Mediators of cognitive-behavioral therapy for insomnia: A review of randomized controlled trials and secondary analysis studies

Schwartz, Danielle R.; Carney, Colleen E.

doi:10.1016/j.cpr.2012.06.006

Cited by 116 publications

(95 citation statements)

References 101 publications

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“…39 A number of trials have examined mediators of change in adult CBT-I and have provided some evidence that the intervention leads to changes in the factors thought to perpetuate insomnia, including presleep hyperarousal and maladaptive sleep beliefs. 41 However, in statistical analyses, these variables were often assessed as dependent variables, measures of adherence, or moderators, rather than as mediating variables.…”

Section: Statement Of Significancementioning

confidence: 99%

“…40 behavioral and mindfulness-based sleep interventions, including napping, sleep effort, sleep-related self-efficacy, and sleep locus of control. 41 Studies are also needed that examine moderators of change (eg, age and gender) and predictors of treatment adherence (eg, baseline symptoms [short sleep duration] and attitude to treatment 77 ). Finally, it is not possible to draw conclusions regarding the stability of treatment-induced improvements from the data reported here.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

“…41 Moreover, cross-sectional studies have shown that adolescents report elevated arousal in the presleep period. [44][45][46] For example, Alfano et al 46 found that the presence of presleep arousal was associated with greater self-reported sleep problems among children and adolescents who were diagnosed with an anxiety disorder.…”

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confidence: 99%

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The SENSE Study: Treatment Mechanisms of a Cognitive Behavioral and Mindfulness-Based Group Sleep Improvement Intervention for At-Risk Adolescents

Blake¹,

Schwartz²,

Waloszek³

et al. 2017

Sleep

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Objectives:The aim of this study was to test whether a cognitive behavioral and mindfulness-based group sleep intervention would improve sleep and anxiety on school nights in a sample of at-risk adolescents. We also examined whether benefits to sleep and anxiety would be mediated by improvements in sleep hygiene awareness and presleep hyperarousal. Methods: Secondary analysis of a randomized controlled trial conducted with 123 adolescent participants (female = 60%; mean age = 14.48) who had high levels of sleep problems and anxiety symptoms. Participants were randomized into a sleep improvement intervention (n = 63) or active control "study skills" intervention (n = 60). Preintervention and postintervention, participants completed the Pittsburgh Sleep Quality Index (PSQI), Spence Children's Anxiety Scale (SCAS), Sleep Beliefs Scale (SBS), and Presleep Hyperarousal Scale (PSAS) and wore an actiwatch and completed a sleep diary for five school nights. Results: The sleep intervention condition was associated with significantly greater improvements in actigraphy-measured sleep onset latency (SOL obj ), sleep diary measured sleep efficiency (SE subj ), PSQI, SCAS, SBS, and PSAS, with medium to large effect sizes. Improvements in the PSQI and SCAS were specifically mediated by the measured improvements in the PSAS that resulted from the intervention. Improvements in SOL obj and SE subj were not specifically related to improvements in any of the putative treatment mechanisms. Conclusions:This study provides evidence that presleep arousal but not sleep hygiene awareness is important for adolescents' perceived sleep quality and could be a target for new treatments of adolescent sleep problems.

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Section: Statement Of Significancementioning

confidence: 99%

Section: Limitations and Strengthsmentioning

confidence: 99%

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The SENSE Study: Treatment Mechanisms of a Cognitive Behavioral and Mindfulness-Based Group Sleep Improvement Intervention for At-Risk Adolescents

Blake¹,

Schwartz²,

Waloszek³

et al. 2017

Sleep

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“…11 High sleep variability in individuals with insomnia is thought to be the consequence of the interaction between sleep homeostasis and poor stimulus control. 12 The greater tendency to engage in "sleep recovery" behavior following poor sleep often leads to elevated sleep-incompatible activities and irregular sleep schedules.…”

Section: Night-to-night Sleep Variability In Older Adults With Chronimentioning

confidence: 99%

“…The aims of this study were to examine whether (1) BBT-I was more efficacious in reducing variability in SOL, WASO, TST, and SE than a selfmonitoring and attention control (SMAC); (2) changes in the theorized behavioral mediators 11 -bedtime variability, wake time variability, nap duration, and TIB-mediated changes in sleep variability; and, (3) baseline sleep variability moderated intraindividual changes in sleep outcome (SOL, WASO, TST, and SE). It was hypothesized that (1) there would be significant reductions of sleep variability in BBT-I recipients compared to the SMAC participants; (2) changes in bedtime variability, wake time variability, nap duration, and TIB would partially mediate the reduction of sleep variability; and (3) sleep variability at baseline would moderate intraindividual changes of sleep outcomes.…”

Section: The Current Studymentioning

confidence: 99%

Night-to-Night Sleep Variability in Older Adults With Chronic Insomnia: Mediators and Moderators in a Randomized Controlled Trial of Brief Behavioral Therapy (BBT-I)

Chan

Williams

Dautovich

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep variability is a clinically significant variable in understanding and treating insomnia in older adults. The current study examined changes in sleep variability in the course of brief behavioral therapy for insomnia (BBT-I) in older adults who had chronic insomnia. Additionally, the current study examined the mediating mechanisms underlying reductions of sleep variability and the moderating effects of baseline sleep variability on treatment responsiveness. Methods: Sixty-two elderly participants were randomly assigned to either BBT-I or self-monitoring and attention control (SMAC). Sleep was assessed by sleep diaries and actigraphy from baseline to posttreatment and at 3-month follow-up. Mixed models were used to examine changes in sleep variability (within-person standard deviations of weekly sleep parameters) and the hypothesized mediation and moderation effects. Results: Variabilities in sleep diary-assessed sleep onset latency (SOL) and actigraphy-assessed total sleep time (TST) significantly decreased in BBT-I compared to SMAC (Pseudo R 2 = .12, .27; P = .018, .008). These effects were mediated by reductions in bedtime and wake time variability and time in bed. Significant time × group × baseline sleep variability interactions on sleep outcomes indicated that participants who had higher baseline sleep variability were more responsive to BBT-I; their actigraphy-assessed TST, SOL, and sleep efficiency improved to a greater degree (Pseudo R 2 = .15 to .66; P < .001 to .044). Conclusions I NTRO DUCTI O NChronic insomnia is the most prevalent sleep disorder and affects 15% to 35% of older adults.1-3 Recent research suggests that night-to-night sleep variability is an important clinical characteristic and therapeutic target in treating insomnia in older adults. 4,5 Higher objective sleep variability is associated with poorer subjective sleep quality, 4,6,7 poorer subjective well-being, 7 and greater risks of cardiometabolic diseases 5,6 in older adults with chronic insomnia. Although objective sleep is often found to be similar in those with and without insomnia, significantly greater sleep variability was observed in older adults with insomnia than in older adults without insomnia. 5,7 Although evidence supports the clinical significance of sleep variability in understanding and treating insomnia, little is known with regard to changes in sleep variability in the treatment of insomnia for older adults, the mechanisms by which changes in sleep variability occur, and the clinical significance of sleep variability in Reduction of sleep variability in the treatment of insomnia has been observed in young and middle-aged adults following BRIEF SUMMARY Current Knowledge/Study Rationale: High night-to-night sleep variability is prevalent in older adults who have chronic insomnia, is associated with poorer health outcomes, and may maintain insomnia. It is unclear if and how sleep variability decreases over the course of a brief behavioral therapy for insomnia (BBT-I) and whether pretreatment slee...

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Remote non-pharmacologic interventions for sleep problems in adults during the COVID-19 pandemic

López

Torrente

Comandé

et al. 2021

Cochrane Database of Systematic Reviews

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Mediators of cognitive-behavioral therapy for insomnia: A review of randomized controlled trials and secondary analysis studies

Cited by 116 publications

References 101 publications

The SENSE Study: Treatment Mechanisms of a Cognitive Behavioral and Mindfulness-Based Group Sleep Improvement Intervention for At-Risk Adolescents

The SENSE Study: Treatment Mechanisms of a Cognitive Behavioral and Mindfulness-Based Group Sleep Improvement Intervention for At-Risk Adolescents

Night-to-Night Sleep Variability in Older Adults With Chronic Insomnia: Mediators and Moderators in a Randomized Controlled Trial of Brief Behavioral Therapy (BBT-I)

Remote non-pharmacologic interventions for sleep problems in adults during the COVID-19 pandemic

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