scholarly journals Impact of Pharmacist-Led Cognitive Behavioural Therapy for Chronic Insomnia

2020 ◽  
Vol 11 (3) ◽  
pp. 2
Author(s):  
Joshua Nurkowski ◽  
Habiba Elshorbagy ◽  
Katelyn Halpape ◽  
Karen Jensen ◽  
Darcy Lamb ◽  
...  
Keyword(s):  
Observational Study ◽  
Outpatient Clinic ◽  
Medication Use ◽  
Behavioural Therapy ◽  
Outpatient Clinics ◽  
Chronic Insomnia ◽  
Sleep Diary ◽  
Clinic Setting ◽  
Cognitive Behavioural ◽  
Hypnotic Medication

Background: Chronic insomnia is a common medical condition that negatively impacts quality of life and daytime function. Access to the first-line treatment for insomnia, cognitive behavioural therapy (CBT-i), is limited. Pharmacists are well positioned to provide this service, but evidence regarding pharmacist delivered CBT-i is sparse. The aim of this study was to evaluate the effectiveness of CBT-i delivered by pharmacists practicing in an outpatient clinic setting. Methods: This study was a retrospective chart audit of adult patients with chronic insomnia who received CBT-i from a pharmacist at one of two outpatient clinics in Canada. The primary endpoints were the differences between patient self-reported sleep diary parameters and utilization of hypnotic medications before and after CBT-i was delivered. The differences in patient reported sleep parameters were compared using Wilcoxon Signed Rank test and paired samples t-test and changes in hypnotic utilization was compared using McNemar Chi-square test. Results: 183 patients were referred for CBT-i and attended an initial appointment with a pharmacist. Of these, 105 did not receive the CBT-i. This resulted in 78 patients who met the inclusion criteria. Changes in sleep diary parameters were all statistically significantly improved after patients received CBT-i, except for total sleep time. Hypnotic medication use was also reduced. At baseline, 71.8% (n=56/78) of patients were taking one or more hypnotic medications compared to 52.6% (n=41/78) after CBT-i (p=0.0003). Discussion: The results of this study provide preliminary evidence that pharmacists working in an outpatient clinic setting may be able to effectively deliver CBT-i for patients with chronic insomnia. The external validity of these results is limited by the observational study design and the inclusion of pharmacists practicing in outpatient clinics, which is not the setting where most pharmacists currently practice. Conclusion: This observational study found improvements in sleep quality and efficiency, as well as, a reduction in hypnotic medication use, in patients who received CBT-i from pharmacists practicing in an outpatient clinic setting. Future randomized, controlled trials should evaluate the impact of CBT-i in a larger sample of patients, provided by pharmacists practicing in both outpatient clinics and community pharmacies.   Original Research  

scholarly journals P093 A Systematic Review of Adherence to Cognitive Behavioural Therapy for Insomnia (CBT-I) - Key Findings

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A51-A51
Author(s):  
A Mellor ◽  
E Kavaliotis ◽  
S Drummond
Keyword(s):  
Systematic Review ◽  
Treatment Outcomes ◽  
Psychosocial Support ◽  
Behavioural Therapy ◽  
Sleep Diary ◽  
Sleep Diaries ◽  
Cognitive Behavioural ◽  
Psychological Comorbidities ◽  
Digital Studies ◽  
Sleep Questionnaires

Abstract Introduction Research into factors influencing adherence to CBT-I and how adherence impacts treatment outcomes remains scarce. Through a systematic review, we aimed to determine how adherence is assessed; which factors predict adherence; and which treatment outcomes are predicted by adherence. Methods Included publications met the following criteria: adults with insomnia; an intervention of CBT-I, including sleep restriction (SRT) and/or stimulus control (SCT); a reported measure of adherence; and written in English. Results Final n=103 papers. Measures assessed either global adherence or adherence to specific components of CBT-I via questionnaires, sleep diaries, interviews, or actigraphy. Most common measures were sleep diary-derived CBT-I components for therapist-led studies, and module completion for digital studies. Twenty-eight papers (27.2% of total) examined predictors of adherence. Depression, pre- and post-session sleep, psychosocial support, and dysfunctional beliefs about sleep predicted adherence. Demographic variables, other psychological comorbidities, insomnia severity, and sleep questionnaires did not predict adherence. Twenty-eight papers (27.2%) examined whether adherence predicted treatment outcomes. Neither global adherence nor adherence to any specific component of therapist-led CBT-I reliably predicted sleep outcomes. For digital CBT-I, completion of treatment modules was linked to improvements in ISI, however there were only five studies. Conclusion There was a high degree of heterogeneity in how adherence was measured, and in predictors and outcome variables assessed. This heterogeneity likely explains why adherence does not appear to predict treatment outcome. The field needs to develop a standardised method for assessing each specific adherence construct to fully understand the role of adherence in CBT-I.

scholarly journals Clinical practice guidelines for insomnia disorder

2017 ◽  
Vol 59 (3) ◽  
pp. 45-51
Author(s):  
Lucille Malan ◽  
Nokuthula Dlamini
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Treatment Options ◽  
Early Morning ◽  
Behavioural Therapy ◽  
Pharmacological Therapy ◽  
Chronic Insomnia ◽  
First Line Therapy ◽  
Insomnia Disorder ◽  
Cognitive Behavioural ◽  
Falling Asleep

Insomnia disorder is defined as difficulty in falling asleep, maintaining sleep, and early morning awakenings. Common daytime consequences experienced are fatigue, mood instability and impaired concentration. In chronic insomnia these symptoms persist over a period of at least three months. Chronic insomnia can also be a symptom of a variety of disorders. The pathophysiology of insomnia is theorised as a disorder of nocturnal and daytime hyper-arousal as a result of increased somatic, cortical and cognitive activation. The causes of insomnia can be categorized into situational, medical, psychiatric and pharmacologically-induced. To diagnose insomnia, it is required to evaluate the daytime and nocturnal symptoms, as well as psychiatric and medical history. The Diagnostic and Statistical Manual 5 Criteria (DSM-5) also provides guidelines and criteria to be followed when diagnosing insomnia disorder. Goals of treatment for insomnia disorder are to correct the underlying sleep complaint and this, together with insomnia symptoms, their severity and duration, as well as co-morbid disorders will determine the choice of treatment. In the majority of patients, insomnia can be treated without pharmacological therapy and cognitive behavioural therapy is considered first-line therapy for all patients with insomnia. The most common pharmacological insomnia treatments include benzodiazepines and benzodiazepines receptor agonists. To avoid tolerance and dependence, these hypnotics are recommended to be used at the lowest possible dose, intermittently and for the shortest duration possible. A combination of cognitive behavioural therapy and pharmacological treatment options is recommended for chronic insomnia.

Psychiatry

2018 ◽  
Author(s):  
Isabel McMullen
Keyword(s):  
Mental Health ◽  
Psychiatric Illness ◽  
Mental Health Problems ◽  
Ethical Issues ◽  
Behavioural Therapy ◽  
Outpatient Clinics ◽  
Personal Stories ◽  
Cognitive Behavioural ◽  
The Uk ◽  
State Examination

Mental health problems are estimated to affect one in four people each year in the UK, making mental illness one of the commonest presentations to GP surgeries, outpatient clinics, and Emergency Departments. Yet many doctors and medical students feel uncertain about how to approach patients with a psychiatric disorder. The key to becoming a good psychiatrist lies in the clinical interview. There are few physical signs or investigations that allow doctors to diagnose psychiatric illness, so a detailed history and mental state examination are important. As a psychiatrist, you are in the privileged position of having patients tell you their personal stories, and the skill is in listening attentively and asking relevant questions to help to clarify parts of the story. The best way to practise these techniques is to watch experienced clinicians at work and to interview patients yourself. Obviously diagnosis is important, so you need to be aware of the types of symptoms that fit with each type of disorder, as well as the medical conditions that may mimic psychiatric illness. Investigations may be necessary to rule out other diseases, and you need to be able to request these appropriately. Psychiatrists have access to a range of treatments—medical (e.g. antidepressants), psychological (e.g. cognitive behavioural therapy), and physical (e.g. electroconvulsive therapy)—and you need to know which ones to recommend. Most of these treatments are delivered in conjunction with the multidisciplinary team, so you should be clear about the roles of each team member. Finally, there is overlap between psychiatry and the law, which can raise interesting ethical issues. It is sometimes necessary to treat a person against their will, for the safety of that person or others, so you need to know about mental health law. Psychiatrists are also often requested to provide a second opinion in difficult capacity assessments.

scholarly journals Treating Patients With Co-occurring Autism Spectrum Disorder and Substance Use Disorder: A Clinical Explorative Study

2019 ◽  
Vol 13 ◽  
pp. 117822181984329 ◽  
Author(s):  
Sissel Berge Helverschou ◽  
Anette Ræder Brunvold ◽  
Espen Ajo Arnevik
Keyword(s):  
Autism Spectrum Disorder ◽  
Substance Use ◽  
Well Being ◽  
Behavioural Therapy ◽  
Autism Spectrum ◽  
Group Supervision ◽  
Post Treatment ◽  
Spectrum Disorder ◽  
Outpatient Clinics ◽  
Cognitive Behavioural

Background: Substance use disorders (SUDs) have been assumed to be rare in individuals with autism spectrum disorder (ASD). Recent research suggests that the rates of SUD among individuals with ASD may be higher than assumed although reliable data on the prevalence of SUD in ASD are lacking. Typical interventions for SUD may be particularly unsuitable for people with ASD but research on intervention and therapy are limited. Methods: This study addresses ways of improving services for individuals with ASD and SUD by enhancing the competence of professionals in ordinary SUD outpatient clinics. Three therapists were given monthly ASD education and group supervision. The participants were ordinary referred patients who wanted to master their problems with alcohol or drugs. Four patients, all men diagnosed with ASD and intelligence quotient (IQ) ⩾ 70 completed the treatment. The participants were given cognitive behavioural therapy (CBT) modified for their ASD over a minimum of 10 sessions. The therapies lasted between 8 and 15 months. Standardised assessments were conducted pre- and post-treatment. Results: Post-treatment, 2 participants had ended their drug and alcohol abuse completely, 1 had reduced his abuse, and 1 still had a heavy abuse of alcohol. Physical well-being was the most prevalent reported positive aspect of drug or alcohol use, whereas the experience of being left out from social interaction was the most frequent negative aspects of intoxication. Conclusions: CBT may represent a promising treatment option for individuals with ASD and SUD. The results suggest that patients’ symptoms can be reduced by providing monthly ASD education and group supervision to therapists in ordinary SUD outpatient clinics. This group of patients need more sessions than other client groups, the therapy has to be adapted to ASD, ie, direct, individualised, and more extensive. Moreover, the patients need psychoeducation on ASD generally, social training, and support to organise several aspects of their lives and some patients need more support than can be provided in an outpatient clinic.

scholarly journals How was cognitive behavioural therapy for mood disorder implemented in Japan? A retrospective observational study using the nationwide claims database from FY2010 to FY2015

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e033365 ◽  
Author(s):  
Yuta Hayashi ◽  
Naoki Yoshinaga ◽  
Yosuke Sasaki ◽  
Hiroki Tanoue ◽  
Kensuke Yoshimura ◽  
...  
Keyword(s):  
Health Insurance ◽  
Observational Study ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Behavioural Therapy ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Cognitive Behavioural ◽  
Number Of Patients

ObjectivesTo clarify the dissemination status of cognitive behavioural therapy (CBT) in Japan under the national health insurance scheme.DesignRetrospective observational study.SettingNational Database of Health Insurance Claims and Specific Health Checkups of Japan.ParticipantsPatients who received CBT under the national health insurance scheme from fiscal years (FY) 2010 to 2015.Primary and secondary outcome measuresWe estimated the change rate and the standardised claim ratio (SCR) for the number of patients receiving CBT and analysed the association between the CBT status and several regional factors.ResultsWe found that (a) a total of 60 304 patients received CBT during the study period; (b) the number of patients receiving CBT was highest in the first year (−1.8% from FY2010 to FY2015); (c) the number of patients who received CBT per 100 000 population decreased (or remained at zero) in most prefectures (32 out of 47); (d) there was a maximum 424.7-fold difference between prefectures in the standardised claim ratio for CBT and (e) the number of registered CBT institutions was significantly associated with the number of patients who received CBT.ConclusionsThe provision of CBT did not increase in the first 6 years (FY2010–2015) after its coverage in Japan’s national health insurance scheme. Further studies including a questionnaire survey of registered CBT institutions are required to get more detailed information on the dissemination of CBT in Japan.

scholarly journals Cognitive behavioural treatment for insomnia in primary care: a systematic review of sleep outcomes

2019 ◽  
Vol 69 (686) ◽  
pp. e657-e664 ◽  
Author(s):  
Judith R Davidson ◽  
Ciara Dickson ◽  
Han Han
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Nurse Practitioners ◽  
Severity Index ◽  
Sleep Diary ◽  
Behavioural Treatment ◽  
Positive Effects ◽  
Cognitive Behavioural ◽  
Hypnotic Medication ◽  
The Impact

BackgroundPractice guidelines recommend that chronic insomnia be treated first with cognitive behavioural therapy for insomnia (CBT-I), and that hypnotic medication be considered only when CBT-I is unsuccessful. Although there is evidence of CBT-I’s efficacy in research studies, systematic reviews of its effects in primary care are lacking.AimTo review the effects on sleep outcomes of CBT-I delivered in primary care.Design and settingSystematic review of articles published worldwide.MethodMedline, PsycINFO, EMBASE, and CINAHL were searched for articles published from January 1987 until August 2018 that reported sleep results and on the use of CBT-I in general primary care settings. Two researchers independently assessed and then reached agreement on the included studies and the extracted data. Cohen’s d was used to measure effects on sleep diary outcomes and the Insomnia Severity Index.ResultsIn total, 13 studies were included. Medium-to-large positive effects on self-reported sleep were found for CBT-I provided over 4–6 sessions. Improvements were generally well maintained for 3–12 months post-treatment. Studies of interventions in which the format or content veered substantially from conventional CBT-I were less conclusive. In only three studies was CBT-I delivered by a GP; usually, it was provided by nurses, psychologists, nurse practitioners, social workers, or counsellors. Six studies included advice on withdrawal from hypnotics.ConclusionThe findings support the effectiveness of multicomponent CBT-I in general primary care. Future studies should use standard sleep measures, examine daytime symptoms, and investigate the impact of hypnotic tapering interventions delivered in conjunction with CBT-I.

scholarly journals Cost-effectiveness of cognitive–behavioural therapy for sleep disorder added to usual care in patients with schizophrenia: the BEST study

BJPsych Open ◽  
2018 ◽  
Vol 4 (3) ◽  
pp. 126-135 ◽  
Author(s):  
Apostolos Tsiachristas ◽  
Felicity Waite ◽  
Daniel Freeman ◽  
Ramon Luengo-Fernandez
Keyword(s):  
Cost Effectiveness ◽  
Usual Care ◽  
Cognitive Behavioural Therapy ◽  
Patient Group ◽  
Sleep Problems ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Potential Cost ◽  
Cognitive Behavioural ◽  
Hypnotic Medication

BackgroundSleep problems are pervasive in people with schizophrenia, but there are no clinical guidelines for their treatment. The Better Sleep Trial (BEST) concluded that suitably adapted cognitive–behavioural therapy (CBT) is likely to be highly effective, although its cost-effectiveness is unknown.AimsTo assess the potential cost-effectiveness of CBT for sleep disorders in patients with schizophrenia.MethodAn economic evaluation of the BEST study with a 6-month time horizon was used to establish the cost-effectiveness of CBT plus usual care in terms of costs per quality-adjusted life year (QALY) gained. Uncertainty was displayed on cost-effectiveness planes and acceptability curves. Value of information analysis was performed to estimate the benefits of obtaining further evidence.ResultsOn average, the treatment led to a 0.035 QALY gain (95% CI −0.016 to 0.084), and £1524 (95% CI −10 529 to 4736) and £1227 (95% CI −10 395 to 5361) lower costs from National Health Service and societal perspectives, respectively. The estimated value of collecting more information about the effects of the CBT on costs and QALYs was approximately £87 million.ConclusionsCBT for insomnia in people with schizophrenia is effective and potentially cost-effective. A larger trial is needed to provide clear evidence about its cost-effectiveness.RelevancePatients with schizophrenia have multiple complex health needs, as well as very high rates of depression, suicidal ideation and poor physical health. The results of this study showed that treating pervasive sleep problems in this patient group with cognitive–behavioural therapy (CBT) is very likely to improve patient quality of life in the short term. Clinicians most commonly use hypnotic medication to treat sleeping disorders. This study indicates that CBT may be an effective and cost-effective intervention in this patient group. This alternative would also be aligned with patient preferences for psychological and behavioural-type therapy.Declaration of interestNone.

Cognitive behavioural therapy with behavioural analysis for pharmacological treatment-resistant chronic insomnia

2013 ◽  
Vol 210 (2) ◽  
pp. 515-521 ◽  
Author(s):  
Isa Okajima ◽  
Masaki Nakamura ◽  
Shingo Nishida ◽  
Akira Usui ◽  
Ken-ichi Hayashida ◽  
...  
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Pharmacological Treatment ◽  
Behavioural Therapy ◽  
Chronic Insomnia ◽  
Treatment Resistant ◽  
Behavioural Analysis ◽  
Cognitive Behavioural
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