Sleep disturbances in treatment‐seeking OCD‐patients: Changes after concentrated exposure treatment

Abstract

Research indicates that patients with Obsessive Compulsive Disorder (OCD) frequently suffer from comorbid sleep difficulties, and that these difficulties often are not clinically recognized and diagnosed. There has been limited research investigating if comorbid sleep difficulties impair treatment outcome for OCD and if the sleep difficulties change following OCD-treatment. Thirty-six patients with obsessive compulsive disorder underwent concentrated exposure treatment delivered in a group over four consecutive days and were assessed with measures of OCD, depressive symptoms and sleep disturbance at three different time points (pre, post and 6 months follow-up). The sample was characterized by a high degree of comorbidity with other psychiatric disorders. At pre-treatment nearly 70% of the patients reported sleep difficulties indicative of primary insomnia. The results showed that patients had large reductions of OCD-symptoms as well as significant improvements in sleep disturbance assessed after treatment, and that these improvements were maintained at follow-up. Sleep disturbance did not impair treatment outcome, on the contrary patients with higher degree of sleep disturbance at pre-treatment had better outcome on OCD-symptoms after treatment. The results indicated that the majority of the OCD sample suffered from sleep disturbances and that these sleep disturbances were significantly reduced following adequate treatment of OCD without specific sleep interventions. However, a proportion of the patients suffered from residual symptoms of insomnia after treatment.

Does Concentrated Exposure Treatment for Obsessive-Compulsive Disorder Improve Insomnia Symptoms? Results From a Randomized Controlled Trial

“…This reflects a high rate of insomnia in the current group of patients and further add to the growing body of research indicating insomnia as a problem area for people with OCD ( 7 , 37 , 38 ). This finding is also in accordance with our previous finding of 70% insomnia in OCD ( 12 , 13 , 20 ).…”

“…In a previous effectiveness study ( 20 ), we explored whether concurrent self-reported insomnia in patients with OCD improved following the B4DT. There was a significant change in symptoms of insomnia from pre-treatment to 6-month follow-up, however residual symptoms were observed.…”

“…The study also indicated that insomnia did not impair the primary treatment outcome, and that there was a reduction in insomnia symptoms independent of depressive symptoms. The Nordahl et al ( 20 ) study had an open trial design, which did not allow inferring any causality between the intervention and improvement of the self-reported insomnia. We have now conducted a randomized controlled trial, primarily focusing on the effects of B4DT when compared to a self-help (SH) intervention, and a waiting list (WL) condition with a 6-month follow-up ( 21 ).…”

“…The aims of this study were: (1) To investigate differences in self-reported insomnia between patients who received B4DT with patients who received unguided self-help or were on a waitlist, (2) To investigate if insomnia is associated with treatment outcome for the primary OCD-disorder, (3) To investigate the relationship between depressive symptoms and insomnia. Based on our previous open trial ( 20 ), as well as the clinical results from the RCT ( 21 ), we expected that patients treated with the B4DT would show more improvement in self-reported insomnia than patients in the SH and WL groups. Furthermore, and based on the previous study ( 20 ), we hypothesized that symptoms of insomnia would not be associated with treatment outcome.…”

“…Based on our previous open trial ( 20 ), as well as the clinical results from the RCT ( 21 ), we expected that patients treated with the B4DT would show more improvement in self-reported insomnia than patients in the SH and WL groups. Furthermore, and based on the previous study ( 20 ), we hypothesized that symptoms of insomnia would not be associated with treatment outcome. We had no clear hypothesis regarding the relationship between depression and insomnia due to different findings in the research literature.…”