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Hicks M, Simonds LM, Morison L. The Effectiveness of Imagery Rescripting Interventions for Military Veterans With Nightmares and Sleep Disturbances: A Systematic Review and Meta-Analysis. Clin Psychol Psychother 2024; 31:e3025. [PMID: 39074713 DOI: 10.1002/cpp.3025] [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: 09/26/2023] [Revised: 04/08/2024] [Accepted: 06/12/2024] [Indexed: 07/31/2024]
Abstract
Imagery rescripting (ImRs) interventions have been found effective in improving sleep outcomes, although research has mostly focused on civilian, rather than military, samples. The aim of this review was to estimate the overall effectiveness of ImRs interventions for military veterans on primary outcomes of nightmare frequency and sleep quality. A systematic search was conducted in CINAHL, MEDLINE, PsycArticles, PsycINFO, Psychology and Behavioural Sciences Collection and the PTSDpubs database and was completed on 1 November 2021. Randomised controlled trials, nonrandomised trials and pre-post studies of ImRs interventions in veterans with sleep disturbances or nightmares were included. The methodological quality of the studies was assessed using the Effective Public Health Practice Project (EPHPP) tool, and meta-analysis was performed using Stata. Nineteen articles from 15 empirical studies were included in the review, and data from the 15 studies (involving 658 participants) were included in the meta-analysis. Meta-analysis findings indicated that ImRs interventions are associated with significant positive changes from pretreatment to posttreatment for nightmare and sleep quality. Significantly greater improvements were found in ImRs interventions compared to control groups for sleep quality (Hedges' g = -0.65, 95% CI [-1.20, -0.10]) but not for nightmare frequency (Hedges' g = -0.10, 95% CI [-0.34, 0.14]). Overall, the meta-analysis included a relatively small number of studies with poor methodological quality and considerable heterogeneity; therefore, findings should be cautiously interpreted. Further research should focus on veteran participants with larger samples and from a broader range of sources to determine effectiveness more confidently.
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Affiliation(s)
- Marya Hicks
- School of Psychology, University of Surrey, Guildford, UK
| | | | - Linda Morison
- School of Psychology, University of Surrey, Guildford, UK
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2
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Nazem S, Sun S, Barnes SM, Monteith LL, Hostetter TA, Forster JE, Brenner LA, Galfalvy H, Haghighi F. Impact of an internet-based insomnia intervention on suicidal ideation and associated correlates in veterans at elevated suicide risk. Transl Behav Med 2024:ibae032. [PMID: 38864695 DOI: 10.1093/tbm/ibae032] [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] [Indexed: 06/13/2024] Open
Abstract
Improving public health approaches to suicide prevention requires scalable evidence-based interventions that can be easily disseminated. Given empirical data supporting the association between insomnia and suicide risk, internet-delivered insomnia interventions are promising candidates to meet this need. The purpose of this study was to examine whether an unguided internet-delivered cognitive-behavioral therapy for insomnia (iCBT-I) improved insomnia severity, suicidal ideation (SI), and suicide risk correlates (depression, post-traumatic stress disorder, anxiety, hostility, belongingness, hopelessness, agitation, irritability, concentration) in a sample of veterans. Secondary data analysis of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (n = 50) with clinically significant insomnia and elevated SI drawn from a larger randomized controlled trial (RCT) of an iCBT-I, Sleep Healthy Using the Internet (SHUTi). Two-sample t-tests or Wilcoxon rank sum tests were used to evaluate between-group differences (SHUTi vs. Insomnia Education Website control) in symptom improvement from baseline to post-intervention. SHUTi participants experienced a significant improvement in insomnia severity (P < .001; d = -1.08) and a non-significant with small (subthreshold medium) effect size reduction of SI (P = .17, d = 0.40), compared to control participants. Significant improvement in hopelessness was observed (medium effect size), with non-significant small to medium effect size reductions in most remaining suicide risk correlates. Self-administered iCBT-I was associated with improvements in insomnia severity in veterans at elevated risk for suicide. These preliminary findings suggest that SI and suicide risk correlates may improve following an iCBT-I intervention, demonstrating the need for future well-powered iCBT-I RCTs targeted for populations at elevated suicide risk.
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Affiliation(s)
- Sarra Nazem
- Dissemination and Training Division, National Center for PTSD, Palo Alto, CA, USA
| | - Shengnan Sun
- Department of Neuroscience, Icahn School of Medicine, New York, NY, USA
- General Medical Research (GMR), James J. Peters VA Medical Center, Bronx, NY, USA
| | - Sean M Barnes
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Co, USA
| | - Trisha A Hostetter
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, CO, USA
| | - Jeri E Forster
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Co, USA
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Co, USA
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University, New York, NY, USA
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Fatemeh Haghighi
- Department of Neuroscience, Icahn School of Medicine, New York, NY, USA
- General Medical Research (GMR), James J. Peters VA Medical Center, Bronx, NY, USA
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Kehr T, Haeyen S. Drawing your way out: Imagery rehearsal based art therapy (IR-AT) for post-traumatic nightmares in borderline personality disorder. J Clin Psychol 2024; 80:1015-1030. [PMID: 38193630 DOI: 10.1002/jclp.23638] [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: 09/02/2023] [Revised: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024]
Abstract
Posttraumatic nightmares (PTN) are a frequent symptom after a traumatic event and often play part in the psychopathology of patients with borderline personality disorder (BPD). Imagery rehearsal therapy (IRT) currently offers the best evidence for an effective treatment to reduce PTNs, although high drop-out rates are common. Art therapy in IRT may counteract this, by its indirect, nonverbal, and often playful approach that helps to break through avoidance. This case study focusses on the perception of a patient with BPD in an art therapy based IRT treatment for patients with PTNs. It tells the story of Aurelia, a 40-year-old woman who, within this treatment, processes traumatic contents of her childhood like physical and sexual violence, but also current interactional problems that manifest themselves in her nightmares. Following the IR-AT treatment for PTNs Aurelia noticed a reduction in her nightmares, was less afraid of them and felt calmer towards her trauma. She expressed herself in the art medium and by this developed more self-efficacy. Her process resulted in an integration of the trauma and a perceived decrease in borderline symptoms. Future research can build on this basis to further explore the mechanisms and effects of IR-AT for PTNs.
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Affiliation(s)
- Timea Kehr
- LVR, Psychosomatic Medicine and Psychotraumatology, Cologne, Germany
| | - Suzanne Haeyen
- Academy of Health and Vitality, Research Group Arts & Psychomor Therapies in Health Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
- GGNet, Centre for Mental Health, Scelta, Expert Centre for Personality Disorders Apeldoorn, Warnsveld, The Netherlands
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Fellman V, Heppell PJ, Rao S. Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents. Psychiatr Clin North Am 2024; 47:229-253. [PMID: 38302209 DOI: 10.1016/j.psc.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.
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Affiliation(s)
- Veronica Fellman
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA.
| | - Patrick J Heppell
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA
| | - Suchet Rao
- Psychiatry and Behavioral Health, NYC Administration for Children's Services, 150 William Street, 11th Floor, New York City, NY 10038, USA
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So CJ, Miller KE, Gehrman PR. Sleep Disturbances Associated With Posttraumatic Stress Disorder. Psychiatr Ann 2023; 53:491-495. [PMID: 38293647 PMCID: PMC10825808 DOI: 10.3928/00485713-20231012-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Sleep disturbances, namely insomnia and recurrent nightmares, are ubiquitous following trauma exposure and are considered hallmarks of posttraumatic stress disorder (PTSD). Other sleep disorders frequently co-occur with PTSD. This article describes research examining sleep problems most common in PTSD, including prevalence and clinical characteristics. Sleep disturbances are often robust to trauma-focused treatment; thus, evidence for psychological and pharmacological interventions for insomnia and nightmares in PTSD are discussed. Given the high prevalence of sleep problems in PTSD, more work is needed to empirically study putative mechanisms linking trauma exposure and sleep, as well as how to best target these symptoms in patients with PTSD.
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Affiliation(s)
- Christine J So
- Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania (CJS, PRG), the Minneapolis VA Health Care System, Minneapolis, Minnesota (KEM), and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (PRG)
| | - Katherine E Miller
- Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania (CJS, PRG), the Minneapolis VA Health Care System, Minneapolis, Minnesota (KEM), and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (PRG)
| | - Philip R Gehrman
- Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania (CJS, PRG), the Minneapolis VA Health Care System, Minneapolis, Minnesota (KEM), and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (PRG)
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Prguda E, Evans J, McLeay S, Romaniuk M, Phelps AJ, Lewis K, Brown K, Fisher G, Lowrie F, Saunders-Dow E, Dwyer M. Posttraumatic sleep disturbances in veterans: A pilot randomized controlled trial of cognitive behavioral therapy for insomnia and imagery rehearsal therapy. J Clin Psychol 2023; 79:2493-2514. [PMID: 37392411 DOI: 10.1002/jclp.23561] [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: 08/17/2022] [Revised: 05/29/2023] [Accepted: 06/07/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVES Posttraumatic stress disorder (PTSD) is associated with sleep disturbances including insomnia and nightmares. This study compared cognitive behavioral therapy for insomnia (CBT-I) with CBT-I combined with imagery rehearsal therapy (IRT) for nightmares to evaluate if the combined treatment led to greater reductions in trauma-related sleep disturbances in Australian veterans. METHODS Veterans with diagnosed PTSD, high insomnia symptom severity, and nightmares (N = 31) were randomized to eight group CBT-I sessions or eight group CBT-I + IRT sessions. Self-reported sleep, nightmare, and psychological measures (primary outcome: Pittsburgh Sleep Quality Index), and objective actigraphy data were collected; the effect of obstructive sleep apnea (OSA) risk on treatment outcomes was also examined. RESULTS No treatment condition effects were detected for the combined treatment compared to CBT-I alone, and no moderating effect of OSA risk was detected. On average, participants from both groups improved on various self-report measures over time (baseline to 3 months posttreatment). Despite the improvements, mean scores for sleep-specific measures remained indicative of poor sleep quality. There were also no significant differences between the groups on the actigraphy indices. CONCLUSIONS The findings indicate that there is potential to optimize both treatments for veterans with trauma-related sleep disturbances.
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Affiliation(s)
- Emina Prguda
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Justine Evans
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
| | - Sarah McLeay
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
| | - Madeline Romaniuk
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea J Phelps
- Department of Psychiatry, Phoenix Australia-Centre for Posttraumatic Mental Health, University of Melbourne, Carlton, Victoria, Australia
| | - Kerri Lewis
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
| | - Kelly Brown
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Gina Fisher
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Fraser Lowrie
- Sleep Care, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | | | - Miriam Dwyer
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
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Rolling J, Rabot J, Reynaud E, Kolb O, Bourgin P, Schroder CM. Nightmares and Sleep Disturbances in Children with PTSD: A Polysomnographic and Actigraphy Approach Evaluation. J Clin Med 2023; 12:6570. [PMID: 37892709 PMCID: PMC10607571 DOI: 10.3390/jcm12206570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/18/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
RATIONALE Sleep disturbances (insomnia and nightmare symptoms) are the most sensitive and persistent symptoms of pediatric post-traumatic stress disorder (PTSD). Untreated, these sleep disturbances (SD) associated with PTSD are predictive of PTSD persistence and increased psychiatric complications. The aim of this study was to evaluate sleep and circadian rhythms in children with PTSD under both laboratory and ecological conditions in comparison with a control population and to test for the first time the hypothesis that SD and circadian rhythms are positively correlated with PTSD severity and its comorbidities. METHOD This prospective pilot study evaluated PTSD, SD (insomnia, nightmares), and sleep-wake rhythms in 11 children with PTSD (aged 3-18), compared with the age and sex-matched control groups. Assessment of PTSD and subjective and objective measures of sleep and sleep-wake rhythms (questionnaires, 24-h in-laboratory video-polysomnography, 15-day at-home actigraphy recording) were performed between 1 and 6 months after the traumatic event. RESULTS Children with PTSD had higher sleep fragmentation (increased wake-after-sleep onset, increased number of sleep stage changes) compared to controls, with a change in sleep microarchitecture (micro-arousal index at 14.8 versus 8.2, p = 0.039). Sleep fragmentation parameters correlated with PTSD symptomatology, insomnia, and post-traumatic nightmare severity. The within-group comparison revealed a better sleep architecture in the controlled (sleep laboratory) than in the ecological condition (at home) (total sleep time 586 versus 464 min, p = 0.018). CONCLUSIONS Sleep and rhythm disturbances are strongly associated with PTSD in children. The assessment of SD in children with PTSD should be carried out systematically and preferentially under ecological conditions, and management of SD should integrate the environment (environmental design, psycho-education for the children and their parents) more fully into therapy focused on sleep and trauma.
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Affiliation(s)
- Julie Rolling
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Regional Center for Psychotraumatism Great East, Strasbourg University Hospital, 67091 Strasbourg, France
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
| | - Juliette Rabot
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
- Center for Research, Integrated University Health and Social Services Center (CIUSSS) Nord-de-l’Île-de-Montréal, Montréal, QC H2M 2W1, Canada
- Department of Psychiatry & Addictology, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Eve Reynaud
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
- CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, Forgetting, Université Claude Bernard Lyon 1, 69500 Bron, France
| | - Oriane Kolb
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
| | - Patrice Bourgin
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
| | - Carmen M. Schroder
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
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Kip A, Schoppe L, Arntz A, Morina N. Efficacy of imagery rescripting in treating mental disorders associated with aversive memories - An updated meta-analysis. J Anxiety Disord 2023; 99:102772. [PMID: 37699277 DOI: 10.1016/j.janxdis.2023.102772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/09/2023] [Accepted: 09/03/2023] [Indexed: 09/14/2023]
Abstract
Imagery rescripting (ImRs) is frequently applied to treat different psychological complaints. We conducted an updated meta-analysis based on randomised controlled trials on the efficacy of ImRs for mental disorders associated with aversive memories. Medline, PsycInfo, and Web of Science were searched up to May 2023. Seventeen trials were included with a total of 908 participants (417 in the ImRs condition), suffering from posttraumatic stress disorder, anxiety disorders, depression, or eating disorders. Random effect models yielded an overall effect of g = 0.68 (95 % CI 0.18 to 1.18; k = 7) compared to passive controls (mostly waitlist). The effect compared to (prolonged) exposure, cognitive restructuring, and EMDR was non-significant (g = -0.01; 95 % CI -0.18 to 0.15; k = 11). Follow-up assessments indicated a long-term treatment effect. Results suggest that ImRs can effectively treat a variety of psychological disorders and produce similar treatment effects as evidence-based interventions. Limitations include the bounded number of included trials for each mental disorder. The meta-analysis was registered on PROSPERO (CRD42020220696) and received no funding.
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Affiliation(s)
- Ahlke Kip
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany.
| | - Luisa Schoppe
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS Amsterdam, the Netherlands
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany
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Rapelli G, Varallo G, Scarpelli S, Pietrabissa G, Musetti A, Plazzi G, Franceschini C, Castelnuovo G. The long wave of COVID-19: a case report using Imagery Rehearsal Therapy for COVID-19-related nightmares after admission to intensive care unit. Front Psychol 2023; 14:1144087. [PMID: 37275716 PMCID: PMC10232986 DOI: 10.3389/fpsyg.2023.1144087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/19/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction The COVID-19 pandemic caused several psychological consequences for the general population. In particular, long-term and persistent psychopathological detriments were observed in those who were infected by acute forms of the virus and need specialistic care in the Intensive Care Unit (ICU). Imagery rehearsal therapy (IRT) has shown promising results in managing nightmares of patients with different traumas, but it has never been used with patients admitted to ICUs for severe COVID-19 despite this experience being considered traumatic in the literature. Methods The purpose of this case study is to describe the application of a four-session IRT for the treatment of COVID-related nightmares in a female patient after admission to the ICU. A 42-year-old Caucasian woman who recovered from a pulmonary rehabilitation program reported shortness of breath, dyspnea, and everyday life difficulties triggered by the long-COVID syndrome. She showed COVID-related nightmares and signs of post-traumatic symptoms (i.e., hyperarousal, nightmares, and avoidance of triggers associated with the traumatic situation). Psychological changes in the aftermath of a trauma, presence, and intensity of daytime sleepiness, dream activity, sleep disturbances, aspects of sleep and dreams, and symptoms of common mental health status are assessed as outcomes at the baseline (during the admission to pneumology rehabilitation) at 1-month (T1) and 3-month follow-up (T2). Follow-up data were collected through an online survey. Results By using IRT principles and techniques, the patient reported a decrease in the intensity and frequency of bad nightmares, an increase in the quality of sleep, and post-traumatic growth, developing a positive post-discharge. Conclusion Imagery rehearsal therapy may be effective for COVID-19-related nightmares and in increasing the quality of sleep among patients admitted to the ICU for the treatment of COVID-19. Furthermore, IRT could be useful for its brevity in hospital settings.
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Affiliation(s)
- Giada Rapelli
- Department of Medicine and Surgery, University of Parma, Parma, Emilia-Romagna, Italy
| | - Giorgia Varallo
- Department of Medicine and Surgery, University of Parma, Parma, Emilia-Romagna, Italy
| | - Serena Scarpelli
- Department of Psychology, Sapienza—University of Rome, Rome, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Lombardy, Italy
- Faculty of Psychology, Catholic University of the Sacred Heart, Milan, Milan, Lombardy, Italy
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Emilia-Romagna, Italy
| | - Giuseppe Plazzi
- IRCCS Institute of Neurological Sciences of Bologna (ISNB), Bologna, Emilia-Romagna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | | | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Lombardy, Italy
- Faculty of Psychology, Catholic University of the Sacred Heart, Milan, Milan, Lombardy, Italy
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Sheaves B, Rek S, Freeman D. Nightmares and psychiatric symptoms: A systematic review of longitudinal, experimental, and clinical trial studies. Clin Psychol Rev 2023; 100:102241. [PMID: 36566699 PMCID: PMC10933816 DOI: 10.1016/j.cpr.2022.102241] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/24/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Nightmares occur across a wide range of psychiatric disorders, but outside of PTSD presentations are infrequently considered a treatment priority. We aimed to assess evidence for a contributory causal role of nightmares to the occurrence of psychiatric disorders, and vice versa. A systematic review was conducted of longitudinal, experimental, and clinical trial studies. Twenty-four longitudinal, sixteen trials, and no experimental studies were identified. Methodological shortcomings were common, especially the use of single-item nightmare assessment. Thirty-five studies assessed the path from nightmares to psychiatric symptoms. Depression (n = 10 studies), PTSD (n = 10) and anxiety (n = 5) were the most commonly assessed outcomes in trials. Most were not designed to assess the effect of nightmare treatment on psychiatric symptoms. Treating nightmares led to moderate reductions in PTSD and depression, small to moderate reductions in anxiety, and potentially moderate reductions in paranoia. Nightmares increased the risk of later suicide outcomes (n = 10), but two small pilot trials indicated that treating nightmares might potentially prevent recovery of suicidal ideation. PTSD treatment led to large reductions in trauma-related nightmares (n = 3). The limited literature suggests that treating nightmares may be one route to lessening threat-based disorders in particular, suggestive of a causal relationship. Overall, however, nightmares in most disorders are greatly understudied.
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Affiliation(s)
- Bryony Sheaves
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Stephanie Rek
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
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11
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Jou YC, Pace-Schott EF. Call to action: Addressing sleep disturbances, a hallmark symptom of PTSD, for refugees, asylum seekers, and internally displaced persons. Sleep Health 2022; 8:593-600. [PMID: 36511279 PMCID: PMC9757843 DOI: 10.1016/j.sleh.2022.09.003] [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: 04/22/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 12/13/2022]
Abstract
Sleep difficulty is a recognized hallmark symptom of post-traumatic stress disorder (PTSD) yet often remains an enduring and neglected problem post-treatment. Around 4.4%- 88.0% of refugees, asylum seekers, and internally displaced persons report PTSD, of which 39%- 99% report sleep difficulties. These percentages substantially exceed those of the general population. Yet there has been a lack of research examining evidence-based stand-alone and add-on treatments for PTSD and related sleep disturbances among this population. Barriers to treatment encountered by this population often vary by their legal status or location, but generally include lack of access due to insufficient evidence-based treatments or mental health practitioner shortages, lack of psychoeducation on mental health, cultural stigma, language barriers, situational instability, and racial bias. The refugee population has been on the rise over the past 10 years, and the United Nations estimated the recent Ukraine-Russia conflict would lead to an additional 12 million people needing humanitarian assistance inside Ukraine and more than 6.9 million refugees fleeing to neighboring countries in the coming months. Given that refugees, asylum seekers, and internally displaced persons repeatedly encounter barriers to mental health care specific to their predicament, interventions designed to accommodate their situation are imperative for improving their sleep and mental health. We therefore call for there to be more research on integrative programs incorporating evidence-based treatments that allow for scalability, adaptability, and rapid dissemination to maximize impact in this population. Further, we encourage trainings among clinicians and researchers to increase knowledge and confidence in working with this population.
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Affiliation(s)
| | - Edward F Pace-Schott
- Harvard Extension School, Cambridge, Massachusetts, USA; Massachusetts General Hospital, Department of Psychiatry, Charlestown, Massachusetts, USA; Harvard Medical School, Department of Psychiatry, Charlestown, Massachusetts, USA; Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA.
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12
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Schwartz S, Clerget A, Perogamvros L. Enhancing imagery rehearsal therapy for nightmares with targeted memory reactivation. Curr Biol 2022; 32:4808-4816.e4. [PMID: 36306786 DOI: 10.1016/j.cub.2022.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/14/2022] [Accepted: 09/15/2022] [Indexed: 11/21/2022]
Abstract
Nightmare disorder (ND) is characterized by dreams with strong negative emotions occurring during rapid eye movement (REM) sleep. ND is mainly treated by imagery rehearsal therapy (IRT), where the patients are asked to change the negative story line of their nightmare to a more positive one. We here used targeted memory reactivation (TMR) during REM sleep to strengthen IRT-related memories and accelerate remission of ND. Thirty-six patients with ND were asked to perform an initial IRT session and, while they generated a positive outcome of their nightmare, half of the patients were exposed to a sound (TMR group), while no such pairing took place for the other half (control group). During the next 2 weeks, all patients performed IRT every evening at home and were exposed to the sound during REM sleep with a wireless headband, which automatically detected sleep stages. The frequency of nightmares per week at 2 weeks was used as the primary outcome measure. We found that the TMR group had less frequent nightmares and more positive dream emotions than the control group after 2 weeks of IRT and a sustained decrease of nightmares after 3 months. By demonstrating the effectiveness of TMR during sleep to potentiate therapy, these results have clinical implications for the management of ND, with relevance to other psychiatric disorders too. Additionally, these findings show that TMR applied during REM sleep can modulate emotions in dreams.
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Affiliation(s)
- Sophie Schwartz
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland
| | - Alice Clerget
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland
| | - Lampros Perogamvros
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland; Center for Sleep Medicine, Geneva University Hospitals, 1225 Geneva, Switzerland; Department of Psychiatry, Geneva University Hospitals, 1225 Geneva, Switzerland.
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13
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Isaac F, Toukhsati SR, DiBenedetto M, Kennedy GA. Cognitive behavioral therapy-based treatments for insomnia and nightmares in adults with trauma symptoms: a systematic review. CURRENT PSYCHOLOGY 2022; 42:1-11. [PMID: 35891889 PMCID: PMC9303051 DOI: 10.1007/s12144-022-03512-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Fadia Isaac
- Institute of Health and Wellbeing, Federation University, Office 211, Building HP, Mt Helen Campus, PO Box 663, Ballarat, Victoria 3353 Australia
| | - Samia R. Toukhsati
- Institute of Health and Wellbeing, Federation University, Office 211, Building HP, Mt Helen Campus, PO Box 663, Ballarat, Victoria 3353 Australia
| | | | - Gerard A. Kennedy
- Institute of Health and Wellbeing, Federation University, Office 211, Building HP, Mt Helen Campus, PO Box 663, Ballarat, Victoria 3353 Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria Australia
- Institute for Breathing and Sleep, Austin Health, Victoria, Australia
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14
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Pharmacological Management of Nightmares Associated with Posttraumatic Stress Disorder. CNS Drugs 2022; 36:721-737. [PMID: 35688992 DOI: 10.1007/s40263-022-00929-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Abstract
Posttraumatic stress disorder (PTSD) can be a chronic and disabling condition. Post-traumatic nightmares (PTNs) form a core component of PTSD and are highly prevalent in this patient population. Nightmares in PTSD have been associated with significant distress, functional impairment, poor health outcomes, and decreased quality of life. Nightmares in PTSD are also an independent risk factor for suicide. Nightmare cessation can lead to improved quality of life, fewer hospital admissions, lower healthcare costs, and reduced all-cause mortality. Effective treatment of nightmares is critical and often leads to improvement of other PTSD symptomatology. However, approved pharmacological agents for the treatment of PTSD have modest effects on sleep and nightmares, and may cause adverse effects. No pharmacological agent has been approved specifically for the treatment of PTNs, but multiple agents have been studied. This current narrative review aimed to critically appraise proven as well as novel pharmacological agents used in the treatment of PTNs. Evidence of varying quality exists for the use of prazosin, doxazosin, clonidine, tricyclic antidepressants, trazodone, mirtazapine, atypical antipsychotics (especially risperidone, olanzapine and quetiapine), gabapentin, topiramate, and cyproheptadine. Evidence does not support the use of venlafaxine, β-blockers, benzodiazepines, or sedative hypnotics. Novel agents such as ramelteon, cannabinoids, ketamine, psychedelic agents, and trihexyphenidyl have shown promising results. Large randomized controlled trials (RCTs) are needed to evaluate the use of these novel agents. Future research directions are identified to optimize the treatment of nightmares in patients with PTSD.
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15
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Abstract
This article reviews the literature on the relationship between sleep deficiency and unipolar and bipolar depression, anxiety disorders, and posttraumatic stress disorder. We consider the evidence for sleep as a contributory causal factor in the development of psychiatric disorders, as well as sleep as an influential factor related to the outcome and recurrence of psychopathology. A case for sleep deficiency being an important treatment target when sleep and psychiatric disorders are comorbid is also made. Our recommendation is that sleep deficiency is recognized as a means to positively impact the development and course of psychopathology and, as such, is routinely assessed and treated in clinical practice.
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16
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Downey C, Crummy A. The impact of childhood trauma on children's wellbeing and adult behavior. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2021.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Roche L, McLay L, Sigafoos J, Whitcombe‐Dobbs S. A review of behavioral treatments for sleep disturbances in civilians who have experienced trauma. BEHAVIORAL INTERVENTIONS 2021. [DOI: 10.1002/bin.1853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Laura Roche
- School of Education University of Newcastle Newcastle New South Wales Australia
| | - Laurie McLay
- School of Health Sciences University of Canterbury Christchurch New Zealand
| | - Jeff Sigafoos
- School of Education Victoria University of Wellington Wellington New Zealand
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18
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Schmid C, Hansen K, Kröner-Borowik T, Steil R. Imagery Rescripting and Imaginal Exposure in Nightmare Disorder Compared to Positive Imagery: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:328-340. [PMID: 33477151 DOI: 10.1159/000512757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 11/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Both imagery rescripting and imaginal exposure have been proven to be effective in the treatment of chronic nightmares when compared to a waitlist condition. Little is known about their comparative efficacy and their efficacy compared to an active control. OBJECTIVE The aims of this study were to compare the two treatments to one another and to positive imagery as an active control, and to explore covariates of the treatment effect. METHODS In this single-blinded randomized controlled trial, 96 patients with nightmare disorder (idiopathic nightmares) from an outpatient clinic were randomly assigned to a single individual treatment session of rescripting, exposure, or positive imagery and 4 weeks of practice at home. The primary outcome was nightmare distress, and the secondary outcomes were nightmare frequency, nightmare effects, self-efficacy, and general psychopathology. RESULTS Nightmare distress was reduced in all groups (imagery rescripting: Cohen's d = -1.04, imaginal exposure: d = -0.68, positive imagery: d = -0.57), as were nightmare frequency, nightmare effects, and psychopathology. Self-efficacy was enhanced. No differential treatment effects were found on any primary or secondary measure. Treatment gains were not associated with demographic or disorder characteristics, baseline values, treatment credibility, or the number of practice sessions. CONCLUSIONS Even short nightmare treatments are effective regardless of personal characteristics, and different interventions produce similar results. Future research should aim to clarify the mechanisms of action. Health care should make more use of these powerful and easy-to-administer nightmare treatments.
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Affiliation(s)
- Carolin Schmid
- Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany,
| | - Kathrin Hansen
- Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany
| | - Tana Kröner-Borowik
- Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany
| | - Regina Steil
- Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany
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19
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Lortye SA, Will JP, Marquenie LA, Goudriaan AE, Arntz A, de Waal MM. Treating posttraumatic stress disorder in substance use disorder patients with co-occurring posttraumatic stress disorder: study protocol for a randomized controlled trial to compare the effectiveness of different types and timings of treatment. BMC Psychiatry 2021; 21:442. [PMID: 34493253 PMCID: PMC8423329 DOI: 10.1186/s12888-021-03366-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity. Although prior research indicated that PTSD can effectively be treated with Prolonged Exposure (PE) in these patients, reported effects are small and treatment dropout rates high. Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs) are other promising treatment options for PTSD, that have not yet been examined in this patient group. Furthermore, it is unclear whether PTSD treatment is most effective when offered simultaneous to or after SUD treatment. METHODS In this article, the Treatment Of PTSD and Addiction (TOPA) study is described: a Dutch randomized controlled trial (RCT) that studies the effectiveness of PTSD treatment as an add-on to regular SUD treatment in patients with SUD and co-occurring PTSD. Effects of PE, EMDR, ImRs, and a 3-month SUD treatment only condition will be compared, as well as simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment. The primary outcome measure is PTSD symptoms. Secondary outcomes are: treatment completion, psychological distress, substance use, interpersonal problems, emotion dysregulation, and trauma-related emotions guilt, shame, and anger. DISCUSSION This study is the first to compare effects of PE, EMDR, and ImRs in one study and to compare simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment as well. This RCT will provide more knowledge about the effectiveness of different treatment strategies for PTSD in patients with co-occurring SUD and will ultimately improve treatment outcomes for patients with this common co-morbidity worldwide. TRIAL REGISTRATION Netherlands Trial Register (NTR), Identifier: NL7885 . Registered 22 July 2019.
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Affiliation(s)
- Sera A Lortye
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands.
| | - Joanne P Will
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Loes A Marquenie
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Anna E Goudriaan
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marleen M de Waal
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
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20
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Doxazosin improved COVID-19 associated nightmare in a patient with major depressive disorder: a case report with a positive rechallenge. Int Clin Psychopharmacol 2021; 36:221-223. [PMID: 34030164 PMCID: PMC8162045 DOI: 10.1097/yic.0000000000000364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article reports on the treatment of a patient with nightmares who was treated with doxazosin of an alpha 1-adrenergic antagonists. A 71-year-old Japanese major depressive disorder (MDD) woman experienced nightmares after the coronavirus disease 2019 pandemic. She had nightmares about being chased by a coronavirus and catching the corona virus. After adding doxazosin 1 mg daily in the morning, her nightmares led to remission without side effects. We also had a rechallenge regimen with doxazosin. The nightmares ceased on the second night of the rechallenge and did not return with continued treatment. This case report suggests that doxazosin may be a useful therapeutic option to target nightmares in individuals with MDD.
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21
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Steine IM, Skogen JC, Hysing M, Puigvert L, Schønning V, Sivertsen B. Sexual harassment and assault predict sleep disturbances and is partly mediated by nightmares: Findings from a national survey of all university students in Norway. J Sleep Res 2021; 30:e13338. [PMID: 34130358 DOI: 10.1111/jsr.13338] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/05/2021] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Abstract
Sexual harassment and assault is common in most domains of society, and has been linked to several adverse outcomes, including reduced sleep quality. However, less is known about the possible impact of sexual harassment and assault on various sleep problems among university students. In a sample of 49,051 students in Norway (69.2% women), we examined i) the associations of varying extents of sexual harassment (unwanted sexual comments, looks or gestures, photographs, indecent exposure, and physical harassment) and sexual assault (attempted or completed rape), with meeting Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic criteria of insomnia and with sleep duration, ii) the association of cumulative exposure to sexual harassment/assault with insomnia and sleep duration, and iii) to what extent nightmares could explain the association between sexual harassment and insomnia and sleep duration. For both genders, all forms of harassments with the exception of "indecent exposure" and "unwanted sexual photographs" for men were negatively associated with sleep duration, with the strongest associations being found for "rape" and "attempted rape". For both genders, the odds of insomnia increased as a function of cumulative harassment exposure. Similarly, a graded, negative association was found between cumulative harassment and sleep duration for both genders. Mediation analyses showed that 28% of the observed association between cumulative harassment and insomnia, and 15% of the association between cumulative harassment and sleep duration, was mediated by frequency of nightmares.
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Affiliation(s)
- Iris M Steine
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway.,Department of Psychology, UC Berkeley, Berkeley, CA, USA
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Alcohol and Drug Research Western Norway, Stavanger University Hospital, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Lidia Puigvert
- Department of Sociology, University of Barcelona, Barcelona, Spain
| | - Viktor Schønning
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway.,Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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22
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Szabó J, Tóth S. Collision Every Night: Treating Nightmares with Trauma-focused Methods: Case Report. SLEEP AND VIGILANCE 2021; 5:151-156. [PMID: 33554009 PMCID: PMC7849612 DOI: 10.1007/s41782-021-00126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/02/2020] [Accepted: 01/16/2021] [Indexed: 12/03/2022]
Abstract
Introduction We would like to present the case of a young patient with acute stress disorder and recurrent nightmares following the psychological trauma caused by a severe road traffic accident. The comprehensive therapy carried out at the Department of Traumatology included medication, trauma processing and a psychological method whose aim is to cease the development of nightmares. Case Presentation Psychiatric assessment and treatment was asked for a polytraumatised female patient at the Intensive Care Unit after she had undergone a neurosurgical intervention. Her medicinal treatment was continued at the Department of Traumatology. Besides the antidepressant venlafaxine she was treated in accordance with the EMDR protocol for acute stress disorder, and we also applied imagery rescripting to prevent her from having recurrent (daily) nightmares. As a result of the therapy, her symptoms were fast relieved, the nightmares stopped almost instantly, her mood improved, rumination and anxiety decreased significantly. Conclusions In view of the fast and significant symptomatic improvement, we can expect that the EMDR therapy and its protocol for acute stress disorder have successfully reactivated information processing, and besides the subjective relief we have managed to prevent a mental crisis that could lead to a suicide risk as well as the development of post-traumatic stress disorder. We also hope that the improvement will be long-lasting.
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23
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Paulik G, Maloney G, Arntz A, Bachrach N, Koppeschaar A, McEvoy P. Delivering Imagery Rescripting via Telehealth: Clinical Concerns, Benefits, and Recommendations. Curr Psychiatry Rep 2021; 23:24. [PMID: 33725200 PMCID: PMC7962431 DOI: 10.1007/s11920-021-01238-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE OF THE REVIEW Delivery of psychological therapies via telehealth has increased with the emergence of the COVID-19 pandemic. Therapists may be hesitant in moving to telehealth when delivering therapies targeting memories of traumatic experiences. This paper collates the clinical experiences of clinicians and clients who have delivered or received imagery rescripting, respectively, via telehealth across a range of clinical presentations, and describes key clinical considerations and recommendations. RECENT FINDINGS It is important to consider perceived and real safety; practical and technological issues; therapeutic alliance; depth of emotional processing; and dissociation. There was support for the delivery of imagery rescripting via telehealth being no less effective than face-to-face delivery; however, telehealth delivery was not a viable option for many clients during COVID-19 lockdowns who were living in high density housing, old houses with thin walls, or with some complex disorders.
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Affiliation(s)
- Georgie Paulik
- Perth Voices Clinic, School of Psychology, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia.
- School of Psychological Science, University of Western Australia, Crawley, Australia.
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia.
| | - Gayle Maloney
- Perth OCD Clinic, West Perth, Australia
- Yale OCD Research Clinic, Yale University School of Medicine, New Haven, USA
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Nathan Bachrach
- GGZ Oost Brabant, Boekel, Netherlands
- RINO ZUID, Eindhoven, Netherlands
- Tilburg University, Tilburg, Netherlands
| | | | - Peter McEvoy
- School of Psychology, Curtin University, Perth, Australia
- Centre for Clinical Interventions, Northbridge, Australia
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24
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Sandahl H, Carlsson J, Sonne C, Mortensen EL, Jennum P, Baandrup L. Investigating the link between subjective sleep quality, symptoms of PTSD and level of functioning in a sample of trauma-affected refugees. Sleep 2021; 44:6168908. [PMID: 33710347 DOI: 10.1093/sleep/zsab063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/01/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To examine whether baseline sleep quality is associated with baseline symptoms of posttraumatic stress disorder (PTSD) and level of functioning, and whether baseline sleep quality and improvement of sleep quality are specific predictors of change in PTSD symptoms and level of functioning. METHODS Data were derived from a four-armed randomised controlled superiority trial (N=219 trauma-affected refugees). All four groups received treatment as usual consisting of a 10-12 months bio-psycho-social treatment program with an additional differential treatment component added to each arm. We performed bivariate correlation analyses, multiple linear regression analyses and mediation analyses to examine associations between baseline sleep quality, change in sleep quality and treatment response for PTSD symptoms and level of functioning. RESULTS Baseline sleep quality correlated with symptoms of PTSD (r = .33) and level of functioning (r=0.15). Baseline sleep quality, improvement of sleep quality and improvement of general well-being were predictors of treatment response for symptoms of PTSD and level of functioning when controlling for age, gender, and baseline symptoms of PTSD and depression. CONCLUSIONS We found that good sleep quality at baseline and improvement of sleep quality were predictors of PTSD treatment response. However, treatment response was more closely associated with improvement in general well-being. The results indicate that the effect of improved sleep quality was partly mediated by a more general mental state improvement. Further research is needed to differentiate if a selected subgroup of patients may profit from sleep enhancing treatment.
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Affiliation(s)
- Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Sonne
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet - Glostrup, Copenhagen University Hospital, Denmark
| | - Lone Baandrup
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
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25
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Abstract
Objectives/Background: Despite Cognitive Behavioral Therapy for Insomnia (CBT-I) being considered the first-line treatment for insomnia, it is not without its challenges. As such it is worthwhile to consider, and test, alternative or adjuvant management options. Methods/Participants: The aim of the present study was to examine whether Lucid Dreaming Training for insomnia (LDT-I) impacted on insomnia, depressive and anxious symptomology in an open label trial of 48 adults with Insomnia Disorder. Participants completed the Insomnia Severity Index, General Anxiety Disorder-7 and Patient Health Questionnaire at baseline then one month following LDT-I. Training consisted of four modules delivered over a period of two consecutive weeks. Results: The results suggest, albeit preliminarily, that LDT-I may have a place within the non-pharmacological management of insomnia, as there were significant reductions in insomnia severity (t(46) = 8.16,p <.001), anxious symptomology (t(46) = 4.75,p <.001) and depressive symptomology (t(46) = 5.87,p <.001). Further, the effect size in terms of pre-post reductions on ISI scores was large (dz 1.17). Conclusions: Whilst the results are promising, further testing of LDT-I is needed to inform its place amongst the non-pharmacological treatments for insomnia.
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Affiliation(s)
- Jason G Ellis
- Northumbria Centre for Sleep Research, Northumbria University , Newcastle, UK
| | - Joseph De Koninck
- School of Psychology, University of Ottawa , Ottowa, Ontario, Canada
| | - Celyne H Bastien
- Department of Psychology, Université Laval , Quebec, Canada.,CERVO Research Center , Quebec, Canada
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26
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Brownlow JA, Miller KE, Gehrman PR. Treatment of Sleep Comorbidities in Posttraumatic Stress Disorder. ACTA ACUST UNITED AC 2021; 7:301-316. [PMID: 33552844 DOI: 10.1007/s40501-020-00222-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of the review Sleep disturbances, insomnia and recurrent nightmares in particular, are among the most frequently endorsed symptoms of posttraumatic stress disorder (PTSD). The present review provides a summary of the prevalence estimates and methodological challenges presented by sleep disturbances in PTSD, highlights the recent evidence for empirically supported psychotherapeutic and pharmacological interventions for comorbid sleep disturbances implicated in PTSD, and provides a summary of recent findings on integrated and sequential treatment approaches to ameliorate comorbid sleep disturbances in PTSD. Recent Findings Insomnia, recurrent nightmares, and other sleep disorders are commonly endorsed among individuals with PTSD; however, several methodological challenges contribute to the varying prevalence estimates. Targeted sleep-focused therapeutic interventions can improve sleep symptoms and mitigate daytime PTSD symptoms. Recently, attention has focused on the role of integrated and sequential approaches, suggesting that comprehensively treating sleep disturbances in PTSD is likely to require novel treatment modalities. Summary Evidence is growing on the development, course, and treatment of comorbid sleep disturbances in PTSD. Further, interventions targeting sleep disturbances in PTSD show promise in reducing symptoms. However, longitudinal investigations and additional rigorous controlled trials with diverse populations are needed to identify key features associated with treatment response in order to alleviate symptoms.
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Affiliation(s)
- Janeese A Brownlow
- Department of Psychology, College of Health & Behavioral Sciences, Delaware State University, Dover, Delaware, USA.,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine E Miller
- Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Philip R Gehrman
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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27
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Haeyen S, Staal M. Imagery Rehearsal Based Art Therapy: Treatment of Post-traumatic Nightmares in Art Therapy. Front Psychol 2021; 11:628717. [PMID: 33519657 PMCID: PMC7840539 DOI: 10.3389/fpsyg.2020.628717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022] Open
Abstract
Imagery Rehearsal Therapy (IRT) is effective for trauma-related nightmares and is also a challenge to patients in finding access to their traumatic memories, because these are saved in non-verbal, visual, or audiovisual language. Art therapy (AT) is an experiential treatment that addresses images rather than words. This study investigates the possibility of an IRT-AT combination. Systematic literature review and field research was conducted, and the integration of theoretical and practice-based knowledge resulted in a framework for Imagery Rehearsal-based Art Therapy (IR-AT). The added value of AT in IRT appears to be more readily gaining access to traumatic experiences, living through feelings, and breaking through avoidance. Exposure and re-scripting take place more indirectly, experientially and sometimes in a playlike manner using art assignments and materials. In the artwork, imagination, play and fantasy offer creative space to stop the vicious circle of nightmares by changing theme, story line, ending, or any part of the dream into a more positive and acceptable one. IR-AT emerges as a promising method for treatment, and could be especially useful for patients who benefit least from verbal exposure techniques. This description of IR-AT offers a base for further research.
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Affiliation(s)
- Suzanne Haeyen
- GGNet Centre of Mental Health, Apeldoorn, Netherlands.,Hogeschool van Arnhem en Nijmegen [HAN] University of Applied Sciences, Nijmegen, Netherlands
| | - Merel Staal
- GGNet Centre of Mental Health, Apeldoorn, Netherlands
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Sandahl H, Jennum P, Baandrup L, Lykke Mortensen E, Carlsson J. Imagery rehearsal therapy and/or mianserin in treatment of refugees diagnosed with PTSD: Results from a randomized controlled trial. J Sleep Res 2021; 30:e13276. [PMID: 33529449 PMCID: PMC8365672 DOI: 10.1111/jsr.13276] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
Abstract
Sleep disturbances are frequently part of the symptomatology in refugees with post‐traumatic stress disorder (PTSD). It has been suggested that targeting sleep disturbances may enhance the outcome of PTSD treatment. However, randomized studies on the effect of treatment focusing on sleep disturbances in refugees with PTSD are lacking. The aim of this study was to examine add‐on treatment with imagery rehearsal therapy (IRT) and/or mianserin against treatment as usual (TAU) alone in a sample of trauma‐affected refugees with PTSD at 8–12 months follow‐up. In a randomized controlled trial, 219 adult refugees diagnosed with PTSD and suffering from sleep disturbances were randomized to four groups (1:1:1:1) receiving, respectively, TAU, TAU + mianserin, TAU + IRT, and TAU + IRT + mianserin. The primary outcome was subjective sleep quality (Pittsburgh Sleep Quality Index) and the secondary outcomes included PTSD and depression symptoms, level of functioning and subjective well‐being. The data were analysed using mixed models. The only significant effect of IRT was on level of functioning (p = .040, ES 0.44), whereas there was no significant effect of mianserin on any of the measured outcomes. Low adherence to both IRT (39%) and mianserin (20%) was observed. Contrary to our hypothesis, we did not find IRT or mianserin to be superior to TAU. The low adherence may potentially cause an underestimation of the effect of IRT and mianserin and indicates a necessity to further analyse the complex factors that may impact the motivation and ability of trauma‐affected refugees to participate in and profit from available treatment options.
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Affiliation(s)
- Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Poul Jennum
- Danish Centre for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet - Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - Lone Baandrup
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Mental Health Centre Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Centre for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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29
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Fellman V, Heppell PJ, Rao S. Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:225-249. [PMID: 33223064 DOI: 10.1016/j.chc.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.
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Affiliation(s)
- Veronica Fellman
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA.
| | - Patrick J Heppell
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA
| | - Suchet Rao
- Psychiatry and Behavioral Health, NYC Administration for Children's Services, 150 William Street, 11th Floor, New York City, NY 10038, USA
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30
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Hayes SC, Hofmann SG, Ciarrochi J. A process-based approach to psychological diagnosis and treatment:The conceptual and treatment utility of an extended evolutionary meta model. Clin Psychol Rev 2020; 82:101908. [PMID: 32932093 PMCID: PMC7680437 DOI: 10.1016/j.cpr.2020.101908] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/18/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022]
Abstract
For half a century, the dominant paradigm in psychotherapy research has been to develop syndrome-specific treatment protocols for hypothesized but unproved latent disease entities, as defined by psychiatric nosological systems. While this approach provided a common language for mental health problems, it failed to achieve its ultimate goal of conceptual and treatment utility. Process-based therapy (PBT) offers an alternative approach to understanding and treating psychological problems, and promoting human prosperity. PBT targets empirically established biopsychosocial processes of change that researchers have shown are functionally important to long terms goals and outcomes. By building on concepts of known clinical utility, and organizing them into coherent theoretical models, an idiographic, functional-analytic approach to diagnosis is within our grasp. We argue that a multi-dimensional, multi-level extended evolutionary meta-model (EEMM) provides consilience and a common language for process-based diagnosis. The EEMM applies the evolutionary concepts of context-appropriate variation, selection, and retention to key biopsychosocial dimensions and levels related to human suffering, problems, and positive functioning. The EEMM is a meta-model of diagnostic and intervention approaches that can accommodate any set of evidence-based change processes, regardless of the specific therapy orientation. In a preliminary way, it offers an idiographic, functional analytic, and clinically useful alternative to contemporary psychiatric nosological systems.
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Abstract
Abstract. Posttraumatic stress disorder (PTSD) is characterized by intrusive re-experiencing of emotional memories of a traumatic event. Such memories are formed after exposure to trauma in the context of a cascading stress response including high levels of emotional arousal and stress hormone release. Sleep could be a key modulator of early memory formation and re-consolidation processes. Initial studies have investigated this association in this early time period, that is, hours and days after trauma exposure, and its role in modulating trauma memories and PTSD. The time is thus ripe to integrate findings from these studies. The current review consolidated evidence from five experimental and seven naturalistic studies on the association between trauma, sleep, and the development of intrusive emotional memories and PTSD, respectively. Together, the studies point to a potential protective role of sleep after trauma for the development of intrusive memories and PTSD. Findings regarding key sleep architecture features are more mixed and require additional investigation. The findings are important for prevention and intervention science.
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Affiliation(s)
- Yasmine Azza
- Division of Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
- Sleep & Health Zurich, University of Zurich, Switzerland
| | - Ines Wilhelm
- Division of Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - Birgit Kleim
- Division of Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
- Sleep & Health Zurich, University of Zurich, Switzerland
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32
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Fear of sleep and trauma-induced insomnia: A review and conceptual model. Sleep Med Rev 2020; 55:101383. [PMID: 32992229 DOI: 10.1016/j.smrv.2020.101383] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023]
Abstract
Trauma-induced insomnia is a symptom of posttraumatic stress disorder (PTSD), and is reported to be particularly distressing and often persists even after remission of the core symptoms of PTSD. Recently, it has been suggested that fear of sleep plays an important role in the development and maintenance of trauma-induced insomnia. The aim of this review is to propose a conceptual model of fear of sleep as a maintaining factor of trauma-induced insomnia. After a brief overview of the role of sleep in PTSD, the concept of fear of sleep is introduced. Theoretical considerations and empirical findings on the role of fear of sleep for trauma-induced insomnia in the context of PTSD are summarized and integrated. Specifically, links between PTSD symptoms and fear of sleep are presented, as well as possible consequences of fear of sleep leading to trauma-induced insomnia. Finally, we highlight methodological issues, identify areas for future research, and discuss potential clinical implications.
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Putois B, Peter-Derex L, Leslie W, Braboszcz C, El-Hage W, Bastuji H. Internet-Based Intervention for Posttraumatic Stress Disorder: Using Remote Imagery Rehearsal Therapy to Treat Nightmares. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:315-316. [PMID: 31284286 DOI: 10.1159/000501105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 05/22/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Benjamin Putois
- Swiss Distance Learning University, Study Centre of Sierre, Sierre, Switzerland, .,Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France,
| | - Laure Peter-Derex
- Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France.,Sleep Medicine and Respiratory Disease Center, Croix-Rousse Hôpital, CHU of Lyon, Lyon, France.,Lyon 1 University, Lyon, France
| | - Wendy Leslie
- Clinical Health Psychology, University of Ulster, Ulster, United Kingdom
| | - Claire Braboszcz
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Wissam El-Hage
- CHU de Tours, Clinique Psychiatrique Universitaire, Tours, France.,UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Hélène Bastuji
- Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France.,Sleep Medicine and Respiratory Disease Center, Croix-Rousse Hôpital, CHU of Lyon, Lyon, France
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34
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Werner GG, Danböck SK, Metodiev S, Kunze AE. Pre-Sleep Arousal and Fear of Sleep in Trauma-Related Sleep Disturbances: A Cluster-Analytic Approach. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e2699. [PMID: 36397829 PMCID: PMC9645493 DOI: 10.32872/cpe.v2i2.2699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background Trauma-related sleep disturbances constitute critical symptoms of posttraumatic stress disorder (PTSD), but sleep symptoms often reside even after successful trauma-focused psychotherapy. Therefore, currently unattended factors - like fear of sleep (FoS) - might play a crucial role in the development and maintenance of residual sleep disturbances. However, it is unclear whether trauma-exposed individuals exhibit different symptomatic profiles of sleep disturbances that could inform individualized therapeutic approaches and eventually enhance treatment efficacy. Method In a large online study, a two-step cluster analysis and a hierarchical cluster analysis using Ward's method were performed to explore subgroups among trauma-exposed individuals (N = 471) in terms of FoS, different aspects of trauma-related sleep disturbances (e.g., insomnia symptoms, nightmares, arousal), and PTSD symptoms. These variables were compared between resulting clusters using ANOVAs and Scheffé's post-hoc tests. Results The hierarchical cluster analysis supported 3- and 4-cluster solutions. The 3-cluster solution consisted of one "healthy" (n = 199), one "subclinical" (n = 223), and one "clinical" (n = 49) cluster, with overall low, medium, and high symptomatology on all used variables. In the 4-cluster solution, the clinical cluster was further divided into two subgroups (n = 38, n = 11), where one cluster was specifically characterized by elevated somatic pre-sleep arousal and high levels of FoS. Conclusions A subgroup of trauma-exposed individuals with PTSD and sleep disturbances suffers from increased pre-sleep arousal and FoS, which has been suggested as one possible explanation for residual sleep disturbances. In these patients, FoS might be a relevant treatment target.
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Affiliation(s)
- Gabriela G. Werner
- Department of Psychology, LMU Munich [study institution], Munich, Germany
| | - Sarah K. Danböck
- Department of Psychology, LMU Munich [study institution], Munich, Germany
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Stanislav Metodiev
- Department of Psychology, LMU Munich [study institution], Munich, Germany
| | - Anna E. Kunze
- Department of Psychology, LMU Munich [study institution], Munich, Germany
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35
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Yücel DE, van Emmerik AA, Souama C, Lancee J. Comparative efficacy of imagery rehearsal therapy and prazosin in the treatment of trauma-related nightmares in adults: A meta-analysis of randomized controlled trials. Sleep Med Rev 2020; 50:101248. [DOI: 10.1016/j.smrv.2019.101248] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 01/28/2023]
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36
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Dowd SM, Zalta AK, Burgess HJ, Adkins EC, Valdespino-Hayden Z, Pollack MH. Double-blind randomized controlled study of the efficacy, safety and tolerability of eszopiclone vs placebo for the treatment of patients with post-traumatic stress disorder and insomnia. World J Psychiatry 2020; 10:21-28. [PMID: 32257848 PMCID: PMC7099286 DOI: 10.5498/wjp.v10.i3.21] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/10/2020] [Accepted: 02/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sleep disturbance is a core feature of post-traumatic stress disorder (PTSD). Given the relationship between sleep disturbance and PTSD, there has been a relative paucity of studies examining the potential therapeutic impact of using pharmacotherapy to target sleep disturbance in patients with PTSD. Eszopiclone (ESZ) is a non-benzodiazepine y-aminobutyric acid-A receptor agonist indicated for the treatment of sleep and may affect sleep in patients with PTSD.
AIM To evaluate the efficacy of ESZ vs placebo (PBO) for patients with PTSD and insomnia.
METHODS The study was a 12-wk, double blind, randomized controlled trial with 3 mg of ESZ (n = 13) or PBO (n = 12).
RESULTS Patients in both arms experienced significant improvement in PTSD symptoms as assessed by the Clinician-Administered PTSD Scale for DSM-IV (CAPS): ESZ (t11 = -3.12, P = 0.005) and PBO (t11 = -3.5, P = 0.002) and by self-report with the Short PTSD Rating Interview (ESZ t11 = -3.38, P = 0.003 and PBO t11 = -4.48, P = 0.0005). There were no significant differences between treatments on the CAPS (t22 = -0.13, P = 0.70) or the Short PTSD Rating Interview (t22 = -0.58, P = 0.56). Similarly, both treated groups improved on sleep measures as assessed by the Pittsburgh Sleep Quality Index with PTSD Addendum (PSQI) and on total sleep time (TST) and sleep latency assessed by actigraphy with no significant differences between groups (PSQI t22 = -0.24, P = 0.81; total sleep time t10 = 0.13, P = 0.90 and sleep latency t10 = 0.68, P = 0.50). There was a significant correlation between improvement in sleep and overall improvement in PTSD as measured by change scores on the PSQI and CAPS, r(8) = 0.79, P = 0.01 for ESZ treated subjects, but not for those treated with PBO r(9) = 0.16, P = 0.69. Adverse events of ESZ were consistent with the known profile of the medication including dysgeusia (30%, mild), sedation (20%, mild) and headache (20%, moderate to severe).
CONCLUSION Results do not support the hypothesis of a specific positive effect of ESZ compared to PBO for measures of PTSD and associated sleep disturbance.
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Affiliation(s)
- Sheila M Dowd
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL 60601, United States
| | - Alyson K Zalta
- Department of Psychological Science, University of California Irvine, Irvine, CA 92697, United States
| | - Helen J Burgess
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Elizabeth C Adkins
- Center for Behavioral Intervention Technologies | Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | | | - Mark H Pollack
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL 60601, United States
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37
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Bourchtein E, Langberg JM, Eadeh HM. A Review of Pediatric Nonpharmacological Sleep Interventions: Effects on Sleep, Secondary Outcomes, and Populations With Co-occurring Mental Health Conditions. Behav Ther 2020; 51:27-41. [PMID: 32005338 DOI: 10.1016/j.beth.2019.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 04/18/2019] [Accepted: 04/27/2019] [Indexed: 12/19/2022]
Abstract
Sleep problems are common in school-age children and linked to numerous negative outcomes. Sleep disturbances are particularly common in children with mental health disorders, such as attention-deficit/hyperactivity disorder, depression, and anxiety. Despite frequent use of nonpharmacological pediatric sleep interventions to treat common sleep problems, there is a paucity of research on whether these interventions are effective. Further, it is unclear whether by targeting sleep, these interventions lead to broader improvements in the domains of functioning that are commonly affected by poor sleep. The present review includes 20 studies that evaluated nonpharmacological sleep treatments for school-aged youth, including 5 studies specifically focused on youth with externalizing or internalizing problems. Multimodal approaches consisting of psychoeducation and sleep hygiene in combination with other components were effective at treating insomnia and general sleep problems in typically developing samples. The addition of behavioral parent training to sleep interventions was effective for youth with externalizing problems, whereas incorporating cognitive strategies into sleep interventions for youth with internalizing problems was found to be ineffective. A variety of secondary outcomes were examined, with the strongest support emerging for improvement in anxiety and behavioral problems. Implications for clinical practice and future research directions are discussed.
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38
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Vallat R, Ruby PM. Is It a Good Idea to Cultivate Lucid Dreaming? Front Psychol 2019; 10:2585. [PMID: 31803118 PMCID: PMC6874013 DOI: 10.3389/fpsyg.2019.02585] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Raphael Vallat
- Department of Psychology, Center for Human Sleep Science, University of California, Berkeley, Berkeley, CA, United States.,DYCOG Team, Lyon Neuroscience Research Center, CNRS UMR 5292 - INSERM U1028 - Lyon 1 University, Bron, France
| | - Perrine Marie Ruby
- DYCOG Team, Lyon Neuroscience Research Center, CNRS UMR 5292 - INSERM U1028 - Lyon 1 University, Bron, France
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39
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Pruiksma KE, Taylor DJ, Mintz J, Nicholson KL, Rodgers M, Young-McCaughan S, Hall-Clark BN, Fina BA, Dondanville KA, Cobos B, Wardle-Pinkston S, Litz BT, Roache JD, Peterson AL. A pilot randomized controlled trial of cognitive behavioral treatment for trauma-related nightmares in active duty military personnel. J Clin Sleep Med 2019; 16:29-40. [PMID: 31957648 DOI: 10.5664/jcsm.8116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The aim of this study was to obtain preliminary data on the efficacy, credibility, and acceptability of Exposure, relaxation, and rescripting therapy for military service members and veterans (ERRT-M) in active duty military personnel with trauma-related nightmares. METHODS Forty participants were randomized to either 5 sessions of ERRT-M or 5 weeks of minimal contact control (MCC) followed by ERRT-M. Assessments were completed at baseline, posttreatment/postcontrol, and 1-month follow-up. RESULTS Differences between ERRT-M and control were generally medium in size for nightmare frequency (Cohen d = -0.53), nights with nightmares (d = -0.38), nightmare severity (d = -0.60), fear of sleep (d = -0.44), and symptoms of insomnia (d = -0.52), and depression (d = -0.51). In the 38 participants who received ERRT-M, there were statistically significant, medium-sized decreases in nightmare frequency (d = -0.52), nights with nightmares (d = -0.50), nightmare severity (d = -0.55), fear of sleep (d = -0.48), and symptoms of insomnia (d = -0.59), posttraumatic stress disorder (PTSD) (d = -0.58) and depression (d = -0.59) from baseline to 1-month follow-up. Participants generally endorsed medium to high ratings of treatment credibility and expectancy. The treatment dropout rate (17.5%) was comparable to rates observed for similar treatments in civilians. CONCLUSIONS ERRT-M produced medium effect-size reductions in nightmares and several secondary outcomes including PTSD, depression, and insomnia. Participants considered ERRT-M to be credible. An adequately powered randomized clinical trial is needed to confirm findings and to compare ERRT-M to an active treatment control. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: A Pilot Randomized Controlled Trial of Treatment for Trauma-Related Nightmares In Active Duty Military Personnel; Identifier: NCT02506595; URL: https://clinicaltrials.gov/ct2/show/NCT02506595.
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Affiliation(s)
- Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, Texas
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Karin L Nicholson
- Department of Medicine, Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | - Matthew Rodgers
- Department of Medicine, Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Brittany N Hall-Clark
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Brooke A Fina
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Katherine A Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Briana Cobos
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | | | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.,Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - John D Roache
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
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40
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Sheaves B, Holmes EA, Rek S, Taylor KM, Nickless A, Waite F, Germain A, Espie CA, Harrison PJ, Foster R, Freeman D. Cognitive Behavioural Therapy for Nightmares for Patients with Persecutory Delusions (Nites): An Assessor-Blind, Pilot Randomized Controlled Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:686-696. [PMID: 31129983 PMCID: PMC6783669 DOI: 10.1177/0706743719847422] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Nightmares are relatively common in patients experiencing psychosis but rarely assessed or treated. Nightmares may maintain persecutory delusions by portraying fears in sensory-rich detail. We tested the potential benefits of imagery-focused cognitive behavioural therapy (CBT) for nightmares on nightmare severity and persecutory delusions. METHOD This assessor-blind parallel-group pilot trial randomized 24 participants with nightmares and persecutory delusions to receive CBT for nightmares delivered over 4 weeks in addition to treatment as usual (TAU) or TAU alone. Assessments were at 0, 4 (end of treatment), and 8 weeks (follow-up). Feasibility outcomes assessed therapy uptake, techniques used, satisfaction, and attrition. The primary efficacy outcome assessed nightmare severity at week 4. Analyses were intention to treat, estimating treatment effect with 95% confidence intervals (CIs). RESULTS All participants offered CBT completed therapy (mean [SD], 4.8 [0.6] sessions) with high satisfaction, and 20 (83%) participants completed all assessments. Compared with TAU, CBT led to large improvements in nightmares (adjusted mean difference = -7.0; 95% CI, -12.6 to -1.3; d = -1.1) and insomnia (6.3; 95% CI, 2.6 to 10.0; d = 1.4) at week 4. Gains were maintained at follow-up. Suicidal ideation was not exacerbated by CBT but remained stable to follow-up, compared with TAU, which reduced at follow-up (6.8; 95% CI, 0.3 to 3.3; d = 0.7). CBT led to reductions in paranoia (-20.8; 95% CI, -43.2 to 1.7; d = -0.6), although CIs were wide. Three serious adverse events were deemed unrelated to participation (CBT = 2, TAU = 1). CONCLUSIONS CBT for nightmares is feasible and may be efficacious for treating nightmares and comorbid insomnia for patients with persecutory delusions. It shows promise on paranoia but potentially not on suicidal ideation.
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Affiliation(s)
- Bryony Sheaves
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Emily A Holmes
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,Department of Psychology, Uppsala University, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Stephanie Rek
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Kathryn M Taylor
- Nuffield Department of Primary Care Health Sciences, Primary Care Clinical Trials Unit, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Alecia Nickless
- Nuffield Department of Primary Care Health Sciences, Primary Care Clinical Trials Unit, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Felicity Waite
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Colin A Espie
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paul J Harrison
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Russell Foster
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Daniel Freeman
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.,Nuffield Department of Primary Care Health Sciences, Primary Care Clinical Trials Unit, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
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41
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Mascarel P, Poirot I, Lardinois M, Debien C, Vaiva G. [Sleep disorders and their treatment in post-traumatic stress disorder]. Presse Med 2019; 48:1051-1058. [PMID: 31473024 DOI: 10.1016/j.lpm.2019.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 07/12/2019] [Accepted: 08/02/2019] [Indexed: 12/31/2022] Open
Abstract
Subjects suffering from post-traumatic stress disorder present sleeping disorders like a chronic insomnia, traumatic nightmares, but also less expected, sleep breathing disorders. Sleep problems are a factor of development and maintenance of PTSD, but also a factor of resistance to treatment. After a therapy focused on PTSD, they represent frequent residual symptoms. It is necessary to couple, with the usual management of PTSD, targeted approaches for sleep problems. These targeted approaches allow an improvement of the nocturnal properties but also diurnal specific symptoms of PTSD. Stakes around primary, secondary and tertiary prevention of PTSD emerge around these sleep disorders.
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Affiliation(s)
- Pauline Mascarel
- CHU de Lille, secteur des urgences psychiatriques, pôle de l'urgence, 59037 Lille, France.
| | - Isabelle Poirot
- CHU de Lille, service de psychiatrie adulte, médecine légale et médecine en milieu pénitentiaire, pôle de psychiatrie, 59037 Lille, France
| | - Marine Lardinois
- Centre hospitalier de Versailles, service de psychiatrie adulte, 78150 Le Chesnay, France
| | - Christophe Debien
- CHU de Lille, service de psychiatrie adulte, médecine légale et médecine en milieu pénitentiaire, pôle de psychiatrie, 59037 Lille, France; Centre national de ressources et de résilience pour le psychotraumatisme (CN2R), 59000 Lille, France
| | - Guillaume Vaiva
- CHU de Lille, service de psychiatrie adulte, médecine légale et médecine en milieu pénitentiaire, pôle de psychiatrie, 59037 Lille, France; Centre national de ressources et de résilience pour le psychotraumatisme (CN2R), 59000 Lille, France
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42
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Harb GC, Cook JM, Phelps AJ, Gehrman PR, Forbes D, Localio R, Harpaz-Rotem I, Gur RC, Ross RJ. Randomized Controlled Trial of Imagery Rehearsal for Posttraumatic Nightmares in Combat Veterans. J Clin Sleep Med 2019; 15:757-767. [PMID: 31053215 PMCID: PMC6510682 DOI: 10.5664/jcsm.7770] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVES To examine the efficacy of imagery rehearsal (IR) combined with cognitive behavioral therapy for insomnia (CBT-I) compared to CBT-I alone for treating recurrent nightmares in military veterans with posttraumatic stress disorder (PTSD). METHODS In this randomized controlled study, 108 male and female United States veterans of the Iraq and Afghanistan conflicts with current, severe PTSD and recurrent, deployment-related nightmares were randomized to six sessions of IR + CBT-I (n = 55) or CBT-I (n = 53). Primary outcomes were measured with the Nightmare Frequency Questionnaire (NFQ) and Nightmare Distress Questionnaire (NDQ). RESULTS Improvement with treatment was significant (29% with reduction in nightmare frequency and 22% with remission). Overall, IR + CBT-I was not superior to CBT-I (NFQ: -0.12; 95% confidence interval = -0.87 to 0.63; likelihood ratio chi square = 4.7(3), P = .2); NDQ: 1.5, 95% confidence interval = -1.4 to 4.4; likelihood ratio chi square = 7.3, P = .06). CONCLUSIONS Combining IR with CBT-I conferred no advantage overall. Further research is essential to examine the possibly greater benefit of adding IR to CBT-I for some subgroups of veterans with PTSD. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Cognitive Behavioral Therapy (CBT) for Nightmares in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans; Identifier: NCT00691626; URL: https://clinicaltrials.gov/ct2/show/NCT00691626.
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Affiliation(s)
- Gerlinde C. Harb
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Joan M. Cook
- Yale University and National Center for PTSD, New Haven, Connecticut
| | - Andrea J. Phelps
- Phoenix Australia Centre for Posttraumatic Mental Health, Melbourne, Australia
| | - Philip R. Gehrman
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, Melbourne, Australia
| | - Russell Localio
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ilan Harpaz-Rotem
- Yale University and National Center for PTSD, New Haven, Connecticut
| | - Ruben C. Gur
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Richard J. Ross
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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43
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Post-Traumatic Stress among Evacuees from the 2016 Fort McMurray Wildfires: Exploration of Psychological and Sleep Symptoms Three Months after the Evacuation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091604. [PMID: 31071909 PMCID: PMC6540600 DOI: 10.3390/ijerph16091604] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 11/17/2022]
Abstract
This study documents post-traumatic stress symptoms after the May 2016 wildfires in Fort McMurray (Alberta, Canada). A sample of 379 evacuees completed an online questionnaire from July to September 2016, and a subsample of 55 completed a psychiatric/psychological diagnostic interview. According to a self-report questionnaire, 62.5% of respondents had a provisional post-traumatic stress disorder (PTSD). The interview confirmed that 29.1% met criteria for PTSD, 25.5% for depression, and 43.6% for insomnia; in most cases, insomnia was definitely or probably related to the fires. Traumatic exposure may elicit or exacerbate sleep problems, which are closely associated with PTSD after a disaster.
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44
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A methodological review of meta-analyses of the effectiveness of clinical psychology treatments. Behav Res Methods 2019; 50:2057-2073. [PMID: 29052165 DOI: 10.3758/s13428-017-0973-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article presents a methodological review of 54 meta-analyses of the effectiveness of clinical psychological treatments, using standardized mean differences as the effect size index. We statistically analyzed the distribution of the number of studies of the meta-analyses, the distribution of the sample sizes in the studies of each meta-analysis, the distribution of the effect sizes in each of the meta-analyses, the distribution of the between-studies variance values, and the Pearson correlations between effect size and sample size in each meta-analysis. The results are presented as a function of the type of standardized mean difference: posttest standardized mean difference, standardized mean change from pretest to posttest, and standardized mean change difference between groups. These findings will help researchers design future Monte Carlo and theoretical studies on the performance of meta-analytic procedures, based on the manipulation of realistic model assumptions and parameters of the meta-analyses. Furthermore, the analysis of the distribution of the mean effect sizes through the meta-analyses provides a specific guide for the interpretation of the clinical significance of the different types of standardized mean differences within the field of the evaluation of clinical psychological interventions.
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45
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Gieselmann A, Ait Aoudia M, Carr M, Germain A, Gorzka R, Holzinger B, Kleim B, Krakow B, Kunze AE, Lancee J, Nadorff MR, Nielsen T, Riemann D, Sandahl H, Schlarb AA, Schmid C, Schredl M, Spoormaker VI, Steil R, van Schagen AM, Wittmann L, Zschoche M, Pietrowsky R. Aetiology and treatment of nightmare disorder: State of the art and future perspectives. J Sleep Res 2019; 28:e12820. [PMID: 30697860 PMCID: PMC6850667 DOI: 10.1111/jsr.12820] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/17/2018] [Accepted: 11/22/2018] [Indexed: 12/11/2022]
Abstract
This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumatized and non‐traumatized individuals. Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep‐disordered breathing. Accordingly, different treatment options for nightmares focus on their meaning, on the chronic repetition of the nightmare or on maladaptive beliefs. Clinically, knowledge of healthcare providers about nightmare disorder and the delivery of evidence‐based interventions in the healthcare system is discussed. Based on these findings, we highlight some future perspectives and potential further developments of nightmare treatments and research into nightmare aetiology.
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Affiliation(s)
- Annika Gieselmann
- Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Malik Ait Aoudia
- Centre du Psychotrauma de l'Institut de Victimologie à Paris, Paris, France
| | - Michelle Carr
- Department of Psychology, Swansea University, Swansea, UK
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Gorzka
- Central Institute for Mental Health, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | | | - Birgit Kleim
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Zürich, Switzerland
| | - Barry Krakow
- Maimonides Sleep Arts and Sciences, Ltd, Albuquerque, New Mexico, USA
| | - Anna E Kunze
- Department of Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA
| | - Tore Nielsen
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany
| | - Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Angelika A Schlarb
- Department of Psychology and Sports, Bielefeld University, Bielefeld, Germany
| | - Carolin Schmid
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Michael Schredl
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | | | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Annette M van Schagen
- Foundation Centrum '45, Partner in Arq Psychotrauma Expert Group, Oegstgeest, the Netherlands
| | - Lutz Wittmann
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Maria Zschoche
- Department of Psychology and Sports, Bielefeld University, Bielefeld, Germany
| | - Reinhard Pietrowsky
- Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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46
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Abstract
Nightmares are considered the hallmark of posttraumatic stress disorder (PTSD). Although the characteristics of these distressing dreams may vary with the type of traumatic event, the pathophysiology exposes central dysfunction of brain structures at the level of the hippocampus, amygdala, and locus coeruleus, modulated by neurochemical imbalance in nor-adrenergic, dopaminergic, and serotonin pathways. Underlying comorbid conditions, including other sleep disorders, may contribute to worsening symptoms. Addressing sleep disruption can alleviate the severity of these nocturnal events and augment the effectiveness of other PTSD treatments. The expansion of behavioral treatment modalities for PTSD-related nightmares has been encouraging, but the core of these interventions is heavily structured around memory manipulation and imagery rescripting. A lack of a standardized delivery and a high dropout rate continue to pose significant challenges in achieving successful outcomes. The efficacy of existing pharmacological studies, such as α-adrenergic blocking agents, antidepressants, and atypical antipsychotics, has been undermined by methodological limitations and absence of large randomized controlled trials. This review is aimed at reviewing the available treatment strategies for alleviating nightmares in subjects with PTSD. Given the intricate relationship between PTSD and nightmares, future clinical trials have to adopt a more pragmatic approach focused not only on efficacy of novel interventions but also on adjunctive iteration of existing therapies tailored to individual socio-cultural background.
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Affiliation(s)
- Ali A El-Solh
- Research Department, VA Western New York Healthcare System, Buffalo, NY, USA,
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA,
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University of Buffalo, Buffalo, NY, USA,
- Department of Community and Health Behavior, School of Public Health and Health Professions, University of Buffalo, Buffalo, NY, USA,
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47
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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]
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48
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Self-efficacy as a Mechanism of Action of Imagery Rehearsal Therapy's Effectiveness: An Exploratory Mediation Analysis. J Nerv Ment Dis 2018; 206:749-756. [PMID: 30273270 DOI: 10.1097/nmd.0000000000000862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Imagery rehearsal therapy (IRT) is an empirically validated therapy targeting recurring nightmares, for which the mechanisms of action remain poorly understood. The objective of this study was to investigate how an exploratory measure of self-efficacy could mediate IRT's effectiveness. Thirty-five victims of sexual assault with recurring nightmares were randomly assigned to either IRT or a control condition. Participants completed questionnaires about self-efficacy and nocturnal symptoms at pre- and posttreatment. Regression analyses showed that IRT predicted greater self-efficacy about dreams (β = .578) and that self-efficacy about dreams predicted improvement in insomnia (β = -.378). IRT also predicted greater self-efficacy about nightmares (β = .366), which in turn predicts sleep quality (β = -.412). However, self-efficacy was not a significant mediator of IRT's effectiveness on insomnia and sleep quality. Although IRT did increase patients' self-efficacy over dreams and nightmares, self-efficacy may not be a primary mechanism of action explaining IRT's effectiveness.
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49
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Seeman MV. Successful treatment of nightmares may reduce psychotic symptoms in schizophrenia. World J Psychiatry 2018; 8:75-78. [PMID: 30254976 PMCID: PMC6147773 DOI: 10.5498/wjp.v8.i3.75] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 02/05/2023] Open
Abstract
Nightmares occur more frequently in patients with schizophrenia than they do in the general population. Nightmares are profoundly distressing and may exacerbate daytime psychotic symptoms and undermine day-to-day function. Clinicians do not often ask about nightmares in the context of psychotic illness and patients may underreport them or, if nightmares are reported, they may be disregarded; it may be assumed that they will disappear with antipsychotic medication and that they do not, therefore, require separate intervention. This is a missed opportunity because Image Rehearsal Therapy, among other psychological and pharmacological interventions, has proven effective for nightmares in non-schizophrenia populations and should be considered at an early stage of psychotic illness as an important adjunct to standard treatment. There is active ongoing research in this field, which will undoubtedly benefit patients with schizophrenia in the future.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5P 3L6, Canada
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50
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Belleville G, Dubé-Frenette M, Rousseau A. Efficacy of Imagery Rehearsal Therapy and Cognitive Behavioral Therapy in Sexual Assault Victims With Posttraumatic Stress Disorder: A Randomized Controlled Trial. J Trauma Stress 2018; 31:591-601. [PMID: 30070398 DOI: 10.1002/jts.22306] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 03/19/2018] [Accepted: 04/02/2018] [Indexed: 01/14/2023]
Abstract
Sleep disturbances are common among sexual assault victims with posttraumatic stress disorder (PTSD), but cognitive behavioral therapy (CBT) for PTSD does not directly address sleep-related symptoms. Trauma-related sleep disturbances are associated with more impairment and contribute to the maintenance of PTSD. In this study, we evaluated the efficacy of a combination of CBT and nightmare therapy (imagery rehearsal therapy; IRT) compared to CBT alone for the treatment of PTSD. We recruited 42 adult victims of sexual assault who were suffering from PTSD and randomly assigned them to either the experimental (IRT + CBT) or control condition (waiting period followed by CBT). After CBT, both groups demonstrated significant decreases in nighttime symptoms (except nightmare frequency) and PTSD symptoms and showed improvements in functional impairment and mental health, ds = 0.13-0.83, ps = .005-.008. Outcomes between the two groups did not differ significantly after CBT; however, we observed medium to medium-large differences between the control group and experimental group in terms of nighttime symptoms, ds = 0.45-0.63. Although results did not clearly establish the superiority of IRT + CBT over CBT alone, they demonstrated that IRT yielded greater improvement in nighttime symptoms than the waiting period, ds = 0.72-1.13, ps = .006-.047 for all interaction effects. Findings suggest that targeting nightmares at the beginning of treatment for PTSD may yield rapid improvement in nighttime symptoms. This strategy could be useful for patients with time or resource constraints or those for whom nightmares are the primary complaint.
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