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

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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Efficacy of cognitive-behavioral therapy for insomnia: a group format implementation in the Spanish National Health System

Revista de Psicopatología y Psicología Clínica ◽

10.5944/rppc.29423 ◽

2021 ◽

Vol 26 (3) ◽

pp. 173-180

Author(s):

Paula Lantarón-Imedio ◽

Mª Rosario Pina-Camacho ◽

Marcos L. Moya-Diago ◽

Belén Pascual-Vera ◽

César Mateu ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Health System ◽

Behavioral Therapy ◽

National Health System ◽

Cognitive Behavioral ◽

Dysfunctional Beliefs ◽

Group Format ◽

Insomnia Disorder ◽

Spanish National Health System ◽

Beliefs And Attitudes

Background. Cognitive-behavioral therapy for insomnia (CBT-i) is considered the first-line treatment for this disorder, but it is not widely implemented in clinical settings. This study aims to examine the efficacy of a CBT-i in group format in the Spanish National Health System. Method. Fifty-two participants with a Primary Insomnia Disorder (55.8% women; Mage = 47.19, SD = 11.02) were assigned to a CBT-i (n =17) or waiting list condition (n = 21). Treatment consisted of eight group format sessions (2 hours/week). Results. Significant improvements in insomnia severity, sleep quality, and insomnia-related dysfunctional beliefs and attitudes were observed in patients who received CBT-i. Emotional symptoms also decreased after the intervention in the CBT-i group. Conclusion. Findings support the efficacy of cognitive-behavioral therapy for insomnia with a group protocol for patients with primary insomnia disorder. The maintenance role of insomnia-related dysfunctional beliefs and attitudes in this disorder is also suggested.

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0525 Subtypes of Efficacy of Cognitive-Behavioral Therapy for Insomnia

SLEEP ◽

10.1093/sleep/zsaa056.522 ◽

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

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370 Depressive symptoms in the context of Cognitive-Behavioral Therapy for Insomnia, a long-term follow-up study

SLEEP ◽

10.1093/sleep/zsab072.369 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A147-A147

Author(s):

Marco Sforza ◽

Andrea Salibba ◽

Alessandro Scarpellino ◽

Andrea Galbiati ◽

Marco Zucconi ◽

...

Keyword(s):

Depressive Symptoms ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Sleep Diary ◽

Secondary Outcome ◽

Term Evaluation ◽

Clinically Significant

Abstract Introduction Cognitive-Behavioral Therapy for Insomnia (CBT-I) is considered the first-choice treatment for Insomnia Disease (ID). The bi-directional causal relationship between insomnia and depression is recognized. Aim of our study is to investigate the role of depressive symptoms in predicting CBT-I outcomes, and the effectiveness of the treatment both on insomnia and depression. Methods 77 ID patients (mean age 38.2±10.4 years, 69.2% females) underwent 7-sessions group CBT-I and were assessed pre- (T0) post- (T1) and at long-term after CBT-I (T2=7.6±1.6 years after treatment). The primary outcomes are Insomnia Severity Index (ISI) and Sleep Diary parameters. The secondary outcome is Beck Depression Inventory-II (BDI). Patients were divided in two groups according to BDI baseline score (≥14): depressive (D) vs non-depressive (ND). Results All patients showed significant improvements at ISI score at T1 that were maintained at T2 (T0=16.2±4.8 vs T1=8.2±4.5 vs T2=10.0±6.1;p<0.001). Also Sleep Diary parameters (sleep latency, wake after sleep onset and sleep efficiency) showed significant improvement at T1 (p<0.001). Moreover all patients showed improvements of depressive symptoms at T1 that were maintained at T2 (T0=10.8±6.8 vs T1=6.2±5.5 vs T2=8.2±6.6; p<0.001). Indeed, if 29.3% if ID patients at T0 presented clinically significant depressive symptoms (BDI≥14), only 9.7% at T1 and 20.5% at T2. Nevertheless, we found an interaction between ISI along time (T0-T1-T2) and D vs ND group membership (ISI_TREAT*BDI_BL_GROUP Sig=p<0.05). In other words, group D patients at baseline showed a worsening of insomnia symptoms at the long-term evaluation (T2). Conclusion CBT-I showed improvements both in insomnia and in depressive symptoms at the end of treatment that are maintained at long-term (7.6yrs after treatment). Nevertheless, clinically significant depressive symptoms at the baseline predicted a worsening of insomnia at the long-term evaluation. This could suggest the need of a more frequent follow-up evaluation of CBT-I efficacy in those patients presenting depressive symptoms at the baseline. Support (if any) None

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Faculty Opinions recommendation of A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718391340.793495402 ◽

2014 ◽

Author(s):

Wilfred Pigeon

Keyword(s):

Cognitive Behavioral Therapy ◽

Web Application ◽

Behavioral Therapy ◽

Controlled Trial ◽

Cognitive Behavioral ◽

Chronic Insomnia ◽

Insomnia Disorder

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361 Relative Effectiveness of Cognitive Behavioral Therapy and its Components in Improving Insomnia Symptoms in Older Adults

SLEEP ◽

10.1093/sleep/zsab072.360 ◽

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

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