lead to increased occupational and social functioning, as well as better treatment responses in PTSD.
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Schuman DL, Slone NC, Reese RJ, Duncan B. Efficacy of client feedback in group psychotherapy with soldiers referred for substance abuse treatment. Psychother Res 2014; 25:396-407. [PMID: 24708386 DOI: 10.1080/10503307.2014.900875] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
This study investigated whether routine monitoring of client progress, often called "client feedback," via an abbreviated version of the Partners for Change Outcome Management System (PCOMS) resulted in improved outcomes for soldiers receiving group treatment at an Army Substance Abuse Outpatient Treatment Program (ASAP). Participants (N = 263) were active-duty male and female soldiers randomized into a group feedback condition (n = 137) or a group treatment-as-usual (TAU) condition (n = 126). Results indicated that clients in the feedback condition achieved significantly more improvement on the outcome rating scale (d = 0.28), higher rates of clinically significant change, higher percentage of successful ratings by both clinicians and commanders, and attended significantly more sessions compared to the TAU condition. Despite a reduced PCOMS protocol and a limited duration of intervention, preliminary results suggest that the benefits of client feedback appear to extend to group psychotherapy with clients in the military struggling with substance abuse.
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Margolies SO, Rybarczyk B, Vrana SR, Leszczyszyn DJ, Lynch J. Efficacy of a cognitive-behavioral treatment for insomnia and nightmares in Afghanistan and Iraq veterans with PTSD. J Clin Psychol 2013; 69:1026-42. [PMID: 23629959 DOI: 10.1002/jclp.21970] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Sleep disturbances are a core and salient feature of posttraumatic stress disorder (PTSD). Pilot studies have indicated that combined cognitive-behavioral therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT) for nightmares improves sleep as well as PTSD symptoms. METHOD The present study randomized 40 combat veterans (mean age 37.7 years; 90% male and 60% African American) who served in Afghanistan and/or Iraq (Operation Enduring Freedom [OEF]/Operation Iraqi Freedom [OIF]) to 4 sessions of CBT-I with adjunctive IRT or a waitlist control group. Two thirds of participants had nightmares at least once per week and received the optional IRT module. RESULTS At posttreatment, veterans who participated in CBT-I/IRT reported improved subjectively and objectively measured sleep, a reduction in PTSD symptom severity and PTSD-related nighttime symptoms, and a reduction in depression and distressed mood compared to the waitlist control group. CONCLUSION The findings from this first controlled study with OEF/OIF veterans suggest that CBT-I combined with adjunctive IRT may hold promise for reducing both insomnia and PTSD symptoms. Given the fact that only half of the patients with nightmares fully implemented the brief IRT protocol, future studies should determine if this supplement adds differential efficacy to CBT-I alone.
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Abstract
More than 70 million people in the United States experience primary insomnia (PI) at some point in their life, resulting in an estimated $65 billion in health care costs and lost productivity. PI is therefore one of the most common health care problems in the United States. To mollify the negative effects of PI, scholars have sought to evaluate and improve treatments of this costly health care problem. A breadth of research has demonstrated that cognitive behavioral therapy (CBT) is an effective intervention for PI. The goal of this article is to provide an overview of CBT for PI, including evidence regarding treatment efficacy, effectiveness, and practitioner considerations.
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Affiliation(s)
- Kimberly A Babson
- Department of Psychology, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA.
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Swanson LM, Favorite TK, Horin E, Arnedt JT. A combined group treatment for nightmares and insomnia in combat veterans: a pilot study. J Trauma Stress 2009; 22:639-42. [PMID: 19908322 DOI: 10.1002/jts.20468] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Insomnia and nightmares are hallmarks of posttraumatic stress disorder (PTSD). Sleep disturbances in PTSD negatively impact clinical course and functioning. In this open clinical trial, the preliminary effects of a combined treatment for insomnia and nightmares in combat veterans with PTSD were assessed. Ten combat veterans participated in a 10-session group treatment combining cognitive-behavioral therapy for insomnia with exposure, rescripting, and relaxation therapy. Participants maintained daily sleep and dream diaries and completed self-report measures of sleep quality and PTSD symptoms pre- and posttreatment. Participants reported improvements in sleep and nightmares following treatment. Future research using controlled designs to evaluate this treatment is warranted.
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Affiliation(s)
- Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
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Ramsawh HJ, Stein MB, Belik SL, Jacobi F, Sareen J. Relationship of anxiety disorders, sleep quality, and functional impairment in a community sample. J Psychiatr Res 2009; 43:926-33. [PMID: 19269650 DOI: 10.1016/j.jpsychires.2009.01.009] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Revised: 01/22/2009] [Accepted: 01/23/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Anxiety disorders and insomnia are each prevalent, impairing, and highly comorbid. However, little is known about whether specific types of sleep complaints are associated with specific anxiety disorders, and whether poor sleep has an additive effect on functional impairment in anxiety disorders. METHOD Data from the German Health Survey (GHS; N = 4181; ages 18-65) were utilized to examine relationships among anxiety disorders, sleep quality (assessed by the Pittsburgh Sleep Quality Inventory; PSQI), and functional impairment (assessed by the Medical Outcomes Scale Short Form; SF-36; and past-month disability days due to physical and emotional problems, respectively). RESULTS Most anxiety disorders were significantly associated with global PSQI scores. Social phobia (AOR 3.95, 95% CI 1.73-9.04) and GAD (AOR 3.94, 95% CI 1.66-9.34) had the strongest relationships with global PSQI scores. Daytime dysfunction was the PSQI subscale most strongly associated with anxiety disorders, particularly GAD. Having a comorbid anxiety disorder and poor sleep was associated with significantly lower Mental Component Scores on the SF-36 than having an anxiety disorder alone (40.87 versus 43.87, p = .011) and with increased odds of one or more disability days due to emotional problems (AOR 2.72, 95% CI 1.35-5.48), even after controlling for sociodemographic factors and past-month mood and substance use disorders. CONCLUSIONS Most anxiety disorders are moderately associated with reduced sleep quality. Individuals with anxiety disorders and poor sleep experience significantly worse mental health-related quality of life and increased disability relative to those with anxiety disorders alone.
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Affiliation(s)
- Holly J Ramsawh
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0855), La Jolla, CA 92093-0855, USA.
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