scholarly journals Rewriting One Patient’s Story of Disrupted Sleep

2019 ◽  
pp. 161-172
Author(s):  
Samantha Domingo ◽  
Michelle L. Drerup
Keyword(s):  
Social Support ◽  
Treatment Adherence ◽  
Relaxation Training ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Cognitive Restructuring ◽  
Sleep Hygiene ◽  
Sleep Restriction ◽  
Insomnia Disorder

This chapter covers treatment options for individuals with chronic insomnia disorder. We describe the effectiveness of cognitive behavioral therapy for insomnia (CBT-i) and various modalities of delivery of the treatment. CBT-i is an alternative treatment for insomnia that has been demonstrated to be as successful as pharmacological therapies in the short term, and more effective in the long term. CBT-i comprises sleep restriction, stimulus control, relaxation training, sleep hygiene, and cognitive restructuring. The authors examine group CBT-i as a way to increase social support and enhance treatment adherence. Computerized CBT-i is a newer option to provide increased access to this treatment.

Clinical considerations for the management of pediatric patients with attention-deficit/hyperactivity disorder

2013 ◽  
Vol 2 (11) ◽  
pp. 362-369
Author(s):  
Dustin Linn ◽  
Andrea Murray ◽  
Thomas Smith ◽  
David Fuentes
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
English Language ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Time Frame ◽  
Chronic Health Condition ◽  
Hyperactivity Disorder ◽  
Long Term Treatment

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a chronic health condition presenting with symptoms of hyperactivity, impulsivity, and/or inattention in early childhood, adolescence and adulthood. Many patients will persist with associated symptoms throughout their life and may require long term treatment to maintain adequate control. Objective: The purpose of this article is to review the current literature in regards to diagnosis, treatment, and management of ADHD in the pediatric and adolescent population. Methods: A search was conducted using PubMed, Medline, Ovid, and CINHAL with a focus on studies and reviews in the English language from 2008 – 2013, featuring pediatric/adolescent patients across the ages of 4–17 years using the terms: “management”, “attention-deficit”, “hyperactivity”, and “treatment.” Literature referenced prior to the five-year time frame outlined herein provided foundational information on diagnostics and medications. Discussion: Stimulants, in conjunction with behavioral therapy, are standard first line treatments used in ADHD. While stimulant medications have been shown to be effective in treating symptoms associated with ADHD, there are a variety of concerns that may prevent their use. These concerns are related to adverse consequences, many of which are not supported by concrete evidence. Other pharmacotherapy options such as norepinephrine reuptake inhibitors and selective alpha-2 adrenergic agonists are typically reserved as second line options. The use of novel and emerging complementary therapies will also be explored. Conclusion: Patients diagnosed with ADHD must be thoroughly evaluated when making decisions regarding treatment. Many studies and reviews support the efficacy of pharmacotherapy in treatment of ADHD; however, there is insufficient evidence regarding long-term safety of the medications. Further research is warranted to evaluate current treatment options and associated risks and benefits to guide the clinician in optimal management of these patients.

Five-year outcome of cognitive behavioral therapy and exposure with response prevention for bulimia nervosa

2010 ◽  
Vol 41 (5) ◽  
pp. 1061-1071 ◽  
Author(s):  
V. V. W. McIntosh ◽  
F. A. Carter ◽  
C. M. Bulik ◽  
C. M. A. Frampton ◽  
P. R. Joyce
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Bulimia Nervosa ◽  
Relaxation Training ◽  
Behavioral Therapy ◽  
Response Prevention ◽  
Cognitive Behavioral ◽  
Term Outcome ◽  
Definition Of

BackgroundFew data exist examining the longer-term outcome of bulimia nervosa (BN) following treatment with cognitive behavioral therapy (CBT) and exposure with response prevention (ERP).MethodOne hundred and thirty-five women with purging BN received eight sessions of individual CBT and were then randomly assigned to either relaxation training (RELAX) or one of two ERP treatments, pre-binge (B-ERP) or pre-purge cues (P-ERP). Participants were assessed yearly following treatment and follow-up data were recorded.ResultsEighty-one per cent of the total sample attended long-term follow-up. At 5 years, abstinence rates from binging were significantly higher for the two exposure treatments (43% and 54%) than for relaxation (27%), with no difference between the two forms of exposure. Over 5 years, the frequency of purging was lower for the exposure treatments than for relaxation training. Rates of recovery varied according to definition of recovery. Recovery continued to increase to 5 years. At 5 years, 83% no longer met DSM-III-R criteria for BN, 65% received no eating disorder diagnosis, but only 36% had been abstinent from bulimic behaviors for the past year.ConclusionsThis study provides possible evidence of a conditioned inoculation from exposure treatment compared with relaxation training in long-term abstinence from binge eating at 5 years, and the frequency of purging over 5 years, but not for other features of BN. Differences among the groups were not found prior to 5 years. CBT is effective for BN, yet a substantial group remains unwell in the long term. Definition of recovery impacts markedly on recovery rates.

0525 Subtypes of Efficacy of Cognitive-Behavioral Therapy for Insomnia

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A201-A201
Author(s):  
V Castronovo ◽  
M Sforza ◽  
A Galbiati ◽  
M Salsone ◽  
S Marelli ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Latent Class ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Long Term Outcome ◽  
Insomnia Disorder ◽  
Significant Difference ◽  
Class 1 ◽  
Anxiety Depression

Abstract Introduction Cognitive-Behavioral Therapy for Insomnia (CBT-I) is the first-line treatment for Insomnia disorder (ID). We aimed to identify ID patients’ subtypes based on clinical features and their response to CBT-I. Methods 294 chronic insomnia patients (61.6% female, mean age 40.7 ± 12.3 yrs) underwent 7-sessions group CBT-I. By use of latent class analysis (LCA) we identified insomnia disorder subtypes according to baseline (BL) evaluation of non-sleep indices and the response to CBT-I (Delta score of Insomnia Severity Index ISI between BL and end-of-treatment (ET). Moreover, we assessed ISI in 123 out of 294 insomnia patients (82 females (66.7%), mean age 40.59 ± 11.89 years) who completed a follow-up evaluation (FU) within a range of 4-10 years. Results We chose 3 latent classes as most parsimonious model. We identified Class 1 (insomnia+anxiety+depression+stress) (n=62), Class 2 (insomnia+anxiety+depression) (n=153) and Class 3 (only-insomnia) (n=79). The effect of CBT-I was maintained up to 10 years after the ET in the three classes but with significant difference between classes (p<0.05). At the ET, the largest percentage of responders (ISI decrease ≥ 8) was found in Class 1 (63.5%). Results of overall CBT-I effectiveness: in Class 3, 98.6% had subthreshold insomnia (ISI score=0-14) at the ET, and 97.2% at the FU; in Class 2, 89.0% at the ET, and 78.2% at the FU; in Class 1, 80.7% at ET and 51.8% at the FU. Conclusion Our analysis identified three different subtypes of insomniacs on the basis of clinical outcomes. The presence of anxiety and depression did not diminish the effect of CBT-I both short and long term. However, ID patients characterized by the presence of stress (Class 1) were the best responders at the ET but this was not maintained at the FU evaluation. We can speculate that stress could be considered a risk factor that plays an important role in the long-term outcome of CBT-I. Support No

scholarly journals Primary care treatment of insomnia: study protocol for a pragmatic, multicentre, randomised controlled trial comparing nurse-delivered sleep restriction therapy to sleep hygiene (the HABIT trial)

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e036248
Author(s):  
Simon D Kyle ◽  
Claire Madigan ◽  
Nargis Begum ◽  
Lucy Abel ◽  
Stephanie Armstrong ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Sleep Hygiene ◽  
Sleep Restriction ◽  
Insomnia Disorder ◽  
Randomised Controlled ◽  
Insomnia Severity

IntroductionInsomnia is a prevalent sleep disorder that negatively affects quality of life. Multicomponent cognitive-behavioural therapy (CBT) is the recommended treatment but access remains limited, particularly in primary care. Sleep restriction therapy (SRT) is one of the principal active components of CBT and could be delivered by generalist staff in primary care. The aim of this randomised controlled trial is to establish whether nurse-delivered SRT for insomnia disorder is clinically and cost-effective compared with sleep hygiene advice.Methods and analysisIn the HABIT (Health-professional Administered Brief Insomnia Therapy) trial, 588 participants meeting criteria for insomnia disorder will be recruited from primary care in England and randomised (1:1) to either nurse-delivered SRT (plus sleep hygiene booklet) or sleep hygiene booklet on its own. SRT will be delivered over 4 weekly sessions; total therapy time is approximately 1 hour. Outcomes will be collected at baseline, 3, 6 and 12 months post-randomisation. The primary outcome is self-reported insomnia severity using the Insomnia Severity Index at 6 months. Secondary outcomes include health-related and sleep-related quality of life, depressive symptoms, use of prescribed sleep medication, diary and actigraphy-recorded sleep parameters, and work productivity. Analyses will be intention-to-treat. Moderation and mediation analyses will be conducted and a cost-utility analysis and process evaluation will be performed.Ethics and disseminationEthical approval was granted by the Yorkshire and the Humber - Bradford Leeds Research Ethics Committee (reference: 18/YH/0153). We will publish our primary findings in high-impact, peer-reviewed journals. There will be further outputs in relation to process evaluation and secondary analyses focussed on moderation and mediation. Trial results could make the case for the introduction of nurse-delivered sleep therapy in primary care, increasing access to evidence-based treatment for people with insomnia disorder.Trial registration numberISRCTN42499563

scholarly journals Non-Pharmacological Treatment Options for Patients with Fibromyalgia

2018 ◽  
Vol 8 (3) ◽  
pp. 165-169
Author(s):  
Md Shahidur Rahman
Keyword(s):  
Pharmacological Treatment ◽  
Soft Tissues ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Chronic Fatigue ◽  
Treatment Modalities ◽  
Pharmacological Interventions ◽  
Beneficial Effects

Fibromyalgia is a generalized chronic pain syndrome characterized by widespread pain and tenderness to palpation at multiple anatomically defined soft tissues and associated with depression, anxiety, insomnia, cognitive dysfunction, chronic fatigue, and autonomic dysfunction. In 2010, American College of Rheumatology modified classification criteria defined in 1990. This is one of the most common musculoskeletal complaints in physician’s chambers. For lack of specific pharmacological treatment options, non-pharmacological treatment modalities are found to have some immediate efficacy and a variable efficacy in the long term. We searched literatures and reviewed randomized controlled trials for possible predictors of outcome in fibromyalgia. The effects of non-pharmacological interventions are limited and positive outcomes largely disappear in the long term. However, within the various populations with fibromyalgia, treatment outcomes showed considerable individual variations. Subgroups of patients with high levels of psychological distress may benefit from non-pharmacological interventions. Some of the relevant published articles demonstrated the beneficial effects of non-pharmacological treatment options, specially exercise, cognitive behavioral therapy and alternative and complementary medicine, in the context of non-availability of specific pharmacotherapy.J Enam Med Col 2018; 8(3): 165-169

scholarly journals Efficacy of Cognitive Behavior Therapy and Pharmacotherapy on Adolescent Obesity

2017 ◽  
Vol 6 (1) ◽  
pp. 52-55
Author(s):  
Danielle Grassi ◽  
Cassidy Forsyth ◽  
Masaru Teramoto ◽  
Krista Rompolski
Keyword(s):  
Weight Loss ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Adolescent Obesity ◽  
Lifestyle Changes ◽  
Cognitive Behavior ◽  
Psychological Conditions ◽  
Mental And Physical Health ◽  
The U.S

Adolescent obesity is an urgent health issue in the U.S., and is a precursor to many physiological and psychological conditions. There are different treatment options for adolescent obesity, and it is important for the general public to understand the benefits and risks associated with the particular treatments. This paper focuses on two treatment options for adolescent obesity, cognitive behavioral therapy (CBT; type of psychological therapy) and Orlistat (medication for obesity), and discusses the effectiveness of each treatment for adolescent obesity. CBT focuses on the behaviors that are associated with the development and maintenance of obesity, while Orlistat targets the physiologic mechanisms of obesity. It appears that while both treatments may be effective for obesity, in general, CBT could help adolescents make lifestyle changes that are more beneficial in long-term mental and physical health. Additionally, when CBT is combined with Orlistat to initiate weight loss, which is then maintained by CBT alone, it could have the greater treatment effects.

scholarly journals “Thinking About Thinking” in Insomnia Disorder: The Effect of Cognitive-Behavioral Therapy for Insomnia on Sleep-Related Metacognition

2021 ◽  
Vol 12 ◽  
Author(s):  
Andrea Galbiati ◽  
Marco Sforza ◽  
Alessandro Scarpellino ◽  
Andrea Salibba ◽  
Caterina Leitner ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Sleep Diary ◽  
Dysfunctional Beliefs ◽  
Beneficial Effects ◽  
Group Format ◽  
Insomnia Disorder ◽  
Insomnia Symptoms

Metacognition is defined as the ability to reflect on one’s mental state and to govern thoughts and beliefs. Metacognitive dysfunctions are typical of several psychopathologic conditions, and also a feature of insomnia disorder, possibly playing a crucial role in its genesis and maintenance. In the context of insomnia, metacognition describes how individuals react to their own sleep-related thoughts and beliefs, boosting the hyperarousal state experienced by these patients. Up to now, no studies evaluated the effect of cognitive behavioral therapy for insomnia (CBT-I) on metacognitive functioning. Therefore, the aim of our study was to evaluate the effect of CBT-I administered in group format in patients with insomnia disorder. As expected, all patients showed significant improvements in both insomnia and sleep diary parameters after treatment. Furthermore, an improvement was observed also in dysfunctional metacognitive levels, assessed by means of the Metacognitions Questionnaire-Insomnia (MCQ-I). However, 63% of patients still showed a MCQ-I score above the clinical cutoff after treatment. Dividing the sample on the basis of MCQ-I questionnaire scores after CBT-I, we found that patients, who still presented metacognitive impairment, received significant beneficial effects from CBT-I both on insomnia symptoms and on dysfunctional beliefs, but not on dysfunctional metacognitive functioning. These findings suggest that metacognition should be carefully evaluated in insomnia patients and further studies are needed to evaluate long-term implications of this remaining dysfunction.

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