Clinical efficacy of individual cognitive behavior therapy for psychophysiological insomnia in 20 outpatients

Abstract

Aim: Twenty patients (14 of them women) suffering from psychophysiological insomnia (PPI) were enrolled for cognitive behavior therapy (CBT). The mean age of the patients was 56.9 years, and the mean duration of insomnia morbidity was 8.9 years. Each received individual combined CBT treatments consisting of stimulus control, sleep reduction, cognitive therapy and sleep hygiene education over a period of 1 month.Methods: Just before the CBT and after its completion, sleep measurements were conducted that involved (i) sleep logs, Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), and the Pittsburgh Sleep Quality Index (PSQI); (ii) actigraphy measurement; (iii) dissociation between subjective and objective evaluation of sleep calculated from sleep logs and actigraphy results; and (iv) correlation between DBAS and the aforementioned sleep parameters. Because the intention was to focus on patients' incorrect cognition about sleep, the definition 'changes in dissociation between the sleep log and actigraphically measured sleep' was used as the primary outcome and 'changes in DBAS score' as the secondary outcome.Results: After the CBT the following was found: (i) underestimation by PPI patients of the objective evaluation of sleep; (ii) a decrease in the dissociation between the subjective and objective evaluation of sleep; (iii) improvement of the DBAS; and (iv) improvement of sleep logs and actigraphy measurements. Moreover, there was a correlation between the improvement of PSQI, sleep logs and DBAS.Conclusion: CBT for insomnia is able to redress incorrect cognition about sleep, leading to improvement of the disorder.

The Pittsburgh Sleep Quality Index in older primary care patients with generalized anxiety disorder: Psychometrics and outcomes following cognitive behavioral therapy

“…It also suggests that CBT for anxiety alleviates some aspects of sleep difficulty over time; whereas other aspects are not improved, which is consistent with research examining CBT for insomnia (Sato et al, 2010). It is evident that exclusive reliance on the global score would not allow one to capture which specific aspects of sleep are improved following treatment.…”

“…It is evident that exclusive reliance on the global score would not allow one to capture which specific aspects of sleep are improved following treatment. CBT for insomnia has been shown to improve subjective sleep quality, sleep latency, and sleep duration (Sato et al, 2010), whereas the current findings suggest that CBT for anxiety improves only global sleep difficulties immediately following active treatment. Therefore, although CBT targeting insomnia may immediately improve several specific qualities or domains of sleep disturbance, CBT for anxiety may be useful in immediately attenuating general sleep disturbances as a secondary symptom in older adults with GAD.…”

“…However, CBT for insomnia has been shown to improve subjective sleep quality, sleep latency, and sleep duration (but not habitual sleep efficiency) in adult outpatients (Sato et al, 2010), suggesting that the components do not uniformly respond to treatment. To better understand the precise effects of CBT for anxiety on sleep difficulties in older adults, an examination of the results of treatment on both global and individual domains is warranted.…”

A “Sleep 101” Program for College Students Improves Sleep Hygiene Knowledge and Reduces Maladaptive Beliefs about Sleep

“…Namely, participants in our 37,40,51,52 and correcting maladaptive beliefs and attitudes about sleep can promote better sleep over time. 40,41 These unhelpful thoughts are theorized to lead to increases in pre-sleep arousal that may inhibit normal sleep onset processes or result in sleep fragmentation (when associated with nighttime awakenings). This theory is a fundamental component of cognitive and behavioral therapy for insomnia (CBT-I), a widely used and effective treatment for insomnia in a multitude of populations.…”

“…38 In turn, improvement in maladaptive attitudes about sleep has been shown to correlate with reductions in sleep disturbance. 32,[39][40][41] Given that difficulty falling asleep is one of the primary complaints of college students, 5 brief educational strategies to correct or decrease the such unhelpful beliefs and attitudes about sleep could be vital to healthy sleep.…”