Development and Evaluation of a Cognitive Behavioural Intervention for Chronic Post-Stroke Insomnia

2018 ◽  
Vol 46 (6) ◽  
pp. 641-660 ◽  
Author(s):  
Katie Herron ◽  
Lorna Farquharson ◽  
Abigail Wroe ◽  
Annette Sterr
Keyword(s):  
Sleep Onset ◽  
Community Dwelling ◽  
Post Treatment ◽  
Dysfunctional Attitudes ◽  
Future Research ◽  
Behavioural Intervention ◽  
Sleep Onset Latency ◽  
Post Stroke ◽  
Cognitive Behavioural

Background:Cognitive behavioural therapy for insomnia (CBTI) has been successfully applied to those with chronic illness. However, despite the high prevalence of post-stroke insomnia, the applicability of CBTI for this population has not been substantially researched or routinely used in clinical practice.Aims:The present study developed a ‘CBTI+’ protocol for those with post-stroke insomnia and tested its efficacy. The protocol also incorporated additional management strategies that considered the consequences of stroke.Method:A single-case experimental design was used with five community-dwelling individuals with post-stroke insomnia. Daily sleep diaries were collected over 11 weeks, including a 2-week baseline, 7-week intervention and 2-week follow-up. The Insomnia Severity Index, Dysfunctional Attitudes and Beliefs About Sleep Scale, Epworth Sleepiness Scale, Fatigue Severity Scale and Stroke Impact Scale were administered pre- and post-treatment, as well as at 2-week follow-up.Results:At post-treatment, three participants no longer met diagnostic criteria for insomnia and all participants showed improvements on two or more sleep parameters, including sleep duration and sleep onset latency. Three participants showed a reduction in daytime sleepiness, increased quality of life and reduction in unhelpful beliefs about sleep.Conclusions:This study provides initial evidence that CBTI+ is a feasible and acceptable intervention for post-stroke insomnia. Furthermore, it indicates that sleep difficulties in community-dwelling stroke populations are at least partly maintained by unhelpful beliefs and behaviours. The development and delivery of the CBTI+ protocol has important clinical implications for managing post-stroke insomnia and highlights directions for future research.

Multicomponent Cognitive-Behavioural Intervention to Improve Sleep in Adolescents: A Multiple Baseline Design

2013 ◽  
Vol 42 (3) ◽  
pp. 368-373 ◽  
Author(s):  
Melissa C. Hendricks ◽  
Cynthia M. Ward ◽  
Lauren K. Grodin ◽  
Keith J. Slifer
Keyword(s):  
Relaxation Training ◽  
Sleep Problems ◽  
Sleep Onset ◽  
Multiple Baseline ◽  
Behavioural Intervention ◽  
Sleep Onset Latency ◽  
Multiple Baseline Design ◽  
Baseline Design ◽  
Cognitive Behavioural ◽  
Cognitive Behavioural Intervention

Background: Adolescents are prone to sleep problems that have unique developmental aspects and contribute to physical, emotional, and behavioural problems. Aims: This study evaluated an individualized, multicomponent intervention that considered developmental factors, and promoted age-appropriate autonomy in three adolescent females with disrupted sleep. Method: Adolescents recorded sleep data on daily logs. A nonconcurrent multiple baseline design was used to evaluate a cognitive-behavioural intervention including sleep hygiene training, bedtime routine development, cognitive restructuring, relaxation training, stimulus control, sleep restriction, bedtime fading, and problem-solving, along with clinically indicated individualization. Results: Outcomes demonstrated clinically meaningful improvements and decreased variability in sleep parameters following intervention. Each participant's sleep log data indicated improvement in, or maintenance of, adequate total sleep time (TST), decreased sleep onset latency (SOL), improved sleep efficiency (SE), improvement in time of sleep onset, and decreased or continued low frequency of night awakenings (NA). Anecdotally, adolescents and parents reported improvement in daytime functioning, coping, and sense of wellbeing. Conclusions: These cases highlight the potential for cognitive-behavioural interventions to facilitate healthy sleep in adolescents with challenging sleep problems.

SHORT TERM DURABILITY OF A COGNITIVE BEHAVIOURAL INTERVENTION IN PSYCHOSIS: EFFECTS FROM A PILOT STUDY

2004 ◽  
Vol 32 (1) ◽  
pp. 117-121 ◽  
Author(s):  
Pauline L. Hall ◽  
Nicholas Tarrier
Keyword(s):  
Pilot Project ◽  
Self Esteem ◽  
Psychotic Symptoms ◽  
Future Research ◽  
Small Scale ◽  
Behavioural Intervention ◽  
Cognitive Behavioural ◽  
Self Worth ◽  
Cognitive Behavioural Intervention

Low self-esteem in psychosis is common and has been found to be significantly related to a number of clinical variables and to symptom severity. This report describes the follow-up evaluation of a simple time-limited cognitive behavioural intervention aimed to improve feelings of low self-worth in the treatment of psychotic symptoms. A previous small scale pilot project found encouraging results for the efficacy of the novel intervention following its delivery and at 3-month follow-up. This report examines the benefits of the technique at 12 months following delivery of the intervention. These preliminary results suggest that the intervention may promote improved levels of self-esteem, psychotic symptomatology and social functioning over the longer term. Implications for practice and future research are discussed.

scholarly journals Cognitive behavioural therapy for worry in young individuals with at-risk mental states: a preliminary investigation

2019 ◽  
Vol 12 ◽  
Author(s):  
Andrea Pozza ◽  
Sandro Domenichetti ◽  
Davide Dèttore
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Psychiatric Care ◽  
Mental States ◽  
Behavioural Therapy ◽  
Post Treatment ◽  
Future Research ◽  
Cognitive Behavioural ◽  
At Risk Mental States

Abstract Cognitive behavioural therapy (CBT) is a first-line strategy in reducing or delaying risk of transition to psychosis among young individuals with at-risk mental states (ARMS). However, there is little knowledge about its effects on other outcomes associated with ARMS. No study on CBT for ARMS has assessed worry, an important process associated with this condition. The present study investigated changes in worry at immediate post-treatment and 14-month follow-up after CBT for young individuals with ARMS seeking psychiatric care in mental health services. Thirty-seven young individuals (mean age = 26 years, SD = 6.07; 22.20% female) seeking psychiatric care in mental health services and classified as reporting ARMS through the Comprehensive Assessment of At-Risk Mental States were included. The Positive And Negative Syndrome Scales (PANSS) and Penn State Worry Questionnaire (PSWQ) were administered at baseline, post-treatment, and follow-up. CBT consisted of 30 weekly individual 1-hour sessions based on a validated CBT for ARMS manual enriched with components targeting worry [psychoeducation, problem-solving, (meta)cognitive restructuring, behavioural experiments]. Seven participants (18.91%) at follow-up had cumulatively made transition to psychosis. Repeated measures ANOVA with post-hoc pairwise comparisons showed significant changes in PSWQ scores from baseline to post-treatment and from baseline to follow-up; PSWQ scores remained stable from post-treatment to follow-up. This is the first study investigating changes in worry after CBT for ARMS, which appears to be a promising strategy also for this outcome. Future research with a larger sample size and control group may determine whether changes in worry are also associated with reduced transition risk. Key learning aims (1) To understand CBT evidence and procedures for young individuals with ARMS. (2) To reflect on the current limitations in the literature on CBT for ARMS. (3) To understand the importance and clinical implications of assessing worry in ARMS. (4) To focus on changes in worry as an outcome after CBT for ARMS. (5) To reflect on future research directions on the role of worry in CBT for ARMS.

A Multiple Treatment Approach to the Group Treatment of Insomnia: A Follow-up Study

1989 ◽  
Vol 17 (4) ◽  
pp. 323-331 ◽  
Author(s):  
Dilys R. Davies
Keyword(s):  
Group Treatment ◽  
Post Treatment ◽  
Progressive Relaxation ◽  
Future Research ◽  
Anxiety Management ◽  
Multiple Treatment ◽  
Cognitive Behavioural ◽  
One Year ◽  
General Coping

The present study was carried out to evaluate the effectiveness of psychological methods on the group treatment of insomnia. Assessments were administered on measures of general and physical health, symptoms associated with anxiety and benzodiazepine usage and specific measures related to sleep pre- and post-treatment, and at a one year follow up. Fifteen patients were referred from GPs in one practice, and were sequentially assigned into three groups. Treatment took the form of 11 to 13 sessions of weekly group therapy. The group treatment consisted of (1) cognitive-behavioural strategies, including sleep monitoring, stimulus control, cognitive restructuring, problem solving, anxiety management and progressive relaxation; (2) sleep education; (3) gradual drug withdrawal. The results indicated that immediate post-treatment improvements on measures of general health, symptom reduction, reduction of hypnotic-sedative medication, and on the quantity and quality of sleep were maintained after an interval of one year after treatment. Insomnia was less severe, less frequent, of shorter duration and more easily managed. However, there were no improvements on measures aimed to assess general coping strategies nor on measures of sleep maintenance insomnia between the three periods. The findings and implications for future research in this area are discussed.

An integrated sleep and anxiety intervention for anxious children: A pilot randomized controlled trial

2020 ◽  
Vol 25 (4) ◽  
pp. 945-957 ◽  
Author(s):  
Michelle A Clementi ◽  
Candice A Alfano
Keyword(s):  
Sleep Problems ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Sleep Onset ◽  
Case Series ◽  
Post Treatment ◽  
Sleep Onset Latency ◽  
Randomized Controlled ◽  
Small Effect Size

Sleep-related complaints hold complex reciprocal relationships with anxiety and are a pervasive, distressing feature of childhood generalized anxiety disorders (GAD). Although evidence suggests purely anxiety-focused treatments reduce some sleep problems of anxious children, interventions that directly target both anxiety and sleep might produce superior outcomes in both domains. Targeted Behavioral Therapy (TBT), developed for co-morbid sleep and anxiety problems, demonstrated initial efficacy in a small case series but has not been directly compared to anxiety-focused treatment. The current pilot study used a randomized controlled design to compare TBT to “gold standard” cognitive-behavioral therapy (CBT) for anxiety among n = 20 children (ages 6–12) with primary GAD. Multi-informant measures of anxiety and sleep (including actigraphy) were obtained at baseline, post-treatment, and 6-month follow-up. Results indicated significant improvements (based on moderate to large effect sizes) in anxiety and subjective sleep in both treatment groups at post-treatment. Improvements were maintained at 6-month follow-up. Objective sleep onset latency also decreased marginally for both groups at post-treatment (based on small effect size). Findings provide preliminary support for the feasibility and potential utility of anxiety-focused interventions for improving some sleep-related problems among anxious youth. Future studies including large samples are needed.

608 Efficacy of a Treatment for Sleep-Related Problems in Children with Anxiety: A Mixed Methods Study

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A239-A239
Author(s):  
Lydia Chevalier ◽  
Emily Pariseau ◽  
Kristin Long ◽  
David Langer ◽  
Donna Pincus
Keyword(s):  
Mixed Methods ◽  
Parent Training ◽  
Sleep Onset ◽  
Post Treatment ◽  
Chronic Insomnia ◽  
Training Intervention ◽  
Sleep Onset Latency ◽  
School Aged Children ◽  
Parents And Children

Abstract Introduction School-aged children with anxiety frequently experience sleep-related problems (SRPs) such as bedtime resistance. Results are mixed, but some children with anxiety also report longer sleep onset latency (SOL). Despite the link between SRPs and mental and physical health consequences, limited research has evaluated the efficacy of brief sleep treatments in this population. Methods A mixed methods approach employing a multiple-baseline single-case design and qualitative methods was used to evaluate the efficacy of a four-session parent training intervention in ten children with anxiety and chronic insomnia (M=9.6 years, range 8–12 years, 8 female). Questionnaires on SRPs and anxiety were completed by parents and children at baseline, one-week post-treatment, and one-month follow-up assessments. Subjective SOL (i.e., sleep diary) and objective SOL (i.e., actigraphy) were measured daily during assessment and treatment weeks. Parents and children completed qualitative interviews at the post-treatment assessment. Results The majority of participants no longer met criteria for chronic insomnia at post-treatment (n=9) or follow-up (n=6). SRPs (e.g., bedtime resistance) were significantly less frequent at post-treatment and follow-up than at baseline. The majority of participants demonstrated significant reductions in subjective (n=7) but not objective (n=3) SOL at post-treatment or follow-up compared to baseline. Qualitatively, parents and children described improvements in sleep during treatment. Some parents described discovering while completing sleep diaries that their child believed themselves to be taking longer to fall asleep at the beginning of treatment than they actually were (i.e., sleep misperception), and that this sleep misperception improved during treatment. Conclusion The findings of the current study support the preliminary efficacy of a brief parent training intervention to treat SRPs in school-aged children with anxiety. They also begin to help elucidate mixed findings in the literature on sleep of children with anxiety by providing a potential reason for discrepancies between subjective and objective SOL in this population. Specifically, qualitative findings suggest that this discrepancy may be related to sleep misperception, that children with anxiety may feel themselves to be taking a long time to fall asleep even when objective measures of SOL are within the normative range. Support (if any) Boston University Clara Mayo Memorial Research Fellowship

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 Effect of early intervention for anxiety on sleep outcomes in adolescents: a randomized trial

2021 ◽  
Author(s):  
Bente Storm Mowatt Haugland ◽  
Mari Hysing ◽  
Asle Hoffart ◽  
Åshild Tellefsen Haaland ◽  
Jon Fauskanger Bjaastad ◽  
...  
Keyword(s):  
Early Intervention ◽  
Standard Length ◽  
Sleep Problems ◽  
Sleep Onset ◽  
Cognitive Behavioral ◽  
Control Group ◽  
Sleep Onset Latency ◽  
Post Intervention ◽  
Clinical Trial Registration

AbstractThe potential effect of early intervention for anxiety on sleep outcomes was examined in a sample of adolescents with anxiety (N = 313, mean 14.0 years, SD = 0.84, 84% girls, 95.7% Norwegians). Participants were randomized to one of three conditions: a brief or a standard-length cognitive-behavioral group-intervention (GCBT), or a waitlist control-group (WL). Interventions were delivered at schools, during school hours. Adolescents with elevated anxiety were recruited by school health services. Questionnaires on self-reported anxiety symptoms, depressive symptoms, and sleep characteristics were administered at pre- and post-intervention, post-waitlist, and at 1-year follow-up. Adolescents reported reduced insomnia (odds ratio (OR) = 0.42, p < 0.001) and shorter sleep onset latency (d = 0.27, p <  0.001) from pre- to post-intervention. For insomnia, this effect was maintained at 1-year follow-up (OR = 0.54, p = 0.020). However, no effect of GCBT on sleep outcomes was found when comparing GCBT and WL. Also, no difference was found in sleep outcomes between brief and standard-length interventions. Adolescents defined as responders (i.e., having improved much or very much on anxiety after GCBT), did not differ from non-responders regarding sleep outcomes. Thus, anxiety-focused CBT, delivered in groups, showed no effect on sleep outcomes. Strategies specifically targeting sleep problems in adolescents should be included in GCBT when delivered as early intervention for adolescents with elevated anxiety.Trial registry Clinical trial registration: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/; NCT02279251, Date: 11.31. 2014

Mindfulness and Behaviour Therapy for Insomnia: An Assessment of Treatment Effect in a Sleep Disorders Clinic Population with Insomnia

2020 ◽  
pp. 1-15
Author(s):  
Allie Peters ◽  
John Reece ◽  
Hailey Meaklim ◽  
Moira Junge ◽  
David Cunnington ◽  
...  
Keyword(s):  
Sleep Disorders ◽  
Treatment Effect ◽  
Sleep Onset ◽  
Sleep Efficiency ◽  
Health Concern ◽  
Sleep Diary ◽  
Sleep Onset Latency ◽  
Subjective Sleep ◽  
Sleep Parameters

Abstract Insomnia is a common major health concern, which causes significant distress and disruption in a person's life. The objective of this paper was to evaluate a 6-week version of Mindfulness-Based Therapy for Insomnia (MBTI) in a sample of people attending a sleep disorders clinic with insomnia, including those with comorbidities. Thirty participants who met the DSM-IV-TR diagnosis of insomnia participated in a 6-week group intervention. Outcome measures were a daily sleep diary and actigraphy during pre-treatment and follow-up, along with subjective sleep outcomes collected at baseline, end-of-treatment, and 3-month follow-up. Trend analyses showed that MBTI was associated with a large decrease in insomnia severity (p < .001), with indications of maintenance of treatment effect. There were significant improvements in objective sleep parameters, including sleep onset latency (p = .005), sleep efficiency (p = .033), and wake after sleep onset (p = .018). Significant improvements in subjective sleep parameters were also observed for sleep efficiency (p = .005) and wake after sleep onset (p < .001). Overall, this study indicated that MBTI can be successfully delivered in a sleep disorders clinic environment, with evidence of treatment effect for both objective and subjective measures of sleep.

scholarly journals Treatment of adult post-traumatic stress disorder using a future-oriented writing therapy approach

2009 ◽  
Vol 2 (4) ◽  
pp. 243-255 ◽  
Author(s):  
Reginald D. V. Nixon ◽  
Leonard W. Kling
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Expressive Writing ◽  
Stress Disorder ◽  
Post Treatment ◽  
Future Research ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Ptsd Severity

AbstractThe aim of this pilot study was to test whether a future-oriented expressive writing intervention is able to reduce post-traumatic stress disorder (PTSD) severity and associated symptoms such as depression and unhelpful trauma-related beliefs. In an uncontrolled pre-/ post-design participants attended 8 weeks of manualized therapy. Assessment was undertaken pre- and post-treatment, and participants also completed a 3-month follow-up assessment. Of the 17 participants who began therapy, 13 were treatment completers. Results indicated a significant decrease in PTSD severity, depression and unhelpful trauma-related cognitions from pre- to post-treatment and at 3-month follow-up. Clinically meaningful change was more modest; however, three participants reported PTSD remission at 3-month follow-up. It is concluded that expressive writing with a focus on achieving future goals and personal change may have some utility in reducing post-traumatic stress but future research will need to investigate this with greater methodological rigour before firm conclusions can be made.

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