Cognitive behavioral therapy for chronic insomnia in occupational health services: Analyses of outcomes up to 24 months post-treatment

2014 ◽  
Vol 56 ◽  
pp. 16-21 ◽  
Author(s):  
Heli Järnefelt ◽  
Mikael Sallinen ◽  
Ritva Luukkonen ◽  
Soili Kajaste ◽  
Aslak Savolainen ◽  
...  
Keyword(s):  
Occupational Health ◽  
Health Services ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Chronic Insomnia ◽  
Occupational Health Services

Randomized Study on the Efficacy of Cognitive-Behavioral Therapy for Insomnia Secondary to Breast Cancer, Part II: Immunologic Effects

2005 ◽  
Vol 23 (25) ◽  
pp. 6097-6106 ◽  
Author(s):  
Josée Savard ◽  
Sébastien Simard ◽  
Hans Ivers ◽  
Charles M. Morin
Keyword(s):  
Breast Cancer ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Chronic Insomnia ◽  
Controlled Study ◽  
Immune Functioning ◽  
Ifn Γ

Purpose Cross-sectional studies suggest that clinical insomnia is associated with immune downregulation. However, there is a definite need for experimental studies on this question. The goal of this randomized controlled study was to assess the effect of an 8-week cognitive-behavioral therapy (CBT) for chronic insomnia on immune functioning of breast cancer survivors. Previous analyses of this study showed that CBT was associated with improved sleep and quality of life, and reduced psychological distress. Patients and Methods Fifty-seven women with chronic insomnia secondary to breast cancer were randomly assigned to CBT (n = 27) or to a waiting-list control condition (WLC; n = 30). Peripheral-blood samples were taken at baseline and post-treatment (and postwaiting for WLC patients), as well as at 3-, 6-, and 12-month follow-up for immune measures, including enumeration of blood cell counts (ie, WBCs, monocytes, lymphocytes, CD3+, CD4+, CD8+, and CD16+/CD56+) and cytokine production (ie, interleukin-1-beta [IL-1β] and interferon gamma [IFN-γ]). Results Patients treated with CBT had higher secretion of IFN-γ and lower increase of lymphocytes at post-treatment compared with control patients. Pooled data from both treated groups indicated significantly increased levels of IFN-γ and IL-1β from pre- to post-treatment. In addition, significant changes in WBCs, lymphocytes, and IFN-γ were found at follow-up compared with post-treatment. Conclusion This study provides some support to the hypothesis of a causal relationship between clinical insomnia and immune functioning. Future studies are needed to investigate the clinical impact of such immune alterations.

scholarly journals Comparing the Effects of Cognitive-behavioral Therapy and Zolpidem 10 mg on Illness Perception and Sleep Efficiency in Individuals With Chronic Insomnia

2021 ◽  
Vol 24 (2) ◽  
pp. 292-305
Author(s):  
Behzad Salmani ◽  
◽  
Jaafar Hasani ◽  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Illness Perception ◽  
Post Treatment ◽  
Sleep Efficiency ◽  
Waiting List ◽  
Cognitive Behavioral ◽  
Chronic Insomnia ◽  
Insomnia Disorder

Background & Aim: This study aimed at comparing efficacy of cognitive behavioral therapy, Zolpidem 10 mg, and waiting list group on illness perception and sleep efficiency in individuals with chronic insomnia disorder. Materials & Methods: Participants included 74 (female = 43) individuals with chronic insomnia disorder who were recruited from 2018 December to 2020 February by purposive sampling (inclusive & exclusive criteria). Then, patients randomly allocated to one of the three conditions, including cognitive behavioral therapy (N=25), pharmacotherapy (Zolpidem 10 mg.; N=29), and the waiting list (N=20). All patients were assessed three times at pretreatment, post-treatment, and 3-month follow-up by the Persian version of Brief Illness Perception Questionnaire and Sleep Efficiency Index. The data were analyzed by mixed analysis of variance with Bonferroni post-hoc test and repeated measure analysis of variance. Ethical Considerations: All stages of the research have been carried after taking supervising and approving of Kharazmi University's ethics in research committee. Findings: The patients who received cognitive behavioral therapy compared to patients in waiting list group, obtained significantly lower scores in illness perception and sleep efficiency during post-treatment and 3-month follow-up. Efficacy of pharmacotherapy only observed during post-treatment but there were no significant differences between pharmacotherapy and waiting list patients during 3-month follow-up. Conclusion: Cognitive behavioral therapy for insomnia reduced significantly illness perceptions and sleep efficiency during 3 months. All the treatment gains remain stable even 3 months later treatment ends. In addition, not receiving any treatment in waiting list and gradually discontinued the treatment in pharmacotherapy group leads to decreasing of sleep efficiency and increasing of illness perception.

349 Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain - A Systematic Review and Meta-Analysis

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A139-A140
Author(s):  
Janannii Selvanathan ◽  
Chi Pham ◽  
Mahesh Nagappa ◽  
Philip Peng ◽  
Marina Englesakis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Behavioral Therapy ◽  
Cancer Pain ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Comorbid Insomnia ◽  
Patient Reported

Abstract Introduction Patients with chronic non-cancer pain often report insomnia as a significant comorbidity. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first line of treatment for insomnia, and several randomized controlled trials (RCTs) have examined the efficacy of CBT-I on various health outcomes in patients with comorbid insomnia and chronic non-cancer pain. We conducted a systematic review and meta-analysis on the effectiveness of CBT-I on sleep, pain, depression, anxiety and fatigue in adults with comorbid insomnia and chronic non-cancer pain. Methods A systematic search was conducted using ten electronic databases. The duration of the search was set between database inception to April 2020. Included studies must be RCTs assessing the effects of CBT-I on at least patient-reported sleep outcomes in adults with chronic non-cancer pain. Quality of the studies was assessed using the Cochrane risk of bias assessment and Yates quality rating scale. Continuous data were extracted and summarized using standard mean difference (SMD) with 95% confidence intervals (CIs). Results The literature search resulted in 7,772 articles, of which 14 RCTs met the inclusion criteria. Twelve of these articles were included in the meta-analysis. The meta-analysis comprised 762 participants. CBT-I demonstrated a large significant effect on patient-reported sleep (SMD = 0.87, 95% CI [0.55–1.20], p < 0.00001) at post-treatment and final follow-up (up to 9 months) (0.59 [0.31–0.86], p < 0.0001); and moderate effects on pain (SMD = 0.20 [0.06, 0.34], p = 0.006) and depression (0.44 [0.09–0.79], p= 0.01) at post-treatment. The probability of improving sleep and pain following CBT-I at post-treatment was 81% and 58%, respectively. The probability of improving sleep and pain at final follow-up was 73% and 57%, respectively. There were no statistically significant effects on anxiety and fatigue. Conclusion This systematic review and meta-analysis showed that CBT-I is effective for improving sleep in adults with comorbid insomnia and chronic non-cancer pain. Further, CBT-I may lead to short-term moderate improvements in pain and depression. However, there is a need for further RCTs with adequate power, longer follow-up periods, CBT for both insomnia and pain, and consistent scoring systems for assessing patient outcomes. Support (if any):

361 Relative Effectiveness of Cognitive Behavioral Therapy and its Components in Improving Insomnia Symptoms in Older Adults

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A144-A144
Author(s):  
Kathleen O’Hora ◽  
Beatriz Hernandez ◽  
Laura Lazzeroni ◽  
Jamie Zeitzer ◽  
Leah Friedman ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Sleep Onset ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Sleep Onset Latency ◽  
Significant Group ◽  
Time Interaction ◽  
Insomnia Symptoms

Abstract Introduction The prevalence of insomnia complaints in older adults is 30–48%, compared to 10–15% in the general population. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a first-line, non-pharmacological sleep treatment for Insomnia. However, the relative impact of Behavioral (BT) and Cognitive (CT) components compared to that of CBT-I in older adults is unknown. Methods 128 older adults with insomnia were randomized to receive CBT-I, BT, or CT. Sleep diaries and the Insomnia Severity Index (ISI) were collected pre- and post-treatment and at a 6-month follow-up. We conducted split-plot linear mixed models with age and sex as covariates to assess within and between subject changes to test effects of group, time, and their interaction on ISI, sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), time in bed (TIB), sleep efficiency (SE), and percent of treatment responders (ISI decrease>7) and remitters (ISI<8). Effect size (d) was calculated by dividing the difference between means by the root-mean-squared error of the mixed effects model. Results All treatments lead to a significant improvement across outcome measures at post-treatment (p’s<0.001) and 6-months (p’s<0.01), with the exception of TIB, response, and remission. For TIB, there was a significant Group x Time interaction (p<0.001): while all treatments significantly reduced TIB post-treatment relative to baseline, CBT-I (p<0.001,d=-2.26) and BT (p<0.001,d=-1.59) performed significantly better than CT (p=0.003, d=-0.68). In contrast, at 6-months CBT-I (p<0.001,d=-1.16) performed significantly better at reducing TIB than CT (p=0.195,d=-0.24) or BT (p=0.023,d=-0.61) relative to baseline. There was also a non-significant trend for a Group x Time interaction for remission status (p=0.062). Whereas, the percentage of remitters within all groups post-treatment did not differ from chance (p>0.234), at 6 months, the percentage of remitters was significantly higher than chance in CBT-I (73.63%,p=0.026) and BT (78.08%,p=0.012), but not CT (47.85%,p=0.826). There were no other significant time or interaction effects (all p>0.05). Conclusion CBT-I and its components are effective in improving subjective insomnia symptoms in older adults. Evidence suggests CBT-I may be superior to either CT or BT alone in improving TIB in older adults. Support (if any) NIMHR01MH101468; MIRECC at VAPAHCS

scholarly journals The Chicken and/or the Egg?

2019 ◽  
pp. 555-570
Author(s):  
Ketan Deoras ◽  
Jonathan Oliver ◽  
Mita S. Deoras
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Sleep Disturbance ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Chronic Insomnia ◽  
Comorbid Insomnia ◽  
Time Treatment ◽  
Bidirectional Relationship ◽  
Prevalence Of Depression ◽  
Sedative Hypnotics

This chapter covers the bidirectional relationship between depression and insomnia. Patients with insomnia are more likely to develop depression; the prevalence of depression in people with comorbid insomnia is almost 10 times greater than in those without insomnia. Conversely, depression itself has sleep disturbance as a symptom 80% of the time. Treatment of comorbid insomnia and depression should aim at treating both conditions. While cognitive-behavioral therapy for insomnia (CBT-i) should always be considered in the treatment of chronic insomnia, instances may arise when medications are required. Sedative–hypnotics derive from a wide variety of classes of medications and may need to be used in conjunction with antidepressants in the depressed insomniac.

scholarly journals Cognitive-Behavioral Therapy for Insomnia: An Effective and Underutilized Treatment for Insomnia

2019 ◽  
Vol 13 (6) ◽  
pp. 544-547 ◽  
Author(s):  
Jeffrey Rossman
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Health Care Providers ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Chronic Insomnia ◽  
Relaxation Techniques ◽  
Care Providers ◽  
Medical Problems ◽  
Sleep Medication ◽  
Falling Asleep

Sleep difficulties are an extremely prevalent health problem, with about 33% to 50% of adults reporting regular difficulty falling asleep or staying asleep. About 7% to 18% of adults meet the criteria for an insomnia disorder.1,2 Sleep disruptions contribute to a variety of medical problems, including cognitive impairment, reduced immune function, metabolic imbalance, and exacerbation of psychiatric conditions.3 The most effective nonpharmacological treatment for chronic insomnia is cognitive-behavioral therapy for insomnia (CBT-i). CBT-i produces results that are equivalent to sleep medication, with no side effects, fewer episodes of relapse, and a tendency for sleep to continue to improve long past the end of treatment. The long-term improvements seem to result from the patient learning how to support and promote the body’s natural sleep mechanism. The five key components of CBT-i are sleep consolidation, stimulus control, cognitive restructuring, sleep hygiene, and relaxation techniques. Although CBT-i is a safe and highly effective treatment for insomnia, unfortunately, it is underutilized, primarily because of two reasons: (1) There is currently a shortage of trained CBT-i practitioners. (2) Patient are much more likely to learn about sleep medication as a treatment for their insomnia (via drug advertisements and prescribing physicians) than CBT-i. Physicians and health care providers can play an important role in educating their patients about CBT-i and recommending it as a first-line treatment for chronic insomnia.

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