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Chalet FX, Luyet PP, Rabasa C, Vaillant C, Saskin P, Ahuja A, Citrome L. Daridorexant for patients with chronic insomnia disorder: number needed to treat, number needed to harm, and likelihood to be helped or harmed. Postgrad Med 2024; 136:396-405. [PMID: 38814132 DOI: 10.1080/00325481.2024.2359891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Appraise the evidence for daridorexant 50 mg and 25 mg versus placebo when treating chronic insomnia disorder in terms of number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH). METHODS NNT, NNH, and LHH were calculated from a 3-month pivotal Phase 3 study (N = 930; randomized 1:1:1 to daridorexant 50 mg, daridorexant 25 mg, or placebo once nightly). Wakefulness after sleep onset, latency to persistent sleep, self-reported total sleep time, Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ), and Insomnia Severity Index were used for the NNT efficacy analysis. NNH safety analysis was performed using rates of adverse events (AEs) occurring in >1% of the participants in any arm. LHH was assessed for all NNT estimates, contrasting them with NNH estimates for somnolence, headache, and fatigue AEs. RESULTS NNT estimates for daridorexant 50 mg versus placebo were <10 for clinically meaningful thresholds across all outcomes. NNT estimates for daridorexant 25 mg versus placebo were not as robust as those observed for daridorexant 50 mg, with many values exceeding 10. NNH estimates for daridorexant 50 mg and 25 mg versus placebo did not show a statistically significant treatment difference except for falls, where NNH was negative for the daridorexant 50 mg group (-44 [95% CI -328; -21]; rate of falls was greater with placebo than for daridorexant 50 mg). All LHH ratios at Months 1 and 3 were >1 (except for daridorexant 25 mg for the IDSIQ alert/cognition domain), indicating that patients were more likely to respond to daridorexant 50 mg and 25 mg than to experience an AE of somnolence, headache, or fatigue. CONCLUSION Daridorexant 50 mg and 25 mg have a favorable benefit-risk ratio over 3 months. Daridorexant 50 mg demonstrated more robust (lower) NNT estimates versus placebo than daridorexant 25 mg.
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Affiliation(s)
- François-Xavier Chalet
- Global Clinical Development & Medical Affairs, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Pierre-Philippe Luyet
- Global Clinical Development & Medical Affairs, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Cristina Rabasa
- Global Clinical Development & Medical Affairs, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Cédric Vaillant
- Global Clinical Development & Medical Affairs, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Paul Saskin
- Medical Affairs US, Idorsia Pharmaceuticals US Inc, Radnor, PA, USA
| | - Ajay Ahuja
- Medical Affairs US, Idorsia Pharmaceuticals US Inc, Radnor, PA, USA
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
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Bai N, Cao J, Zhang H, Liu X, Yin M. Digital cognitive behavioural therapy for patients with insomnia and depression: A systematic review and meta-analysis. J Psychiatr Ment Health Nurs 2024. [PMID: 38226714 DOI: 10.1111/jpm.13024] [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] [Received: 08/03/2023] [Revised: 12/01/2023] [Accepted: 01/07/2024] [Indexed: 01/17/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT Sleep problems are common among those with depression, and there is increasing evidence that sleep problems should be addressed during treatment simultaneously rather than treating depression alone. The first-line treatment for insomnia is cognitive behavioural therapy for insomnia (CBT-I), due to a lack of well-trained therapists and patient time constraints (travelling, work), CBT-I has not been popularized. The development of digital cognitive behavioural therapy for insomnia (dCBT-I) is making the treatment more accessible. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE Interventions for dCBT-I were significantly better than other control conditions in both reducing insomnia and improving depression in patients with depression and insomnia comorbidities. The effect was found to be related to the duration of the intervention and the severity of insomnia before the intervention and therapist-involved dCBT-I has less shedding than self-help. WHAT ARE THE IMPLICATIONS FOR PRACTICE It's important for mental health practitioners to realize that insomnia in depressed people needs to be treated. Future trials may explore the effectiveness of therapist-guided dCBT-I in depressed populations and analyse the cost-effectiveness of this treatment. ABSTRACT Aim The aim of the study was to systematically identify and synthesize the evidence for the effectiveness of digital cognitive behavioural therapy in insomnia with comorbid depression. Design Systematic review and metaanalysis. Methods A search was conducted on five English and four non-English databases from the inception of the databases to November 2023. This review adhered to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement 2020 and the included studies were evaluated using version 2 of the Cochrane risk of bias tool. This review examined sleep-related outcomes, including insomnia severity and sleep diaries, along with psychological outcomes, such as depression. We conducted a meta-analysis of each outcome using a random effects model. Heterogeneity was assessed by the I2 statistic. Results A total of seven articles with 1864 participants were included in this review. The results showed that the digital cognitive behavioural therapy group demonstrated a statistically significant amelioration in the severity of insomnia symptoms, as well as a reduction in depressive symptomatology compared with the control groups. The post-intervention effect was found to be related to the duration of the intervention and the severity of insomnia before the intervention. Conclusions Digital cognitive behavioural therapy for insomnia application in patients with depression and insomnia was demonstrated to be effective, less time-consuming and more accessible. Relevance to Clinical Practice We may consider incorporating nurses into treatment plans and conducting nurse-led interventions in specific programs. In the future, nurses may be able to provide exclusive digital behavioural therapy for insomnia to patients with depression to achieve greater effectiveness.
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Affiliation(s)
- Nan Bai
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Juling Cao
- Department of Psychiatry, Lanzhou University Second Hospital, Lanzhou, China
| | - Huiyue Zhang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Xin Liu
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Min Yin
- School of Nursing, Lanzhou University, Lanzhou, China
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3
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Riemann D, Espie CA, Altena E, Arnardottir ES, Baglioni C, Bassetti CLA, Bastien C, Berzina N, Bjorvatn B, Dikeos D, Dolenc Groselj L, Ellis JG, Garcia-Borreguero D, Geoffroy PA, Gjerstad M, Gonçalves M, Hertenstein E, Hoedlmoser K, Hion T, Holzinger B, Janku K, Jansson-Fröjmark M, Järnefelt H, Jernelöv S, Jennum PJ, Khachatryan S, Krone L, Kyle SD, Lancee J, Leger D, Lupusor A, Marques DR, Nissen C, Palagini L, Paunio T, Perogamvros L, Pevernagie D, Schabus M, Shochat T, Szentkiralyi A, Van Someren E, van Straten A, Wichniak A, Verbraecken J, Spiegelhalder K. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. J Sleep Res 2023; 32:e14035. [PMID: 38016484 DOI: 10.1111/jsr.14035] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 11/30/2023]
Abstract
Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).
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Affiliation(s)
- Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
| | | | - Erna Sif Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Chiara Baglioni
- Human Sciences Department, University of Rome Guglielmo Marconi Rome, Rome, Italy
| | | | - Celyne Bastien
- École de Psychologie, Université Laval, Québec, Québec, Canada
| | | | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Dimitris Dikeos
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Leja Dolenc Groselj
- Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Jason G Ellis
- Northumbria Sleep Research Laboratory, Northumbria University, Newcastle, UK
| | | | | | | | | | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kerstin Hoedlmoser
- Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria
| | - Tuuliki Hion
- East-Viru Central Hospital, Kohtla-Järve, Estonia
| | | | - Karolina Janku
- Center for Sleep and Chronobiology Research, National Institute of Mental Health, Klecany, Czech Republic
| | - Markus Jansson-Fröjmark
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden
| | - Heli Järnefelt
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Susanna Jernelöv
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden
| | - Poul Jørgen Jennum
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Samson Khachatryan
- Department of Neurology and Neurosurgery, Armenian National Institute of Health, Yerevan, Armenia
| | - Lukas Krone
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
- Department of Neurology, Inselspital, University of Bern, Berne, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Damien Leger
- Université Paris Cité, APHP, Hôtel Dieu de Paris, Centre du Sommeil et de la Vigilance, Paris, France
| | - Adrian Lupusor
- Functional Neurology, Institute of Neurology and Neurosurgery, Chisinau, Moldova
| | - Daniel Ruivo Marques
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Christoph Nissen
- Department of Psychiatry, University Hospital Geneve, Geneve, Switzerland
| | - Laura Palagini
- Psychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - Tiina Paunio
- Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Dirk Pevernagie
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Manuel Schabus
- Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria
| | - Tamar Shochat
- The Cheryl Spencer Institute of Nursing Research, University of Haifa, Haifa, Israel
| | - Andras Szentkiralyi
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Eus Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
- Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro- and Developmental Psychology & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adam Wichniak
- Sleep Medicine Center and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Maruani J, Stern E, Boiret C, Leseur J, Romier A, Lejoyeux M, Geoffroy PA. Predictors of cognitive behavioral therapy for insomnia (CBT-I) effects in insomnia with major depressive episode. Psychiatry Res 2023; 329:115527. [PMID: 37839317 DOI: 10.1016/j.psychres.2023.115527] [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: 07/28/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
Insomnia plays a critical role in the onset and maintenance of Major Depressive Episode (MDE). Cognitive behavioral therapy for insomnia (CBT-I) can successfully improve the sleep of patients with insomnia and MDE. Nonetheless, the factors influencing CBT-I's effects in MDE remain uncertain. This study aimed to identify predictors of insomnia improvement following CBT-I, as well as predictors of insomnia response, remission in patients with MDE and specific insomnia subtypes. Initially, we compared a 4-session weekly CBT-I treatment to baseline sleep education (SE) in a control group. This confirmed CBT-I's positive effects and the need to explore predictive factors. Notably, treatment-resistant depression (TRD) predicted reduced insomnia severity with CBT-I. Patients exhibiting seasonal fluctuations in depressive symptoms and sleep patterns throughout the year, or having daytime dysfunction, experienced enhanced CBT-I efficacy, especially for early awakenings insomnia. Conversely, shorter sleep duration predicted a less favorable response to CBT-I, less improvement in daytime dysfunction and sleep disturbance worries. Additionally, MDE with suicide attempts predicted a poorer improvement of daytime dysfunction. Further research is essential to comprehensively grasp the mechanisms behind CBT-I's heightened effectiveness in MDE patients with TRD and seasonal fluctuations.
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Affiliation(s)
- Julia Maruani
- Département de Psychiatrie et D'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris F-75018, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France; Centre ChronoS, GHU Paris - Psychiatrie & Neurosciences, 1 rue Cabanis, Paris 75014, France.
| | - Emilie Stern
- Centre ChronoS, GHU Paris - Psychiatrie & Neurosciences, 1 rue Cabanis, Paris 75014, France; Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé, Boulogne-Billancourt F-92100, France
| | - Charlotte Boiret
- Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France
| | - Jeanne Leseur
- Département de Psychiatrie et D'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris F-75018, France
| | - Alix Romier
- Département de Psychiatrie et D'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris F-75018, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France
| | - Michel Lejoyeux
- Département de Psychiatrie et D'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris F-75018, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France; Centre ChronoS, GHU Paris - Psychiatrie & Neurosciences, 1 rue Cabanis, Paris 75014, France
| | - Pierre A Geoffroy
- Département de Psychiatrie et D'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris F-75018, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France; Centre ChronoS, GHU Paris - Psychiatrie & Neurosciences, 1 rue Cabanis, Paris 75014, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg F-67000, France.
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5
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Lin W, Li N, Yang L, Zhang Y. The efficacy of digital cognitive behavioral therapy for insomnia and depression: a systematic review and meta-analysis of randomized controlled trials. PeerJ 2023; 11:e16137. [PMID: 37927792 PMCID: PMC10624170 DOI: 10.7717/peerj.16137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023] Open
Abstract
Background Insomnia and depression often co-occur. Cognitive behavioral therapy for insomnia (CBT-I) seems to be effective and safe for mitigating insomnia and depression. However, the efficacy of digitally-delivered CBT-I (dCBT-I) remains unclear. Therefore, this meta-analysis of randomized controlled trials (RCTs) was to systematically review and evaluate the efficacy of dCBT-I in adults with insomnia and depression. Methods A systematic search in PubMed, Cochrane, Embase, and Web of Science databases (as of June 5, 2022) was conducted for RCTs on dCBT-I. Statistical analyses were performed using Revan Manager. The effects of dCBT-I on insomnia and depression were expressed as standardized mean difference (SMD) with 95% confidence intervals (CIs). Results Seven studies involving 3,597 participants were included. This meta-analysis showed that dCBT-I reduced the severity of insomnia (SMD = -0.85, 95% CI [-1.00 to -0.69], p < 0.001) and depression (SMD = -0.47, 95% CI [-0.55 to -0.38], p < 0.001) in short terms, and also mitigated the severity of insomnia (SMD = -0.71, 95% CI [-1.00 to -0.44], p < 0.001) and depression (SMD = -0.42, 95% CI [-0.68 to -0.15], p = 0.002) in long terms. The effect of dCBT-I was comparable to that of traditional face-to-face CBT-I, and was generally maintained at follow-ups of 6 weeks to 6 months. Conclusion dCBT-I seems to be effective in alleviating insomnia and depression and might be considered as a viable treatment option for depression.
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Affiliation(s)
- Wenyao Lin
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academic of Sciences, Beijing, China
| | - Na Li
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academic of Sciences, Beijing, China
| | - Lili Yang
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academic of Sciences, Beijing, China
| | - Yuqing Zhang
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academic of Sciences, Beijing, China
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6
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Chan CS, Wong CYF, Yu BYM, Hui VKY, Ho FYY, Cuijpers P. Treating depression with a smartphone-delivered self-help cognitive behavioral therapy for insomnia: a parallel-group randomized controlled trial. Psychol Med 2023; 53:1799-1813. [PMID: 37310329 DOI: 10.1017/s0033291721003421] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Despite its efficacy in treating comorbid insomnia and depression, cognitive behavioral therapy for insomnia (CBT-I) is limited in its accessibility and, in many countries, cultural compatibility. Smartphone-based treatment is a low-cost, convenient alternative modality. This study evaluated a self-help smartphone-based CBT-I in alleviating major depression and insomnia. METHODS A parallel-group randomized, waitlist-controlled trial was conducted with 320 adults with major depression and insomnia. Participants were randomized to receive either a 6-week CBT-I via a smartphone application, proACT-S, or waitlist condition. The primary outcomes included depression severity, insomnia severity, and sleep quality. The secondary outcomes included anxiety severity, subjective health, and acceptability of treatment. Assessments were administered at baseline, post-intervention (week 6) follow-up, and week 12 follow-up. The waitlist group received treatment after the week 6 follow-up. RESULTS Intention to treat analysis was conducted with multilevel modeling. In all but one model, the interaction between treatment condition and time at week 6 follow-up was significant. Compared with the waitlist group, the treatment group had lower levels of depression [Center for Epidemiologic Studies Depression Scale (CES-D): Cohen's d = 0.86, 95% CI (-10.11 to -5.37)], insomnia [Insomnia Severity Index (ISI): Cohen's d = 1.00, 95% CI (-5.93 to -3.53)], and anxiety [Hospital Anxiety and Depression Scale - Anxiety subscale (HADS-A): Cohen's d = 0.83, 95% CI (-3.75 to -1.96)]. They also had better sleep quality [Pittsburgh Sleep Quality Index (PSQI): Cohen's d = 0.91, 95% CI (-3.34 to -1.83)]. No differences across any measures were found at week 12, after the waitlist control group received the treatment. CONCLUSION proACT-S is an efficacious sleep-focused self-help treatment for major depression and insomnia. TRIAL REGISTRATION ClinicalTrials.gov, NCT04228146. Retrospectively registered on 14 January 2020. http://www.w3.org/1999/xlink">https://clinicaltrials.gov/ct2/show/NCT04228146.
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Affiliation(s)
| | | | | | | | | | - Pim Cuijpers
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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7
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Latocha KM, Løppenthin KB, Østergaard M, Jennum PJ, Hetland ML, Røgind H, Lundbak T, Midtgaard J, Christensen R, Esbensen BA. The effect of group-based cognitive behavioural therapy for insomnia in patients with rheumatoid arthritis: a randomized controlled trial. Rheumatology (Oxford) 2023; 62:1097-1107. [PMID: 35951745 DOI: 10.1093/rheumatology/keac448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/18/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The primary objective was to compare the effect of cognitive behavioural therapy for insomnia (CBT-I) to usual care on sleep efficiency, measured by polysomnography (PSG) immediately after the intervention at week 7. Secondary objectives included comparing the longer-term effect on sleep- and RA-related outcomes at week 26. METHODS In a randomized controlled trial using a parallel group design, the experimental intervention was 6 weeks' nurse-led group-based CBT-I; the comparator was usual care. Analyses were based on the intention-to-treat (ITT) principle; missing data were statistically modelled using repeated-measures linear mixed effects models adjusted for the level at baseline. RESULTS The ITT population consisted of 62 patients (89% women), with an average age of 58 years and an average sleep efficiency of 83.1%. At primary end point, sleep efficiency was 88.7% in the CBT-I group, compared with 83.7% in the control group (difference: 5.03 [95% CI -0.37, 10.43]; P = 0.068) measured by PSG at week 7. Key secondary outcomes measured with PSG had not improved at week 26. However, for all the patient-reported key secondary sleep- and RA-related outcomes, there were statistically highly significant differences between CBT-I and usual care (P < 0.0001), e.g. insomnia (Insomnia Severity Index: -9.85 [95% CI -11.77, -7.92]) and the RA impact of disease (RAID: -1.36 [95% CI -1.92, -0.80]) at week 26. CONCLUSION Nurse-led group-based CBT-I did not lead to an effect on sleep efficiency objectively measured with PSG. However, CBT-I showed improvement on all patient-reported key secondary sleep- and RA-related outcomes measured at week 26. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT03766100.
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Affiliation(s)
- Kristine M Latocha
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet, Glostrup.,Section for Biostatistics and Evidence-Based Research, The Parker Institute, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen
| | - Katrine B Løppenthin
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet.,Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet, Glostrup.,Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Poul J Jennum
- Department of Clinical Medicine, University of Copenhagen, Copenhagen.,Danish Center for Sleep Medicine, Department of Clinical Neurophysiology
| | - Merete L Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet, Glostrup.,Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Henrik Røgind
- Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet
| | - Tine Lundbak
- Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen.,Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, University of Copenhagen, Glostrup
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Bente A Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet, Glostrup.,Department of Clinical Medicine, University of Copenhagen, Copenhagen
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8
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Kristiansen ST, Videbech P, Kragh M, Sigaard KR, Lyhne CN, Larsen ER, Bjerrum M. Experiences of adult patients living with depression-related insomnia: a qualitative systematic review protocol. JBI Evid Synth 2023; 21:200-206. [PMID: 35975302 DOI: 10.11124/jbies-21-00403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of this review is to identify and synthesize the best available evidence on how adult patients experience living with depression-related insomnia. In particular, the review will examine the experiences related to pharmacological and non-pharmacological interventions to improve sleep. INTRODUCTION Approximately 80% to 90% of patients with depression have insomnia, which is associated with substantial personal and social costs. Despite these costs, insomnia is often underdiagnosed and viewed as a symptom that disappears when depression abates. However, research indicates that insomnia and depression are overlapping but distinct disorders. Thus, it is important to treat both disorders simultaneously, as improving sleep may, in turn, ease core symptoms of depression. Optimal care and treatment rely on patients' experiences of insomnia and their attitudes toward treatment options. Therefore, it is important to synthesize evidence of patients' experiences of living with insomnia, and the experiences of pharmacological and non-pharmacological sleep interventions, to understand the consequences of insomnia and to optimize sleep interventions. INCLUSION CRITERIA This systematic review will synthesize qualitative studies exploring how adults with depression experience living with insomnia and how they experience pharmacological or non-pharmacological sleep interventions. Both inpatient and outpatient populations will be considered. METHODS Databases to be searched include MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, SveMed+, Scopus, and Web of Science Core Collection. Google Scholar and ProQuest Dissertations and Theses will be searched for unpublished studies. Studies in English, German, Danish, Swedish, and Norwegian will be included. Databases will be searched from their inception to the present date. All studies will be screened against the inclusion criteria and critically appraised for methodological quality. Findings will be pooled using meta-aggregation, and a ConQual Summary of Findings will be presented. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021276048.
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Affiliation(s)
- Sanne T Kristiansen
- Research Unit for Nursing and Healthcare, Department of Public Health, Health, Aarhus University, Aarhus, Denmark.,Protac A/S, Skanderborg, Denmark
| | - Poul Videbech
- Centre for Neuropsychiatric Depression Research, Mental Health Centre Glostrup, Glostrup, Denmark
| | - Mette Kragh
- Department of Affective Disorders, Aarhus University Hospital, Aarhus N, Denmark
| | - Karen R Sigaard
- Aarhus University Library, Health Sciences, Aarhus C, Denmark
| | - Cecilie N Lyhne
- Research Unit for Nursing and Healthcare, Department of Public Health, Health, Aarhus University, Aarhus, Denmark
| | - Erik R Larsen
- Mental Health Department Odense, University Clinic, Mental Health Service, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Merete Bjerrum
- Research Unit for Nursing and Healthcare, Department of Public Health, Health, Aarhus University, Aarhus, Denmark.,The Centre of Clinical Guidelines - Danish National Clearing House, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,The Danish Centre of Systematic Reviews: A JBI Centre of Excellence, Aalborg University, Aalborg, Denmark
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9
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Cognitive Behavioral Therapy for Chronic Insomnia in Outpatients with Major Depression-A Randomised Controlled Trial. J Clin Med 2022; 11:jcm11195845. [PMID: 36233712 PMCID: PMC9570822 DOI: 10.3390/jcm11195845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this randomised controlled assessor-blinded trial was to examine the effect of cognitive behavioural therapy for insomnia on sleep variables and depressive symptomatology in outpatients with comorbid insomnia and moderate to severe depression. Forty-seven participants were randomized to receive one weekly session in 6 weeks of cognitive behavioural therapy for insomnia or treatment as usual. The intervention was a hybrid between individual and group treatment. Sleep scheduling could be especially challenging in a group format as patients with depression may need more support to adhere to the treatment recommendations. The primary outcome measure was the Insomnia Severity Index. Secondary measures were sleep diary data, the Dysfunctional Beliefs and Attitudes about Sleep Questionnaire, the Hamilton Depression Rating Scale, and the World Health Organization Questionnaire for Quality of Life and polysomnography. Compared to treatment as usual, cognitive behavioural therapy significantly reduced the insomnia severity index (mean ISI 20.6 to 12.1, p = 0.001) and wake after sleep onset (mean 54.7 min to 19.0 min, p = 0.003) and increased sleep efficiency (mean SE 71.6 to 83.4, p = 0.006). Total sleep time and sleep onset latency were not significantly changed. The results were supported by analyses of the other rating scales and symptom dimensions. In conclusion, cognitive behavioural therapy for insomnia as add-on to treatment as usual was effective for treating insomnia and depressive symptoms in a small sample of outpatients with insomnia and major depression. ClinicalTrials.gov Identifier: NCT02678702.
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10
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Ludwig VM, Münch I, Wirz-Justice A, Ritter P. [Chronotherapy of affective disorders: principles and clinical aspects]. DER NERVENARZT 2022; 93:892-900. [PMID: 35687164 DOI: 10.1007/s00115-022-01323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronobiological processes play a critical role in the initial manifestation and course of affective disorders. Chronotherapeutic agents aim to improve sleep-wake cycle disturbances and affective symptoms by modulating the chronobiological neuronal circuitry. OBJECTIVE To review the different chronotherapeutic procedures, the current evidence situation and recommendations for clinical applications. METHOD Narrative review. RESULTS Chronotherapeutic interventions for patients with affective disorders can be nonpharmacological, e.g., light therapy, sleep deprivation, sleep phase advance and dark therapy, pharmacological in the form of melatonin and psychological consisting of interpersonal and social rhythm therapy or cognitive behavioral therapy for insomnia modified for patients with bipolar disorder. Nearly all these interventions show promising data regarding their efficacy in acute depressive or manic episodes or as maintenance therapy. For melatonin, there is less evidence for improvement of affective symptoms than for stabilizing the sleep-wake cycle. Some interventions are well-suited for an outpatient setting, e.g., light therapy, dark therapy and psychotherapy, while others, such as triple chronotherapy consisting of sleep deprivation, sleep phase advance and light therapy, are more suited for in-patient treatment. CONCLUSION Chronotherapeutic interventions are versatile in their application and can be combined with each other and used concomitantly with classical psychopharmacotherapy. With a benign side effect profile and good evidence for efficacy, they could play an important role in the treatment of affective disorders; however, this potential is used too rarely in the clinical context.
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Affiliation(s)
- Vera Miriam Ludwig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - Ilka Münch
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Anna Wirz-Justice
- Zentrum für Chronobiologie, Universitäre Psychiatrische Kliniken Basel, Basel, Schweiz
| | - Philipp Ritter
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland
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11
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Sridhar GR. Can the management of depression in type 2 diabetes be democratized? World J Diabetes 2022; 13:203-212. [PMID: 35432759 PMCID: PMC8984566 DOI: 10.4239/wjd.v13.i3.203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/07/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Both type 2 diabetes and depression are common and are projected to increase. There is increasing evidence for a bidirectional relationship between the two. Diabetes is a risk factor for depression; contrariwise, individuals with depression are at greater risk of developing diabetes. They are a burden for both the individual and the society. Co-existent depression worsens diabetic control because of obesity, insulin resistance and the adverse metabolic effects of anti-diabetes medicines. In addition, compliance to lifestyle measures required for diabetes is also compromised such as following a specific diet, taking proper medications on time, getting metabolic parameters assessed and maintaining a sleep cycle. Depression occurs in many grades; mild depression is more common in diabetes than frank or full-blown depression leading to suicide. Unfortunately, there are not enough trained and accessible mental health professionals such as psychologists or psychiatrists to deal with the increasing burden of depression in diabetes. Therefore, alternate models for management of mild to moderate depression are required. There is evidence that a team-approach by employing health care assistants can lower the risk of cardiac risk factors. INtegrating DEPrEssioN and Diabetes treatmENT study was carried out to determine whether the team-approach using non-health care professionals could be effective in managing mild to moderate depression and to study its effects on metabolic parameters among subjects with type 2 diabetes mellitus. The international study, carried out in four independent centers in India assessed the impact of a trained but not qualified non-psychiatrist in coordinating and forming a fulcrum between the patient, the family and the consultant endocrinologist/diabetologist. The interventions were fine-tuned to be culturally appropriate by qualitative interviews before they began. It was shown that the outcomes of both depression and diabetes could be improved by the employment of a clinical care coordinator. It is possible to scale up the studies to wider geographical areas and health-care organizations.
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Affiliation(s)
- Gumpeny R Sridhar
- Department of Endocrinology, Endocrine & Diabet Ctr, Visakhapatnam 530002, India
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12
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Moghimi E, Knyahnytska Y, Zhu Y, Kumar A, Knyahnytski A, Patel C, Omrani M, Gerritsen C, Martin M, Simpson AIF, Alavi N. A qualitative exploration of the mental health challenges and therapeutic needs of Canadian correctional workers. Front Psychiatry 2022; 13:1004143. [PMID: 36386978 PMCID: PMC9641701 DOI: 10.3389/fpsyt.2022.1004143] [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] [Received: 07/26/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Correctional work is described as a high-stress environment associated with increased prevalence of mental health disorders in employees. Identifying appropriate healthcare services necessitates investigating the mental health challenges and needs of correctional workers (CWs). METHODS Individual interviews (n = 9; 5 M and 4 W) and a mixed gender focus group (n = 6; 3 M and 3 W) were conducted to gather a general sense of the mental health landscape. Data were analyzed to develop a targeted and comprehensive question guide for gender-specific focus groups (n = 14 unique participants; 6 M and 8 W). RESULTS Eight themes emerged from the gender-specific focus groups. Themes focusing on work culture described the negative repercussions of job stress and the inability to discuss challenges openly due to confidentiality concerns and feelings of seclusion associated with the CW profession. Men were more likely to be subjected to physical violence and women to emotional and sexual harassment from staff and inmates. Themes related to mental health care described the benefits and limitations of the current services and digital mental healthcare. Stigma and accessibility were notable treatment barriers. Lastly, sector-specific therapy was seen as an important component in enhancing engagement and therapist interaction. CONCLUSION The study demonstrates the interconnection between work culture and CW mental health that needs to be acknowledged when addressing mental health care.
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Affiliation(s)
- Elnaz Moghimi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Yiran Zhu
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Anchan Kumar
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Charmy Patel
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Mohsen Omrani
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,OPTT Inc., Toronto, ON, Canada
| | - Cory Gerritsen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Michael Martin
- Correctional Service of Canada, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Nazanin Alavi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,OPTT Inc., Toronto, ON, Canada.,Faculty of Health Sciences, Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
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13
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Moghimi E, Knyahnytska Y, Omrani M, Nikjoo N, Stephenson C, Layzell G, Frederic Simpson AI, Alavi N. Benefits of Digital Mental Health Care Interventions for Correctional Workers and Other Public Safety Personnel: A Narrative Review. Front Psychiatry 2022; 13:921527. [PMID: 35873240 PMCID: PMC9304966 DOI: 10.3389/fpsyt.2022.921527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/07/2022] [Indexed: 01/12/2023] Open
Abstract
Chronic exposure to stressors and potentially psychologically traumatic events contributes to the high prevalence of mental health disorders in correctional workers (CWs) and other public safety personnel (PSP). Digital mental health interventions are an accessible and scalable method of improving and maintaining the mental health of this population. The current review explores the benefits of digital mental health interventions for PSP-with a focus on CWs-and how these innovations can address the limitations in in-person mental health care. A systematic literature search of five databases (Medline, PsycInfo, Embase, CINAHL, Google Scholar) was conducted until March 2022. The search yielded 16 publications that focused on digital mental health interventions or care available to CWs and other PSP. The benefits of digital innovations were summarized into five categories which discussed (1) their ability to enhance accessibility and reduce stigma; (2) the provision of evidence-based and structured psychotherapy programs; (3) variability in the degree of therapist engagement; (4) the integration of proactive interventions; and (5) enhancing engagement by acknowledging unique experiences and interpersonal relationships. Although digital mental health technologies for CWs are still in their infancy, there is strong evidence to support their effectiveness in ameliorating symptoms of mental distress. Future research should consider how ethnicity, gender, culture, sexual orientation, and socioeconomic status can be integrated into these therapies and how the interplay between different stakeholders and organizations can impact the effectiveness of online therapies and programs.
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Affiliation(s)
- Elnaz Moghimi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Mohsen Omrani
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,OPTT Inc., Toronto, ON, Canada
| | - Niloofar Nikjoo
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Callum Stephenson
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Gina Layzell
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Nazanin Alavi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
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Mirchandaney R, Barete R, Asarnow LD. Moderators of Cognitive Behavioral Treatment for Insomnia on Depression and Anxiety Outcomes. Curr Psychiatry Rep 2022; 24:121-128. [PMID: 35061137 PMCID: PMC8948126 DOI: 10.1007/s11920-022-01326-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW With a focus on reviewing adequately powered randomized controlled trials, we present recent research on the potential of cognitive behavioral therapy for insomnia (CBT-I) to improve depression and anxiety outcomes among patients with insomnia and one of the following comorbid psychiatric disorders: major depressive disorder (MDD), generalized anxiety disorder (GAD), or posttraumatic stress disorder (PTSD). We also examine potential moderators of CBT-I on depression and anxiety outcomes in this population. RECENT FINDINGS Despite high comorbidity rates, current behavioral and pharmacological treatments for MDD, GAD, and PTSD do not substantially target or improve insomnia symptoms; residual insomnia is exceedingly common even among patients who experience remission. Insomnia plays a critical role in the onset and maintenance of depression and anxiety, and treating insomnia with CBT-I may improve global outcomes for patients with MDD, GAD, and PTSD. CBT-I is superior to traditional depression/anxiety treatment in improving insomnia symptoms among patients with comorbid psychiatric disorders. Results are mixed on whether CBT-I (either alone or augmented with depression/anxiety treatment) is effective in improving overall MDD, GAD, and PTSD outcomes. Evening circadian preference and depression/anxiety symptom severity may moderate the effect of CBT-I on depression and anxiety outcomes.
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Affiliation(s)
- Riya Mirchandaney
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Raul Barete
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Lauren D. Asarnow
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143 USA
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15
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Schredl M, Schackert M, Feld GB, Schilling C. Ein Fragebogen zur Erfassung von schlafbezogenen Metakognitionen: Deutsche Kurzform des MCQ-I. SOMNOLOGIE 2021. [DOI: 10.1007/s11818-021-00293-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Hintergrund und Fragestellung
Schlafbezogene Kognitionen, aber auch schlafbezogene Metakognitionen (Umgang mit Gedanken) spielen in der Ätiologie der Insomnie, vor allem bei der Aufrechterhaltung, eine Rolle. Bisher liegt nur ein englischsprachiger Fragebogen (MCQ-I) mit 60 Items zur Erfassung schlafbezogener Metakognitionen vor. Ziel dieser Arbeit war das Zusammenstellen einer kürzeren, deutschen Version, die sowohl gute Reliabilität als auch Validität aufweist.
Material und Methoden
Insgesamt nahmen 512 Patienten mit unterschiedlichen Schlafstörungen (264 Frauen, 248 Männer; mittleres Alter: 45,04 ± 16,70 Jahre) an der Erhebung teil. Der MCQ‑I wurde vor dem Erstgespräch ausgefüllt mitgebracht.
Ergebnisse
Die 20-Item-Version wies eine hohe interne Konsistenz (r = 0,906) und hohe Retest-Reliabilität (r = 0,916) auf. Patienten mit der Diagnose einer Insomnie zeigten einen signifikant höheren Summenwert im MCQ-I 20 als Patienten mit anderen Schlafstörungen. Interessanterweise waren auch die Diagnose einer depressiven Erkrankung und das Auftreten einer Alptraumstörung mit vermehrten schlafbezogenen Metakognitionen verbunden.
Schlussfolgerung
Schlafbezogene Metakognitionen scheinen in der Insomnie-Ätiologie eine Rolle zu spielen. Interessant wäre es zu überprüfen, ob eine rein metakognitive Therapie die Symptomatik bei Insomniepatienten in ähnlicher Weise wie die klassische kognitive Verhaltenstherapie der Insomnie verbessern kann.
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