1
|
Crosby Ms Msw ES, Witte PhD TK. A pilot study of sleep scholar: A single-session, internet-based insomnia intervention for college students with a history of suicide ideation. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1984-1998. [PMID: 34283711 DOI: 10.1080/07448481.2021.1953028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 05/18/2021] [Accepted: 07/02/2021] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Establish the feasibility and acceptability of Sleep Scholar, a single-session, self-guided, internet-based insomnia intervention. PARTICIPANTS College students with a lifetime history of suicide ideation and at least subclinical insomnia symptoms. METHODS Participants (N = 38) completed pretreatment sleep diaries, Sleep Scholar, and post-treatment feasibility, acceptability, and clinical measures. RESULTS Approximately 33 students could be recruited per semester, the overall attrition rate was 47%, Sleep Scholar was completed in approximately 30 minutes, and the majority of treatment information was retained. Participants reported positive acceptability and satisfaction, and approximately half of participants adhered to their prescribed time in bed recommendations. Most clinical measures had adequate variability and internal consistency, and post-hoc analyses revealed clinically significant reductions in several mental health symptoms. CONCLUSIONS Sleep Scholar is feasible in college settings, acceptable for college students, and produced reductions in mental health symptoms during an uncontrolled trial. Implications for a randomized-controlled trial are discussed.
Collapse
Affiliation(s)
| | - Tracy K Witte PhD
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| |
Collapse
|
2
|
Bishop TM, Crean HF, Funderburk JS, Pigeon WR. Initial Session Effects of Brief Cognitive Behavioral Therapy for Insomnia: A Secondary Analysis of A Small Randomized Pilot Trial. Behav Sleep Med 2021; 19:769-782. [PMID: 33410336 DOI: 10.1080/15402002.2020.1862847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective/Background: While cognitive-behavioral therapy for insomnia (CBT-I) is typically delivered over six-eight sessions, the field has introduced ever briefer versions. We examined session by session effects on both insomnia and depression outcomes in a brief, four-session version of CBT-I.Participants: This is a secondary analysis of data drawn from participants randomized to brief cognitive behavioral therapy for insomnia (bCBTi) in a pilot clinical trial. All participants (n = 19) were veterans enrolled in primary care who screened positive for insomnia and co-occurring PTSD and/or depression.Methods: Participants received four, weekly, individual sessions of bCBTi during which they provided self-report data on insomnia, depression, and sleep parameters over the preceding week. Baseline and follow-up assessments were also collected.Results: Changes in insomnia and depression severity between baseline and the beginning of session one were non-significant. Statistically significant decreases were observed, however, for insomnia severity between sessions one to two (g = -.65) and sessions two to three (g = -.59). This pattern was mirrored for depression severity with significant decreases between sessions one and two (g = -.65) and sessions two to three (g = -.68). However, there was little change for either outcome from session three to session four (insomnia g = -.16; depression g = -.14).Conclusions: This session by session analyses of bCBTi revealed that the majority of the treatment effect occurred over the first two sessions. Findings suggest that even brief interventions addressing insomnia may have a positive impact on both insomnia and co-occurring depression.
Collapse
Affiliation(s)
- Todd M Bishop
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York, USA
| | - Hugh F Crean
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer S Funderburk
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York, USA.,Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York, USA
| |
Collapse
|
3
|
Pigeon WR, Funderburk JS, Cross W, Bishop TM, Crean HF. Brief CBT for insomnia delivered in primary care to patients endorsing suicidal ideation: a proof-of-concept randomized clinical trial. Transl Behav Med 2020; 9:1169-1177. [PMID: 31271210 DOI: 10.1093/tbm/ibz108] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Insomnia co-occurs frequently with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD); all three conditions are prevalent among primary care patients and associated with suicidal ideation (SI). The purpose of the article was to test the effects of a brief cognitive behavioral therapy for insomnia (bCBTi) and the feasibility of delivering it to primary care patients with SI and insomnia in addition to either MDD and/or PTSD. Fifty-four patients were randomized to receive either bCBTi or treatment-as-usual for MDD and/or PTSD. The primary outcome was SI intensity as measured by the Columbia-Suicide Severity Rating Scale; secondary clinical outcomes were measured by the Insomnia Severity Index, Patient Health Questionnaire for depression, and PTSD Symptom Checklist. Effect sizes controlling for baseline values and sample size were calculated for each clinical outcome comparing pre-post differences between the two conditions with Hedge's g. The effect size of bCBTi on SI intensity was small (0.26). Effects were large on insomnia (1.91) and depression (1.16) with no effect for PTSD. There was a marginally significant (p = .069) effect of insomnia severity mediating the intervention's effect on SI. Findings from this proof-of-concept trial support the feasibility of delivering bCBTi in primary care and its capacity to improve mood and sleep in patients endorsing SI. The results do not support bCBTi as a stand-alone intervention to reduce SI, but this or other insomnia interventions may be considered as components of suicide prevention strategies.
Collapse
Affiliation(s)
- Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Jennifer S Funderburk
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Wendi Cross
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Todd M Bishop
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Hugh F Crean
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
4
|
Ho FYY, Chan CS, Lo WY, Leung JCY. The effect of self-help cognitive behavioral therapy for insomnia on depressive symptoms: An updated meta-analysis of randomized controlled trials. J Affect Disord 2020; 265:287-304. [PMID: 32090753 DOI: 10.1016/j.jad.2020.01.062] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/05/2020] [Accepted: 01/14/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sleep disturbances commonly occur in patients with depression. Insomnia is considered not only a symptom of but also a risk factor for depression. Psychological treatments for insomnia have been demonstrated to be efficacious in alleviating depressive symptoms. This meta-analysis examined the effect of self-help cognitive behavioral therapy for insomnia (CBT-I) in treating depressive symptoms. METHODS A systematic review was performed up to April 2019 in 6 major electronic databases. The literature search retrieved 4190 potentially relevant citations; 30 randomized controlled trials (total N = 5945) that compared self-help CBT-I vs. waiting-list (WL), routine care, no treatment, individual cognitive behavioral therapy (CBT), group CBT and placebo were included in the current review. RESULTS Random effects models showed significant reduction in self-report depressive symptoms (Hedges' g = 0.35; 95% CI: -0.47, -0.23) and insomnia symptoms (Hedges' g = 0.79; 95% CI: -0.56, -1.03) in the self-help CBT-I group when compared to the WL/routine care/no treatment/psychoeducation control group. LIMITATIONS The findings should be interpreted with caution due to potential publication bias. CONCLUSIONS CBT-I appears to be efficacious in treating depressive symptoms. Given the current results and study limitations, large-scale, high-quality trials that specifically target individuals with a clinical diagnosis of depression are warranted in the future.
Collapse
Affiliation(s)
- Fiona Yan-Yee Ho
- The Public Mental Health Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Christian S Chan
- Department of Psychology, The University of Hong Kong, Hong Kong.
| | - Wing-Ying Lo
- The Public Mental Health Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong
| | | |
Collapse
|
5
|
Special Considerations in the Adaptation of Cognitive Behavioral Therapy for Insomnia With Active-Duty U.S. Army Personnel. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
6
|
|
7
|
Pigeon WR, Funderburk J, Bishop TM, Crean HF. Brief cognitive behavioral therapy for insomnia delivered to depressed veterans receiving primary care services: A pilot study. J Affect Disord 2017; 217:105-111. [PMID: 28395207 DOI: 10.1016/j.jad.2017.04.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/23/2017] [Accepted: 04/02/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Depression and insomnia are treatable, often co-occur and are common among primary care patients. Treatments designed for primary care must be brief, effective and ideally have the potential to address multiple symptoms. A brief form of cognitive behavioral therapy for insomnia (CBT-I) was piloted among depressed primary care patients with insomnia some of whom endorsed suicidal ideation. METHODS Veterans Affairs primary care patients were randomized to either CBT-I or sleep hygiene. CBT-I consisted of two, 20-40min in-person sessions and two 15-20min telephone sessions; SH consisted of one in-person and one telephone session. Participants were assessed at baseline, post-treatment, and a 3 month follow-up. RESULTS Compared to SH (n=14), brief CBT-I (n=13) had large effects on insomnia severity, sleep efficiency, number of awakenings, and time awake after sleep onset with between group effect sizes ranging from .75 to 1.09 at post-treatment and .66-.89 at follow-up, though significance was not maintained at follow-up. Although both groups experienced significant reductions in depression severity, statistically significant group by time interactions were not observed for depression. LIMITATIONS Notable limitations include the small sample size, having excluded patients with the most severe suicide risk, and the absence of objective testing to detect presence of sleep disorders other than insomnia. CONCLUSIONS The effects observed for insomnia outcomes, corroborate support for using CBT-I in depressed patients and extend this support to a brief from of CBT-I structured for delivery in primary care. Whether a brief form of CBT-I delivered to patients in primary care who endorse suicidal ideation would have a significant effect on depressive symptoms and/or suicidal ideation remains to be tested in a fully powered trial.
Collapse
Affiliation(s)
- Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, USA; Center for Integrated Healthcare, Syracuse VA Medical Center, USA; University of Rochester Medical Center, Department of Psychiatry, USA.
| | - Jennifer Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center, USA; University of Rochester Medical Center, Department of Psychiatry, USA; Syracuse University, USA
| | - Todd M Bishop
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, USA; Center for Integrated Healthcare, Syracuse VA Medical Center, USA; University of Rochester Medical Center, Department of Psychiatry, USA
| | - Hugh F Crean
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, USA; University of Rochester School of Nursing, USA
| |
Collapse
|
8
|
Pigeon WR, Heffner KL, Crean H, Gallegos AM, Walsh P, Seehuus M, Cerulli C. Responding to the need for sleep among survivors of interpersonal violence: A randomized controlled trial of a cognitive-behavioral insomnia intervention followed by PTSD treatment. Contemp Clin Trials 2015; 45:252-260. [PMID: 26343743 DOI: 10.1016/j.cct.2015.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/27/2015] [Accepted: 08/30/2015] [Indexed: 02/03/2023]
Abstract
Sleep disturbance is a common feature of posttraumatic stress disorder (PTSD), but is not a focus of standard PTSD treatments. Psychological trauma exposure is associated with considerable physical and mental health morbidity, possibly due to the alterations in neuroendocrine function and inflammation observed in trauma exposed individuals. Although PTSD treatments are efficacious, they are associated with high drop-out rates in clinical trials and clinical practice. Finally, individuals with PTSD stemming from exposure to interpersonal violence represent an especially under-treated population with significant sleep disturbance. Community-based participatory research was utilized to design and prepare a clinical trial that randomizes recent survivors of interpersonal violence who have PTSD, depression, and insomnia to receive either: (1) Cognitive Behavioral Therapy for Insomnia (CBTi) followed by Cognitive Processing Therapy (CPT) for trauma, or (2) attention control followed by CPT. Outcome measures include subjective and objective measures of sleep, clinician-administered PTSD and depression scales, inflammatory cytokines, and salivary cortisol. Assessments are conducted at baseline, following the sleep or control intervention, and again following CPT. The design allows for: (1) the first test of a sleep intervention in this population; (2) the comparison of sequenced CBTi and CPT to attention control followed by CPT, and (3) assessing the roles of neuroendocrine function, inflammatory processes, and objective sleep markers in mediating treatment outcomes. The study's overarching hypothesis is that treating insomnia will produce reduction in insomnia, PTSD, and depression severity, allowing patients to more fully engage in, and derive optimal benefits from, cognitive processing therapy.
Collapse
Affiliation(s)
- Wilfred R Pigeon
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA; U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY USA.
| | - Kathi L Heffner
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - Hugh Crean
- School of Nursing, University of Rochester Medical Center, Rochester, NY USA
| | - Autumn M Gallegos
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - Patrick Walsh
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - Martin Seehuus
- Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - Catherine Cerulli
- Susan B. Anthony Center and Laboratory of Interpersonal Violence and Victimization, University of Rochester Medical Center, Rochester, NY USA
| |
Collapse
|
9
|
Weisberg RB, Magidson JF. Integrating cognitive behavioral therapy into primary care settings. COGNITIVE AND BEHAVIORAL PRACTICE 2014; 21:247-251. [PMID: 27471370 PMCID: PMC4961302 DOI: 10.1016/j.cbpra.2014.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Risa B Weisberg
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Department of Family Medicine
| | - Jessica F Magidson
- Massachusetts General Hospital/Harvard Medical School, Department of Psychiatry, Behavioral Medicine Service, The Chester M. Pierce, MD Division of Global Psychiatry
| |
Collapse
|