New developments in cognitive behavioral therapy as the first-line treatment of insomnia

Siebern, Allison T.; Manber, Rachel

doi:10.2147/prbm.s10041

Cited by 76 publications

(59 citation statements)

References 71 publications

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“…There is now increasing evidence that sleep disturbances among people with psychiatric disorders may not improve with treatment of the psychiatric illness [36]. While the DSM-IV required insomnia to be coded as a secondary disorder in those with other psychiatric conditions, DSM-5 allows coding insomnia as a primary disorder alongside other psychiatric conditions [37].…”

Section: Diagnosismentioning

confidence: 99%

“…Evidence-based psychological and behavioral treatments include stimulus control therapy, relaxation, paradoxical intention, sleep restriction, biofeedback therapy, and cognitive-behavioral therapy for insomnia (CBT-I) [41]. CBT-I is classified by the NIH as a firstline treatment for insomnia due to its comparable efficacy and better durability of treatment gains compared to medication [36]. This is likely due, at least in part, to its focus on teaching clients to use sleep strategies on their own after treatment discontinuation; a unique advantage over pharmacological approaches [36].…”

Section: Treatment and Managementmentioning

confidence: 99%

“…CBT-I is classified by the NIH as a firstline treatment for insomnia due to its comparable efficacy and better durability of treatment gains compared to medication [36]. This is likely due, at least in part, to its focus on teaching clients to use sleep strategies on their own after treatment discontinuation; a unique advantage over pharmacological approaches [36]. For those with severe or refractory insomnia or chronic comorbid illness, which characterizes many individuals with schizophrenia, long-term use of sleep aids may be warranted.…”

Section: Treatment and Managementmentioning

confidence: 99%

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Sleep Disorders Among People With Schizophrenia: Emerging Research

Klingaman

Palmer-Bacon

Bennett

et al. 2015

Curr Psychiatry Rep

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Up to 80 % of individuals with schizophrenia spectrum disorders experience sleep disturbances, which impact physical and mental health, as well as quality of life. In this paper, we review and integrate emerging literature, published between 2012 and 2014, regarding approaches to diagnosis and treatment of major sleep disorders for people with schizophrenia spectrum disorders, including insomnia, obstructive sleep apnea (OSA), circadian rhythm dysfunction, and restless legs syndrome (RLS). We advocate for (1) the need to evaluate the utility of nonpharmacological approaches in people with schizophrenia spectrum disorders; (2) documentation of guidelines to assist providers in clinically tailoring such interventions when their clients experience positive, negative, and/or cognitive symptoms; (3) research on the best ways providers can capitalize on clients' self-identified needs and motivation to engage in sleep treatments through shared decision making; and (4) the importance of investigating whether and how mental health and sleep treatment services should be better connected to facilitate access for people with schizophrenia spectrum disorders. Assessment and tailored treatment of sleep disorders within mental health treatment settings has the potential to reduce sleep problems and improve functioning, quality of life, and recovery of this population.

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Section: Diagnosismentioning

confidence: 99%

Section: Treatment and Managementmentioning

confidence: 99%

Section: Treatment and Managementmentioning

confidence: 99%

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Sleep Disorders Among People With Schizophrenia: Emerging Research

Klingaman

Palmer-Bacon

Bennett

et al. 2015

Curr Psychiatry Rep

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“…It has been demonstrated convincingly that CBT is at least as effective as benzodiazepines in the short term, whereas in the longer term CBT is more effective than sleep medication (Smith et al 2002;Morin et al 2009b). However, although CBT is the preferred treatment according to several guidelines (Siebern & Manber, 2011), it is often unavailable. There is a shortage of CBT therapists, and professionals are often unaware of the treatment facilities that do exist.…”

Section: Introductionmentioning

confidence: 99%

Guided Internet-delivered cognitive behavioural treatment for insomnia: a randomized trial

Straten¹,

Emmelkamp²,

Wit³

et al. 2013

Psychol. Med.

114

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Background. Insomnia is a prevalent problem with a high burden of disease (e.g. reduced quality of life, reduced work capacity) and a high co-morbidity with other mental and somatic disorders. Cognitive behavioural therapy (CBT) is effective in the treatment of insomnia but is seldom offered. CBT delivered through the Internet might be a more accessible alternative. In this study we examined the effectiveness of a guided Internet-delivered CBT for adults with insomnia using a randomized controlled trial (RCT).Method. A total of 118 patients, recruited from the general population, were randomized to the 6-week guided Internet intervention (n = 59) or to a wait-list control group (n = 59). Patients filled out an online questionnaire and a 7-day sleep diary before (T0) and after (T1) the 6-week period. The intervention group received a follow-up questionnaire 3 months after baseline (T2).Results. Almost three-quarters (72.9%) of the patients completed the whole intervention. Intention-to-treat (ITT) analysis showed that the treatment had statistically significant medium to large effects (p < 0.05; Cohen's d between 0.40 and 1.06), and resulted more often in clinically relevant changes, on all sleep and secondary outcomes with the exception of sleep onset latency (SOL) and number of awakenings (NA). There was a non-significant difference in the reduction in sleep medication between the intervention (a decrease of 6.8%) and control (an increase of 1.8%) groups (p = 0.20). Data on longer-term effects were inconclusive.Conclusions. This study adds to the growing body of literature that indicates that guided CBT for insomnia can be delivered through the Internet. Patients accept the format and their sleep improves.

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“…This included treatment components of cognitive therapy, stimulus control, sleep restriction, sleep practice (hygiene) education, and time monitoring behavior. 24,25 Participants diagnosed with comorbid insomnia with obstructive sleep apnea (OSA) received either sleep education or 4-8 biweekly sessions of CBT-i for their insomnia, and automatic positive airway pressure (APAP) for their OSA. All treatments were administered and supervised by either a psychologist certified in Behavioral Sleep Medicine or a sleep medicine physician with expertise in CBT-i.…”

Section: Methodsmentioning

confidence: 99%

Improved Sleep Quality is Associated with Reductions in Depression and PTSD Arousal Symptoms and Increases in IGF-1 Concentrations

Rusch

Guardado

Baxter

et al. 2015

Journal of Clinical Sleep Medicine

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predict depression reoccurrence, 7 which highlights the critical importance of treating underlying sleep disturbances in patients with mood and anxiety disorders to maintain psychiatric recovery, especially in the often stressful period of deployment readjustment. Although sleep disturbance represents a strong risk factor for depression and PTSD, less is known regarding the impact of targeting sleep disturbances directly to improve BRIEF SUMMARY Current Knowledge/Study Rationale: Previous studies recognized a relationship between sleep disturbance and psychiatric morbidity; however, limited work has examined this link in military personnel, a cohort at elevated risk for both insomnia and psychopathology. The current study examines the relation between improved sleep and attenuation of depression and posttraumatic symptoms in military personnel, as well as changes in trophic factors that likely modulate these conditions. Study Impact: Results indicate a strong association between improved sleep and reduced psychiatric symptoms, as well as enriched healthrelated quality of life. Sleep-focused treatments may be an effective means to facilitate psychiatric recovery. Findings highlight the importance of conducting sleep assessments in military personnel with mood and anxiety disorders.Study Objectives: One-third of deployed military personnel will be diagnosed with insomnia, placing them at high risk for comorbid depression, posttraumatic stress disorder (PTSD), and medical conditions. The disruption of trophic factors has been implicated in these comorbid conditions, which can impede postdeployment recovery. This study determined if improved sleep quality is associated with (1) reductions in depression and posttraumatic symptoms, as well as enrichments in health-related quality of life (HRQOL), and (2) changes in plasma concentrations of brain derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1). Methods: Forty-four military personnel diagnosed with insomnia underwent clinical evaluations and blood draws at pretreatment and at posttreatment following cognitive behavioral therapy for insomnia and automatic positive airway pressure treatment. Participants were classifi ed as sleep improved (n = 28) or sleep declined (n = 16) based on their change in pretreatment to posttreatment Pittsburgh Sleep Quality Index (PSQI) score. Both groups were compared on outcomes of depression, PTSD, HRQOL, BDNF, and IGF-1. Results: Paired t-tests of the sleep improved group revealed signifi cant declines in depression (p = 0.005) and posttraumatic arousal (p = 0.006) symptoms, and a signifi cant increase in concentrations of IGF-1 (p = 0.009). The sleep declined group had no relevant change in psychiatric symptoms or trophic factors, and had further declines on fi ve of eight dimensions of HRQOL. Between-group change score differences were signifi cant at p < 0.05. Conclusions: These fi ndings suggest that interventions, which successfully improve sleep quality, are an effective means to reduce the depression and ...

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New developments in cognitive behavioral therapy as the first-line treatment of insomnia

Cited by 76 publications

References 71 publications

Sleep Disorders Among People With Schizophrenia: Emerging Research

Sleep Disorders Among People With Schizophrenia: Emerging Research

Guided Internet-delivered cognitive behavioural treatment for insomnia: a randomized trial

Improved Sleep Quality is Associated with Reductions in Depression and PTSD Arousal Symptoms and Increases in IGF-1 Concentrations

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