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.

scholarly journals 0524 Web-Delivered CBT for Insomnia Intervention Improves Sleep Among Adults with Insomnia and Depressive Symptoms

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A200-A201
Author(s):  
P J Batterham ◽  
H Christensen ◽  
F P Thorndike ◽  
L M Ritterband ◽  
R Gerwien ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Sleep Quality ◽  
Large Scale ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Sleep Onset ◽  
Sleep Diary ◽  
Sleep Onset Latency ◽  
Sleep Diaries

Abstract Introduction Cognitive behavioral therapy for insomnia (CBT-I) is the first line recommended treatment for adults with chronic insomnia. In a prior randomized controlled trial (RCT), data showed web-delivered CBT-I (SHUTi) reduced insomnia severity as well as symptoms of depression, among adults with insomnia and elevated depressive symptoms. The present study aimed to further evaluate the effectiveness of web CBT-I to improve sleep outcomes as measured by prospectively entered sleep diaries in this same sample. Methods A large-scale RCT (N=1149) of Australian adults with insomnia and depressive symptoms compared a 9-week, web CBT-I therapeutic with an attention-matched web program at baseline, posttest and 6-, 12-, and 18-month follow-ups. Although depression outcomes have been presented previously, the online sleep-diary derived variables have not yet been presented, including sleep-onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), number of awakenings, sleep quality, and total sleep time (TST). Sleep diaries were entered online for 10 days at each assessment period. Results Data showed web CBT-I participants demonstrated greater reductions from baseline to posttest compared with control for the following sleep variables: SOL (LS mean difference [95% CI]=-22.3 min [-29.2, -15.3]; p<.0001), WASO (-17.8 min [-23.4, -12.3]; p<.0001), and number of awakenings (-0.38 [-0.68, -0.09]; p=.0113). Web CBT-I also showed greater improvements in SE (9.18% [7.25%, 11.10%]; p<.0001) and sleep quality (0.41 [0.30, 0.53]; p<.0001) from baseline to posttest compared with control. TST was not significantly different between groups at posttest or 6-month follow-up, although it improved over baseline at 12 (18.73 min [7.39, 30.07]; p=.0013) and 18 months (23.76 min [9.15, 38.36]; p=.0015) relative to control. All other significant sleep treatment effects were maintained in the treatment arm at 6, 12, and 18-month follow-up. Conclusion Data showed web CBT-I produced lasting improvements in sleep outcomes among adults with insomnia and elevated depressive symptoms. Support Clinical trial ACTRN12611000121965 was funded by the Australian National Health and Medical Research Council. The statistical analysis described here was funded by Pear Therapeutics, Inc and conducted by Provonix.

scholarly journals A ChineseChan-Based Mind-Body Intervention Improves Sleep on Patients with Depression: A Randomized Controlled Trial

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Agnes S. Chan ◽  
Queenie Y. Wong ◽  
Sophia L. Sze ◽  
Patrick P. K. Kwong ◽  
Yvonne M. Y. Han ◽  
...  
Keyword(s):  
Effect Size ◽  
Sleep Problems ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Onset Latency ◽  
Sleep Quantity ◽  
Wake Time ◽  
Positive Effects

Sleep disturbance is a common problem associated with depression, and cognitive-behavioral therapy (CBT) is a more common behavioral intervention for sleep problems. The present study compares the effect of a newly developed ChineseChan-based intervention, namelyDejianmind-body intervention (DMBI), with the CBT on improving sleep problems of patients with depression. Seventy-five participants diagnosed with major depressive disorder were randomly assigned to receive 10 weekly sessions of CBT or DMBI, or placed on a waitlist. Measurements included ratings by psychiatrists who were blinded to the experimental design, and a standardized questionnaire on sleep quantity and quality was obtained before and after the 10-week intervention. Results indicated that both the CBT and DMBI groups demonstrated significantly reduced sleep onset latency and wake time after sleep onset (effect size range=0.46–1.0,P≤0.05) as compared to nonsignificant changes in the waitlist group (P>0.1). Furthermore, the DMBI group, but not the CBT or waitlist groups, demonstrated significantly reduced psychiatrist ratings on overall sleep problems (effect size=1.0,P=0.00) and improved total sleep time (effect size=0.8,P=0.05) after treatment. The present findings suggest that a ChineseChan-based mind-body intervention has positive effects on improving sleep in individuals with depression.

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

The conceptual invariance, trajectory, and outcome associations of working alliance in unguided and guided internet-based psychological interventions: A randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Xiaochen Luo ◽  
Matteo Bugatti ◽  
Lucero Molina ◽  
Jacqueline L. Tilley ◽  
Brittain Mahaffey ◽  
...  
Keyword(s):  
Working Alliance ◽  
Support Group ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Post Treatment ◽  
Depression Symptoms ◽  
Therapy Program ◽  
Initial Sessions ◽  
Clinician Support

BACKGROUND The role of working alliance is largely unknown for internet-based interventions (IBI), an effective alternative for traditional psychotherapy. OBJECTIVE This study examined the conceptual invariance, trajectory, and outcome associations of working alliance in internet-based interventions incorporating or excluding clinician support via text or video. METHODS One hundred and forty-three adults with subclinical anxiety, stress, and/or depression symptoms were randomized to one of three treatment conditions for 7 weeks. All participants received access to MyCompass, an internet-delivered Cognitive Behavioral Therapy program. Participants in Condition 1 did not receive clinician support. Participants in Condition 2 and 3 received supplemental asynchronous clinician support via text or video respectively. Working alliance was measured weekly. Symptom outcomes were assessed at baseline, post-treatment, and 1-month follow-up. RESULTS We found scalar invariance of working alliance, indicating that working alliance was conceptually invariant across three conditions. Working alliance decreased significantly over time only in the text support group. Stronger baseline level and Faster increases in alliance predicted better outcomes at both post-treatment and follow-up only in the video support group. CONCLUSIONS Working alliance is methodologically comparable with or without clinician support and is generally established at initial sessions of IBI. Better alliance contributed to better outcomes only when clinician support is available via videos. CLINICALTRIAL clinicaltrials.gov ID: NCT05122429

Effect of psychoeducation website named “Imacoco-care” on improving psychological distress among workers under COVID-19 pandemic: a randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Kotaro Imamura ◽  
Natsu Sasaki ◽  
Yuki Sekiya ◽  
Kazuhiro Watanabe ◽  
Asuka Sakuraya ◽  
...  
Keyword(s):  
Mental Health ◽  
Adverse Effect ◽  
Psychological Distress ◽  
Controlled Trial ◽  
Intervention Group ◽  
Psychoeducational Intervention ◽  
Favorable Effect ◽  
Randomized Controlled ◽  
Small Effect Size

BACKGROUND The prolonged coronavirus disease 2019 (COVID-19) pandemic affected mental health among workers. Psychoeducational intervention via an Internet website could be effective for primary prevention of mental health among workers in the current COVID-19 pandemic. OBJECTIVE The aim of this randomized controlled trial (RCT) was to examine the effect of a newly developed online psychoeducational website named "Imacoco-care" on reducing psychological distress and fear about COVID-19 infection among workers. METHODS Participants in the present study were recruited from registered members of a web survey company in Japan. Participants who fulfilled the eligibility criteria were randomly allocated to intervention or control groups. Participants in the intervention group were invited to access the Imacoco-care within a month after the baseline survey. Kessler’s Psychological Distress Scale (K6) and The Fear of COVID-19 Scale (FCV-19S) were obtained at baseline, 1-, and 3-month follow-ups. RESULTS A total of 1200 workers were randomly allocated to an intervention or control group (n = 600 for each). In the intention-to-treat (ITT) analyses, the Imacoco-care showed significant favorable effect on K6 (p = 0.03) with small effect size (d = -0.14), and adverse effect on FCV-19S (p = 0.01) with small effect size (d = 0.16) in the intervention group at 3-month follow-up. In the per-protocol analyses (only included participants who have read the Imacoco-care at least one time), the Imacoco-care also showed significant favorable effect on reducing K6 (p = 0.03), while adverse effect on FCV-19S was not significant (p = 0.06) in the intervention group at 3-month follow-up. CONCLUSIONS A web-based psychoeducation approach may be effective on improving psychological distress in a general working population, while it may be important not only distributing information but also encouraging to access and see the contents to prevent the adverse effect of psychoeducational intervention. CLINICALTRIAL The University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR). The registration number is UMIN000042556 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048548).

Personalized attention control therapy for PTSD: effectiveness and moderators of outcome in a randomized controlled trial

2020 ◽  
pp. 1-11
Author(s):  
Adva Segal ◽  
Daniel S. Pine ◽  
Yair Bar-Haim
Keyword(s):  
Treatment Outcome ◽  
Clinical Symptoms ◽  
Controlled Trial ◽  
Post Treatment ◽  
Attention Control ◽  
Randomized Controlled ◽  
Control Therapy ◽  
Pre Treatment ◽  
Attentional Interference

Abstract Background Previous randomized controlled trials (RCTs) suggest that attention control therapy (ACT), targeting aberrant fluctuations of attention toward and away from threats in patients with PTSD, may be effective in reducing symptoms. The current RCT examined whether the use of personalized-trauma stimuli enhances ACT efficacy in patients with PTSD. Additional moderators of treatment outcome were tested on an exploratory basis. Methods Sixty patients with PTSD were randomly assigned to either personalized ACT, non-personalized ACT, or a control condition. Changes in symptoms were examined across pre-treatment, post-treatment, and a 3-month follow-up. Attentional interference was examined pre- and post-treatment. Baseline clinical and cognitive indices as well as the time elapsed since the trauma were tested as potential moderators of treatment outcome. Results A significant reduction in clinical symptoms was noted for all three conditions with no between-group differences. Attention bias variability decreased following ACT treatment. Personalized ACT was more effective relative to the control condition when less time had elapsed since the trauma. Baseline clinical and cognitive indices did not moderate treatment outcome. Conclusions In this RCT of patients with PTSD, ACT was no more effective in reducing PTSD symptoms than a control condition. The data also suggest a potential benefit of personalized ACT for patients who experienced their trauma more recently.

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.

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