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Tighe CA, Berlin GS, Boland EM, Miller KE, Bramoweth AD. Identifying predictors of the amount of veteran participation in cognitive behavioral therapy for insomnia in the Veterans Affairs health care system. Psychol Serv 2024; 21:581-588. [PMID: 37917476 PMCID: PMC11063118 DOI: 10.1037/ser0000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Insomnia is a prevalent and negatively impactful disorder among veterans. The Department of Veterans Affairs (VA) has committed significant resources to the development and dissemination of training related to cognitive behavioral therapy for insomnia (CBT-I), the recommended first-line intervention for chronic insomnia disorder. It has been established that VA clinicians can be effectively trained to deliver high fidelity CBT-I and that treatment results in significant improvements in insomnia. However, there is a paucity of research examining rates and predictors of veterans' participation in CBT-I in routine VA clinical care. In this study, we conducted a secondary analysis of data from VA electronic health records (EHR) to determine individual predisposing, enabling, and need factors associated with CBT-I participation. The sample included veterans who had at least one CBT-I templated note from the VA mid-Atlantic region of the United States (VISN4) between 2015 and 2019 in their chart (N = 2,801). CBT-I participation was defined by number of CBT-I templated notes occurring within a 6-month period from the initial note. Findings indicated that veterans most often completed only one session of CBT-I and, on average, completed approximately three sessions. Results from multinomial logistic regression identified significant associations of race, the presence of comorbid mental health disorders, rurality, presence of insomnia diagnosis, and insomnia medication with CBT-I participation; associations varied depending on how CBT-I participation was defined. More work is needed to better understand factors contributing to participation and reasons for completion and noncompletion of CBT-I. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Caitlan A Tighe
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System
| | | | | | - Katherine E Miller
- Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center
| | - Adam D Bramoweth
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System
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2
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Shi Y, Ren R, Zhang Y, Vitiello MV, Tang X. Factors influencing the effectiveness of digital cognitive behavioural therapy for chronic insomnia in clinical practice. J Sleep Res 2024; 33:e14077. [PMID: 37897204 DOI: 10.1111/jsr.14077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
Digital cognitive behavioural therapy for chronic insomnia (D-CBT-I) has been shown to be as efficacious as traditional CBT-I. However, not all patients achieve insomnia remission after treatment. We explored the factors influencing the effectiveness of D-CBT-I in a clinical practice. A total of 414 Asian chronic insomniacs were studied during a 6 week D-CBT-I intervention. All patients were assessed at baseline and posttreatment and were determined to be remitters or non-remitters, responders or non-responders by posttreatment criteria; Insomnia Severity Index (ISI <8) or ISI reduction ≥8, to examine whether remission and response status were associated with patient baseline characteristics. The average baseline ISI score in all subjects was 16.29 points. At posttreatment, 192 (46.4%) patients achieved ISI remission and 218 (52.7%) patients demonstrated an ISI response. An increased baseline early morning awakening time and ISI score were independently associated with a lower odds for remission (OR, 0.995 and 0.991, respectively). Increased baseline Patients Health Questionnaire-9 score was independently associated with higher odds for response (OR, 1.114). Our results suggest that D-CBT-I can be recommended as the first-line treatment for chronic insomnia, particularly in insomniacs with milder insomnia symptoms and more severe depressive symptoms. Meanwhile, the effectiveness of D-CBT-I was adversely affected by longer early morning awakening time and higher insomnia severity at pretreatment, which may be improved by more intense intervention and greater therapeutic support or by traditional CBT-I.
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Affiliation(s)
- Yuan Shi
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Zhang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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3
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Wright ID, Jensen CD, Duraccio KM. Predictors of adherence to a brief sleep extension protocol in emerging adults. J Pediatr Psychol 2024; 49:442-447. [PMID: 38578604 DOI: 10.1093/jpepsy/jsae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVES This study examined how mental health symptoms (i.e., depression, anxiety, stress) and baseline sleep characteristics (i.e., sleep quality and levels of daytime sleepiness) predicted adherence to and initial success of a brief sleep extension research protocol in emerging adults. METHODS 184 emerging adults (ages 18-25; M = 20.96, SD = 2.04) were asked to extend their nightly sleep opportunity to 8 hr for 1 week and to anchor bedtime and waketime. Sleep outcomes (adherence and initial protocol success) were tracked using actigraphy. Baseline sleep quality, daytime sleepiness, depression, anxiety, and stress were assessed using self-report questionnaires. RESULTS Poorer baseline sleep quality predicted better adherence to the protocol (p = .002). Other baseline sleep characteristics and mental health were not predictive of adherence (ps>.50). Lower levels of baseline daytime sleepiness approached significance in predicting greater initial protocol success following the protocol (p = .05). Baseline sleep quality and mental health did not predict initial protocol success (ps > 0.34). CONCLUSIONS Mental health symptoms did not significantly predict adherence to or the success of a sleep extension protocol. Surprisingly, individuals with poor baseline sleep quality were more likely to adhere to the extension protocol, perhaps suggesting heightened motivation for change or increased risk for sleep problems. This research provides valuable insight into factors that predict adherence to sleep extension protocols in emerging adults.
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Affiliation(s)
- Isabella D Wright
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Chad D Jensen
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Kara M Duraccio
- Department of Psychology, Brigham Young University, Provo, UT, United States
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4
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Fleming MK, Smejka T, Macey E, Luengo-Fernandez R, Henry AL, Robinson B, Kyle SD, Espie CA, Johansen-Berg H. Improving sleep after stroke: A randomised controlled trial of digital cognitive behavioural therapy for insomnia. J Sleep Res 2024; 33:e13971. [PMID: 37407096 DOI: 10.1111/jsr.13971] [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: 02/07/2023] [Revised: 04/11/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Abstract
Stroke is frequently accompanied by long-term sleep disruption. We therefore aimed to assess the efficacy of digital cognitive behavioural therapy for insomnia to improve sleep after stroke. A parallel group randomised controlled trial was conducted remotely in participant's homes/online. Randomisation was online with minimisation of between-group differences in age and baseline Sleep Condition Indicator-8 score. In total, 86 community-dwelling stroke survivors consented, of whom 84 completed baseline assessments (39 female, mean 5.5 years post-stroke, mean 59 years old), and were randomised to digital cognitive behavioural therapy or control (sleep hygiene information). Follow-up was at post-intervention (mean 75 days after baseline) and 8 weeks later. The primary outcome was self-reported insomnia symptoms, as per the Sleep Condition Indicator-8 (range 0-32, lower numbers indicate more severe insomnia, reliable change 7 points) at post-intervention. There were significant improvements in Sleep Condition Indicator-8 for digital cognitive behavioural therapy compared with control (intention-to-treat, digital cognitive behavioural therapy n = 48, control n = 36, 5 imputed datasets, effect of group p ≤ 0.02,η p 2 = 0.07-0.12 [medium size effect], pooled mean difference = -3.35). Additionally, secondary outcomes showed shorter self-reported sleep-onset latencies and better mood for the digital cognitive behavioural therapy group, but no significant differences for self-efficacy, quality of life or actigraphy-derived sleep parameters. Cost-effectiveness analysis found that digital cognitive behavioural therapy dominates over control (non-significant cost savings and higher quality-adjusted life years). No related serious adverse events were reported to the researchers. Overall, digital cognitive behavioural therapy for insomnia effectively improves sleep after stroke. Future research is needed to assess earlier stages post-stroke, with a longer follow-up period to determine whether it should be included as part of routine post-stroke care. Clinicaltrials.gov NCT04272892.
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Affiliation(s)
- Melanie K Fleming
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Tom Smejka
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ellie Macey
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ramon Luengo-Fernandez
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alasdair L Henry
- Big Health Ltd, London, UK
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Barbara Robinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Simon D Kyle
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Colin A Espie
- Big Health Ltd, London, UK
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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5
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Chang JR, Cheung YK, Sharma S, Li SX, Tao RR, Lee JLC, Sun ER, Pinto SM, Zhou Z, Fong H, Chan WW, Zheng K, Samartzis D, Fu SN, Wong AY. Comparative effectiveness of non-pharmacological interventions on sleep in individuals with chronic musculoskeletal pain: A systematic review with network meta-analysis. Sleep Med Rev 2024; 73:101867. [PMID: 37897843 DOI: 10.1016/j.smrv.2023.101867] [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: 06/05/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/30/2023]
Abstract
This network meta-analysis aimed to estimate the comparative effectiveness of non-pharmacological interventions on sleep in individuals with chronic musculoskeletal pain. Seven databases were systematically searched up to February 2023. A random-effects network meta-analysis in a frequentist framework was performed to synthesize continuous data as standardized mean differences (SMD) along with a 95% confidence interval (95% CI). A total of 15,641 records were identified, and 107 randomized controlled trials involving 8,121 participants were included. Of 14 identified interventions, eight were significantly more effective than passive control in improving sleep quality at immediate post-intervention (SMDs = 0.67-0.74), with cognitive behavioral therapy (CBT) being the most effective treatment (SMD = 0.74, 95% CI: 0.45-1.03). Only CBT demonstrated sustained effects at short-term (SMD = 1.56; 95% CI: 0.62-2.49) and mid-term (SMD = 1.23; 95% CI: 0.44-2.03) follow-ups. Furthermore, CBT significantly improved subjective (SMD = 0.64; 95% CI: 0.25-1.03) and objective (SMD = 0.30; 95% CI: 0.01-0.59) sleep efficiency compared with passive control at immediate post-intervention. Our findings support CBT as the first-line treatment for improving sleep in individuals with chronic musculoskeletal pain, given its superior effectiveness across multiple sleep outcomes and its sustainable effects until mid-term follow-up. However, the certainty of evidence for these interventions in improving sleep quality was very low to low.
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Affiliation(s)
- Jeremy R Chang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yuen Kwan Cheung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Shirley X Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR, China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, China
| | - Rae Ry Tao
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Janet Lok Chun Lee
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Eliza R Sun
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Sabina M Pinto
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Zhixing Zhou
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Howard Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Winnie Wy Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kangyong Zheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Centre, Chicago, United States
| | - Siu-Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Arnold Yl Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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6
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Crowther ME, Saunders WJ, Sletten TL, Drummond SPA, Bei B. Tailoring cognitive behavioural therapy for insomnia across contexts, conditions, and individuals: What do we know, where do we go? J Sleep Res 2023; 32:e14023. [PMID: 37641983 DOI: 10.1111/jsr.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
Cognitive behavioural therapy for insomnia (CBT-I) is considered the front-line treatment for insomnia. Despite the demonstrated effectiveness of CBT-I, it is necessary to consider how CBT-I may be tailored to different individuals. The purpose of the present review is to provide a summary of literature on tailoring CBT-I to different individuals and provide directions for future research. This review focused on the following domains of adaptation: (i) tailoring CBT-I components to individuals with comorbid mental or physical health conditions such as comorbid depression and pain; (ii) adapting CBT-I delivery for different contexts in which individuals exist, such as inpatient, educational, and different social/cultural settings, (iii) adapting CBT-I to specific individuals via case-formulation in clinical settings. We highlight current gaps in the exploration of tailored CBT-I, including a lack of research methodology to evaluate tailored interventions, a need for the integration of ongoing individualised assessment to inform treatment, and the necessary involvement of consumers and stakeholders throughout the research and treatment development process. Together, this review showed abundant adaptations in CBT-I already exist in the literature. Future research is needed in understanding when and how to apply adaptations in CBT-I and evaluate the benefits of these adaptations.
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Affiliation(s)
- Meagan E Crowther
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - William J Saunders
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Tracey L Sletten
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Bei Bei
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
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7
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Nyhuis CC, Fernandez-Mendoza J. Insomnia nosology: a systematic review and critical appraisal of historical diagnostic categories and current phenotypes. J Sleep Res 2023; 32:e13910. [PMID: 37122153 DOI: 10.1111/jsr.13910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/02/2023]
Abstract
Insomnia nosology has significantly evolved since the Diagnostic and Statistical Manual (DSM)-III-R first distinguished between 'primary' and 'secondary' insomnia. Prior International Classification of Sleep Disorders (ICSD) nosology 'split' diagnostic phenotypes to address insomnia's heterogeneity and the DSM nosology 'lumped' them into primary insomnia, while both systems assumed causality for insomnia secondary to health conditions. In this systematic review, we discuss the historical phenotypes in prior insomnia nosology, present findings for currently proposed insomnia phenotypes based on more robust approaches, and critically appraise the most relevant ones. Electronic databases PsychINFO, PubMED, Web of Science, and references of eligible articles, were accessed to find diagnostic manuals, literature on insomnia phenotypes, including systematic reviews or meta-analysis, and assessments of the reliability or validity of insomnia diagnoses, identifying 184 articles. The data show that previous insomnia diagnoses lacked reliability and validity, leading current DSM-5-TR and ICSD-3 nosology to 'lump' phenotypes into a single diagnosis comorbid with health conditions. However, at least two new, robust insomnia phenotyping approaches were identified. One approach is multidimensional-multimethod and provides evidence for self-reported insomnia with objective short versus normal sleep duration linked to clinically relevant outcomes, while the other is multidimensional and provides evidence for two to five clusters (phenotypes) based on self-reported trait, state, and/or life-history data. Some approaches still need replication to better support whether their findings identify true phenotypes or simply different patterns of symptomatology. Regardless, these phenotyping efforts aim at improving insomnia nosology both as a classification system and as a mechanism to guide treatment.
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Affiliation(s)
- Casandra C Nyhuis
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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Michaud AL, Bice B, Miklos E, McCormick K, Medeiros-Nancarrow C, Zhou ES, Recklitis CJ. Sleep Treatment Education Program for Young Adult Cancer Survivors (STEP-YA): Protocol for an Efficacy Trial. JMIR Res Protoc 2023; 12:e52315. [PMID: 38019571 PMCID: PMC10719817 DOI: 10.2196/52315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Young adult cancer survivors (YACS) are at elevated risk for chronic insomnia, even years after completing treatment. In addition to potential health consequences, insomnia can interrupt social, educational, and vocational development just as they are trying to "make up" for time lost to cancer. Cognitive behavioral therapy for insomnia (CBTI) is recommended as first-line treatment for insomnia but remains largely unavailable to YACS due to several barriers (ie, shortage of trained providers, geographic limitations, financial limitations). Traditional CBTI has not been adapted to meet YACS' unique developmental and circadian challenges. To improve availability of effective behavioral insomnia treatment for this population, we developed the Sleep Treatment Education Program for Young Adult Cancer Survivors (STEP-YA), a low-intensity educational intervention delivered virtually online. OBJECTIVE In this phase 2 "proof of concept" trial, primary aims are to test the efficacy of STEP-YA to improve insomnia symptoms and mood in YACS and assess the utility of individualized coaching to improve treatment effects. A secondary aim will explore participant variables associated with clinically significant response to STEP-YA. METHODS This 2-arm randomized prospective trial will enroll 74 off-treatment YACS aged 20 years to 39 years with clinically significant insomnia. Each participant completes the STEP-YA intervention in a 1-on-1 synchronous online session led by a trained interventionist following a structured outline. The 90-minute intervention presents educational information on the development of insomnia after cancer and offers specific suggestions for improving insomnia symptoms. During the session, participants review the suggestions and develop a personalized sleep action plan for implementing them. After the session, participants are randomized to either the coaching condition, in which they receive 2 telephone coaching sessions, or the no-coaching condition, which offers no subsequent coaching. The Insomnia Severity Index (ISI) and the Profile of Mood States: Short Form (POMS-SF) are assessed at baseline and 4 and 8 weeks postintervention. RESULTS Enrollment began in November 2022, with 28 participants currently enrolled. We anticipate recruitment will be completed in 2024. The primary endpoint is a change in ISI score from baseline to 8 weeks postintervention. The secondary endpoint is change in mood symptoms (POMS-SF) from baseline to 8 weeks postintervention. Change scores will be treated as continuous variables. Primary analyses will use ANOVA methods. A within-subjects analysis will examine if the STEP-YA intervention is associated with significant changes in insomnia and mood over time. A 2-way ANOVA will be used to evaluate the utility of coaching sessions to improve treatment effects. CONCLUSIONS Chronic insomnia has significant negative effects on YACS' medical, educational, and psychological functioning. STEP-YA aims to address their needs; study results will determine if the intervention warrants future effectiveness and dissemination studies and if individualized coaching is necessary for adequate treatment response. TRIAL REGISTRATION ClinicalTrials.gov NCT05358951: https://clinicaltrials.gov/study/NCT05358951. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52315.
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Affiliation(s)
- Alexis L Michaud
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
- Department of Psychology, Suffolk University, Boston, MA, United States
| | - Briana Bice
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
| | - Eva Miklos
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
| | - Katherine McCormick
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
| | | | - Eric S Zhou
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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9
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Martin JL, Carlson GC, Kelly MR, Song Y, Mitchell MN, Josephson KR, McGowan SK, Culver NC, Kay M, Erickson A, Saldana KS, May K, Fiorentino L, Alessi CA, Washington DL, Yano EM. Novel treatment based on acceptance and commitment therapy versus cognitive behavioral therapy for insomnia: A randomized comparative effectiveness trial in women veterans. J Consult Clin Psychol 2023; 91:626-639. [PMID: 37535521 PMCID: PMC10592426 DOI: 10.1037/ccp0000836] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVE This randomized comparative effectiveness trial evaluated a novel insomnia treatment using acceptance and commitment therapy (ACT) among women veterans. Participants received either the acceptance and the behavioral changes to treat insomnia (ABC-I) or cognitive behavioral therapy for insomnia (CBT-I). The primary objectives were to determine whether ABC-I was noninferior to CBT-I in improving sleep and to test whether ABC-I resulted in higher treatment completion and adherence versus CBT-I. METHOD One hundred forty-nine women veterans with insomnia disorder (Mage = 48.0 years) received ABC-I or CBT-I. The main sleep outcomes were Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and sleep efficiency (SE) by actigraphy (objective) and sleep diary (subjective). Measures were collected at baseline, immediate posttreatment, and 3-month posttreatment follow-up. Treatment completion and adherence were assessed during the interventions. RESULTS Both interventions improved all sleep outcomes from baseline to immediate posttreatment and 3-month posttreatment follow-up. At immediate posttreatment, ABC-I was statically noninferior for sleep diary SE and objective SE, but noninferiority was not statistically confirmed for ISI or PSQI total scores. At 3-month posttreatment follow-up, ABC-I was noninferior for all four of the key outcome variables. There was not a statistically significant difference between the number of participants who discontinued CBT-I (11%) versus ABC-I (18%; p = .248) before completing treatment. ABC-I was superior to CBT-I for some adherence metrics. CONCLUSIONS Overall, ABC-I was similar in effectiveness compared to CBT-I for the treatment of insomnia and may improve adherence to some behavioral elements of treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Jennifer L. Martin
- Geriatric Research, Education and Clinical Center, Veteran Affairs (VA) Greater Los Angeles Healthcare System
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Gwendolyn C. Carlson
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System
| | - Monica R. Kelly
- Geriatric Research, Education and Clinical Center, Veteran Affairs (VA) Greater Los Angeles Healthcare System
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Yeonsu Song
- Geriatric Research, Education and Clinical Center, Veteran Affairs (VA) Greater Los Angeles Healthcare System
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
- School of Nursing at University of California, Los Angeles
| | - Michael N. Mitchell
- Geriatric Research, Education and Clinical Center, Veteran Affairs (VA) Greater Los Angeles Healthcare System
| | - Karen R. Josephson
- Geriatric Research, Education and Clinical Center, Veteran Affairs (VA) Greater Los Angeles Healthcare System
| | - Sarah Kate McGowan
- Department of Mental Health, VA Greater Los Angeles Healthcare System
- Department of Psychiatry, David Geffen School of Medicine at University of California, Los Angeles
| | - Najwa C. Culver
- Department of Mental Health, VA Greater Los Angeles Healthcare System
| | - Morgan Kay
- Department of Mental Health, VA Greater Los Angeles Healthcare System
| | - Alexander Erickson
- Geriatric Research, Education and Clinical Center, Veteran Affairs (VA) Greater Los Angeles Healthcare System
| | - Katie S. Saldana
- Department of Mental Health, VA Greater Los Angeles Healthcare System
| | - Kimiko May
- Department of Mental Health, VA Greater Los Angeles Healthcare System
| | | | - Cathy A. Alessi
- Geriatric Research, Education and Clinical Center, Veteran Affairs (VA) Greater Los Angeles Healthcare System
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Donna L. Washington
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System
| | - Elizabeth M. Yano
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System
- Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles
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10
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Zhang H, Yang Y, Hao X, Qin Y, Li K. Effects of digital sleep interventions on sleep and psychological health during the COVID-19 pandemic: A systematic review and meta-analysis. Sleep Med 2023; 110:190-200. [PMID: 37625326 DOI: 10.1016/j.sleep.2023.07.036] [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] [Received: 05/26/2023] [Revised: 07/10/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Various digital sleep interventions have been implemented to address sleep and psychological complications during the coronavirus disease 2019 (COVID-19) pandemic. However, the characteristics and effectiveness of digital sleep interventions on sleep and psychological outcomes for people with sleep problems during the COVID-19 pandemic are unknown. METHODS The protocol of this systematic review and meta-analysis was registered on PROSPERO (ID: CRD42022325662), seven databases were searched from December 2019 to June 2023. Reference lists from digital sleep reviews were also identified and selected. Two reviewers independently screened eligible articles and extracted data. Quality appraisal was undertaken by two independent reviewers using the Cochrane Risk-of-Bias Tools. Data synthesis was conducted using fixed- or random-effects model based on the results of the heterogeneity test. RESULTS A total of 20 studies were identified, including nine randomised controlled trials (RCTs) and 11 non-RCTs, involving 3860 participants. Meta-analyses showed that digital sleep interventions significantly improve sleep quality, insomnia, and depression during the COVID-19 pandemic. Subgroup analysis showed that interventions of more than four weeks, healthcare workers as participants, and relaxation therapies may have the advantage of improving sleep quality. Most non-RCTs supported the efficacy of digital sleep interventions on sleep and psychological health. CONCLUSION Digital sleep interventions during the COVID-19 pandemic had significant effectiveness in improving sleep and psychological outcomes for people with sleep problems. More structured and personalised digital sleep interventions should be designed, and other diverse digital technologies could be used to improve sleep and psychological disorders.
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Affiliation(s)
- Huijing Zhang
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China
| | - Yuhang Yang
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China
| | - Xiaonan Hao
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China
| | - Yuan Qin
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China
| | - Kun Li
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China.
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11
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Ito-Masui A, Sakamoto R, Matsuo E, Kawamoto E, Motomura E, Tanii H, Yu H, Sano A, Imai H, Shimaoka M. Effect of an Internet-Delivered Cognitive Behavioral Therapy-Based Sleep Improvement App for Shift Workers at High Risk of Sleep Disorder: Single-Arm, Nonrandomized Trial. J Med Internet Res 2023; 25:e45834. [PMID: 37606971 PMCID: PMC10481224 DOI: 10.2196/45834] [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: 01/19/2023] [Revised: 06/02/2023] [Accepted: 07/04/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Shift workers are at high risk of developing sleep disorders such as shift worker sleep disorder or chronic insomnia. Cognitive behavioral therapy (CBT) is the first-line treatment for insomnia, and emerging evidence shows that internet-based CBT is highly effective with additional features such as continuous tracking and personalization. However, there are limited studies on internet-based CBT for shift workers with sleep disorders. OBJECTIVE This study aimed to evaluate the impact of a 4-week, physician-assisted, internet-delivered CBT program incorporating machine learning-based well-being prediction on the sleep duration of shift workers at high risk of sleep disorders. We evaluated these outcomes using an internet-delivered CBT app and fitness trackers in the intensive care unit. METHODS A convenience sample of 61 shift workers (mean age 32.9, SD 8.3 years) from the intensive care unit or emergency department participated in the study. Eligible participants were on a 3-shift schedule and had a Pittsburgh Sleep Quality Index score ≥5. The study comprised a 1-week baseline period, followed by a 4-week intervention period. Before the study, the participants completed questionnaires regarding the subjective evaluation of sleep, burnout syndrome, and mental health. Participants were asked to wear a commercial fitness tracker to track their daily activities, heart rate, and sleep for 5 weeks. The internet-delivered CBT program included well-being prediction, activity and sleep chart, and sleep advice. A job-based multitask and multilabel convolutional neural network-based model was used for well-being prediction. Participant-specific sleep advice was provided by sleep physicians based on daily surveys and fitness tracker data. The primary end point of this study was sleep duration. For continuous measurements (sleep duration, steps, etc), the mean baseline and week-4 intervention data were compared. The 2-tailed paired t test or Wilcoxon signed rank test was performed depending on the distribution of the data. RESULTS In the fourth week of intervention, the mean daily sleep duration for 7 days (6.06, SD 1.30 hours) showed a statistically significant increase compared with the baseline (5.54, SD 1.36 hours; P=.02). Subjective sleep quality, as measured by the Pittsburgh Sleep Quality Index, also showed statistically significant improvement from baseline (9.10) to after the intervention (7.84; P=.001). However, no significant improvement was found in the subjective well-being scores (all P>.05). Feature importance analysis for all 45 variables in the prediction model showed that sleep duration had the highest importance. CONCLUSIONS The physician-assisted internet-delivered CBT program targeting shift workers with a high risk of sleep disorders showed a statistically significant increase in sleep duration as measured by wearable sensors along with subjective sleep quality. This study shows that sleep improvement programs using an app and wearable sensors are feasible and may play an important role in preventing shift work-related sleep disorders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/24799.
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Affiliation(s)
- Asami Ito-Masui
- Emergency and Critical Care Center, Mie University, Tsu, Japan
| | - Ryota Sakamoto
- Department of Medical Informatics, Mie University Hospital, Tsu, Japan
| | - Eri Matsuo
- Department of Molecular Pathology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eiji Kawamoto
- Emergency and Critical Care Center, Mie University, Tsu, Japan
| | - Eishi Motomura
- Department of Neuropsychiatry, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hisashi Tanii
- Center for Physical & Mental Health, Mie University, Tsu, Japan
| | - Han Yu
- Department of Electrical & Computer Engineering, Rice University, Houston, TX, United States
| | - Akane Sano
- Department of Electrical & Computer Engineering, Rice University, Houston, TX, United States
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University, Tsu, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
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12
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Shin JW, Kim S, Shin YJ, Park B, Park S. Comparison of Acceptance and Commitment Therapy (ACT) and Cognitive Behavior Therapy (CBT) for Chronic Insomnia: A Pilot Randomized Controlled Trial. Nat Sci Sleep 2023; 15:523-531. [PMID: 37431325 PMCID: PMC10329838 DOI: 10.2147/nss.s409981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023] Open
Abstract
Purpose Acceptance and Commitment Therapy (ACT) is part of the third wave of cognitive behavior therapy, and has six core components: acceptance, cognitive defusion, self as context, being present, values, and committed behavior. This study aimed to examine the efficacy of ACT for insomnia compared with cognitive behavior therapy for insomnia (CBT-I) in patients with chronic primary insomnia. Methods The study recruited patients with chronic primary insomnia from a university hospital between August 2020 and July 2021. Thirty patients were enrolled and randomly assigned to receive either ACT (n = 15) or CBT-I (n = 15). Interventions were performed over four weeks, with four sessions of face-to-face therapy and four sessions of online therapy. The outcomes were measured using a sleep diary and a questionnaire. Results Post-intervention, the ACT and CBT-I groups had significantly improved sleep quality, insomnia severity, depression, beliefs about sleep, sleep onset latency (SOL), and sleep efficacy (SE) (p < 0.05). However, anxiety was significantly reduced in the ACT group (p = 0.015), but not in the CBT-I group. Conclusion ACT had a significant effect on primary insomnia and secondary symptoms, especially anxiety related to insomnia. These findings suggest that ACT could be a potential intervention for individuals who do not respond to CBT-I, who have high anxiety regarding sleep problems.
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Affiliation(s)
- Jung-Won Shin
- Department of Neurology, Memory Center, Bundang CHA Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Seonyeop Kim
- Graduate School of Clinical Counselling Psychology, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yoon Jung Shin
- Graduate School of Clinical Counselling Psychology, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Bomi Park
- Graduate School of Clinical Counselling Psychology, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sunyoung Park
- Graduate School of Clinical Counselling Psychology, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
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13
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Boland EM, Goldschmied JR, Gehrman PR. Does insomnia treatment prevent depression? Sleep 2023; 46:zsad104. [PMID: 37029781 PMCID: PMC10262035 DOI: 10.1093/sleep/zsad104] [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: 11/01/2022] [Revised: 03/21/2023] [Indexed: 04/09/2023] Open
Abstract
Rates of major depressive disorder (MDD) are increasing globally, in part due to the coronavirus disease 2019 pandemic, contributing to disease burden. It has long been known that insomnia is intricately connected with depression as indicated by greater depression severity and lower treatment response. Furthermore, insomnia is a significant risk factor for new-onset depression. Treatment of insomnia is thus a logical target for prevention of incidents and recurrent MDD. This systematic review sought to evaluate the current evidence for the preventive effects of insomnia treatment on depression onset. A database search yielded 186 studies, six of which met criteria for inclusion in this review. All of the studies utilized cognitive behavioral treatment for insomnia (CBT-I) as the target intervention and most delivered treatment via a digital platform. Four of the studies found significantly lower rates of MDD onset in those who received CBT-I compared to a control condition. The two remaining studies failed to confirm these effects in primary analyses but secondary analyses suggested evidence of a preventive effect. There was significant methodologic heterogeneity across studies in terms of sample selection, outcomes, and follow-up periods, limiting the ability to draw firm conclusions. The evidence overall is in the direction of insomnia treatment reducing the risk for onset of MDD, but further research is warranted.
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Affiliation(s)
- Elaine M Boland
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Cpl. Michael J. Crescenz VA Medical Center, Mental Illness Research Education and Clinical Center, Philadelphia, PA, USA
| | - Jennifer R Goldschmied
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Philip R Gehrman
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Cpl. Michael J. Crescenz VA Medical Center, Mental Illness Research Education and Clinical Center, Philadelphia, PA, USA
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14
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Jeoung S, Jeon H, Yang HC, An H, Suh S. A randomized controlled trial of a behavioral intervention for decreasing bedtime procrastination using a wait-list control group in a non-clinical sample of young adults. Sleep Med 2023; 108:114-123. [PMID: 37354745 DOI: 10.1016/j.sleep.2023.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/14/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
STUDY OBJECTIVES Bedtime Procrastination (BP) is defined as the behavior of going to bed later than intended, without external reasons. This study is a randomized controlled trial aiming to establish efficacy of a behavioral intervention to decrease BP in a non-clinical sample. METHOD This was an open-label trial that was conducted in sixty participants (mean age 21.33 ± 2.35 years, 86.7% females) without insomnia or psychopathology who endorsed frequent BP. They were randomized to either the treatment group (n = 32) or wait-list control group (n = 28). Participants completed the Bedtime Procrastination Scale (BPS), the Epworth Sleepiness Scale (ESS), the Insomnia Severity Index (ISI), Center for Epidemiologic Studies Depression Scale (CES-D), Morningness-Eveningness Questionnaire (MEQ), and a weekly sleep diary. Functional analysis was conducted to investigate the function of BP. Linear mixed models were used for analyses. RESULT The treatment group showed significant improvement on the BPS (35.56% decrease, d = 2.19, bedtime procrastination duration based on the sleep diary (-46.29 min, d = 1.22), and sleep efficiency (5.70% increase, d = 1.25) compared to the wait-list control group following the intervention. There were also significant reductions in time spent from bedtime to lights out, and wake time to time out of bed, in addition to improvements in ISI and ESS scores in the treatment group compared to the control group. Functional analysis results indicated emotional regulation (31.3%), compensation (26.5%), and social interaction and belongingness (18.1%) as the most frequent functions of bedtime procrastination. CONCLUSION This study shows promising results for a behavioral intervention targeting BP and sleep. In addition, this study demonstrated various functions of BP as a sleep-interfering behavior. We expect that these findings could be used in future studies and clinical settings to decrease BP.
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Affiliation(s)
- Sonhye Jeoung
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
| | - Huisu Jeon
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
| | - Hae-Chung Yang
- Seoul Graduate School of Counseling Psychology, Republic of Korea
| | - Hyeyoung An
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
| | - Sooyeon Suh
- Department of Psychology, Sungshin University, Seoul, Republic of Korea.
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15
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Cognitive behavioral therapy and acceptance and commitment therapy for insomnia: Exploring the potential benefit of psychological flexibility and self-compassion combined with behavioral strategies. NEW IDEAS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.newideapsych.2023.101013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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16
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Hrozanova M, Meisingset I, Kallestad H, Pallesen S, Nordstoga AL, Skarpsno ES. Group-delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia in primary care: study protocol for a pragmatic, multicentre randomized controlled trial. BMC PRIMARY CARE 2023; 24:61. [PMID: 36864376 PMCID: PMC9979487 DOI: 10.1186/s12875-023-02018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Insomnia is common in the general population and is a risk factor for ill-health, which highlights the importance of treating insomnia effectively and cost-efficiently. Cognitive-behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment due to its long-term effectiveness and few side-effects, but its availability is limited. The aim of this pragmatic, multicentre randomized controlled trial is to investigate the effectiveness of group-delivered CBT-I in primary care compared to a waiting-list control group. METHODS A pragmatic multicentre randomized controlled trial will be conducted with about 300 participants recruited across 26 Healthy Life Centres in Norway. Participants will complete online screening and provide consent before enrolment. Those who meet the eligibility criteria will be randomized to a group-delivered CBT-I or to a waiting list according to a 2:1 ratio. The intervention consists of four two-hour sessions. Assessments will be performed at baseline, 4 weeks, 3- and 6 months post-intervention, respectively. The primary outcome is self-reported insomnia severity at 3 months post-intervention. Secondary outcomes include health-related quality of life, fatigue, mental distress, dysfunctional beliefs and attitudes about sleep, sleep reactivity, 7-day sleep diaries, and data obtained from national health registries (sick leave, use of relevant prescribed medications, healthcare utilization). Exploratory analyses will identify factors influencing treatment effectiveness, and we will conduct a mixed-method process evaluation to identify facilitators and barriers of participants' treatment adherence. The study protocol was approved by the Regional Committee for Medical and Health Research ethics in Mid-Norway (ID 465241). DISCUSSION This large-scale pragmatic trial will investigate the effectiveness of group-delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia, generating findings that are generalizable to day-to-day treatment of insomnia in interdisciplinary primary care services. The trial will identify those who would benefit from the group-delivered therapy, and will investigate the rates of sick leave, medication use, and healthcare utilization among adults who undergo the group-delivered therapy. TRIAL REGISTRATION The trial was retrospectively registered in the ISRCTN registry (ISRCTN16185698).
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Affiliation(s)
- Maria Hrozanova
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Ingebrigt Meisingset
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Mental Health Care, St. Olavs Hospital, Trondheim, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Anne Lovise Nordstoga
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim, Norway
| | - Eivind Schjelderup Skarpsno
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
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17
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Shin JW, Kim S, Park B, Shin YJ, Park S. Improving mental health and daytime function in adult insomnia patients predict cognitive behavioral therapy for insomnia effectiveness: A case-control study. Sleep Med X 2023; 5:100071. [PMID: 37090917 PMCID: PMC10119957 DOI: 10.1016/j.sleepx.2023.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/16/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
Objective This study investigated demographic, sleep related symptoms and mental health status as predictors of clinically significant treatment responses to cognitive behavioral therapy in adults who have good adherence for the cognitive behavioral therapy for insomnia (CBT-I) program in primary insomnia. Methods A total of 42 adults with primary insomnia disorder were treated with CBT-I at a university hospital from June 2020 to January 2021. Demographic variables were surveyed and sleep-related symptoms were measured using self-reported questionnaires before and after the intervention, comprising a 6-week interval. The treatment responder group was defined as patients with an Insomnia Severity Index change score >7 compared to baseline. Logistic regression and paired t-test examined whether these factors predicted treatment outcomes for CBT-I. Results Demographic variables did not predict treatment outcomes. Higher levels of anxiety were associated with a higher likelihood of treatment response (odds ratio [OR] = 1.234; confidence interval [CI]: 1.008-1.511). More severe insomnia at baseline was associated with a greater likelihood of treatment response (OR = 1.450; CI: 1.121-1.875). The lesser the dysfunctional beliefs and attitudes about sleep, the more effective the treatment response (OR = 0.943; CI: 0.904-0.984). Unlike the group of treatment responders, daytime function, depressive mood, and anxiety status did not improve in the group of treatment non-responders after CBT-I intervention. Conclusions Patients with severe insomnia and anxiety at baseline should be treated more aggressively with CBT-I. During treatment, patients' mental health problems and daytime activities should be continuously monitored, in order to help improve these problems which might strengthen the effectiveness of CBT-I.
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Affiliation(s)
- Jung-Won Shin
- Department of Neurology, Memory center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
- Corresponding author. Department of Neurology, CHA Bundang Medical Center, CHA University, 59 Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-712, Republic of Korea.
| | - Seonyeop Kim
- Graduate School of Clinical Counselling Psychology, CHA university, Seongnam, Republic of Korea
| | - Bomi Park
- Graduate School of Clinical Counselling Psychology, CHA university, Seongnam, Republic of Korea
| | - Yoon Jung Shin
- Graduate School of Clinical Counselling Psychology, CHA university, Seongnam, Republic of Korea
| | - Sunyoung Park
- Graduate School of Clinical Counselling Psychology, CHA university, Seongnam, Republic of Korea
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18
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Predictors of dropout in university students participating in an 8-week e-mail-based cognitive-behavioral therapy for insomnia intervention. Sleep Breath 2023; 27:345-353. [PMID: 35412222 DOI: 10.1007/s11325-022-02609-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/07/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE We conducted an exploratory study to identify risk factors of dropout in an 8-week e-mail-based cognitive-behavioral therapy for insomnia (REFRESH) to improve sleep among university students with insomnia symptoms. METHODS University and graduate students in Hong Kong and Korea who scored higher than 10 on the Insomnia Severity Index participated in REFRESH. RESULTS Of 158 participants from Hong Kong (n = 43) and Korea (n = 115), 90 (57%) did not complete all 7 sessions, while 52 of 90 (57.8%) dropped out prior to the fourth session. ROC analysis was conducted on the entire sample of 158 participants with intervention completion vs. dropout (non-completion) as the outcome variable. Predictors of dropout were wake time after sleep onset (WASO) < 7.1 min on the weekly sleep diary and expectations for sleep (a subscale of dysfunctional beliefs and attitudes about sleep; DBAS) < 18 at baseline. CONCLUSIONS These findings indicate that shorter WASO and less expectations for sleep at baseline were associated with risk of dropout from e-mail delivered self-help CBT-I-based intervention. Our results highlight the importance of identifying and tailoring treatment formats to students based on their presenting sleep characteristics.
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19
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Abstract
Cognitive-behavioral therapy for insomnia (CBT-I) is the main recommended treatment for patients presenting with insomnia; however, the treatment is not equally effective for all, and several factors can contribute to a diminished treatment response. The rationale for combining CBT-I treatment with acupuncture is explored, and evidence supporting its use in treating insomnia and related comorbidities is discussed. Practical, regulatory, and logistical issues with implementing a combined treatment are examined, and future directions for research are made. Growing evidence supports the effectiveness of acupuncture in treating insomnia and comorbid conditions, and warrants further investigation of acupuncture as an adjunct to CBT-I.
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20
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Cho JHJ. Adjunct Interventions to Cognitive Behavioral Therapy for Insomnia. Sleep Med Clin 2023; 18:xiii-xiv. [PMID: 36764792 DOI: 10.1016/j.jsmc.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Joshua Hyong-Jin Cho
- UCLA Insomnia Clinic, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 300 UCLA Medical Plaza, Suite 3200A, Los Angeles, CA 90095, USA.
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21
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Ellis JG, Meadows R, Alfonso-Miller P, Bastien CH. Partner Alliance to Enhance Efficacy and Adherence of CBT-I. Sleep Med Clin 2023; 18:1-7. [PMID: 36764781 DOI: 10.1016/j.jsmc.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is now widely recognized as the first-line management strategy for insomnia, both for insomnia in its "pure" form, and when comorbid with a physical or psychological illness. However, there is a definite need to develop and test both alternative and adjunct interventions to CBT-I, before implementing them into routine practice. The aim of this article is to provide a narrative review of the literature with regard to what is known about the influence of partners on sleep, insomnia, and its management.
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Affiliation(s)
- Jason Gordon Ellis
- Northumbria Sleep Research, Northumbria University, 129 NB408 Northumberland Building, Newcastle, NE1 8ST, United Kingdom; Department of Physical Education and Sport Sciences, University of Limerick, Sreelane, Castletroy, Co. Limerick, V94 T9PX, Ireland.
| | - Robert Meadows
- Department of Sociology, University of Surrey, 15 AD 03, GU2 7XH, United Kingdom
| | - Pamela Alfonso-Miller
- Northumbria Sleep Research, Northumbria University, 129 NB408 Northumberland Building, Newcastle, NE1 8ST, United Kingdom
| | - Célyne H Bastien
- École de Psychologie, Pavillon Félix-Antoine-Savard, Université Laval, 2325, Rue des Bibliothèques, Local 1012, Québec (Québec) G1V 0A6, Canada
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22
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Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is the universally recommended treatment of choice for insomnia disorder based on its safety and posttreatment durability of benefit. However, CBT-I does not help all patients achieve remission. The second most evidence-based treatment, hypnotic pharmacotherapy (PCT), does not resolve perpetuating factors of insomnia, resulting in potential waning of benefit and dependence. This article presents a rationale that supports consideration of hypnotic augmentation of CBT-I (COMB), along with a review of select randomized controlled trials relevant to clinical decision-making.
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23
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Leerssen J, Lakbila-Kamal O, Dekkers LMS, Ikelaar SLC, Albers ACW, Blanken TF, Lancee J, van der Lande GJM, Maksimovic T, Mastenbroek SE, Reesen JE, van de Ven S, van der Zweerde T, Foster-Dingley JC, Van Someren EJW. Treating Insomnia with High Risk of Depression Using Therapist-Guided Digital Cognitive, Behavioral, and Circadian Rhythm Support Interventions to Prevent Worsening of Depressive Symptoms: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:168-179. [PMID: 34872087 DOI: 10.1159/000520282] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The global disease burden of major depressive disorder urgently requires prevention in high-risk individuals, such as recently discovered insomnia subtypes. Previous studies targeting insomnia with fully automated eHealth interventions to prevent depression are inconclusive: dropout was high and likely biased, and depressive symptoms in untreated participants on average improved rather than worsened. OBJECTIVE This randomized controlled trial aimed to efficiently prevent the worsening of depressive symptoms by selecting insomnia subtypes at high risk of depression for internet-based circadian rhythm support (CRS), cognitive behavioral therapy for insomnia (CBT-I), or their combination (CBT-I+CRS), with online therapist guidance to promote adherence. METHODS Participants with an insomnia disorder subtype conveying an increased risk of depression (n = 132) were randomized to no treatment (NT), CRS, CBT-I, or CBT-I+CRS. The Inventory of Depressive Symptomatology - Self Report (IDS-SR) was self-administered at baseline and at four follow-ups spanning 1 year. RESULTS Without treatment, depressive symptoms indeed worsened (d = 0.28, p = 0.041) in high-risk insomnia, but not in a reference group with low-risk insomnia. Therapist-guided CBT-I and CBT-I+CRS reduced IDS-SR ratings across all follow-up assessments (respectively, d = -0.80, p = 0.001; d = -0.95, p < 0.001). Only CBT-I+CRS reduced the 1-year incidence of clinically meaningful worsening (p = 0.002). Dropout during therapist-guided interventions was very low (8%) compared to previous automated interventions (57-62%). CONCLUSIONS The findings tentatively suggest that the efficiency of population-wide preventive strategies could benefit from the possibility to select insomnia subtypes at high risk of developing depression for therapist-guided digital CBT-I+CRS. This treatment may provide effective long-term prevention of worsening of depressive symptoms. TRIAL REGISTRATION the Netherlands Trial Register (NL7359).
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Affiliation(s)
- Jeanne Leerssen
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Oti Lakbila-Kamal
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Laura M S Dekkers
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Savannah L C Ikelaar
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Anne C W Albers
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Tessa F Blanken
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.,PsyQ Amsterdam, Amsterdam, The Netherlands
| | - Glenn J M van der Lande
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Teodora Maksimovic
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Sophie E Mastenbroek
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Joyce E Reesen
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Sjors van de Ven
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Tanja van der Zweerde
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.,Specialized Mental Health Care GGZ inGeest, Amsterdam, The Netherlands
| | - Jessica C Foster-Dingley
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
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Manber R, Tully IA, Palaniappan L, Kim JP, Simpson N, Zulman DM, Goldhaber-Fiebert JD, Rangel E, Dietch JR, Rosas LG. RCT of the effectiveness of stepped-care sleep therapy in general practice: The RESTING study protocol. Contemp Clin Trials 2022; 116:106749. [PMID: 35367385 PMCID: PMC10159730 DOI: 10.1016/j.cct.2022.106749] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 11/03/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is an effective, non-pharmacological intervention, designated by the American College of Physicians as the first-line treatment of insomnia disorder. The current randomized controlled study uses a Hybrid-Type-1 design to compare the effectiveness and implementation potential of two approaches to delivering CBT-I in primary care. One approach offers therapy to all patients through an automated, digital CBT-I program (ONLINE-ONLY). The other is a triaged STEPPED-CARE approach that uses a simple Decision Checklist to start patients in either digital or therapist-led treatment; patients making insufficient progress with digital treatment at 2 months are switched to therapist-led treatment. We will randomize 240 individuals (age 50 or older) with insomnia disorder to ONLINE-ONLY or STEPPED-CARE arms. The primary outcomes are insomnia severity and hypnotic medication use, assessed at baseline and at months 2, 4, 6, 9, and 12 after randomization. We hypothesize that STEPPED-CARE will be superior to ONLINE-ONLY in reducing insomnia severity and hypnotic use. We also aim to validate the Decision Checklist and explore moderators of outcome. Additionally, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we will use mixed methods to obtain data on the potential for future dissemination and implementation of each approach. This triaged stepped-care approach has the potential to improve sleep, reduce use of hypnotic medications, promote safety, offer convenient access to treatment, and support dissemination of CBT-I to a large number of patients currently facing barriers to accessing treatment. Clinical trial registration:NCT03532282.
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Affiliation(s)
- Rachel Manber
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Isabelle A Tully
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Latha Palaniappan
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jane P Kim
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Norah Simpson
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Donna M Zulman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jeremy D Goldhaber-Fiebert
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA 94305, USA; Center for Health Policy, Freeman Spogli Institute, Stanford University, Stanford, CA 94305, USA
| | - Elizabeth Rangel
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; SDSU/ UC San Diego Joint Doctoral Program in Clinical Psychology, University of California, San Diego, San Diego State University, San Diego, CA 92120, USA
| | - Jessica R Dietch
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; School of Psychological Science, Oregon State University, Corvallis, OR 97331, USA
| | - Lisa G Rosas
- Center for Health Policy, Freeman Spogli Institute, Stanford University, Stanford, CA 94305, USA
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25
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Chevalier LL, Fine E, Sharma A, Zhou ES, Recklitis CJ. Evaluating the Sleep Treatment Education Program (STEP-1): A single-session educational workshop addressing insomnia in cancer survivors. J Psychosoc Oncol 2022; 41:123-132. [PMID: 35468047 DOI: 10.1080/07347332.2022.2054750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Insomnia is a common late effect of cancer, affecting as many as 27% of cancer survivors. Although cognitive behavioral therapy for insomnia (CBT-I) is highly effective, treatment-associated burdens and limited availability of providers result in few survivors receiving this treatment. To address this gap, we developed the Sleep Treatment Education Program-1 (STEP-1), a single-session intervention addressing insomnia after cancer. As a preliminary evaluation of STEP-1's potential to improve survivors' insomnia, STEP-1 was delivered to a convenience sample of 34 cancer survivors as an educational workshop in person or by videoconference. Participants completed the Insomnia Severity Index (ISI) at the workshop and at 1-month follow-up; items assessing participants' intentions to implement program suggestions and satisfaction were also collected. At 1-month follow-up, mean insomnia symptoms on the ISI were significantly lower compared to baseline (9.73 vs 15.73; d = 1.38, P < .001); the reduction in mean ISI scores did not significantly differ between in-person and videoconference participants (5.82 vs 6.33; P = .78). These results, along with positive indicators of program engagement and satisfaction, support the potential efficacy of STEP-1 to meet survivors' needs for insomnia care. Particularly when delivered by videoconference, STEP-1 has the potential to dramatically improve access and uptake for insomnia treatment in cancer survivors. Results also more generally support development of low-intensity, self-management insomnia interventions for cancer survivors and potentially other populations.
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Affiliation(s)
- Lydia L Chevalier
- Perini Family Survivor's Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth Fine
- Perini Family Survivor's Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Aditi Sharma
- Perini Family Survivor's Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Eric S Zhou
- Perini Family Survivor's Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher J Recklitis
- Perini Family Survivor's Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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26
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Zhao FY, Kennedy GA, Spencer SJ, Conduit R, Zhang WJ, Fu QQ, Zheng Z. The Role of Acupuncture in the Management of Insomnia as a Major or Residual Symptom Among Patients With Active or Previous Depression: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:863134. [PMID: 35492706 PMCID: PMC9051249 DOI: 10.3389/fpsyt.2022.863134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Due to concerns about risks associated with antidepressants and/or hypnotics, complementary therapies such as acupuncture have been sought by patients with active or previous depression to manage insomnia. This systematic review aimed to clarify if acupuncture is effective and safe enough to be recommended as an alternative or adjuvant therapy to standard care in ameliorating concomitant or residual insomnia, two types of insomnia associated with depression. Methods Randomized controlled trials (RCTs) of depression-related insomnia (DI) treatment via acupuncture vs. waitlist-control or placebo-/sham-acupuncture and RCTs of DI treatment via acupuncture alone or combined with standard care [Western pharmacotherapy and/or cognitive-behavioral therapy (CBT)] vs. standard care alone were searched for from seven databases from inception to December 2021. Cochrane criteria were followed. Results Twenty-one studies involving 1,571 participants were analyzed. For insomnia as a major symptom of active depression, meta-analyses suggested that acupuncture significantly reduced the global scores of both the Pittsburg Sleep Quality Index (PSQI) [MD = -3.12, 95% CI (-5.16, -1.08), p < 0.01] and Hamilton Depression Scale (HAMD) [SMD = -2.67, 95% CI (-3.51, -1.84), p < 0.01], in comparison with placebo-acupuncture. When compared with conventional pharmacotherapy (antidepressants and/or hypnotics), the results favored acupuncture in decreasing PSQI [MD = -1.17, 95% CI (-2.26, -0.08), p = 0.03] and HAMD [SMD = -0.47, 95% CI (-0.91, -0.02), p = 0.04]. Acupuncture was comparable to conventional pharmacotherapy in reducing scores of each domain of PSQI. For insomnia as a residual symptom of previous or partially remitted depression, acupuncture conferred a very limited, non-significant therapeutic advantage against sham-/placebo-acupuncture. Whether acupuncture has an add-on effect to conventional pharmacotherapy in this type of insomnia has not been investigated. Also, no study was available to address the efficacy differences between acupuncture and CBT or the synergistic effect of these two therapies. Conclusions There is a low to moderate level of evidence supporting acupuncture as a safe and effective remedy alternative to or adjuvant to conventional pharmacotherapy (antidepressant and/or hypnotic) in improving insomnia and other depression symptoms among patients with active depression. Furthermore, the patients' complaint of disrupted sleep continuity is most likely to benefit from acupuncture. The benefit of acupuncture on residual insomnia associated with previous or partially remitted depression is limited. Future acupuncture studies need to consider applying optimal dosage and addressing deficiencies in trial quality.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021269880, PROSPERO, identifier: CRD42021269880.
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Affiliation(s)
- Fei-Yi Zhao
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gerard A. Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- School of Science, Psychology and Sport, Federation University, Mount Helen, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Sarah J. Spencer
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, RMIT University, Bundoora, VIC, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
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27
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Tapia JL, Puertas FJ, Duñabeitia JA. Study Protocol for a Randomized Controlled Trial Assessing the Effectiveness of Personalized Computerized Cognitive Training for Individuals With Insomnia. Front Behav Neurosci 2022; 16:779990. [PMID: 35296055 PMCID: PMC8919067 DOI: 10.3389/fnbeh.2022.779990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
Insomnia is a frequent and heightened pathology in the general population of developed countries, and its condition generally leads to health discomfort and performance drop in daily and work-related tasks. As current pharmacological treatments for insomnia do not always seem sufficient to mitigate impairment, contemporary cognitive approaches might shed light on developing complementary therapies for this population. We propose a cognitive stimulation intervention program based on the importance of cognitive abilities as precipitating and maintenance variables of sleep disturbances. A full phase I-II-III clinical trial is proposed in which the first two studies will serve to assess the safety of the intervention and to identify the maximum tolerated time of the computerized cognitive training (phase I) and the minimum effective number of training sessions (phase II) in the absence of adverse events or side effects. Next, a phase-III double-blind randomized controlled trial design will be set. Sixty individuals with insomnia aged 25 to 55 years will enroll in a home-based personalized computerized cognitive stimulation program for a total time of 8 weeks, training 5 days per week. Sixty insomnia patients matched in a variety of factors will constitute the active control group, where the orthogonal activities will not be cognitively demanding. Sleep, cognitive, emotional, and quality of life variables will be measured before and immediately after training. A linear mixed model and hierarchical regression analysis will be used to investigate intervention effects. The results derived from this study will be precious for future research and treatment in cognitive performance and clinical pathologies. Clinical Trial Registration: [https://clinicaltrials.gov/], identifier [NCT05050292].
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Affiliation(s)
- Jose Luis Tapia
- Centro de Investigación Nebrija en Cognición (CINC), Universidad Antonio de Nebrija, Madrid, Spain
| | - Francisco Javier Puertas
- Unidad Sueño, Hospital Universitario de la Ribera-FISABIO, Valencia, Spain
- Facultad de Medicina, Universidad Católica de Valencia, Valencia, Spain
| | - Jon Andoni Duñabeitia
- Centro de Investigación Nebrija en Cognición (CINC), Universidad Antonio de Nebrija, Madrid, Spain
- AcqVA Aurora Center, The Arctic University of Norway, Tromsø, Norway
- *Correspondence: Jon Andoni Duñabeitia,
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28
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Cho JH, Kremer S, Young J. Who to Refer to a Behavioral Insomnia Clinic? - Recommendations Based on Treatment Rationale and Response Prediction. CURRENT SLEEP MEDICINE REPORTS 2021; 7:213-220. [PMID: 34804765 PMCID: PMC8596854 DOI: 10.1007/s40675-021-00220-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
Purpose of Review Response to cognitive-behavioral therapy for insomnia (CBT-I) is variable across individuals, and specialty insomnia clinics that provide CBT-I are few. To personalize insomnia treatments and maximize the cost-effectiveness of CBT-I, this paper reviews the conceptual model and content of CBT-I and the predictors of adherence/response to CBT-I as the basis for understanding who is most likely to benefit from CBT-I. Recent Findings Specific patient-related attributes that predict benefit from CBT-I include (1) presence of maladaptive behaviors that serve as perpetuating factors of insomnia; (2) greater motivation to pursue therapy and higher treatment expectancies regarding CBT-I; (3) reduced use of hypnotics; (4) longer sleep duration; and (5) adequately treated psychiatric comorbidities. Summary People presenting with chronic insomnia and these attributes may warrant prioritization in referral to behavioral insomnia clinics. Conversely, those who do not have such favorable characteristics may require interventions that address modifiable factors associated with poor adherence/response to CBT-I.
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Affiliation(s)
- Joshua H Cho
- UCLA Insomnia Clinic, Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, 300 UCLA Medical Plaza, Suite 3200A, Los Angeles, CA 90095 USA
| | - Stephanie Kremer
- UCLA Insomnia Clinic, Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, 300 UCLA Medical Plaza, Suite 3200A, Los Angeles, CA 90095 USA
| | - Jeffrey Young
- UCLA Insomnia Clinic, Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, 300 UCLA Medical Plaza, Suite 3200A, Los Angeles, CA 90095 USA
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29
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Alshehri MM, Alenazi AM, Alothman SA, Rucker JL, Phadnis MA, Miles JM, Siengsukon CF, Kluding PM. Using Cognitive Behavioral Therapy for Insomnia in People with Type 2 Diabetes, Pilot RCT Part I: Sleep and Concomitant Symptom. Behav Sleep Med 2021; 19:652-671. [PMID: 33108932 DOI: 10.1080/15402002.2020.1831501] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE/BACKGROUND The primary aim of this study was to examine the effect of Cognitive Behavioral Therapy for Insomnia (CBT-I) on the severity of insomnia in people with Type 2 diabetes (T2D) compared to a health education (HE) control group. The secondary aim was to explore the effect of CBT-I on other sleep outcomes and concomitant symptoms. PARTICIPANTS Twenty-eight participants with T2D were randomly assigned to CBT-I (n = 14) or HE (n = 14). METHODS Validated assessments were used at baseline and post intervention to assess sleep outcomes and concomitant symptoms. In addition, actigraph and sleep diaries were used to measure sleep parameters. Independent sample t tests and Mann-Whitney U tests were utilized to measure between-group differences in the mean change scores. RESULTS Participants in the CBT-I group showed higher improvements in the following mean change scores compared to the HE group: insomnia symptoms (d = 1.78; p < .001), sleep quality (d = 1.53; p =.001), sleep self-efficacy (d = 1.67; p < .001). Both actigraph and sleep diary showed improvements in sleep latency and sleep efficiency in the CBT-I group as compared to the HE group. In addition, participants in the CBT-I group showed greater improvement in the mean change scores of depression symptoms (d = 1.49; p = .002) and anxiety symptoms (d = 0.88; p = .04) compared to the HE group. CONCLUSION This study identified a clinically meaningful effect of CBT-I on sleep outcomes and concomitant symptoms in people with T2D and insomnia symptoms. Further work is needed to investigate the long-term effects of CBT-I in people with T2D and insomnia symptoms.
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Affiliation(s)
- Mohammed M Alshehri
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, Kansas City, Kansas.,Physical Therapy Department, Jazan University, Jazan, Saudi Arabia
| | - Aqeel M Alenazi
- Physical Therapy Department, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Shaima A Alothman
- Lifestyle and Health Research Center, Princess Nora Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Jason L Rucker
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, Kansas City, Kansas
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas
| | - John M Miles
- Endocrinology Department, University of Kansas Medical Center, Kansas City, Kansas
| | - Catherine F Siengsukon
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, Kansas City, Kansas
| | - Patricia M Kluding
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, Kansas City, Kansas
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30
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Effects of Lactobacillus plantarum PS128 on Depressive Symptoms and Sleep Quality in Self-Reported Insomniacs: A Randomized, Double-Blind, Placebo-Controlled Pilot Trial. Nutrients 2021; 13:nu13082820. [PMID: 34444980 PMCID: PMC8402034 DOI: 10.3390/nu13082820] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 01/08/2023] Open
Abstract
Recent animal studies have supported that Lactobacillus plantarum PS128 (PS128) can reduce the severity of anxiety and depression. However, previous studies did not focus on the sleep quality and mood of humans. This study determines whether PS128 reduces the severity of anxiety and depressive symptoms, regulates autonomic nervous system function, and improves sleep quality. Forty participants between 20 and 40 years of age with self-reported insomnia were randomly assigned to two groups, a PS128 group and a placebo group, in a double-blind trial. Participants took two capsules of either PS128 or a placebo after dinner for 30 days. Study measures included subjective depressive symptoms, anxiety and sleep questionnaires, and miniature-polysomnography recordings at baseline and on the 15th and 30th days of taking capsules. Overall, all outcomes were comparable between the two groups at baseline and within the 30-day period, yet some differences were still found. Compared to the control group, the PS128 group showed significant decreases in Beck Depression Inventory-II scores, fatigue levels, brainwave activity, and awakenings during the deep sleep stage. Their improved depressive symptoms were related to changes in brain waves and sleep maintenance. These findings suggest that daily administration of PS128 may lead to a decrease in depressive symptoms, fatigue level, cortical excitation, and an improvement in sleep quality during the deep sleep stage. Daily consumption of PS128 as a dietary supplement may improve the depressive symptoms and sleep quality of insomniacs, although further investigation is warranted.
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31
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Jiang A, Rosario M, Stahl S, Gill JM, Rusch HL. The Effect of Virtual Mindfulness-Based Interventions on Sleep Quality: A Systematic Review of Randomized Controlled Trials. Curr Psychiatry Rep 2021; 23:62. [PMID: 34297230 PMCID: PMC8300082 DOI: 10.1007/s11920-021-01272-6] [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: 06/04/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE OF REVIEW We summarized peer-reviewed literature investigating the effect of virtual mindfulness-based interventions (MBIs) on sleep quality. We aimed to examine the following three questions: (1) do virtual MBIs improve sleep quality when compared with control groups; (2) does the effect persist long-term; and (3) is the virtual delivery method equally feasible compared to the in-person delivery method? RECENT FINDINGS Findings suggest that virtual MBIs are equivalent to evidence-based treatments, and to a limited extent, more effective than non-specific active controls at reducing some aspects of sleep disturbance. Overall, virtual MBIs are more effective at improving sleep quality than usual care controls and waitlist controls. Studies provide preliminary evidence that virtual MBIs have a long-term effect on sleep quality. Moreover, while virtual MBI attrition rates are comparable to in-person MBI attrition rates, intervention adherence may be compromised in the virtual delivery method. This review highlights virtual MBIs as a potentially effective alternative to managing sleep disturbance during pandemic-related quarantine and stay-at-home periods. This is especially relevant due to barriers of accessing in-person interventions during the pandemic. Future studies are needed to explore factors that influence adherence and access to virtual MBIs, with a particular focus on diverse populations.
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Affiliation(s)
- Amanda Jiang
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Michael Rosario
- Washington University School of Medicine, St. Louis, MO, USA
| | - Sara Stahl
- TEACCH Autism Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Heather L Rusch
- National Institutes of Health, 3 Center Drive, Building 3, Room 5E/26, Bethesda, MD, 20892, USA.
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32
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Dyrberg H, Juel A, Kragh M. Experience of Treatment and Adherence to Cognitive Behavioral Therapy for Insomnia for Patients with Depression: An Interview Study. Behav Sleep Med 2021; 19:481-491. [PMID: 32627595 DOI: 10.1080/15402002.2020.1788033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE/BACKGROUND Research supports the efficacy of Cognitive Behavioral Therapy for Insomnia (CBT-I) for patients suffering from depression and insomnia, but little is known about how they experience treatment and adhere to it. Our objective, therefore, was to explore how patients with depression experience treatment components and how their experiences influence adherence to CBT-I as a full-package treatment. PARTICIPANTS/METHODS Twelve patients with depression and comorbid insomnia were interviewed after six sessions of CBT-I, and a conventional qualitative content analysis was conducted. RESULTS Two themes were found. The theme "I picked what I needed" showed that participants chose among CBT-I methods. Behavioral methods were considered hard but so effective that they reduced the need to learn other methods. Participants had difficulty learning cognitive methods, such as the restructuring of negative thoughts, owing to lack of energy and cognitive problems aggravated by sleep loss. Sleep hygiene education was regarded as common knowledge. The theme "Staying on track" highlighted factors promoting adherence, such as a preference for non-pharmacological treatment, rapid improvement, and support from relatives and therapists. Factors impeding adherence were: a perceived lack of support from the ongoing group setting, side effects of medication, changes in daily routine, and daytime fatigue influencing cognitive and emotional functioning. CONCLUSION The study suggests: focusing on adherence throughout treatment; actively using support from relatives and therapists; preferring individual treatment; and prioritizing behavioral treatment components, with cognitive components introduced later in the treatment course when the negative effects on cognitive functioning due to sleep restriction have diminished.
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Affiliation(s)
- Henny Dyrberg
- Department for Affective Disorders, Aarhus University Hospital, Aarhus N, Denmark
| | - Anette Juel
- Department for Affective Disorders, Aarhus University Hospital, Aarhus N, Denmark.,Centre for Relationships and De-escalation, Mental Health Services Region Zealand
| | - Mette Kragh
- Department for Affective Disorders, Aarhus University Hospital, Aarhus N, Denmark
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33
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Dietch JR, Manber R. Insomnia and cognitive arousal are important potential targets to reduce perinatal depression risk. Sleep 2021; 44:6219632. [PMID: 33837426 PMCID: PMC8193559 DOI: 10.1093/sleep/zsab091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
- Corresponding author. Jessica R. Dietch, School of Psychological Science, Oregon State University, Corvallis, OR 97331.
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
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34
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Zavalko IM. [Options to enhance the efficacy of cognitive-behavior therapy of insomnia]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:36-40. [PMID: 34078858 DOI: 10.17116/jnevro202112140236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cognitive-behavior therapy of insomnia (CBT-I) is first-line treatment for insomnia, but it produces a clinical significant result only in 60-80% of patients. Addition reason of reduction of CBT-I efficacy is a relatively low adherence: the attrition rate is 10-39%. The authors discuss options to enhance efficacy of the therapy by usage of complex approach, individualized choice of technics, motivating a patient and his relatives, and combination of CBT-I with hypnotics.
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Affiliation(s)
- I M Zavalko
- State Research Center Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
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35
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Darden M, Espie CA, Carl JR, Henry AL, Kanady JC, Krystal AD, Miller CB. Cost-effectiveness of digital cognitive behavioral therapy (Sleepio) for insomnia: a Markov simulation model in the United States. Sleep 2021; 44:5957088. [PMID: 33151330 DOI: 10.1093/sleep/zsaa223] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
STUDY OBJECTIVES To examine the cost-effectiveness and potential net monetary benefit (NMB) of a fully automated digital cognitive behavioral therapy (CBT) intervention for insomnia compared with no insomnia treatment in the United States (US). Similar relative comparisons were made for pharmacotherapy and clinician-delivered CBT (individual and group). METHODS We simulated a Markov model of 100,000 individuals using parameters calibrated from the literature including direct (treatment) and indirect costs (e.g. insomnia-related healthcare expenditure and lost workplace productivity). Health utility estimates were converted into quality-adjusted life years (QALYs) and one QALY was worth $50,000. Simulated individuals were randomized equally to one of five arms (digital CBT, pharmacotherapy, individual CBT, group CBT, or no insomnia treatment). Sensitivity was assessed by bootstrapping the calibrated parameters. Cost estimates were expressed in 2019 US dollars. RESULTS Digital CBT was cost beneficial when compared with no insomnia treatment and had a positive NMB of $681.06 (per individual over 6 months). Bootstrap sensitivity analysis demonstrated that the NMB was positive in 94.7% of simulations. Relative to other insomnia treatments, digital CBT was the most cost-effective treatment because it generated the smallest incremental cost-effectiveness ratio (-$3,124.73). CONCLUSIONS Digital CBT was the most cost-effective insomnia treatment followed by group CBT, pharmacotherapy, and individual CBT. It is financially prudent and beneficial from a societal perspective to utilize automated digital CBT to treat insomnia at a population scale.
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Affiliation(s)
- Michael Darden
- Carey Business School, Johns Hopkins University, Baltimore, MD
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Inc., London, UK.,Big Health Inc., San Francisco, CA
| | - Jenna R Carl
- Big Health Inc., London, UK.,Big Health Inc., San Francisco, CA
| | - Alasdair L Henry
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Inc., London, UK.,Big Health Inc., San Francisco, CA
| | | | - Andrew D Krystal
- Department of Psychiatry, School of Medicine, University of California San Francisco, San Francisco, CA.,Department of Neurology, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Christopher B Miller
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Inc., London, UK.,Big Health Inc., San Francisco, CA
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Ito-Masui A, Kawamoto E, Sakamoto R, Yu H, Sano A, Motomura E, Tanii H, Sakano S, Esumi R, Imai H, Shimaoka M. Internet-Based Individualized Cognitive Behavioral Therapy for Shift Work Sleep Disorder Empowered by Well-Being Prediction: Protocol for a Pilot Study. JMIR Res Protoc 2021; 10:e24799. [PMID: 33626497 PMCID: PMC8088862 DOI: 10.2196/24799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/10/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background Shift work sleep disorders (SWSDs) are associated with the high turnover rates of nurses, and are considered a major medical safety issue. However, initial management can be hampered by insufficient awareness. In recent years, it has become possible to visualize, collect, and analyze the work-life balance of health care workers with irregular sleeping and working habits using wearable sensors that can continuously monitor biometric data under real-life settings. In addition, internet-based cognitive behavioral therapy for psychiatric disorders has been shown to be effective. Application of wearable sensors and machine learning may potentially enhance the beneficial effects of internet-based cognitive behavioral therapy. Objective In this study, we aim to develop and evaluate the effect of a new internet-based cognitive behavioral therapy for SWSD (iCBTS). This system includes current methods such as medical sleep advice, as well as machine learning well-being prediction to improve the sleep durations of shift workers and prevent declines in their well-being. Methods This study consists of two phases: (1) preliminary data collection and machine learning for well-being prediction; (2) intervention and evaluation of iCBTS for SWSD. Shift workers in the intensive care unit at Mie University Hospital will wear a wearable sensor that collects biometric data and answer daily questionnaires regarding their well-being. They will subsequently be provided with an iCBTS app for 4 weeks. Sleep and well-being measurements between baseline and the intervention period will be compared. Results Recruitment for phase 1 ended in October 2019. Recruitment for phase 2 has started in October 2020. Preliminary results are expected to be available by summer 2021. Conclusions iCBTS empowered with well-being prediction is expected to improve the sleep durations of shift workers, thereby enhancing their overall well-being. Findings of this study will reveal the potential of this system for improving sleep disorders among shift workers. Trial Registration UMIN Clinical Trials Registry UMIN000036122 (phase 1), UMIN000040547 (phase 2); https://tinyurl.com/dkfmmmje, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046284 International Registered Report Identifier (IRRID) DERR1-10.2196/24799
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Affiliation(s)
- Asami Ito-Masui
- Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Departments of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Emergency and Critical Care Center, Mie University Hospital, Tsu City, Mie, Japan
| | - Eiji Kawamoto
- Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Departments of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Emergency and Critical Care Center, Mie University Hospital, Tsu City, Mie, Japan
| | - Ryota Sakamoto
- Department of Medical Informatics, Mie University Hospital, Tsu City, Mie, Japan
| | - Han Yu
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, United States
| | - Akane Sano
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, United States
| | - Eishi Motomura
- Department of Neuropsychiatry, Mie University Graduate School of Medicine, Tsu City, Mie, Japan
| | - Hisashi Tanii
- Center for Physical and Mental Health, Mie University, Tsu City, Mie, Japan
| | - Shoko Sakano
- Mie Prefectural Mental Medical Center, Tsu City, Mie, Japan
| | - Ryo Esumi
- Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Departments of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Emergency and Critical Care Center, Mie University Hospital, Tsu City, Mie, Japan
| | - Hiroshi Imai
- Departments of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu City, Mie, Japan.,Emergency and Critical Care Center, Mie University Hospital, Tsu City, Mie, Japan
| | - Motomu Shimaoka
- Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu City, Mie, Japan
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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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Short NA, Uhde TW, Paquet C, Milanak M, Rheingold AA, Wilkerson A. An Investigation of the Rate and Predictors of Initiating and Attending Group Cognitive Behavioral Therapy for Insomnia After Referral. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Leeds R, Shechter A, Alcantara C, Aggarwal B, Usseglio J, Abdalla M, Moise N. Elucidating the Relationship Between Insomnia, Sex, and Cardiovascular Disease. GENDER AND THE GENOME 2020. [DOI: 10.1177/2470289720980018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sex differences in cardiovascular disease (CVD) mortality have been attributed to differences in pathophysiology between men and women and to disparities in CVD management that disproportionately affect women compared to men. Similarly, there has been investigation of differences in the prevalence and presentation of insomnia attributable to sex. Few studies have examined how sex and insomnia interact to influence CVD outcomes, however. In this review, we summarize the literature on sex-specific differences in the prevalence and presentation of insomnia as well as existing research regarding the relationship between insomnia and CVD outcomes as it pertains to sex. Research to date indicate that women are more likely to have insomnia than men, and there appear to be differential associations in the relation between insomnia and CVD by sex. We posit potential mechanisms of the relationship between sex, insomnia and CVD, discuss gaps in the existing literature, and provide commentary on future research needed in this area. Unraveling the complex relations between sex, insomnia, and CVD may help to explain sex-specific differences in CVD, and identify sex-specific strategies for promotion of cardiovascular health. Throughout this review, terms “men” and “women” are used as they are in the source literature, which does not differentiate between sex and gender. The implications of this are also discussed.
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Affiliation(s)
- Rebecca Leeds
- Center for Family and Community Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Brooke Aggarwal
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center, New York, NY, USA
| | - Marwah Abdalla
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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40
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Chapoutot M, Peter-Derex L, Schoendorff B, Faivre T, Bastuji H, Putois B. Telehealth-delivered CBT-I programme enhanced by acceptance and commitment therapy for insomnia and hypnotic dependence: A pilot randomized controlled trial. J Sleep Res 2020; 30:e13199. [PMID: 33020985 DOI: 10.1111/jsr.13199] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 12/22/2022]
Abstract
Cognitive behavioural therapy for insomnia is the recommended treatment for chronic insomnia. However, up to a quarter of patients dropout from cognitive behavioural therapy for insomnia programmes. Acceptance, mindfulness and values-based actions may constitute complementary therapeutic tools to cognitive behavioural therapy for insomnia. The current study sought to evaluate the efficacy of a remotely delivered programme combining the main components of cognitive behavioural therapy for insomnia (sleep restriction and stimulus control) with the third-wave cognitive behavioural therapy acceptance and commitment therapy in adults with chronic insomnia and hypnotic dependence on insomnia symptoms and quality of life. Thirty-two participants were enrolled in a pilot randomized controlled trial: half of them were assigned to a 3-month waiting list before receiving the four "acceptance and commitment therapy-enhanced cognitive behavioural therapy for insomnia" treatment sessions using videoconference. The primary outcome was sleep quality as measured by the Insomnia Severity Index and the Pittsburgh Sleep Quality Index. All participants also filled out questionnaires about quality of life, use of hypnotics, depression and anxiety, acceptance, mindfulness, thought suppression, as well as a sleep diary at baseline, post-treatment and 6-month follow-up. A large effect size was found for Insomnia Severity Index and Pittsburgh Sleep Quality Index, but also daytime improvements, with increased quality of life and acceptance at post-treatment endpoint in acceptance and commitment therapy-enhanced cognitive behavioural therapy for insomnia participants. Improvement in Insomnia Severity Index and Pittsburgh Sleep Quality Index was maintained at the 6-month follow-up. Wait-list participants increased their use of hypnotics, whereas acceptance and commitment therapy-enhanced cognitive behavioural therapy for insomnia participants evidenced reduced use of them. This pilot study suggests that web-based cognitive behavioural therapy for insomnia incorporating acceptance and commitment therapy processes may be an efficient option to treat chronic insomnia and hypnotic dependence.
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Affiliation(s)
- Mélinée Chapoutot
- Lyon Neuroscience Research Centre, CNRS UMR 5292 - INSERM U1028 - Lyon 1 University, Bron, France
| | - Laure Peter-Derex
- Lyon Neuroscience Research Centre, CNRS UMR 5292 - INSERM U1028 - Lyon 1 University, Bron, France.,Sleep Medicine and Respiratory Disease Centre, Croix-Rousse Hospital, CHU of Lyon, Lyon, France.,Lyon 1 University, Lyon, France
| | | | | | - Hélène Bastuji
- Lyon Neuroscience Research Centre, CNRS UMR 5292 - INSERM U1028 - Lyon 1 University, Bron, France.,Sleep Medicine and Respiratory Disease Centre, Croix-Rousse Hospital, CHU of Lyon, Lyon, France.,Lyon 1 University, Lyon, France
| | - Benjamin Putois
- Lyon Neuroscience Research Centre, CNRS UMR 5292 - INSERM U1028 - Lyon 1 University, Bron, France.,Swiss Distance Learning University, Brig, Switzerland
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Siengsukon CF, Beck ES, Drerup M. Feasibility and Treatment Effect of a Web-Based Cognitive Behavioral Therapy for Insomnia Program in Individuals with Multiple Sclerosis: A Pilot Randomized Controlled Trial. Int J MS Care 2020; 23:107-113. [PMID: 34177382 DOI: 10.7224/1537-2073.2019-122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background At least 40% of individuals with multiple sclerosis (MS) experience chronic insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia symptoms in individuals with MS. Delivery of CBT-I using Web-based applications has been shown to be effective and may increase access to CBT-I for individuals with MS who have mobility difficulties, experience fatigue, or live in rural areas. Therefore, the purpose of this study was to assess the feasibility and treatment effect of CBT-I delivered using a Web-based application with or without biweekly telephone calls to improve sleep quality and fatigue in individuals with MS and symptoms of insomnia. Methods Forty-one individuals with MS and symptoms of insomnia were randomized into either a group that participated in a 6-week Web-based CBT-I program (wCBT-I) or a group that participated in a 6-week Web-based CBT-I program and received biweekly support telephone calls (wCBT-I + calls). Participants completed surveys online to assess insomnia severity, sleep quality, fatigue, sleep self-efficacy, depression, anxiety, and motivation to change their sleep behavior. Results The overall retention rate was 48.8%, and the adherence rate was 96.34%. Both groups had significant improvement in insomnia severity, sleep quality, sleep self-efficacy, and anxiety. Only the wCBT-I group had significant improvement in depression and fatigue. Conclusions Web-delivered CBT-I is feasible and effective in improving sleep outcomes and concomitant symptoms in individuals with MS. Web-based CBT-I may increase access to CBT-I treatment and provide a stepped-care approach to treating chronic insomnia in individuals with MS.
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42
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Ho FYY, Chan CS, Lo WY, Leung JCY. The effect of self-help cognitive behavioral therapy for insomnia on depressive symptoms: An updated meta-analysis of randomized controlled trials. J Affect Disord 2020; 265:287-304. [PMID: 32090753 DOI: 10.1016/j.jad.2020.01.062] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/05/2020] [Accepted: 01/14/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sleep disturbances commonly occur in patients with depression. Insomnia is considered not only a symptom of but also a risk factor for depression. Psychological treatments for insomnia have been demonstrated to be efficacious in alleviating depressive symptoms. This meta-analysis examined the effect of self-help cognitive behavioral therapy for insomnia (CBT-I) in treating depressive symptoms. METHODS A systematic review was performed up to April 2019 in 6 major electronic databases. The literature search retrieved 4190 potentially relevant citations; 30 randomized controlled trials (total N = 5945) that compared self-help CBT-I vs. waiting-list (WL), routine care, no treatment, individual cognitive behavioral therapy (CBT), group CBT and placebo were included in the current review. RESULTS Random effects models showed significant reduction in self-report depressive symptoms (Hedges' g = 0.35; 95% CI: -0.47, -0.23) and insomnia symptoms (Hedges' g = 0.79; 95% CI: -0.56, -1.03) in the self-help CBT-I group when compared to the WL/routine care/no treatment/psychoeducation control group. LIMITATIONS The findings should be interpreted with caution due to potential publication bias. CONCLUSIONS CBT-I appears to be efficacious in treating depressive symptoms. Given the current results and study limitations, large-scale, high-quality trials that specifically target individuals with a clinical diagnosis of depression are warranted in the future.
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Affiliation(s)
- Fiona Yan-Yee Ho
- The Public Mental Health Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Christian S Chan
- Department of Psychology, The University of Hong Kong, Hong Kong.
| | - Wing-Ying Lo
- The Public Mental Health Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong
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43
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Thimmapuram J, Yommer D, Tudor L, Bell T, Dumitrescu C, Davis R. Heartfulness meditation improves sleep in chronic insomnia. J Community Hosp Intern Med Perspect 2020; 10:10-15. [PMID: 32128052 PMCID: PMC7034439 DOI: 10.1080/20009666.2019.1710948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/12/2019] [Indexed: 01/12/2023] Open
Abstract
Background: Chronic insomnia is characterized by disturbed sleep that occurs despite adequate opportunity and circumstances to sleep. Many patients with chronic insomnia have comorbid mental illnesses or medical illnesses that contribute and precipitate insomnia. Hallmark of chronic insomnia treatment includes non-pharmacological measures such as Cognitive Behavioral Therapy for Insomnia (CBT-I). Pharmacologic treatment (sedative or hypnotic agents) has been disappointing because of poor efficacy and numerous undesirable side effects. Other new therapies including meditation have been proven to be effective. Objective: This study investigates the effectiveness of Heartfulness meditation coupled with sleep hygiene to treat chronic insomnia. Methods: In this prospective pre-post design cohort study, 32 adult patients with chronic primary insomnia engaged in Heartfulness meditation along with appropriate sleep hygiene for eight weeks. Insomnia Severity Index (ISI) scores, usage of sedative or hypnotic agents were measured at baseline and at the end of the eight-week period. Results: There was a significant decrease in the mean ISI scores from 20.9 to 10.4 (p < 0.001) after eight weeks of Heartfulness meditation. Twenty four of 32 patients were initially on sedative or hypnotic medications. At week eight, 21 of 24 patients (87.5%) were off these medications or the dosage was reduced (p < 0.001). Conclusion: This study demonstrated statistical improvements in the measures of ISI in patients undergoing a Heartfulness meditation program. Heartfulness meditation may facilitate the taper and eventual cessation of sedative hypnotics in patients suffering from chronic insomnia.
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Affiliation(s)
- Jayaram Thimmapuram
- Academic Hospitalist Internal Medicine, WellSpan York Hospital, York, PA, USA
| | - Deborah Yommer
- Pulmonary and Sleep Medicine, WellSpan Health, York, PA, USA
| | - Luminita Tudor
- Pulmonary and Sleep Medicine, WellSpan Health, York, PA, USA
| | - Theodore Bell
- Research Program Manager, Emig Research Center, WellSpan Health, York, PA, USA
| | | | - Robert Davis
- Internal Medicine, PGY2, Internal Medicine, WellSpan Health, York, PA, USA
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Miller KE, Brownlow JA, Gehrman PR. Sleep in PTSD: treatment approaches and outcomes. Curr Opin Psychol 2019; 34:12-17. [PMID: 31541965 DOI: 10.1016/j.copsyc.2019.08.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022]
Abstract
The high incidence of sleep disturbance associated with trauma exposure and posttraumatic stress disorder (PTSD) points to the need for effective sleep interventions for trauma survivors. The present review focuses on recent psychotherapeutic, pharmacological, and sleep medicine treatment approaches for sleep disturbances in PTSD. Findings highlight that targeted sleep interventions can ameliorate sleep symptoms and mitigate daytime PTSD symptoms. Attention has turned to the role of multidisciplinary and integrative approaches, as comprehensive treatment for sleep disturbances in PTSD is likely to require innovative assessment modalities and multiple interventions. A method for compressing these components into a treatment plan acceptable to most PTSD-diagnosed patients remains to be developed.
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Affiliation(s)
- Katherine E Miller
- Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Janeese A Brownlow
- Department of Psychology, College of Health and Behavioral Sciences at Delaware State University, Dover, DE, USA
| | - Philip R Gehrman
- Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA; Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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45
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Real-world evaluation of digital CBT for insomnia in the primary care setting – many should not log on to doze off. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x19000242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractCognitive behaviour therapy for insomnia (CBTi) has emerged as the first-line treatment for insomnia where available. Clinical trials of digital CBTi (dCBTi) have demonstrated similar efficacy and drop-out rates to face-to-face CBTi. Most patients entering clinical trials are carefully screened to exclude other sleep disorders. This is a case series review of all those referred to a dCBTi within an 18-month time period. Those initially screened, accepted after exclusion of other sleep disorders, commencing and completing therapy were assessed to understand patient population referred from general practice in the UK. 390 patient referrals were analysed. 135 were suitable for dCBTi with a high rate of other sleep disorders detected in screening. 78 completed therapy (20.0%) and 44.9% had significant improvement in sleep outcomes, achieving ≥20% improvement in final sleep efficiency. dCBTi can be used within the UK NHS with good benefit for those who are selected as having insomnia and who then complete therapy. Many referrals are made with those likely to have distinct primary sleep disorders highlighting the need for education regarding sleep and sleep disorders prior to dCBTi therapy.Key learning aims(1)The use of unsupported digital cognitive behavioural therapy for insomnia (dCBTi) requires proper patient selection.(2)There are many insomnia mimics and also previously unrecognized sleep and psychiatric disturbances that are under-diagnosed in the primary care setting that are contraindications for unsupported dCBTi.(3)The use of a stepped care approach similar to the UK’s Improving Access to Psychological Therapies (IAPT) model using dCBTi could be feasible in the public health setting.
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46
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Increased Interval From Initial Evaluation to Initial Voice Therapy Session is Associated With Missed Voice Therapy Appointments. J Voice 2019; 34:870-873. [PMID: 31176529 DOI: 10.1016/j.jvoice.2019.05.007] [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: 03/03/2019] [Revised: 04/24/2019] [Accepted: 05/13/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Voice therapy (VT) is an essential component to a successful treatment of laryngological disorders and thus patient outcomes depend on patient compliance with VT. As volume of VT patients' ebb and flow, there is often variation in wait times for initial VT sessions. There is a paucity research evaluating VT latency and missed appointments. It is important to find associations between latency and patient compliance to assist with increasing the quality of patient care in all voice and swallowing clinics and decreasing missed appointments for VT following. Should a clinical setting be able to make changes to better care for the patients, it may show a substantial change in missed appointments and patient outcomes. OBJECTIVE/HYPOTHESIS To determine what factors contribute to missed initial VT session and specifically whether patients who have a time interval of >4 weeks from their initial interdisciplinary evaluation to their initial VT session are more likely to not attend. STUDY DESIGN Retrospective analysis of a database, at a tertiary academic voice and swallowing center. METHODS A prospective voice and swallowing database was evaluated for new voice patient evaluations starting from January 1, 2014 to December 31, 2017. Patients with a primary diagnosis of dysphonia or dyspnea and scheduled for VT after the initial patient evaluation in an interdisciplinary laryngology clinic were included. RESULTS Three hundred and eighteen patients (mean age = 5.27, standard deviation 16.0) met the inclusion criteria. Patients were 73% (n = 231) female, and 81% White/Caucasian. Univariate analysis shows that insurance type, profession, body mass index, interval to VT appointment, Reflux Severity Index (RSI), and Eating Assessment Tool-10 scores were associated with missed appointment rates. Multivariate logistic regression model demonstrated interval to VT, RSI, race, and profession were significant factors in missed appointments. Patients with an interval >4 weeks, were more likely to miss their appointment, as compared to patients <4 weeks (odds ratio 2.07 95% confidence interval 1.18-3.60). CONCLUSION The data presented suggests that patients who have their first VT appointment greater than 4-weeks from the time of their initial interdisciplinary evaluation have an increased risk of missed appointment. Race, RSI, and professional voice use also appear to play a role in missed appointment rates.
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Abstract
This article reviews the literature on cognitive-behavioral therapy for insomnia in adults and adolescents with depression. Recent research has expanded on previous research, which established that sleep problems are an important predictor of depression and that sleep problems are associated with more severe depression, more suicidality, and worse outcomes for treatment of depression. The relationship between sleep problems and depression is complex, likely bidirectional, and impactful. To further improve the lives of patients with depression who experience insomnia, it will be important to investigate which patients will do better in a sequential versus concomitant approach.
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Affiliation(s)
- Lauren D Asarnow
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Room 3342, Stanford, CA 94305, USA.
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Room 3337, Stanford, CA 94305, USA
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Rusch HL, Rosario M, Levison LM, Olivera A, Livingston WS, Wu T, Gill JM. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Ann N Y Acad Sci 2019; 1445:5-16. [PMID: 30575050 PMCID: PMC6557693 DOI: 10.1111/nyas.13996] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/29/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022]
Abstract
There is a growing interest in the effectiveness of mindfulness meditation for sleep disturbed populations. Our study sought to evaluate the effect of mindfulness meditation interventions on sleep quality. To assess for relative efficacy, comparator groups were restricted to specific active controls (such as evidenced-based sleep treatments) and nonspecific active controls (such as time/attention-matched interventions to control for placebo effects), which were analyzed separately. From 3303 total records, 18 trials with 1654 participants were included. We determined the strength of evidence using four domains (risk of bias, directness of outcome measures, consistency of results, and precision of results). At posttreatment and follow-up, there was low strength of evidence that mindfulness meditation interventions had no effect on sleep quality compared with specific active controls (ES 0.03 (95% CI -0.43 to 0.49)) and (ES -0.14 (95% CI -0.62 to 0.34)), respectively. Additionally, there was moderate strength of evidence that mindfulness meditation interventions significantly improved sleep quality compared with nonspecific active controls at postintervention (ES 0.33 (95% CI 0.17-0.48)) and at follow-up (ES 0.54 (95% CI 0.24-0.84)). These preliminary findings suggest that mindfulness meditation may be effective in treating some aspects of sleep disturbance. Further research is warranted.
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Affiliation(s)
- Heather L. Rusch
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | - Michael Rosario
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | | | - Anlys Olivera
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | - Whitney S. Livingston
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | - Tianxia Wu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda,
Maryland
| | - Jessica M. Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
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49
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Cognitive Behavioral Therapy for Insomnia in Patients with Medical and Psychiatric Comorbidities. Sleep Med Clin 2019; 14:167-175. [DOI: 10.1016/j.jsmc.2019.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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50
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Predictors of Adherence to Psychological Treatment for Insomnia and Pain: Analysis from a Randomized Trial. Clin J Pain 2019; 34:375-382. [PMID: 28915152 DOI: 10.1097/ajp.0000000000000546] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Poor adherence to psychological treatment for insomnia is common and limits treatment gains. Very little is known about predictors of adherence among patients with chronic pain, although adherence is theorized to be more critical and more challenging for these patients. This secondary data analysis examines predictors of drop-out and therapy nonattendance in an osteoarthritis population receiving psychological treatment for insomnia and pain. METHODS Data were analyzed from the "Lifestyles" trial, a randomized controlled trial of a 6-week group cognitive behavioral pain coping skills intervention (CBT-P), group cognitive-behavioral therapy for pain and insomnia (CBT-PI), and an education only attention control group (EOC). The current analysis focuses on 122 participants randomized to CBT-PI from 6 primary care clinics. Measures of treatment acceptability, demographics, and symptoms were collected at baseline. Factor analysis was used to clarify the boundaries of these domains, and hierarchical regression was used to examine the incremental predictive power of these patient characteristics on therapy attendance. RESULTS Ratings of treatment acceptability were distinct from demographic and medical variables and baseline symptoms. Treatment acceptability was significantly related to session attendance and drop-out (rs ranging from 0.24 to 0.32) and was also one of the strongest predictors of session attendance (β=0.20; P<0.05). DISCUSSION Perceptions of treatment acceptability early in treatment represent a potentially modifiable target to enhance adherence to psychological treatment for insomnia and pain among patients with chronic pain. This work represents an important step towards understanding how to best maximize sleep treatments for this patient population.
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