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Peng A, Ji S, Lai W, Hu D, Wang M, Zhao X, Chen L. The bidirectional relationship between sleep disturbance and anxiety: Sleep disturbance is a stronger predictor of anxiety. Sleep Med 2024; 121:63-68. [PMID: 38924831 DOI: 10.1016/j.sleep.2024.06.022] [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: 02/08/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Both sleep disturbance and anxiety are common problems that significantly affect human health, but little is known about their causal relationship. The aim of this study was to explore the causal relationship between them with a large sample of community-dwelling adults included. METHODS Data for this study were extracted from the baseline survey of West China Natural Population Cohort Study (WCNPCS) and follow-up in the following year. The sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI), and anxiety was screened using the Generalized Anxiety Disorder Scale (GAD-7). Age, gender, educational level, marital status, smoking status, drinking status, depressive symptoms, loneliness and chronic diseases were taken as covariant factors. Logistic regression and cross-lagged models were used for data analyses. RESULTS A total of 16699 participants (67.5 % females) were enrolled, with the average age of participants being 57.3 ± 12.7 years. A total of 40.50 % of participants experienced poor sleep quality at baseline and 40.52 % at follow-up. The prevalence of anxiety was 7.58 % at baseline and 4.62 % at follow-up. The results showed that the risk of developing anxiety in individuals with sleep disturbance at baseline was 1.89 times higher than those without (95%CI = 1.43-2.48). Similarly, anxiety increased the risk of developing sleep disturbance by 1.20-fold (95%CI = 1.03-1.39). These results were further supported by the cross-lagged panel models. CONCLUSION Sleep disturbance and anxiety are mutually causal, and the effect of poor sleep on anxiety seems to be more significant. Timely interventions targeting sleep may help to break the vicious circle between sleep disturbance and anxiety symptoms, and improve the quality of life.
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Affiliation(s)
- Anjiao Peng
- Department of Neurology and Joint Research Institute of Altitude Health, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Shuming Ji
- Department of Clinical Research Management, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Wanlin Lai
- Department of Neurology and Joint Research Institute of Altitude Health, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Dan Hu
- Department of Clinical Research Management, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Mingda Wang
- Department of Clinical Research Management, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Xia Zhao
- Department of Clinical Research Management, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Lei Chen
- Department of Neurology and Joint Research Institute of Altitude Health, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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Jacoby RJ, Brown ML, Wieman ST, Rosenfield D, Hoeppner SS, Bui E, Hoge EA, Khalsa SBS, Hofmann SG, Simon NM. Effect of cognitive behavioural therapy and yoga for generalised anxiety disorder on sleep quality in a randomised controlled trial: the role of worry, mindfulness, and perceived stress as mediators. J Sleep Res 2024; 33:e13992. [PMID: 37577773 PMCID: PMC10840983 DOI: 10.1111/jsr.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/06/2023] [Accepted: 06/23/2023] [Indexed: 08/15/2023]
Abstract
Sleep disturbances are present in ~65% of individuals with generalised anxiety disorder (GAD). Although both Kundalini yoga (KY) and cognitive behavioural therapy (CBT) are effective treatment options for GAD, little is known about how these treatments compare in improving sleep for GAD and what drives these changes. Accordingly, we examined the effects of CBT, KY, and stress education (SEdu; an attention control condition) on subjective sleep quality (as measured by the Pittsburgh Sleep Quality Index [PSQI] and Insomnia Severity Index [ISI]) in a randomised controlled trial of 226 adults with GAD (mean age 33.37 years; 70% female; 79% White). We hypothesised that both CBT and KY would outperform SEdu in improving sleep disturbances. Three potential mediators of sleep improvement (worry, mindfulness, perceived stress) were also examined. In line with hypotheses, PSQI and ISI scores significantly improved from pre- to post-treatment for all three treatment groups (all p < 0.001, all d > 0.97). However, contrary to predictions, sleep changes were not significantly greater for CBT or KY compared to SEdu. In mediation analyses, within-person deviations in worry, mindfulness, and stress each significantly mediated the effect of time on sleep outcomes. Degree of change in sleep attributable to worry (CBT > KY > SEdu) and perceived stress (CBT, KY > SEdu) was moderated by treatment group. Personalised medicine as well as combined treatment approaches should be studied to help reduce sleep difficulties for patients with GAD who do not respond.
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Affiliation(s)
- Ryan J. Jacoby
- Massachusetts General Hospital / Harvard Medical School, Department of Psychiatry, 185 Cambridge St, Suite 2000, Boston, MA 02114, USA
| | - Mackenzie L. Brown
- University of Louisville, Department of Psychology, 2301 S 3rd St, Louisville, KY 40292, USA
| | - Sarah T. Wieman
- Suffolk University, Department of Psychology, 73 Tremont St., Boston, MA 02108, USA
| | - David Rosenfield
- Southern Methodist University, Department of Psychology, P.O. Box 750442, Dallas, TX 75275, USA
| | - Susanne S. Hoeppner
- Massachusetts General Hospital / Harvard Medical School, Department of Psychiatry, 185 Cambridge St, Suite 2000, Boston, MA 02114, USA
| | - Eric Bui
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), GIP Cyceron, Caen, France & Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - Elizabeth A. Hoge
- Georgetown University Medical Center, Department of Psychiatry, 2115 Wisconsin Ave, NW, Suite 200, Washington, DC, 20007, USA
| | - Sat Bir S. Khalsa
- Brigham and Women’s Hospital / Harvard Medical School, Division of Sleep and Circadian Disorders, Department of Medicine, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Stefan G. Hofmann
- Philipps-University Marburg, Department of Clinical Psychology, Schulstrasse 12, 35037 Marburg/Lahn, Germany
| | - Naomi M. Simon
- New York University Grossman School of Medicine, Department of Psychiatry, One Park Avenue, 8th Floor, New York NY 10016, USA
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Xiao H, Shen Y, Zhang W, Lin R. Applicability of the cognitive model of generalized anxiety disorder to adolescents' sleep quality: A cross-sectional and longitudinal analysis. Int J Clin Health Psychol 2023; 23:100406. [PMID: 37663041 PMCID: PMC10472235 DOI: 10.1016/j.ijchp.2023.100406] [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: 06/28/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Background Poor sleep quality is a prevalent health issue among adolescents, and few studies have examined the variables affecting adolescents' sleep quality from the perspective of the co-occurrence of sleep issues and anxiety disorders. Therefore, the current study investigated whether the cognitive model of generalized anxiety disorder applies to adolescents' sleep quality. Method In Study 1, a total of 2042 adolescents were recruited and they completed questionnaires relating to worry, intolerance of uncertainty (IU), negative problem orientation (NPO), cognitive avoidance (CA), and sleep quality. In Study 2, a total of 379 adolescents participated in a six-month longitudinal survey to verify the model that was obtained in Study 1. Results Study 1 showed the modified cognitive model of generalized anxiety disorder can be applied to adolescents' sleep quality. Specifically, IU was a higher-order vulnerability factor that directly affected worry, and indirectly fostered worry via NPO and CA, where worry only mediated the relationships between IU, NPO, and sleep quality. However, CA exerted no independent effect on worry or sleep quality beyond the influences of IU and NPO, therefore, it dropped out of the final model. Study 2 partially confirmed the above model again from the longitudinal perspective. Conclusion The present study constructs a new model to explain adolescents' sleep quality, providing a foundation for future interventions.
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Affiliation(s)
- Huiwen Xiao
- School of Psychology, Fujian Normal University, Fuzhou 350117, China
- Department of Psychology, Renmin University of China, Beijing 100872, China
| | - Yilin Shen
- School of Psychology, Fujian Normal University, Fuzhou 350117, China
| | - Weizhong Zhang
- School of Psychology, Fujian Normal University, Fuzhou 350117, China
| | - Rongmao Lin
- School of Psychology, Fujian Normal University, Fuzhou 350117, China
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Luo R, Li J, Shang M, Peng Z, Wang Z, Gu J. Behavioral and psychosocial factors and their effects on insomnia among people undergoing entry quarantine in hotels during COVID-19 pandemic: a cross-sectional study in Guangzhou, China. BMC Public Health 2023; 23:996. [PMID: 37248484 DOI: 10.1186/s12889-023-15340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/28/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic continues to impact global health and China requires a 14-day quarantine for individuals on flights with positive COVID-19 cases. This quarantine can impact mental well-being, including sleep. This study aims to examine the impact of psychosocial and behavioral factors on insomnia among individuals undergoing quarantine in hotels. METHODS This study was a cross-sectional survey carried out in Guangzhou, China. The data was gathered through online questionnaires distributed to international passengers who arrived in Guangzhou on flights and were required to undergo a 14-day quarantine in hotels arranged by the local government. The questionnaires were sent to the participants through the government health hotline "12,320." RESULTS Of the 1003 passengers who were quarantined, 6.7% reported significant anxiety and 25.0% had varying degrees of insomnia. Anxiety was positively associated with insomnia (β = 0.92, P < 0.001), while collectivism (β = -0.07, P = 0.036), indoor exercise (β = -0.50, P < 0.001), and the perceived people orientation of the public health service (β = -0.20, P = 0.001) were negatively associated with insomnia. The study also identified moderating effects, such that a higher sense of collectivism, a greater frequency of indoor exercise, and a higher perception of the people-oriented of the public health service were associated with a lower impact of anxiety on insomnia. These moderating effects were also observed in participants with varying degrees of insomnia. CONCLUSIONS This study reveals that a proportion of people undergoing entry quarantine experience insomnia and confirms how psychosocial and behavioral factors can alleviate insomnia in this population.
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Affiliation(s)
- Rui Luo
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, No.74, Zhongshan Second Road, Guangzhou, 510080, China
| | - Jinghua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, No.74, Zhongshan Second Road, Guangzhou, 510080, China
- Sun Yat-Sen University Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-Sen University, Guangzhou, 510080, China
- Guangdong Key Laboratory of Health Informatics, Guangzhou, 510080, China
| | - Menglin Shang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, No.74, Zhongshan Second Road, Guangzhou, 510080, China
| | - Zhili Peng
- Department of Logistics and Security, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Zhiwei Wang
- Department of 12320 Health Hotline, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, No.74, Zhongshan Second Road, Guangzhou, 510080, China.
- Sun Yat-Sen University Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-Sen University, Guangzhou, 510080, China.
- Guangdong Key Laboratory of Health Informatics, Guangzhou, 510080, China.
- Guangzhou Joint Research Center for Disease Surveillance, Early Warning, and Risk Assessment, Guangzhou, China.
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Seifritz E, Kasper S, Möller HJ, Volz HP, Müller WE, Eckert A, Hatzinger M. Effect of anxiolytic drug silexan on sleep - a narrative review. World J Biol Psychiatry 2022; 23:493-500. [PMID: 36259937 DOI: 10.1080/15622975.2021.2013092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Silexan is an orally administered, proprietary essential oil from Lavandula angustifolia with significant anxiolytic and sleep improving properties. Here we present a narrative review that provides an overview of the available evidence of the effects of silexan on sleep. METHODS We start with a summary of the pharmacological background and continue with presenting sleep-related results from controlled clinical trials with silexan. Then we report on a meta-analysis of item 'insomnia' from the Hamilton Anxiety Scale, which includes data from all randomised, placebo-controlled clinical trials with silexan in which the scale was administered. Finally, we summarise the results of a mediation analysis that was performed to elucidate the pathway of the effect of silexan on sleep. RESULTS In randomised, placebo-controlled trials in patients suffering from anxiety disorders silexan had a significant anxiolytic effect and improved sleep along with recovery from anxiety. Mediation analysis demonstrates that more than 98% of the effect of silexan on sleep was mediated by its anxiolytic effect while the direct effect on sleep was marginal. CONCLUSIONS Silexan improves sleep as a result of its anxiolytic effect.
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Affiliation(s)
- Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Center of Brain Research, Medical University of Vienna, Vienna, Austria
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Walter E Müller
- Department of Pharmacology Biocenter, Goethe University, Frankfurt, Germany
| | - Anne Eckert
- Transfaculty Research Platform MCN & Psychiatric University Hospital Basel, University of Basel, Switzerland
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Fear of Sleep Inventory- Short Form (FoSI-SF): A validation study for Turkish speaking populations. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02991-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Psychological impact on COVID-19 patients during the outbreak in China: A case-control study. Psychiatry Res 2021; 305:114180. [PMID: 34461357 PMCID: PMC8381686 DOI: 10.1016/j.psychres.2021.114180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) has caused widespread panic due to its highly infectious and pandemic transmission. We aimed to evaluate the psychological impact of the COVID-19 outbreak on infected subjects in China. METHODS This case-control, survey-based study assessed the psychological status of COVID-19 patients and non-infected controls from February 10 to March 18, 2020, in China. Sex, age, education years, marital status, jobs, annual household income, living status, and geographic origin were matched between the two groups. The main outcome measures included anxiety, depression, insomnia, help-seeking behaviors, and treatment for mental problems. RESULTS A total of 326 patients and 1304 (1:4 ratio) matched non-infected controls were enrolled. Compared with controls, patients had higher scores on the Beck Anxiety Inventory (BAI), Patient Health Questionnaire-9 (PHQ-9), and Insomnia Severity Index (ISI) (all p<0.01). Patients had higher rate of any mental problems (62.6% vs 42.5%, p<0.01), anxiety (27.3% vs 12.2%, p<0.01), depression (26.7% vs 14.6%, p<0.01), suicidal ideation (16.0% vs 10.7%, p<0.01), and insomnia (57.7% vs 36.7%, p<0.01). Among the subjects with mental problems, the proportion of seeking help (15.2% vs 6.9%, p<0.01) and receiving treatment (11.3% vs 4.3%, p<0.01) was higher in patients than controls. CONCLUSIONS Our study showed a higher prevalence of mental problems in COVID-19 patients compared to controls, suggesting a great psychological impact of COVID-19 infection. Our findings highlighted the urgent need for psychological assistance for COVID-19 patients.
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8
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Cognitive behavioural therapy for insomnia for patients with co-morbid generalized anxiety disorder: an open trial on clinical outcomes and putative mechanisms. Behav Cogn Psychother 2021; 49:540-555. [PMID: 33504410 DOI: 10.1017/s1352465821000023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Very little is known concerning the efficacy of psychosocial treatments for patients with insomnia disorder co-morbid with generalized anxiety disorder (GAD). AIM The aim was to examine the efficacy of cognitive behavioral therapy for insomnia (CBT-I) for patients with insomnia disorder co-morbid with GAD. METHOD Given the limited, previous research on therapies for patients with insomnia disorder co-morbid with GAD, an open trial design was used. Twenty-four patients with insomnia disorder and GAD were administered CBT-I across 10 weeks. Across the study period to 6 months follow-up, the participants completed measures indexing insomnia, anxiety, worry, depression, functional impairment, quality of life, treatment perception (credibility, expectancy and satisfaction), adverse events and putative mechanisms. RESULTS Moderate to large effect sizes for CBT-I were observed for insomnia symptoms. In terms of insomnia severity, approximately 61% of the patients responded to CBT-I and 26-48% remitted. Moderate to large effect sizes were also demonstrated for GAD symptoms, depression, functional impairment and quality of life. Roughly one-third of the participants reported an adverse event during CBT-I. Five of the seven putative mechanisms were significantly reversed in the expected direction, i.e. all four cognitive process measures and time in bed. CONCLUSIONS This open trial indicates that CBT-I is an efficacious intervention for patients with insomnia disorder co-morbid with GAD. The results highlight the need for further research using a randomized controlled trial design with analyses of mechanisms of change.
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9
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Huang Y, Zhou Y, Wei Y, Zeng L, Yang J, Li Y, Song X, Li H, He H, Li T, Wu K, Yang M, Wu F, Ning Y, Zhang X. Differences in the Association of Anxiety, Insomnia and Somatic Symptoms between Medical Staff and the General Population During the Outbreak of COVID-19. Neuropsychiatr Dis Treat 2021; 17:1907-1915. [PMID: 34163164 PMCID: PMC8214107 DOI: 10.2147/ndt.s300719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the outbreak of coronavirus disease 2019 (COVID-19), occupational differences were recognized with respect to psychological issues, but there are no reports regarding the insomnia and anxiety comorbidities and their related factors among the general public and medical staff. Our study aimed to compare the prevalence of anxiety and anxiety with insomnia, as well as the relationship between different psychological symptoms between the two groups. METHODS A total of 605 medical staff and 1091 public respondents were assessed through an online questionnaire survey, including the 7-item Insomnia Severity Index (ISI), the somatization subscale of Symptom Checklist 90-Revised (SCL-90-R), and the 7-item Generalized Anxiety Disorder scale (GAD-7). RESULTS Compared with the general public, medical staff had a higher incidence of anxiety (45.5% vs 32.4%). The incidence of insomnia in anxious participants was 52.7% in medical staff and 44.6% in the general public, and the difference was significant (p < 0.05). The GAD-7 score and somatization subscore of the SCI-90 were independently associated with insomnia among anxiety participants in both groups (all p < 0.001). CONCLUSION Our findings suggest that during the epidemic period of COVID-19, medical staff experienced more anxiety and anxiety with insomnia. Somatization, anxiety and insomnia are highly correlated among medical staff and the general public.
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Affiliation(s)
- Yuanyuan Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Yongjie Zhou
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, People's Republic of China
| | - Yi Wei
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Lingyun Zeng
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, People's Republic of China
| | - Jiezhi Yang
- Department of Psychiatry, Shenzhen Health Development Research Center, Shenzhen, People's Republic of China
| | - Yi Li
- Department of Psychiatry, Shenzhen Kangning Hospital, Shenzhen, People's Republic of China
| | - Xiuli Song
- Clinical Psychology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, People's Republic of China
| | - Hehua Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Hongbo He
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Ting Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Kai Wu
- Department of Biomedical Engineering, School of Materials Science and Engineering, South China University of Technology (scUT), Guangzhou, People's Republic of China
| | - Mingzhe Yang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China.,Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, People's Republic of China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Yuping Ning
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Xiangyang Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, People's Republic of China.,CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
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10
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Kaczkurkin AN, Tyler J, Turk-Karan E, Belli G, Asnaani A. The Association between Insomnia and Anxiety Symptoms in a Naturalistic Anxiety Treatment Setting. Behav Sleep Med 2021; 19:110-125. [PMID: 31955594 PMCID: PMC7369215 DOI: 10.1080/15402002.2020.1714624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective/Background: Few studies have examined the relationship between insomnia and anxiety treatment outcomes in naturalistic settings. Furthermore, prior studies typically examine insomnia within a single anxiety diagnosis without accounting for the high overlap between disorders. Here we investigate the association between insomnia and multiple anxiety disorders over a course of cognitive behavioral treatment (CBT) in a naturalistic treatment setting. Participants: Insomnia was assessed in 326 patients seeking treatment at a clinic specializing in CBT for anxiety. Methods: Multilevel modeling was used to investigate whether insomnia moderated reductions in anxiety symptoms. A cross-lagged analysis tested for bidirectional effects between insomnia and anxiety. Multiple regression was used to investigate the relationship between insomnia and anxiety while controlling for the other anxiety disorders and depression. Results: While there was a significant reduction in insomnia during treatment in all anxiety disorders, the majority of the most severe patients remained in the clinical range at post-treatment. Baseline insomnia did not significantly moderate anxiety outcomes, suggesting that patients with high or low levels of insomnia will do equally well in CBT for anxiety. The bidirectional effect between insomnia and anxiety did not reach significance. Additionally, posttraumatic stress disorder, generalized anxiety disorder, and panic disorder were associated with the greatest endorsement of insomnia, after controlling for the overlap between disorders. Conclusions: Sleep problems may persist after anxiety treatment, suggesting that CBT for insomnia may be warranted during or after a course of CBT for anxiety. Importantly, baseline insomnia does not impede anxiety reduction during CBT.
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Affiliation(s)
| | - Jeremy Tyler
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, Philadelphia, PA, USA 19104
| | - Elizabeth Turk-Karan
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, Philadelphia, PA, USA 19104
| | - Gina Belli
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, Philadelphia, PA, USA 19104
| | - Anu Asnaani
- University of Utah, Department of Psychology, Salt Lake City, UT 84112
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11
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Khodarahimi S, Mirderikvand F, Amraei K. The efficacy of affective and sensory psychotherapy module for sleep disturbances in generalized anxiety disorder. Explore (NY) 2020; 18:17-24. [PMID: 33309467 DOI: 10.1016/j.explore.2020.11.011] [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: 05/28/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study was aimed to examine the effectiveness of a newly developed therapeutic method focusing on affective and sensory processes in the treatment of sleep problems in outpatients with Generalized Anxiety Disorder (GAD), called the 'Affective and Sensory Psychotherapy Module' (ASPM). METHOD A randomised controlled trial was conducted, there were 60 outpatient participants. The Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Pittsburgh Sleep Quality Index (PSQI) were used at baseline, post-treatment, and 3 month follow-up. RESULTS There were no significant differences between the therapeutic and control groups at baseline. The therapeutic group showed a significant improvement in sleep quality and anxiety decrease compared to the control group. Sex differences did not occur in the results for within-subjects and between-group effects in this study. CONCLUSIONS The present study supported the efficacy of ASPM in the treatment of sleep problems in adult outpatients with GAD.
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Affiliation(s)
- Siamak Khodarahimi
- Psychology Department, School of Literature and Humanities Sciences, Lorestan University; Khorramabad, Iran
| | - Fazlolah Mirderikvand
- Psychology Department, School of Literature and Humanities Sciences, Lorestan University; Khorramabad, Iran.
| | - Kourosh Amraei
- Psychology Department, School of Literature and Humanities Sciences, Lorestan University; Khorramabad, Iran
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12
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Cai Q, Feng H, Huang J, Wang M, Wang Q, Lu X, Xie Y, Wang X, Liu Z, Hou B, Ouyang K, Pan J, Li Q, Fu B, Deng Y, Liu Y. The mental health of frontline and non-frontline medical workers during the coronavirus disease 2019 (COVID-19) outbreak in China: A case-control study. J Affect Disord 2020; 275:210-215. [PMID: 32734910 PMCID: PMC7329671 DOI: 10.1016/j.jad.2020.06.031] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Coronavirus disease 2019 (COVID-19) is a new infectious disease with high transmissibility and morbidity. It has caused substantial mental distress to medical professionals. We aimed to compare the psychological impact of the COVID-19 outbreak between frontline and non-frontline medical workers in China. METHODS This case-control study recruited 1173 frontline and 1173 age- and sex-matched non-frontline medical workers during the COVID-19 outbreak (February 11 to 26, 2020). A set of online questionnaires were used to measure mental problems (i.e., anxiety, insomnia, and depressive symptoms), and help-seeking behavior and treatment for these mental problems. RESULTS Frontline medical workers had higher rates of any mental problem (52.6% vs. 34.0%, adjusted OR=1.88, 95% CI=1.57-2.25), anxiety symptoms (15.7% vs. 7.4%, adjusted OR=1.95, 95% CI=1.46-2.61), depressed mood (marginally insignificant; 14.3% vs. 10.1%, adjusted OR=1.32, 95% CI=0.99-1.76) and insomnia (47.8% vs. 29.1%, adjusted OR=1.96, 95% CI=1.63-2.36) than non-frontline medical workers. No significant difference was observed in terms of suicidal ideation (12.0% vs. 9.0%, adjusted OR=1.25, 95% CI=0.92-1.71), help-seeking (4.5% vs. 4.5%, adjusted OR=1.00, 95% CI=0.53-1.87) or treatment (3.4% vs. 2.3%, adjusted OR=1.38, 95% CI=0.54-3.52) for mental problems. LIMITATIONS The case-control nature of the data precludes causal inferences, and there is a possibility of bias related to self-reports. CONCLUSIONS Frontline medical workers had more mental problems but comparable help-seeking behaviors and treatment for these problems than non-frontline medical workers. These findings highlight the timely mental support and intervention for medical workers, especially for those on the frontline.
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Affiliation(s)
- Qi Cai
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Hongliang Feng
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jing Huang
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Meiyao Wang
- Department of Ultrasonography, Zhongnan hospital of Wuhan University, Wuhan 430071, Hubei, PR China
| | - Qunfeng Wang
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China; Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Xuanzhen Lu
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Yu Xie
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Xing Wang
- Department of Neurology, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, PR China
| | - Zhenxing Liu
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Botong Hou
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Keni Ouyang
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China
| | - Jing Pan
- Department of Infectious Diseases, Xiaogan hospital affiliated to Wuhan university of science and technology, Xiaogan, Hubei, PR China
| | - Qin Li
- Department of Neurology, The Third people's hospital of Hubei province Affiliated to Wuhan University, Wuhan, Hubei, PR China
| | - Beibei Fu
- Department of Neurology, Shiyan people's hospital, Hubei University of Medicine, ShiYan, Hubei, PR China
| | - Yongchao Deng
- Department of Neurology, The second people's hospital of Jingzhou, Jingzhou, Hubei, PR China
| | - Yumin Liu
- Department of Neurology, Zhongnan hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, Hubei, PR China.
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Moulding HA, Bartsch U, Hall J, Jones MW, Linden DE, Owen MJ, van den Bree MBM. Sleep problems and associations with psychopathology and cognition in young people with 22q11.2 deletion syndrome (22q11.2DS). Psychol Med 2020; 50:1191-1202. [PMID: 31144615 DOI: 10.1017/s0033291719001119] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Young people with 22q11.2 deletion syndrome (22q11.2DS) are at high risk for neurodevelopmental disorders. Sleep problems may play a role in this risk but their prevalence, nature and links to psychopathology and cognitive function remain undescribed in this population. METHOD Sleep problems, psychopathology, developmental coordination and cognitive function were assessed in 140 young people with 22q11.2DS (mean age = 10.1, s.d. = 2.46) and 65 unaffected sibling controls (mean age = 10.8, s.d.SD = 2.26). Primary carers completed questionnaires screening for the children's developmental coordination and autism spectrum disorder. RESULTS Sleep problems were identified in 60% of young people with 22q11.2DS compared to 23% of sibling controls (OR 5.00, p < 0.001). Two patterns best-described sleep problems in 22q11.2DS: restless sleep and insomnia. Restless sleep was linked to increased ADHD symptoms (OR 1.16, p < 0.001) and impaired executive function (OR 0.975, p = 0.013). Both patterns were associated with elevated symptoms of anxiety disorder (restless sleep: OR 1.10, p = 0.006 and insomnia: OR 1.07, p = 0.045) and developmental coordination disorder (OR 0.968, p = 0.0023, and OR 0.955, p = 0.009). The insomnia pattern was also linked to elevated conduct disorder symptoms (OR 1.53, p = 0.020). CONCLUSIONS Clinicians and carers should be aware that sleep problems are common in 22q11.2DS and index psychiatric risk, cognitive deficits and motor coordination problems. Future studies should explore the physiology of sleep and the links with the neurodevelopment in these young people.
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Affiliation(s)
- H A Moulding
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff, CF24 4HQ, UK
| | - U Bartsch
- School Physiology, Pharmacology & Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, BS8 1TD, UK
- Lilly UK, Erl Wood Manor, Windlesham, Surrey, GU20 6PH, UK
| | - J Hall
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff, CF24 4HQ, UK
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - M W Jones
- School Physiology, Pharmacology & Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, BS8 1TD, UK
| | - D E Linden
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff, CF24 4HQ, UK
- Cardiff University Brain Research Imaging Centre, Maindy Road, Cardiff, CF24 4HQ, UK
| | - M J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff, CF24 4HQ, UK
| | - M B M van den Bree
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff, CF24 4HQ, UK
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Richards A, Kanady JC, Neylan TC. Sleep disturbance in PTSD and other anxiety-related disorders: an updated review of clinical features, physiological characteristics, and psychological and neurobiological mechanisms. Neuropsychopharmacology 2020; 45:55-73. [PMID: 31443103 PMCID: PMC6879567 DOI: 10.1038/s41386-019-0486-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 02/08/2023]
Abstract
The current report provides an updated review of sleep disturbance in posttraumatic stress disorder and anxiety-related disorders. First, this review provides a summary description of the unique and overlapping clinical characteristics and physiological features of sleep disturbance in specific DSM anxiety-related disorders. Second, this review presents evidence of a bidirectional relationship between sleep disturbance and anxiety-related disorders, and provides a model to explain this relationship by integrating research on psychological and neurocognitive processes with a current understanding of neurobiological pathways. A heuristic neurobiological framework for understanding the bidirectional relationship between abnormalities in sleep and anxiety-related brain pathways is presented. Directions for future research are suggested.
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Affiliation(s)
- Anne Richards
- The San Francisco VA Health Care System, San Francisco, CA, USA.
- The University of California, San Francisco, San Francisco, CA, USA.
| | - Jennifer C Kanady
- The San Francisco VA Health Care System, San Francisco, CA, USA
- The University of California, San Francisco, San Francisco, CA, USA
| | - Thomas C Neylan
- The San Francisco VA Health Care System, San Francisco, CA, USA
- The University of California, San Francisco, San Francisco, CA, USA
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15
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Comparing primary insomnia to the insomnia occurring in major depression and general anxiety disorder. Psychiatry Res 2019; 282:112514. [PMID: 31474379 DOI: 10.1016/j.psychres.2019.112514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/16/2022]
Abstract
Apart from possibly distinguishing the different clinical causes of insomnia, this article explores the subjective and objective sleep differences amongst primary insomnia, major depression with insomnia and general anxiety disorder with insomnia. Subjective sleep and objective sleep of the participants were evaluated by using the Pittsburgh sleep quality index and polysomnography, respectively. We found that major depression with insomnia exhibited higher daytime dysfunction than primary insomnia; showed significantly higher values of rapid eye movement (REM) periods, time of REM sleep and percentage of REM stage; and presented lower percentage of non-rapid eye movement stage compared with primary insomnia and general anxiety disorder with insomnia (p < 0.05). General anxiety disorder with insomnia showed lower awakening number (AN) than primary insomnia, and other objective and subjective sleep values of general anxiety disorder with insomnia and primary insomnia showed no significant difference (p > 0.05). Our findings showed that major depression with insomnia increased active REM sleep and severe daytime function, which could alert clinicians to the risk of depression. Major depression with insomnia and primary insomnia may be categorically different. However, general anxiety disorder with insomnia and primary insomnia might be a continuum of a disease rather than be categorically distinct.
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16
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Seifritz E, Schläfke S, Holsboer-Trachsler E. Beneficial effects of Silexan on sleep are mediated by its anxiolytic effect. J Psychiatr Res 2019; 115:69-74. [PMID: 31121394 DOI: 10.1016/j.jpsychires.2019.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 12/15/2022]
Abstract
Disturbed sleep is among the most prevalent hyperarousal symptoms in anxiety disorders. Most drugs recommended for anxiety and insomnia have a sedating effect which is related to their beneficial effect on disturbed sleep. Silexan is a proprietary essential oil from Lavandula angustifolia. This drug has significant anxiolytic and sleep improving properties. Interestingly, these effects are not associated with sedation. Here we asked whether the positive effects on sleep are due to primary pharmacodynamic or secondary, disease related effects. We used the data from a double-blind, randomized study in which 212 patients were analyzed for efficacy after ten weeks' treatment with 80 mg/day Silexan or placebo. Anxiety and disturbed sleep were assessed using the Hamilton Anxiety Scale (HAMA) and the Pittsburgh Sleep Quality Index (PSQI), respectively. Regression-based mediation analysis was employed to estimate direct treatment effects and indirect effects mediated by anxiety control separately for each study group. Sobel's test was used to investigate the extent to which the mediator (HAMA change) contributes to the total effect of the independent variable (treatment) on the dependent variable (PSQI change). Compared to placebo, Silexan significantly reduced the total scores of the HAMA (p < 0.001) and of the PSQI (p = 0.002) after ten weeks, with clinically meaningful treatment group differences that were observed already after two and six weeks for HAMA and PSQI, respectively. Silexan had a statistically meaningful indirect effect on sleep (mediated by the effect on anxiety; p < 0.001) but no appreciable direct effect (p = 0.958). The ratio between the indirect and the total effect was determined to be 0.984, i. e., 98.4% of the total effect of Silexan on disturbed sleep were explained by the effect of Silexan on the symptoms of anxiety whereas 1.6% were attributable to a direct effect. The results indicate that Silexan exerts a secondary sleep improving effect almost exclusively through its anxiolytic action rather than by sedation. Findings are consistent with the drug's assumed mechanism of action.
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Affiliation(s)
- Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich Lenggstrasse, 31/PO-Box 1931, 8032, Zürich, Switzerland.
| | - Sandra Schläfke
- Dr. Willmar Schwabe GmbH & Co. KG, Willmar-Schwabe-Straße 4, 76227, Karlsruhe, Germany.
| | - Edith Holsboer-Trachsler
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland.
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17
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Volel BA, Petelin DS, Poluektov MG. [Modern concepts about insomnia in mental disorders: clinical aspects]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:63-68. [PMID: 31317917 DOI: 10.17116/jnevro201911904263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Insomnia is one of the most common symptoms of mental pathology (affective, anxious, hypochondriac, asthenic, psychotic) and reveals a number of characteristic features depending on the structure of the mental disorder. Psychopharmacotherapy for insomnia in mental disorders is an important aspect of patient supervision. Doxylamine (donormil) is one of the promising drugs for the correction of insomnia, both in combination with other psychotropic drugs and in monotherapy.
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Affiliation(s)
- B A Volel
- University Clinical Hospital #3 of Sechenov First Moscow State Medical University Ministry of Health, Moscow, Russia
| | - D S Petelin
- University Clinical Hospital #3 of Sechenov First Moscow State Medical University Ministry of Health, Moscow, Russia
| | - M G Poluektov
- Sechenov First Moscow State Medical University Ministry of Health, Moscow, Russia
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18
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Repetitive transcranial magnetic stimulation of the right parietal cortex for comorbid generalized anxiety disorder and insomnia: A randomized, double-blind, sham-controlled pilot study. Brain Stimul 2018; 11:1103-1109. [DOI: 10.1016/j.brs.2018.05.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 05/20/2018] [Accepted: 05/26/2018] [Indexed: 01/04/2023] Open
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19
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Scogin F, Lichstein K, DiNapoli EA, Woosley J, Thomas SJ, LaRocca MA, Byers HD, Mieskowski L, Parker CP, Yang X, Parton J, McFadden A, Geyer JD. Effects of Integrated Telehealth-Delivered Cognitive-Behavioral Therapy for Depression and Insomnia in Rural Older Adults. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2018; 28:292-309. [PMID: 30930607 DOI: 10.1037/int0000121] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background We examined the effects of integrated cognitive-behavioral therapy for depression and insomnia (CBT-D + CBT-I) delivered via videoconferening in rural, middle aged and older adults with depressive and insomnia symptoms. Method Forty patients with depressive and insomnia symptoms were randomized to receive either 10 sessions of CBT-D + CBT-I or usual care (UC). Patients in the integrated CBT condition were engaged in telehealth treatment through Skype at their primary care clinic. Assessments were conducted at baseline, post-treatment, and 3-month follow-up. Results CBT-D +CBT-I participants had significantly greater improvements in sleep at post-treatment and 3-month follow-up as compared to the UC participants. The time by group interaction for depression was not significant; both the CBT-D + CBT-I and UC conditions had a decrease in depressive symptoms over time. Conclusion While integrated CBT benefits both depression and insomnia symptoms, its effects on depression are more equivocal. Further research should consider expanding the depression treatment component of integrated CBT to enhance effectiveness.
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Affiliation(s)
- Forrest Scogin
- Department of Psychology, University of Alabama, Tuscaloosa, AL
| | | | - Elizabeth A DiNapoli
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | | - S Justin Thomas
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL
| | | | - Haley D Byers
- Southeast Permanente Medical Group, Kaiser Permanente, Atlanta, GA
| | - Lisa Mieskowski
- Department of Psychology, University of Alabama, Tuscaloosa, AL
| | | | - Xin Yang
- Culverhouse College of Commerce and Business Administration, University of Alabama, Tuscaloosa, AL
| | - Jason Parton
- Culverhouse College of Commerce and Business Administration, University of Alabama, Tuscaloosa, AL
| | - Anna McFadden
- College of Human Environmental Sciences, University of Alabama, Tuscaloosa, AL
| | - James D Geyer
- Alabama Neurology and Sleep Medicine, Tuscaloosa, AL
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20
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Schiller H, Söderström M, Lekander M, Rajaleid K, Kecklund G. A randomized controlled intervention of workplace-based group cognitive behavioral therapy for insomnia. Int Arch Occup Environ Health 2018; 91:413-424. [PMID: 29387936 PMCID: PMC5908834 DOI: 10.1007/s00420-018-1291-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 01/22/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Sleep disturbance is common in the working population, often associated with work stress, health complaints and impaired work performance. This study evaluated a group intervention at work, based on cognitive behavioral therapy (CBT) for insomnia, and the moderating effects of burnout scores at baseline. METHODS This is a randomized controlled intervention with a waiting list control group. Participants were employees working at least 75% of full time, reporting self-perceived regular sleep problems. Data were collected at baseline, post-intervention and at a 3-month follow-up through diaries, wrist-actigraphy and questionnaires including the Insomnia Severity Index (ISI) and the Shirom-Melamed Burnout Questionnaire (SMBQ). Fifty-one participants (63% women) completed data collections. RESULTS A multilevel mixed model showed no significant differences between groups for sleep over time, while there was a significant effect on insomnia symptoms when excluding participants working shifts (N = 11) from the analysis (p = 0.044). Moreover, a moderating effect of baseline-levels of burnout scores was observed on insomnia symptoms (p = 0.009). A post-hoc analysis showed that individuals in the intervention group with low burnout scores at baseline (SMBQ < 3.75) displayed significantly reduced ISI scores at follow-up, compared to individuals with high burnout scores at baseline (p = 0.005). CONCLUSIONS Group CBT for insomnia given at the workplace did not reduce sleep problems looking at the group as a whole, while it was indicated that the intervention reduced insomnia in employees with regular daytime work. The results also suggest that workplace-based group CBT may improve sleep in employees with primary insomnia if not concomitant with high burnout scores.
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Affiliation(s)
- Helena Schiller
- Stress Research Institute, Stockholm University, 10691, Stockholm, Sweden.
| | - Marie Söderström
- Stress Research Institute, Stockholm University, 10691, Stockholm, Sweden
- KBT-Centralen, Stockholm, Sweden
| | - Mats Lekander
- Stress Research Institute, Stockholm University, 10691, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristiina Rajaleid
- Stress Research Institute, Stockholm University, 10691, Stockholm, Sweden
- Center for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Göran Kecklund
- Stress Research Institute, Stockholm University, 10691, Stockholm, Sweden
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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21
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Meaklim H, Swieca J, Junge M, Laska I, Kelly D, Joyce R, Cunnington D. The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure identifies high levels of coexistent psychiatric symptomatology in patients referred for insomnia treatment. Nat Sci Sleep 2018; 10:377-383. [PMID: 30464665 PMCID: PMC6223387 DOI: 10.2147/nss.s173381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Referrals to sleep psychology services, even for a perceived single problem such as insomnia, can present with complex, coexistent psychiatric symptoms and comorbid disorders. This study aimed to assess the feasibility of implementing the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure (CCSM) into a sleep psychology clinic to identify coexistent psychiatric symptomatology in insomnia referrals. PATIENTS AND METHODS Patients were 50 consecutive referrals to a private sleep psychology service within a sleep disorders center in Melbourne, Australia. Patients who attended sleep psychology services between June 2015 and January 2017 had their clinical records reviewed. Basic demographic information, comorbidities, and responses to the Insomnia Severity Index were gathered. The Diagnostic and Statistical Manual of Mental Disorders Ed. 5 Task Force and Work Groups created the CCSM in 2013 to deal with the issue of coexistent psychiatric symptomatology across mental health conditions, and this measure was included into the sleep psychology intake procedure and patient responses were reviewed. RESULTS The CCSM was simple and quick to administer and score and revealed high levels of psychiatric symptomatology in sleep psychology referrals. Sleep problems were the most common domain of psychiatric symptomatology reported (86%). Anxiety (66%), depression (64%), anger (64%), and somatic symptoms (50%) were also very common. Suicidal ideation was acknowledged by 26% of patients. In addition, 82% of patients had at least one diagnosed comorbidity upon referral (eg, psychiatric, physical health, or other sleep disorder). CONCLUSION The findings support the CCSM as a feasible measure for identifying the high levels of coexistent psychiatric symptomatology in patients presenting for insomnia treatment at sleep psychology services.
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Affiliation(s)
- Hailey Meaklim
- Melbourne Sleep Disorders Centre, East Melbourne, VIC, Australia, .,Discipline of Psychology, RMIT University, Bundoora, VIC, Australia
| | - John Swieca
- Melbourne Sleep Disorders Centre, East Melbourne, VIC, Australia,
| | - Moira Junge
- Melbourne Sleep Disorders Centre, East Melbourne, VIC, Australia,
| | - Irena Laska
- Melbourne Sleep Disorders Centre, East Melbourne, VIC, Australia,
| | - Danielle Kelly
- Melbourne Sleep Disorders Centre, East Melbourne, VIC, Australia, .,Sleep Disorders Unit, St Vincent's Private Hospital, East Melbourne and Werribee, VIC Australia
| | - Rosemarie Joyce
- Melbourne Sleep Disorders Centre, East Melbourne, VIC, Australia, .,Sleep Disorders Unit, St Vincent's Private Hospital, East Melbourne and Werribee, VIC Australia
| | - David Cunnington
- Melbourne Sleep Disorders Centre, East Melbourne, VIC, Australia,
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22
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Huang Z, Zhan S, Chen C, Li N, Ding Y, Hou Y, Wang L, Wang Y. The Effect of Insomnia on Cortical Excitability in Patients With Generalized Anxiety Disorder. Front Psychiatry 2018; 9:755. [PMID: 30687140 PMCID: PMC6335338 DOI: 10.3389/fpsyt.2018.00755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/20/2018] [Indexed: 12/16/2022] Open
Abstract
The high rate of comorbidity between insomnia and anxiety disorders have been confirmed by previous studies. However, the underlying neurobiological correlates of the relationship between insomnia and anxiety disorders are largely unknown. The aim of the present study was to investigate the effect of insomnia on cortical excitability in patients with generalized anxiety disorder (GAD) by examining the recovery functions of median nerve somatosensory evoked potentials (SEPs) in patients with GAD without insomnia and patients with GAD comorbid with insomnia. We studied the recovery functions of median nerve SEPs in 12 medication-naive patients with GAD without insomnia, 15 medication-naive patients with GAD comorbid with insomnia, and 15 age and sex matched healthy controls. SEPs in response to single stimulus and paired stimuli at interstimulus intervals (ISIs) of 20, 60, 100, and 150 ms were recorded. The recovery function of the P25 component showed significantly reduced suppression in patients with GAD without insomnia as compared to patients with GAD comorbid with insomnia and healthy controls. There were no significant differences in the recovery functions of median nerve SEPs between patients with GAD comorbid with insomnia and healthy controls. The present study suggested that the cortical excitability of right parietal cortex increased in patients with GAD without insomnia, and cortical excitability in patients with GAD comorbid with insomnia was modulated by insomnia. Our findings provide new insights into the underlying neurobiological correlates of the effects of insomnia on GAD, which could ultimately be used to inform clinical intervention.
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Affiliation(s)
- Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Shuqin Zhan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Chao Chen
- Key Laboratory of Complex System Control Theory and Application, Tianjin University of Technology, Tianjin, China
| | - Ning Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yan Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yue Hou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Li Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
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Hui C, Zhihui Y. Group cognitive behavioral therapy targeting intolerance of uncertainty: a randomized trial for older Chinese adults with generalized anxiety disorder. Aging Ment Health 2017; 21:1294-1302. [PMID: 27592635 DOI: 10.1080/13607863.2016.1222349] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES China has entered the aging society, but the social support systems for the elderly are underdeveloped, which may make the elderly feel anxiety about their health and life quality. Given the prevalence of generalized anxiety disorder (GAD) in the elderly, it is very important to pay more attention to the treatment for old adults. Although cognitive behavioral therapy targeting intolerance of uncertainty (CBT-IU) has been applied to different groups of patients with GAD, few studies have been performed to date. In addition, the effects of CBT-IU are not well understood, especially when applied to older adults with GAD. METHOD Sixty-three Chinese older adults with a principal diagnosis of GAD were enrolled. Of these, 32 were randomized to receive group CBT-IU (intervention group) and 31 were untreated (control group). GAD and related symptoms were assessed using the Penn State Worry Questionnaire, Intolerance of Uncertainty Scale-Chinese Version, Beck Anxiety Inventory, Beck Depression Inventory, Why Worry-II scale, Cognitive Avoidance Questionnaire, Generalized Anxiety Disorder Questionnaire-IV, and Generalized Anxiety Disorder Severity Scale across the intervention. The changes between pre and after the intervention were collected, as well as the six-month follow-up. F test and repeated-measures ANOVA were conducted to analyze the data. RESULTS Compared to control group, the measures' scores of experimental group decreased significantly after the intervention and six-month follow-up. Besides the main effects for time and group were significant, the interaction effect for group × time was also significant. These results indicated the improvement of the CBT-IU group and the persistence of effect after six months. CONCLUSION Group CBT-IU is effective in Chinese older adults with GAD. The effects of CBT-IU on GAD symptoms persist for at least six months after treatment.
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Affiliation(s)
- Chen Hui
- a Department of Psychology, School of Humanities and Social Sciences , Beijing Forestry University , Beijing , P. R. China
| | - Yang Zhihui
- a Department of Psychology, School of Humanities and Social Sciences , Beijing Forestry University , Beijing , P. R. China
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Ferre Navarrete F, Pérez Páramo M, Fermin Ordoño J, López Gómez V. Prevalence of Insomnia and Associated Factors in Outpatients With Generalized Anxiety Disorder Treated in Psychiatric Clinics. Behav Sleep Med 2017; 15:491-501. [PMID: 27167699 DOI: 10.1080/15402002.2016.1163703] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sleep disturbance is one of the key diagnostic criteria for generalized anxiety disorder (GAD). In this cross-sectional, prospective, observational, and multicenter study, factors associated with the prevalence of insomnia and the impact of insomnia-associated factors on quality of life were evaluated. Using multivariate analyses, the factor most strongly associated with the presence of insomnia (ISI ≥ 8) was the severity of the disorder (Odds Ratio [OR]: 9.253 for severe GAD; 95% Confidence Interval [CI]: 1.914-44.730; p = 0.006), pain interference and symptoms of depression (OR: 1.018; 95% CI 1.003-1.033; p = 0.016 and OR: 1.059; 95% CI 1.019-1.101; p = 0.004, respectively). Insomnia was not related to quality of life. Our results show insomnia to be a common health condition among patients with GAD, associated with the severity of anxiety and depressive symptoms and pain interference.
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Affiliation(s)
- F Ferre Navarrete
- a Servicio Psiquiatría B ., Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | | | - J Fermin Ordoño
- c Servicio de Neurofisiología , Hospital Arnau de Vilanova , Madrid , Spain
| | - V López Gómez
- b Medical Unit, Pfizer GEP, S. L. U ., Madrid , Spain
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Pace-Schott EF, Zimmerman JP, Bottary RM, Lee EG, Milad MR, Camprodon JA. Resting state functional connectivity in primary insomnia, generalized anxiety disorder and controls. Psychiatry Res 2017; 265:26-34. [PMID: 28500965 PMCID: PMC5505504 DOI: 10.1016/j.pscychresns.2017.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/05/2017] [Accepted: 05/07/2017] [Indexed: 11/17/2022]
Abstract
Sleep abnormalities are extremely common in anxiety disorders and may contribute to their development and persistence. Their shared pathophysiological mechanisms could thus serve as biomarkers or targets for novel therapeutics. Individuals with Primary Insomnia were age- and sex-matched to controls and to persons with Generalized Anxiety Disorder. All underwent fMRI resting-state scans at 3-T. In Primary Insomnia and controls, sleep was recorded for 2 weeks using diaries and actigraphy. All participants completed state-anxiety and neuroticism inventories. Whole-brain connectivity of 6 fear- and extinction-related seeds were compared between the 3 groups using ANOVA. The only significant between-group main effect was seen for connectivity between the left amygdala seed and a bilateral cluster in the rostral anterior cingulate cortex. The latter is believed to exert top-down control over amygdala activity and their interaction may thus constitute an emotion regulatory circuit. This connectivity was significantly greatest in controls while Primary Insomnia was intermediate between that of controls and Generalized Anxiety Disorder. Across Primary Insomnia and control subjects, mean connectivity decreased with poorer sleep. Across all 3 groups, connectivity decreased with greater neuroticism and pre-scan anxiety. Decreased top-down control of the amygdala may increase risk of developing an anxiety disorder with preexisting Primary Insomnia.
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Affiliation(s)
- Edward F Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA.
| | - Jared P Zimmerman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Ryan M Bottary
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Erik G Lee
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Mohammed R Milad
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
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26
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Intolerance of uncertainty and adolescent sleep quality: The mediating role of worry. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2016.12.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sleep Problems are Associated With Chronic Pain Over and Above Mutual Associations With Depression and Catastrophizing. Clin J Pain 2016; 32:792-9. [DOI: 10.1097/ajp.0000000000000329] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Bélanger L, Harvey AG, Fortier-Brochu É, Beaulieu-Bonneau S, Eidelman P, Talbot L, Ivers H, Hein K, Lamy M, Soehner AM, Mérette C, Morin CM. Impact of comorbid anxiety and depressive disorders on treatment response to cognitive behavior therapy for insomnia. J Consult Clin Psychol 2016; 84:659-67. [PMID: 26963600 PMCID: PMC4949114 DOI: 10.1037/ccp0000084] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the impact of comorbid anxiety or depressive disorders on treatment response to cognitive-behavior therapy (CBT) for insomnia, behavior therapy (BT), or cognitive therapy (CT). METHOD Participants were 188 adults (117 women; Mage = 47.4 years) with chronic insomnia, including 45 also presenting a comorbid anxiety or mild to moderate depressive disorder. They were randomized to BT (n = 63), CT (n = 65), or CBT (n = 60). Outcome measures were the proportion of treatment responders (decrease of ≥8 points on the Insomnia Severity Index; ISI) and remissions (ISI score < 8) and depression and anxiety symptoms. RESULTS Proportion of treatment responders and remitters in the CBT condition was not significantly different between the subgroups with and without comorbidity. However, the proportion of responders was lower in the comorbidity subgroup compared to those without comorbidity in both the BT (34.4% vs. 81.6%; p = .007) and CT (23.6% vs. 57.6%; p = .02) alone conditions, although remission rates and prepost ISI change scores were not. Pre to post change scores on the depression (-10.6 vs. -3.9; p < .001) and anxiety measures (-9.2 vs. -2.5; p = .01) were significantly greater in the comorbidity subgroup relative to the subgroup without comorbidity but only for those treated with the full CBT; no difference was found for those treated with either BT or CT alone. CONCLUSIONS The presence of a comorbid anxiety or mild to moderate depressive disorder did not reduce the efficacy of CBT for insomnia, but it did for its single BT and CT components when used alone. (PsycINFO Database Record
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Affiliation(s)
- Lynda Bélanger
- Université Laval and Institut Universitaire en Santé Mentale de Québec, Québec, Canada
- CHU de Québec-Université Laval, Québec, Canada
| | | | - Émilie Fortier-Brochu
- Université Laval and Institut Universitaire en Santé Mentale de Québec, Québec, Canada
| | | | | | | | - Hans Ivers
- Université Laval and Institut Universitaire en Santé Mentale de Québec, Québec, Canada
| | | | - Manon Lamy
- Université Laval and Institut Universitaire en Santé Mentale de Québec, Québec, Canada
| | | | - Chantal Mérette
- Université Laval and Institut Universitaire en Santé Mentale de Québec, Québec, Canada
| | - Charles M. Morin
- Université Laval and Institut Universitaire en Santé Mentale de Québec, Québec, Canada
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McGowan SK, Behar E, Luhmann M. Examining the Relationship Between Worry and Sleep: A Daily Process Approach. Behav Ther 2016; 47:460-73. [PMID: 27423163 DOI: 10.1016/j.beth.2015.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/19/2022]
Abstract
There is growing evidence suggesting that worry and sleep are intimately linked. However, the relationship between these two phenomena over the course of a day remains largely unstudied. It is possible that (a) worry predicts sleep disturbance that night, (b) sleep disturbance predicts worry the following day, or (c) there is a bidirectional relationship between worry and sleep disturbance. The present study examined the daily relationship between worry (both during the day and immediately prior to sleep onset) and sleep in 50 high trait worriers who were randomly assigned to one of two interventions aimed at reducing worry as part of a larger study. A daily process approach was utilized wherein participants completed daily reports of sleep and worry during a 7-day baseline period followed by a 14-day intervention period. Results of repeated measures multilevel modeling analyses indicated that worry experienced on a particular day predicted increased sleep disturbance that night during both the baseline and intervention weeks. However, there was no evidence of a bidirectional relationship as sleep characteristics did not predict worry the following day. Additionally, the type of intervention that participants engaged in did not affect the daily relationship between worry and sleep. Results of the present study are consistent with the cognitive model of insomnia (Harvey, 2002) and highlight the importance of addressing and treating worry among individuals with high trait worry and sleep disturbance.
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Affiliation(s)
| | | | - Maike Luhmann
- University of Illinois at Chicago; University of Cologne
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30
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Singh A, Ghazvini P, Robertson N, Massey AJ, Kirksey O, Honeywell MS. Sleep Disturbances in Patients With Psychiatric Illnesses. J Pharm Pract 2016. [DOI: 10.1177/0897190007300735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sleep is essential not only for our physical well-being but also for our mental well-being. Researchers, however, have determined that specific alterations in sleep patterns do exist among patients with psychiatric illnesses. The causes of these abnormalities include both direct and indirect mechanisms. These abnormalities lead to declines in both cognitive function and quality of life. Management should include both nonpharmacological and pharmacological methods. This article will review the types of sleep abnormalities associated with schizophrenia, depression, bipolar disorder, and anxiety disorders and will additionally review treatment options available for each illness.
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Affiliation(s)
- Angela Singh
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Tallahassee,
| | - Patty Ghazvini
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Tallahassee
| | | | - Angela J. Massey
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Tallahassee
| | - Otis Kirksey
- Division of Pharmacy Practice at Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Tallahassee
| | - Marlon S. Honeywell
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Tallahassee
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Belleville G, Ivers H, Bélanger L, Blais FC, Morin CM. Sequential Treatment of Comorbid Insomnia and Generalized Anxiety Disorder. J Clin Psychol 2016; 72:880-96. [DOI: 10.1002/jclp.22300] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/22/2015] [Accepted: 02/19/2016] [Indexed: 11/07/2022]
Affiliation(s)
| | - Hans Ivers
- École de Psychologie; Université Laval; Québec Canada
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Jonsson K, Kjellgren A. Promising effects of treatment with flotation-REST (restricted environmental stimulation technique) as an intervention for generalized anxiety disorder (GAD): a randomized controlled pilot trial. Altern Ther Health Med 2016; 16:108. [PMID: 27016217 PMCID: PMC4807536 DOI: 10.1186/s12906-016-1089-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/19/2016] [Indexed: 11/24/2022]
Abstract
Background During Flotation-REST a person is floating inside a quiet and dark tank, filled with heated salt saturated water. Deep relaxation and beneficial effects on e.g. stress, sleep difficulties, anxiety and depression have been documented in earlier research. Despite that treatments for generalized anxiety disorder (GAD) are effective; it is till the least successfully treated anxiety disorder, indicating that treatment protocols can be enhanced. The use of Flotation-REST as a treatment of GAD has not been researched. The aim of the present study was to conduct an initial evaluation of the effects in a self-diagnosed GAD sample. Methods This study was a randomized, parallel group, non-blinded trial with 1:1 allocation ratio to waiting list control group (n = 25) or to a twelve session treatment with flotation-REST (n = 25). Inclusion criteria’s were: 18–65 years and GAD (as defined by self-report measures). The primary outcome was GAD-symptomatology, and secondary outcomes were depression, sleep difficulties, emotion regulation difficulties and mindfulness. Assessments were made at three time points (baseline, four weeks in treatment, post-treatment), and at six-month follow-up. The main data analyses were conducted with a two-way MANOVA and additional t-tests. Forty-six participants (treatment, n = 24; control, n = 22) were included in the analyses. Results A significant Time x Group interaction effect for GAD-symptomatology [F(2,88) = 2.93, p < .001, ηp2 = .062] was found. Further analyses showed that the GAD-symptomatology was significantly reduced for the treatment group (t(23) = 4.47, p < .001), but not for the waiting list control group (t(21) = 0.98, p > .05), when comparing baseline to post-treatment scoring. Regarding clinical significant change, 37 % in the treatment group reached full remission at post-treatment. Significant beneficial effects were also found for sleep difficulties, difficulties in emotional regulation, and depression, while the treatment had ambiguous or non-existent effects on pathological worry and mindfulness. All improved outcome variables at post-treatment, except for depression, were maintained at 6-months follow. No negative effects were found. Conclusion The findings suggest that the method has potential as a complementary treatment alongside existing treatment for GAD. More studies are warranted to further evaluate the treatments efficacy. Trial registration Australian New Zealand Clinical Trial Registry: ACTRN12613001105730, Date of registration: 03/10/2013
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McGowan SK, Espejo EP, Balliett N, Werdowatz EA. The Effects of Transdiagnostic Group CBT for Anxiety on Insomnia Symptoms. Cogn Behav Ther 2016; 45:163-75. [DOI: 10.1080/16506073.2015.1134639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ramsawh HJ, Bomyea J, Stein MB, Cissell SH, Lang AJ. Sleep Quality Improvement During Cognitive Behavioral Therapy for Anxiety Disorders. Behav Sleep Med 2016; 14:267-78. [PMID: 26244485 PMCID: PMC4744149 DOI: 10.1080/15402002.2014.981819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite the ubiquity of sleep complaints among individuals with anxiety disorders, few prior studies have examined whether sleep quality improves during anxiety treatment. The current study examined pre- to posttreatment sleep quality improvement during cognitive behavioral therapy (CBT) for panic disorder (PD; n = 26) or generalized anxiety disorder (GAD; n = 24). Among sleep quality indices, only global sleep quality and sleep latency improved significantly (but modestly) during CBT. Sleep quality improvement was greater for treatment responders, but did not vary by diagnosis. Additionally, poor baseline sleep quality was independently associated with worse anxiety treatment outcome, as measured by higher intolerance of uncertainty. Additional intervention targeting sleep prior to or during CBT for anxiety may be beneficial for poor sleepers.
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Affiliation(s)
- Holly J. Ramsawh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences
| | - Jessica Bomyea
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego,Department of Family & Preventive Medicine, University of California San Diego
| | | | - Ariel J. Lang
- Department of Psychiatry, University of California San Diego,VA San Diego Health Care System, Center of Excellence for Stress and Mental Health
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35
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Efficacy of sleep education program based on principles of cognitive behavioral therapy to alleviate workers’ distress. Sleep Biol Rhythms 2015. [DOI: 10.1007/s41105-015-0045-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Boland EM, Ross RJ. Recent Advances in the Study of Sleep in the Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder. Psychiatr Clin North Am 2015; 38:761-76. [PMID: 26600107 DOI: 10.1016/j.psc.2015.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sleep disturbance is frequently associated with generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. This article reviews recent advances in understanding the mechanisms of the sleep disturbances in these disorders and discusses the implications for developing improved treatments.
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Affiliation(s)
- Elaine M Boland
- Behavioral Health, Mental Illness Research Education and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA.
| | - Richard J Ross
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
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Geiger-Brown JM, Rogers VE, Liu W, Ludeman EM, Downton KD, Diaz-Abad M. Cognitive behavioral therapy in persons with comorbid insomnia: A meta-analysis. Sleep Med Rev 2015; 23:54-67. [DOI: 10.1016/j.smrv.2014.11.007] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 12/21/2022]
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Raines AM, Short NA, Sutton CA, Oglesby ME, Allan NP, Schmidt NB. Obsessive-compulsive symptom dimensions and insomnia: The mediating role of anxiety sensitivity cognitive concerns. Psychiatry Res 2015; 228:368-72. [PMID: 26162661 DOI: 10.1016/j.psychres.2015.05.081] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 04/26/2015] [Accepted: 05/25/2015] [Indexed: 11/30/2022]
Abstract
Existing research on the relationship between obsessive-compulsive disorder (OCD) and insomnia is scarce. Moreover, no research has examined potential mechanisms that may account for the observed relations among OCD and sleep difficulties. The cognitive concerns subscale of anxiety sensitivity (AS), which reflects fears of mental incapacitation, has been linked to both symptoms of OCD and insomnia and may serve as a mechanism for increasing sleep disturbance among patients with OCD. The current study examined the relationship between OCD symptoms and insomnia and the potential mediating role of AS cognitive concerns. The sample consisted of 526 individuals recruited through Amazon's Mechanical Turk (Mturk), an online crowdsourcing marketplace. Results revealed distinct associations between the unacceptable thoughts domain of OCD and symptoms of insomnia. Additionally, AS cognitive concerns mediated the relationship between these constructs. Future research should seek to replicate these findings using clinical samples and prospective designs.
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Affiliation(s)
- Amanda M Raines
- Department of Psychology, Florida State University, 1107W Call St., Tallahassee, FL 32306-4301, USA
| | - Nicole A Short
- Department of Psychology, Florida State University, 1107W Call St., Tallahassee, FL 32306-4301, USA
| | - Carson A Sutton
- Department of Psychology, Florida State University, 1107W Call St., Tallahassee, FL 32306-4301, USA
| | - Mary E Oglesby
- Department of Psychology, Florida State University, 1107W Call St., Tallahassee, FL 32306-4301, USA
| | - Nicholas P Allan
- Department of Psychology, Florida State University, 1107W Call St., Tallahassee, FL 32306-4301, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107W Call St., Tallahassee, FL 32306-4301, USA.
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Morris J, Firkins A, Millings A, Mohr C, Redford P, Rowe A. Internet-delivered cognitive behavior therapy for anxiety and insomnia in a higher education context. ANXIETY STRESS AND COPING 2015; 29:415-31. [PMID: 26079158 DOI: 10.1080/10615806.2015.1058924] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Anxiety and insomnia can be treated with internet-delivered Cognitive Behavioral Therapy (iCBT). iCBT may be well-suited to students who are known to be poor help-seekers and suffer these symptoms. iCBT can offer easy access to treatment and increase service availability. The aim of this study was to evaluate the efficacy of anxiety and insomnia iCBT programs in students. DESIGN A randomized, controlled study. METHODS Students were randomly allocated to intervention ("Anxiety Relief": n = 43; "Insomnia Relief": n = 48; control: n = 47). Interventions lasted six weeks. Outcome measures were the State-Trait Anxiety Inventory and the Pittsburgh Sleep Quality Index. RESULTS Significant within-group reductions in anxiety (t(31) = 2.00, p = .03) with moderate between-groups (compared to control) effect size (d = .64) and increases in sleep quality (t(31) = 3.46, p = .002) with a moderate between-groups effect size (d = .55) were found for completers of the anxiety program from pre- to post-intervention. Significant within-group increases in sleep quality were found for completers of the insomnia program from pre- to post-intervention (t(35) = 4.28, p > .001) with a moderate between-groups effect size (d = .51). CONCLUSIONS Findings support the use of iCBT for anxiety and insomnia in students, and indicate that further research is needed.
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Affiliation(s)
- Joanna Morris
- a School of Experimental Psychology , University of Bristol , 12a Priory Road, Bristol BS8 1TU , UK
| | - Ashlyn Firkins
- a School of Experimental Psychology , University of Bristol , 12a Priory Road, Bristol BS8 1TU , UK
| | - Abigail Millings
- b Department of Psychology , University of Sheffield , Western Bank, Sheffield S10 2TP , UK
| | - Christine Mohr
- c Institut de psychologie, Université de Lausanne , Quartier UNIL-Dorigny, Bâtiment Anthropole, CH-1015 Lausanne , Switzerland
| | - Paul Redford
- d Department of Psychology , University of the West of England , Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY , UK
| | - Angela Rowe
- a School of Experimental Psychology , University of Bristol , 12a Priory Road, Bristol BS8 1TU , UK
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Gilbert KS, Kark SM, Gehrman P, Bogdanova Y. Sleep disturbances, TBI and PTSD: Implications for treatment and recovery. Clin Psychol Rev 2015; 40:195-212. [PMID: 26164549 DOI: 10.1016/j.cpr.2015.05.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 04/27/2015] [Accepted: 05/13/2015] [Indexed: 12/26/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD), traumatic brain injury (TBI), and sleep problems significantly affect recovery and functional status in military personnel and Veterans returning from combat. Despite recent attention, sleep is understudied in the Veteran population. Few treatments and rehabilitation protocols target sleep, although poor sleep remains at clinical levels and continues to adversely impact functioning even after the resolution of PTSD or mild TBI symptoms. Recent developments in non-pharmacologic sleep treatments have proven efficacious as stand-alone interventions and have potential to improve treatment outcomes by augmenting traditional behavioral and cognitive therapies. This review discusses the extensive scope of work in the area of sleep as it relates to TBI and PTSD, including pathophysiology and neurobiology of sleep; existing and emerging treatment options; as well as methodological issues in sleep measurements for TBI and PTSD. Understanding sleep problems and their role in the development and maintenance of PTSD and TBI symptoms may lead to improvement in overall treatment outcomes while offering a non-stigmatizing entry in mental health services and make current treatments more comprehensive by helping to address a broader spectrum of difficulties.
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Affiliation(s)
- Karina Stavitsky Gilbert
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Sarah M Kark
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States
| | - Philip Gehrman
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States; Philadelphia VA Medical Center, Philadelphia, PA, United States
| | - Yelena Bogdanova
- Psychology Research, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States.
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Raines AM, Portero AK, Unruh AS, Short NA, Schmidt NB. An Initial Investigation of the Relationship Between Insomnia and Hoarding. J Clin Psychol 2015; 71:707-14. [PMID: 25760757 DOI: 10.1002/jclp.22161] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Insomnia has been shown to have profound negative consequences on multiple aspects of daily functioning. Despite increased interest in the association between insomnia and psychopathology, no research has examined the relationships between insomnia and hoarding. The aim of the current investigation was to examine the associations between insomnia and hoarding severity. METHODS Participants consisted of patients with hoarding disorder (n = 24). RESULTS Results revealed that insomnia was a significant predictor of increased hoarding severity. In addition, when examining the relationships among insomnia and specific hoarding symptoms, sleep difficulties were associated with increased acquiring and difficulty discarding behaviors. CONCLUSIONS These findings add to a growing body of literature on insomnia and various forms of psychopathology, as well as research on symptoms related to hoarding. Reducing insomnia symptoms among hoarders may help to reduce hoarding-related behaviors and increase treatment efficacy.
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Default-mode network activity and its role in comprehension and management of psychophysiological insomnia: A new perspective. NEW IDEAS IN PSYCHOLOGY 2015. [DOI: 10.1016/j.newideapsych.2014.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cognitive behavioural therapy for anxiety disorders and insomnia: a commentary on future directions. COGNITIVE BEHAVIOUR THERAPIST 2014. [DOI: 10.1017/s1754470x14000117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAnxiety disorders and insomnia significantly impair daily functioning. Similar underlying mechanisms may account for the high comorbidity of both disorders, and respective treatments share pharmacological and behavioural features. This review suggests the utility of an integrated CBT approach in the treatment of generalized anxiety, post-traumatic stress, and panic disorders, and comorbid insomnia. Other anxiety disorders were not explored because current data are limited or inconsistent. A comprehensive, non-systematic review of the literature was conducted to evaluate the treatment of comorbid anxiety and insomnia disorders, and data reveal shared pharmacological and behavioural features of insomnia and anxiety disorders treatment. However, research demonstrates that CBT maintains successful treatment results longer than drug therapies. Despite similar treatment approaches, there is a paucity of research that explores integrated CBT approaches for comorbid anxiety and insomnia disorders. This review suggests that future research should assess the impact of combined therapeutic approaches on the simultaneous reduction of anxiety disorders, insomnia, and relapse rates.
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Abstract
Sleep issues are common in people with psychiatric disorders, and the interaction is complex. Sleep disorders, particularly insomnia, can precede and predispose to psychiatric disorders, can be comorbid with and exacerbate psychiatric disorders, and can occur as part of psychiatric disorders. Sleep disorders can mimic psychiatric disorders or result from medication given for psychiatric disorders. Impairment of sleep and of mental health may be different manifestations of the same underlying neurobiological processes. For the primary care physician, key tools include recognition of potential sleep effects of psychiatric medications and familiarity with treatment approaches for insomnia in depression and anxiety.
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Affiliation(s)
- Eliza L Sutton
- Department of Medicine, University of Washington, 4245 Roosevelt Way Northeast, Box 354765, Seattle, WA 98105, USA.
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Hamoen ABH, Redlich EM, de Weerd AW. Effectiveness of cognitive behavioral therapy for insomnia: influence of slight-to-moderate depressive symptom severity and worrying. Depress Anxiety 2014; 31:662-8. [PMID: 24706608 DOI: 10.1002/da.22258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/17/2014] [Accepted: 02/04/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy for insomnia (CBT-I) is a well-known, effective treatment for primary insomnia. However, the majority of sleeping problems occur in the presence of another medical or psychiatric disorder. Depression and general anxiety disorder (with a main feature of excessive generalized worrying) are disorders that frequently co-occur with insomnia. The purpose of this study is to evaluate whether depressive symptom severity or worrying influences the subjective effectiveness of CBT-I. METHODS Patients with a complaint of insomnia received CBT-I. At the beginning of the therapy, patients completed a sleep evaluation list, the Beck Depression Inventory (BDI-II-NL, N = 92), and the Penn State Worry Questionnaire (PSWQ, N = 119). Based on the BDI and the PSWQ, the sample was divided into different groups: patients with low versus high depression scores, low worriers versus high worriers, and patients without depressive symptoms who were also classified as low worriers and patients with depressive symptoms who were also classified as high worriers. The sleep evaluation list was completed directly after the treatment and 6 months later. RESULTS Sleep evaluation scores, subjective total sleep time, subjective sleep onset latency, and subjective wake after sleep onset all changed in a positive way after CBT-I and remained that way over the next 6 months for all patients. These positive effects of CBT-I did not differ between the subgroups. CONCLUSIONS Results suggest that CBT-I improves subjective sleep experiences, regardless of depressive symptom severity or worrying.
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Affiliation(s)
- Astrid B H Hamoen
- Department of Sleep Psychology, Sleep Centre SEIN, Zwolle, The Netherlands
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Fairholme CP, Manber R. Safety behaviors and sleep effort predict sleep disturbance and fatigue in an outpatient sample with anxiety and depressive disorders. J Psychosom Res 2014; 76:233-6. [PMID: 24529043 PMCID: PMC4360894 DOI: 10.1016/j.jpsychores.2014.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 01/01/2014] [Accepted: 01/03/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Theoretical and empirical support for the role of dysfunctional beliefs, safety behaviors, and increased sleep effort in the maintenance of insomnia has begun to accumulate. It is not yet known how these factors predict sleep disturbance and fatigue occurring in the context of anxiety and mood disorders. It was hypothesized that these three insomnia-specific cognitive-behavioral factors would be uniquely associated with insomnia and fatigue among patients with emotional disorders after adjusting for current symptoms of anxiety and depression and trait levels of neuroticism and extraversion. METHODS Outpatients with a current anxiety or mood disorder (N = 63) completed self-report measures including the Dysfunctional Beliefs About Sleep Scale (DBAS), Sleep-Related Safety Behaviors Questionnaire (SRBQ), Glasgow Sleep Effort Scale (GSES), Pittsburgh Sleep Quality Index (PSQI), NEO Five-Factor Inventory (FFI), and the 21-item Depression Anxiety and Stress Scale (DASS). Multivariate path analysis was used to evaluate study hypotheses. RESULTS SRBQ (B = .60, p < .001, 95% CI [.34, .86]) and GSES (B = .31, p < .01, 95% CI [.07, .55]) were both significantly associated with PSQI. There was a significant interaction between SRBQ and DBAS (B = .25, p < .05, 95% CI [.04, .47]) such that the relationship between safety behaviors and fatigue was strongest among individuals with greater levels of dysfunctional beliefs. CONCLUSION Findings are consistent with cognitive behavioral models of insomnia and suggest that sleep-specific factors might be important treatment targets among patients with anxiety and depressive disorders with disturbed sleep.
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Affiliation(s)
- Christopher P Fairholme
- Center for Anxiety and Related Disorders, Boston University, United States; Stanford University, United States.
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Sheehan DV, Svedsäter H, Locklear JC, Eriksson H. Effects of extended-release quetiapine fumarate on long-term functioning and sleep quality in patients with Generalized Anxiety Disorder (GAD): data from a randomized-withdrawal, placebo-controlled maintenance study. J Affect Disord 2013; 151:906-13. [PMID: 24135509 DOI: 10.1016/j.jad.2013.07.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/31/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND This analysis evaluated effects of quetiapine XR maintenance treatment on functioning and sleep in patients with GAD. METHODS Analysis of patient-reported data from a randomized-withdrawal, double-blind, placebo-controlled study of quetiapine XR monotherapy in GAD. Following open-label run-in (4-8 weeks) and a 12-18-week stabilization phase (quetiapine XR 50, 150, or 300 mg/day), eligible patients were randomized to continue on quetiapine XR or receive placebo for up to 52 weeks. Primary variable was time to an anxiety event. Secondary variables included the Sheehan Disability Scale (SDS) and Pittsburgh Sleep Quality Index (PSQI). RESULTS In total, 432 patients were randomized (quetiapine XR, N=216; placebo, N=216). The risk of an anxiety event was significantly reduced for quetiapine XR vs. placebo (HR 0.19; 95% CI 0.12, 0.31; p<0.001). Quetiapine XR was more effective than placebo at maintaining SDS total scores (LSM change: -0.19 vs. 1.01; p=0.017) and non-work-related SDS domain score 'family life/home responsibilities' (-0.13 vs. 0.32; p=0.011), but not 'social life' (0.05 vs. 0.34; p=0.114). Quetiapine XR was more effective than placebo at maintaining the work-related SDS domain score 'days lost' (-0.05 vs. 0.11; p=0.027), but not 'work/school' (-0.10 vs. 0.29; p=0.051) or 'days underproductive' (0.06 vs. 0.13; p=0.619). PSQI global scores were reduced from randomization with quetiapine XR vs. placebo (0.39 vs. 1.60; p<0.001). LIMITATIONS Lack of active-comparator arm, exclusion of patients with comorbid depression. CONCLUSIONS In patients with GAD, long-term treatment with quetiapine XR (50-300 mg/day) monotherapy was effective at maintaining improvements in functioning and sleep quality.
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Affiliation(s)
- David V Sheehan
- University of South Florida College of Medicine, Tampa, FL 33613, USA.
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Abstract
Test anxiety is an incapacitating academic syndrome. This study shows that administration of a polyunsaturated fatty acid mixture of omega-3 and -6 can improve the behavioral variables associated with this type of anxiety, i.e. appetite, mood, mental concentration, fatigue, academic organization and poor sleep, as well as lowering elevated cortisol level, with a corresponding reduction of anxiety.
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Affiliation(s)
- Shlomo Yehuda
- Department of Psychology and Gonda Brain Research Center, Psychopharmacology Laboratory, Bar Ilan University, Ramat Gan, Israel.
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Abstract
Sleep disturbance is a cardinal symptom in both DSM-IV and ICD-10 criteria for generalized anxiety disorder (GAD). This review summarizes the results of clinical trials and pooled analyses that provide data on pregabalin's effect on sleep disturbance in patients diagnosed with GAD. The hypothesized mechanism of action of pregabalin is distinctly different from other anxiolytics. Pregabalin binds to a membrane α2δ subunit protein to inhibit release in excited central nervous system neurons of neurotransmitters implicated in pathological anxiety. Treatment with pregabalin has been found to be associated with significant improvement in GAD-related sleep disturbance across seven placebo-controlled clinical trials. Treatment with pregabalin is associated with improvement in all forms of insomnia and improvement in sleep has been found to be correlated with reduction in functional impairment and improvement in quality of life on subjective global measures. Results of a mediational analysis suggest that 53% of the effect of pregabalin on sleep disturbance was due to a direct effect and 47% was due to an indirect effect, mediated through prior reduction in anxiety symptom severity. In patients with GAD, improvement in sleep has been found to be associated with a reduction in daytime sleepiness. However, dose-related sedation is reported, typically in the first 2 wk of treatment, in approximately 10-30% of patients, depending on the dose used and the speed of titration. Insomnia is a common component of the clinical presentation of GAD and pregabalin appears to be an efficacious treatment for this often chronic and disabling symptom.
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Tsypes A, Aldao A, Mennin DS. Emotion dysregulation and sleep difficulties in generalized anxiety disorder. J Anxiety Disord 2013; 27:197-203. [PMID: 23474909 DOI: 10.1016/j.janxdis.2013.01.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 01/06/2013] [Accepted: 01/13/2013] [Indexed: 10/27/2022]
Abstract
Diagnostic criteria for generalized anxiety disorder (GAD) include sleep problems, which often persist even after successful treatment of the disorder. The purpose of this study was to examine emotion dysregulation as a potential contributor to sleep problems in GAD patients. Participants comprised two groups: 59 individuals diagnosed with GAD and 66 healthy controls. They were assessed for the presence of mood and anxiety disorders and then completed self-report questionnaires assessing problems with sleep and emotion regulation. Participants in the GAD group scored significantly higher on a number of sleep outcomes than did the control group. Importantly, difficulties with emotion regulation statistically mediated the relationship between GAD and a wide range of outcomes of sleep dysfunction independently of the effects of depression and secondary anxiety diagnoses. Emotion regulation difficulties that characterize GAD mediate the relationship between symptoms of this disorder and a wide range of sleep problems. Implications for treatment and future research directions are discussed.
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Affiliation(s)
- Aliona Tsypes
- Department of Psychology, Hunter College, City University of New York, New York, NY 10065, United States.
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