Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders
Section snippets
General rationale, indications, and contraindications for CBT-I in comorbid insomnia
It has been argued that cognitive-behavioral models of insomnia are particularly relevant to patients with medical and psychiatric diseases (e.g., Morin et al., 1989, Smith et al., 2000). Cognitive-behavioral conceptualizations of insomnia posit that as insomnia transitions from an initial acute symptom and/or stress reaction to a chronic problem, maladaptive compensatory strategies and behavioral contingencies begin to play a role in maintaining the sleep disturbance, independent from the
Cognitive behavior therapy for insomnia in mixed samples of medical and psychiatric disorders
Before reviewing the outcome literature for CBT-I in specific medical and psychiatric disorders, we will briefly review four studies that have evaluated the efficacy of CBT-I in patients with heterogeneous medical and/or medical/psychiatric conditions. Two of these studies were randomized clinical trials (Lichstein et al., 2000, Rybarczyk et al., 2002) and the other two were case series (Morin et al., 1994, Perlis et al., 2001).
Lichstein et al. (2000) used a randomized, waitlist control design
Cancer
Given the tremendous emotional and physical burden associated with cancer, it is not surprising that studies have found greater prevalence of self-reported and objectively documented difficulties initiating and maintaining sleep compared with healthy controls (Kaye et al., 1983, Silberfarb et al., 1993). Rates of self-reported sleep disturbance in mixed cancer populations range between 30% and 50%, with highest prevalence (37–38%) among breast and lung cancer patients (Davidson et al., 2002,
Cognitive behavior therapy for insomnia occurring in psychiatric conditions
Disturbed sleep is listed as a diagnostic symptom of mood and anxiety disorders and is an associated symptom of most other psychiatric disorders. A report on the patterns of symptomatic recovery in psychotherapy indicates that sleep complaints do not change as a result of general psychotherapy (Kopta, Howard, Lowry, & Beutler, 1994). This implies that the sleep complaints of psychiatric patients need to be specifically targeted if they are to be improved. In addition to difficulties initiating
Conclusions and future directions
In summarizing the existing outcomes literature for CBT-I, the preliminary data regarding the efficacy of CBT-I for chronic insomnia when it occurs in patients with various medical and psychiatric conditions are encouraging (see Table 1). Effect sizes across most of the studies are quite large and consistent with effect sizes reported in the outcomes literature for primary insomnia. The possibility that improvements in sleep might reciprocally feedback and impact the primary disease processes
References (222)
Neurobiological bases for the relation between sleep and depression
Sleep Medicine Review
(2002)- et al.
Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromyalgia
Pain
(1996) - et al.
Sleep in fall/winter seasonal affective disorder: Effects of light and changing seasons
Journal of Psychosomatic Research
(1994) - et al.
The sleep of dysthymic patients: A comparison with normal controls
Bioloogical Psychiatry
(1990) - et al.
Circadian temperature and cortisol rhythms during a constant routine are phase delayed in hypersomnic winter depression
Biological Psychiatry
(1997) - et al.
The unipolar–bipolar dichotomy and the response to sleep deprivation
Psychiatry Research
(1998) - et al.
Insomnia and generalized anxiety disorder: Effects of cognitive behavior therapy for gad on insomnia symptoms
Journal of Anxiety Disorders
(2004) - et al.
Worsening of delusional depression after sleep deprivation: Case reports
Journal of Psychiatric Research
(1999) - et al.
Clinical effects of sleep fragmentation versus sleep deprivation
Sleep Medicine Reviews
(2003) - et al.
Stimulus control applications to the treatment of worry
Behaviour Research and Therapy
(1983)
Fatigue in ambulatory AIDS patients
Journal of Pain and Symptom Management
Insomnia, alcoholism and relapse
Sleep Medicine Reviews
Electroencephalographic sleep correlates of episode and vulnerability to recurrence in depression
Biological Psychiatry
Electroencephalographic sleep studies in depressed outpatients treated with interpersonal psychotherapy: II. Longitudinal studies at baseline and recovery
Psychiatry Research
The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research
Psychiatry Research
Treatment of insomnia in cancer patients using muscle relaxation training
Journal of Behavior Therapy and Experimental Psychiatry
Rate of switch form depression into mania after therapeutic sleep deprovation in bipolar depression
Psychiatry Research
Reactivity to interoceptive cues in nocturnal panic
Journal of Behavior Therapy and Experimental Psychiatry
Sleep disturbance mediates the association between psychological distress and immune status among HIV-positive men and women on combination antiretroviral therapy
Journal of Psychosomatic Research
Sleep disturbance in cancer patients
Social Science & Medicine
Sleep deprivation and human immune function
Advances in Neuroimmunology
The effect of caffeine reduction on sleep quality and well being in persons with HIV
Journal of Psychosomatic Research
Insomnia symptom or diagnosis
Clinical Psychology Review
Alpha-delta sleep
Electroencephalography and Clinical Neurophysiology
Development of a sleep diary for chronic pain patients
Journal of Pain and Symptom Management
Home-based central nervous system assessment of a multifactor behavioral intervention for chronic sleep-onset insomnia
Behavior Therapy
Latency of eye movement and other REM sleep parameters in bipolar depression
Biological Psychiatry
Imagery rehearsal treatment for chronic nightmares
Behavior Research and Therapy
Sleep of dry alcoholics
Archives of General Psychiatry
Effects on postural oscillation and memory functions of a single dose of zolpidem 5 mg, zopiclone 3.75 mg and lormetazepam 1 mg in elderly healthy subjects. A randomized, cross-over, double-blind study versus placebo
European Journal of Clinical Pharmacology
Diagnositic and Statistical Manual of Mental Disorders (DSM-IV)
The International Classification of Sleep Disorders: Diagnostic and Coding Manual—Revised
Characteristics of insomnia in the United States: Results of the 1991 National Sleep Foundation Survey, I
Sleep
EEG sleep characteristics in dysthymia and major depressive disorder
Neuropsychochobiology
Zolpidem for persistent insomnia in SSRI-treated depressed patients
Journal of Clinical Psychiatry
Mind–body therapies for the management of pain
Clinical Journal of Pain
Subjective sleep disturbance in chronic back pain
The Clinical Journal of Pain
Bright dawn simulation compared with bright morning light in the treatment of winter depression
Acta Psychiatrica Scandinavica
REM latency and temperature in affective disorder before and after treatment
Biological Psychiatry
REM latency and core temperature relationships in primary depression
Acta Psychiatrica Scandinavica
Cognitive Therapy for Depression
Patterns of performance degradation and restoration during sleep restriction and subsequent recovery: A sleep dose–response study
Journal Sleep Research
Eating disorders
Sleep and psychiatric disorders: A meta analysis
Archives of General Psychiatry
Sleep deprivation combined with consecutive sleep phase advance as a fast-acting therapy in depression: An open pilot trial in medicated and unmedicated patients
American Journal of Psychiatry
Benzodiazepines for depression? A review of the literature
International Clinical Psychopharmacology
Heart rate variability in insomniacs and matched normal sleepers
Psychosomatic Medicine
Sleep in lifetime posttraumatic stress disorder: A community-based polysomnographic study
Archives of General Psychiatry
Insomnia, self-medication, and relapse to alcoholism
American Journal of Psychiatry
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