518 Preliminary report on the efficacy of behavioral therapy for insomnia in shift work disorder: a randomized control trial

Abstract Introduction Around 33% of shift workers suffer from shift work disorder (SWD). SWD includes insomnia and sleepiness related to the atypical work schedule. Most SWD treatments rely on light therapy or pharmacology. Few studies explored CBT-I efficacy for insomnia in shift work and reported promising results. The study aims to evaluate the efficacity of a behavioral therapy for insomnia adapted for SWD (BT-SWD). Methods Forty-three night shift workers meeting SWD criteria were recruited (mean age = 34 years old; 77% women) and randomized to either BT-SWD or waiting list control group. Eight participants dropped-out while waiting. Before and after treatment, participants completed questionnaires (ESS, ISI, STAI and BDI-II) and sleep diaries throughout the experimentation. BT-SWD involves sleep restriction therapy and stimulus control for insomnia as well as fixed sleep periods in the dark for shift workers. BT-SWD has been applied to night sleep, day sleep, and naps in this order. It consists of 6 sessions of 50 minutes delivered on 8 weeks. A mixed MANOVA was conducted on questionnaires scores with group (treatment or waitlist) as the between-subject factor and time as the within subject factor. Results A multivariate interaction effect was significant, F(6,21) = 8.24, p<.001. A univariate interaction effect was observed for the BDI-II (p=.042), the trait scale of the STAI (p=.021) and the ISI, both for night sleep (p=.027) and day sleep (p<.001), indicating that the scores of participants in the treatement group lowered significantly more than those of participants on the waiting group. The treatment group had a significantly less severe insomnia, both for day sleep during night work (p<.001), and night sleep during days off (p<.001). There was no significant difference between the control and the treatment group on sleepiness levels. Conclusion BT-SWD is effective at reducing insomnia severity as well as levels of trait anxiety and depression. Results are more equivocal for sleepiness. The waiting list control group design used has led to an important attrition in the context of shift work. Further analyses are needed to determine the BT-SWD efficacy on sleep variables. Support (if any) The study was supported by a CIHR grant (#110254) awarded to the first author

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Anonymous online cognitive behavioral therapy for sleep disorders in shift workers—a study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-021-05437-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Lukas Retzer ◽

Monika Feil ◽

Richard Reindl ◽

Kneginja Richter ◽

Robert Lehmann ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Intervention Group ◽

Online Intervention ◽

Waiting List ◽

Cognitive Behavioral ◽

Control Group ◽

Shift Workers ◽

Face To Face ◽

Randomized Controlled

Abstract Background Many shift workers suffer from sleep issues, which negatively affect quality of life and performance. Scientifically evaluated, structured programs for prevention and treatment are scarce. We developed an anonymous online cognitive behavioral therapy for insomnia (CBT-I) program. After successful completion of a feasibility study, we now start this prospective, randomized, controlled superiority trial to compare outcomes of two parallel groups, namely an intervention group and a waiting-list control-group. Additionally, we will compare these outcomes to those of a face-to-face CBT-I outpatient sample. Methods Collaborating companies will offer our anonymous online intervention to their shift-working employees. Company physicians and counseling services will screen those interested for inclusion and exclusion criteria. Participants will receive access to our online service, where they will complete psychometric assessment and receive random assignment to either the intervention group or the waiting-list control group. Participants and providers will be aware of the group assignment. We aim to allocate at least N = 60 participants to the trial. The intervention consists of psychoeducation, sleep restriction, stimulus control, relaxation techniques, and individual feedback delivered via four e-mail contacts. During the intervention, as well as during the waiting period, participants will fill out weekly sleep diaries. Immediately after completion of the program, the post-intervention assessment takes place. Participants in the control group will be able to participate in the program after all study assessments. To recruit an additional sample, collaborating outpatient sleep clinics will provide six sessions of standard face-to-face CBT-I to an ad hoc sample of shift working patients. We expect both the online and the face-to-face CBT-I interventions to have beneficial effects compared to the control group on the following primary outcomes: self-reported symptoms of depression and insomnia, sleep quality, and daytime sleepiness. Conclusions The online intervention allows shift workers to follow a CBT-I program independently of their working schedule and location. Forthcoming results might contribute to further improvement of prevention and therapy of sleep issues in shift workers. Trial registration German Clinical Trials Register DRKS DRKS00017777. Registered on 14 January 2020—retrospectively registered.

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Does CBT have lasting effects in the treatment of PTSD after one year of follow-up? A systematic review of randomized controlled trials

Trends in Psychiatry and Psychotherapy ◽

10.1590/2237-6089-2017-0153 ◽

2018 ◽

Vol 40 (4) ◽

pp. 352-359

Author(s):

Tânia Macedo ◽

Marllon Barbosa ◽

Helga Rodrigues ◽

Evandro da Silva Freire Coutinho ◽

Ivan Figueira ◽

...

Keyword(s):

Systematic Review ◽

Treatment Group ◽

Behavioral Therapy ◽

Waiting List ◽

Control Group ◽

Term Efficacy ◽

One Year ◽

Meta Analyses

Abstract Introduction: While several previous meta-analyses have documented the short-term efficacy of cognitive-behavioral therapy (CBT), its long-term efficacy remains unknown. Posttraumatic stress disorder (PTSD) is a serious, debilitating, often chronic and disabling disease. Objective: To estimate the long-term efficacy of CBT in the treatment of PTSD by assessing the maintenance of the effect after one year of follow-up. Method: We performed a systematic review through electronic database searches including ISI Web of Science, PubMed, PsycInfo and Pilots. We included randomized studies in which CBT was compared with a control group (waiting list or usual care) in adults with PTSD that reported at least one year of CBT follow-up. Results: Our search identified 2,324 studies and 8 were selected. CBT was shown to be effective in the treatment of PTSD in the post-treatment period. Improvement in PTSD symptoms was statistically significant in relation to the control group. The improvement observed in the treatment group or single group (formed by both treatment group and control group, which was submitted to the intervention after a few weeks on the waiting list) was maintained in the follow-up. Conclusion: Due to the lack of control groups in the follow-up period in six of the eight studies included in this review, there is still no proper methodological basis to assert that CBT has lasting effects in the treatment of PTSD. Our study found serious methodological shortcomings and the need to fill this gap in the literature through the development of studies with robust and sophisticated designs.

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Anonymous Online Cognitive Behavioral Therapy for Sleep Disorders in Shift Workers – A Study Protocol for a Randomized Controlled Trial

10.21203/rs.3.rs-654228/v1 ◽

2021 ◽

Author(s):

Lukas Retzer ◽

Monika Feil ◽

Richard Reindl ◽

Kneginja Richter ◽

Robert Lehmann ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Intervention Group ◽

Online Intervention ◽

Waiting List ◽

Cognitive Behavioral ◽

Control Group ◽

Shift Workers ◽

Face To Face ◽

Randomized Controlled

Abstract Background: Many shift workers suffer from sleep issues, which negatively affect quality of life and performance. Scientifically evaluated, structured programs for prevention and treatment are scarce. We developed an anonymous online cognitive behavioral therapy for insomnia (CBT-I) program. After successful completion of a feasibility study, we now start this prospective, randomized, controlled superiority trial to compare outcomes of two parallel groups, namely an intervention group and a waiting-list control-group. Additionally, we will compare these outcomes to those of a face-to-face CBT-I outpatient sample.Methods: Collaborating companies will offer our anonymous online intervention to their shift-working employees. Company physicians and counseling services will screen those interested for inclusion and exclusion criteria. Participants will receive access to our online service, where they will complete psychometric assessment and receive random assignment to either the intervention group or the waiting-list control group. Participants and providers will be aware of the group assignment. We aim to allocate at least N = 60 participants to the trial. The intervention consists of psychoeducation, sleep restriction, stimulus control, relaxation techniques, and individual feedback delivered via four e-mail contacts. During the intervention, as well as during the waiting period, participants will fill out weekly sleep diaries. Immediately after completion of the program, the post-intervention assessment takes place. Participants in the control group will be able to participate in the program after all study assessments. To recruit an additional sample, collaborating outpatient sleep clinics will provide six sessions of standard face-to-face CBT-I to an ad-hoc sample of shift working patients. We expect both the online and the face-to-face CBT-I interventions to have beneficial effects compared to the control group on the following primary outcomes: self-reported symptoms of depression and insomnia, sleep quality, and daytime sleepiness. Conclusions: The online intervention allows shift workers to follow a CBT-I program independently of their working schedule and location. Forthcoming results might contribute to further improvement of prevention and therapy of sleep issues in shift workers.

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P014 Shift work disorder and the prevalence of help seeking behaviours for sleep concerns in Australia

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.062 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A26-A26

Author(s):

B Brown ◽

M Crowther ◽

S Appleton ◽

Y Melaku ◽

R Adams ◽

...

Keyword(s):

Shift Work ◽

Help Seeking ◽

Management Strategy ◽

Sleep Problems ◽

Caffeine Consumption ◽

Shift Workers ◽

Standard Work ◽

Shift Work Disorder ◽

Help Seeking Behaviour ◽

Seeking Help

Abstract Introduction Shift work disorder is a circadian rhythm sleep-wake disorder, defined by symptoms of insomnia and excessive levels of sleepiness resulting from work that occurs during non-standard hours. Sleep problems are common in shift workers, yet our understanding of help-seeking behaviours for sleep in shift workers is limited. Methods As a part of a national sleep health survey, data were collected on the help-seeking behaviours for sleep problems in an online sample of Australian individuals on non-standard work schedules (n=448). Of the sample of non-standard workers, 10.5% (n=41) met the criteria for probable shift work disorder (pSWD). Results Non-standard workers with pSWD did not seek help for sleep problems at higher rates than workers without SWD (p = .979). General practitioners were the most reported healthcare professional sought out for sleep problems of individuals with pSWD. Self-management was common in workers with pSWD, with a high self-reported prevalence of alcohol use (31.7%) as a sleep management strategy, and caffeine consumption (76.9%) as a sleepiness management strategy. The majority of individuals with pSWD reported the mentality of ‘accept it and keep going’ as a sleepiness management strategy, highlighting a potential barrier to help-seeking behaviour in workers with pSWD. Discussion These findings provide novel insight into the help-seeking behaviours of individuals with pSWD. There is a need for further research to understand why individuals at risk for shift work disorder are not actively seeking help, and to develop health promotion and intervention strategies to improve engagement with healthcare professionals.

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Excessive Sleepiness and Self-Reported Shift Work Disorder: An Internet Survey of Shift Workers

Postgraduate Medicine ◽

10.3810/pgm.2013.05.2669 ◽

2013 ◽

Vol 125 (3) ◽

pp. 162-171 ◽

Cited By ~ 2

Author(s):

Joseph A. Lieberman ◽

Lauren Sylvester ◽

Sharon Paik

Keyword(s):

Shift Work ◽

Internet Survey ◽

Shift Workers ◽

Shift Work Disorder ◽

Excessive Sleepiness

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A Comparison of Secular and Religious Versions of Cognitive Therapy with Depressed Christian College Students

Journal of Psychology and Theology ◽

10.1177/009164718401200106 ◽

1984 ◽

Vol 12 (1) ◽

pp. 45-54 ◽

Cited By ~ 46

Author(s):

David Richard Pecheur ◽

Keith J. Edwards

Keyword(s):

Behavior Modification ◽

Behavioral Treatment ◽

Behavioral Therapy ◽

Waiting List ◽

Cognitive Behavioral ◽

Control Group ◽

Cognitive Behavior ◽

Cognitive Behavioral Treatment ◽

Cognitive Behavior Modification ◽

Treatment Of Depression

This study was designed to answer two related questions: (a) Could Beck's cognitive-behavioral treatment of depression be efficaciously employed in a religious population, and (b) would the efficacy of Beck's cognitive-behavioral treatment of depression be enhanced if it was integrated with the subjects’ religious beliefs? A multiple cutoff procedure was utilized in the selection of subjects for a secular cognitive behavior modification group, a religious cognitive behavior modification group, and a waiting list control group. The results indicated that the secular and the religious cognitive behavior modification groups were significantly more effective than the waiting list control group in alleviating depression. No significant differences were found between secular and the religious cognitive behavior modification groups. The reductions in depression were maintained at a one-month follow-up. The results relevant to Beck's cognitive-behavioral therapy of depression and to the treatment of religious patients are discussed.

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Promoting Employees’ Recovery During Shift Work: Protocol for a Workplace Intervention Study (Preprint)

10.2196/preprints.17368 ◽

2019 ◽

Author(s):

Irene M W Niks ◽

Alwin van Drongelen ◽

Elsbeth M de Korte

Keyword(s):

Shift Work ◽

Repeated Measures ◽

Research Work ◽

Workplace Intervention ◽

Control Group ◽

Negative Effects ◽

Short Term ◽

Shift Workers ◽

Starting Point

BACKGROUND Shift work can be demanding owing to disturbances in the biological and social rhythms. This can cause short-term negative effects in employees, such as increased fatigue and reduced alertness. A potential way to counteract these negative effects is to enhance employees’ recovery from work during working hours. OBJECTIVE The aim of this study is to develop and implement an intervention that focuses on promoting “on-job” recovery of shift workers. METHODS This study is performed in 2 department units with shift workers at a multinational company in the steel industry. For each department, an intervention will be developed and implemented through an iterative process of user-centered design and evaluation. This approach consists of various sessions in which employees and a project group (ie, researchers, line managers, human resource managers, and occupational health experts) provide input on the intervention content and implementation. Intervention effects will be evaluated using pretest and posttest web-based surveys. Digital ecological momentary assessment will be performed to gain insight into the link between the intervention and daily within-person processes. The intervention process and participants’ perception of the interventions will be assessed through a process evaluation. Intervention results will be analyzed by performing mixed model repeated measures analyses and multilevel analyses. RESULTS This study is supported by the Netherlands Organization for Applied Scientific Research Work and Health Research Program, which is funded by the Ministry of Economic Affairs and supported by the Dutch Ministry of Social Affairs and Employment, program number 19.204.1-3. This study was approved by the institutional review board on February 7, 2019. From June to August 2019, baseline data were collected, and from November to December 2019, the first follow-up data were collected. The second follow-up data collection and data analysis are planned for the first two quarters of 2020. Dissemination of the results is planned for the last two quarters of 2020. CONCLUSIONS A strength of this study design is the participatory action approach to enhance the stakeholder commitments, intervention adherence, and compliance. Moreover, since the target group will be participating in the development and implementation of the intervention, the proposed impact will be high. In addition, the short-term as well as the long-term effects will be evaluated. Finally, this study uses a unique combination of quantitative and qualitative evaluation methods. A limitation of this study is that it is impossible to randomly assign participants to an intervention or control group. Furthermore, the follow-up period (6 months) might be too short to establish health-related effects. Lastly, the results of this study might be specific to the department, organization, or sector, which limits the generalizability of the findings. However, as workplace intervention research for shift workers is scarce, this study might serve as a starting point for future research on shift work interventions. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17368

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The role of sleep hygiene in the risk of Shift Work Disorder in nurses

SLEEP ◽

10.1093/sleep/zsz228 ◽

2019 ◽

Author(s):

Lauren A Booker ◽

Maree Barnes ◽

Pasquale Alvaro ◽

Allison Collins ◽

Ching Li Chai-Coetzer ◽

...

Keyword(s):

High Risk ◽

Shift Work ◽

Psychological Health ◽

Odds Ratio ◽

Sleep Hygiene ◽

Low Risk ◽

Shift Workers ◽

Hygiene Practices ◽

Shift Work Disorder ◽

Unit Increase

Abstract A high proportion (20%–30%) of shift workers experience Shift Work Disorder (SWD), characterized by chronic sleepiness and/or insomnia associated with work schedules. The reasons for individual variation in shift work tolerance are not well understood, however. The aim of this study was to identify individual factors that contribute to the risk of SWD. Nurses (n = 202) were categorized as low or high risk of SWD based on the Shift Work Disorder Questionnaire. Participants provided demographic and lifestyle information and completed the Sleep Hygiene Index (SHI) and Morningness–Eveningness Questionnaire (MEQ). High risk of SWD was associated with poorer sleep hygiene (SHI, 35.41 ± 6.19 vs. 31.49 ± 7.08, p < .0001) and greater eveningness (MEQ, 34.73 ± 6.13 vs. 37.49 ± 6.45, p = .005) compared to low risk. No other factors, including body mass index, marital status, having children, or caffeine or alcohol intake were significant. Logistic regression showed that SHI was the most significant contributing factor to SWD risk (odds ratio [OR] = 1.09, 95% confidence interval [CI] = 1.04 to 1.14). Standardized odds ratio further revealed that with every unit increase on the SHI score, the odds of being at high risk of SWD increased by 80% (OR = 1.84). Most individuals at high risk of SWD reported “always” or “frequently” going to bed at different times (79%) and waking at different times (83%; compared to 58%, p = .017, and 61%, p = .002, respectively for the low-risk group), as well as going to bed stressed/angry (67% vs. 41%, p < .0001) and/or planning/worrying in bed (54% vs. 22%, p < .0001). Interventions aimed at improving sleep hygiene practices and psychological health of shift workers may help reduce the risk of SWD.

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She Works Hard for Her Sleep

Sleep Disorders ◽

10.1093/med/9780190671099.003.0050 ◽

2019 ◽

pp. 853-866

Author(s):

Robon Vanek ◽

Nancy Kempke

Keyword(s):

Shift Work ◽

Light Exposure ◽

Poor Sleep ◽

Short Sleep Duration ◽

Shift Workers ◽

Shift Work Disorder ◽

Excessive Sleepiness ◽

Quality Sleep ◽

Sleep Environment ◽

Rhythm Disorder

Shift work and long work hours, such as 12-hour shifts, can disturb sleep and circadian rhythms. Shift work disorder is a circadian rhythm disorder in which excessive sleepiness and/or insomnia due to work schedule occur. There is a circadian misalignment between the timing of the sleep/wake schedule and the circadian pressures for sleep and wakefulness. Between 10% and 38% of nightshift and rotating shift workers experience shift work disorder. There can be interruptions during sleep caused by light, noise, and social obligations when sleep occurs at unusual times, resulting in a short sleep duration/inadequate sleep and poor sleep quality. Sleep logs provide valuable information. To improve the quantity and quality of sleep, the sleep environment and timing of light exposure need to be optimized, and limiting interruptions during sleep is recommended. Wake-promoting agents such as armodafinil prior to work may be needed for fatigue management. Validated tools can aid in diagnosis, and there may be an underutilization of sleep specialists in these patients.

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Promoting Employees’ Recovery During Shift Work: Protocol for a Workplace Intervention Study

JMIR Research Protocols ◽

10.2196/17368 ◽

2020 ◽

Vol 9 (7) ◽

pp. e17368

Author(s):

Irene MW Niks ◽

Alwin van Drongelen ◽

Elsbeth M de Korte

Keyword(s):

Shift Work ◽

Repeated Measures ◽

Research Work ◽

Workplace Intervention ◽

Control Group ◽

Negative Effects ◽

Short Term ◽

Shift Workers ◽

Starting Point

Background Shift work can be demanding owing to disturbances in the biological and social rhythms. This can cause short-term negative effects in employees, such as increased fatigue and reduced alertness. A potential way to counteract these negative effects is to enhance employees’ recovery from work during working hours. Objective The aim of this study is to develop and implement an intervention that focuses on promoting “on-job” recovery of shift workers. Methods This study is performed in 2 department units with shift workers at a multinational company in the steel industry. For each department, an intervention will be developed and implemented through an iterative process of user-centered design and evaluation. This approach consists of various sessions in which employees and a project group (ie, researchers, line managers, human resource managers, and occupational health experts) provide input on the intervention content and implementation. Intervention effects will be evaluated using pretest and posttest web-based surveys. Digital ecological momentary assessment will be performed to gain insight into the link between the intervention and daily within-person processes. The intervention process and participants’ perception of the interventions will be assessed through a process evaluation. Intervention results will be analyzed by performing mixed model repeated measures analyses and multilevel analyses. Results This study is supported by the Netherlands Organization for Applied Scientific Research Work and Health Research Program, which is funded by the Ministry of Economic Affairs and supported by the Dutch Ministry of Social Affairs and Employment, program number 19.204.1-3. This study was approved by the institutional review board on February 7, 2019. From June to August 2019, baseline data were collected, and from November to December 2019, the first follow-up data were collected. The second follow-up data collection and data analysis are planned for the first two quarters of 2020. Dissemination of the results is planned for the last two quarters of 2020. Conclusions A strength of this study design is the participatory action approach to enhance the stakeholder commitments, intervention adherence, and compliance. Moreover, since the target group will be participating in the development and implementation of the intervention, the proposed impact will be high. In addition, the short-term as well as the long-term effects will be evaluated. Finally, this study uses a unique combination of quantitative and qualitative evaluation methods. A limitation of this study is that it is impossible to randomly assign participants to an intervention or control group. Furthermore, the follow-up period (6 months) might be too short to establish health-related effects. Lastly, the results of this study might be specific to the department, organization, or sector, which limits the generalizability of the findings. However, as workplace intervention research for shift workers is scarce, this study might serve as a starting point for future research on shift work interventions.

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