Behandling av svampfobi med modellering

Ett fall av långvarig svampfobi hos en 12-årig flicka redovisas. Klienten behandlades framgångsrikt med modellering och verbal förstärkning i direkt in-vivo träning med olika typer av svampar.     

Psychometric Properties and the Predictive Validity of the Insomnia Daytime Worry Scale: A Pilot Study

The relationship between presleep worry and insomnia has been investigated in previous studies, but less attention has been given to the role of daytime worry and symptoms of insomnia. The aims of the current study were (a) to assess the psychometric properties of a novel scale measuring insomnia-specific worry during daytime and (b) to examine whether levels of daytime worry predict severity of insomnia symptoms. Participants (N = 353) completed the Insomnia Daytime Worry Scale (IDWS) and the Insomnia Severity Index. An explorative principal-axis factor analysis extracted two factors from the IDWS, accounting for 70.5% of the variance. The IDWS demonstrated good reliability. The total score of IDWS and both factors predicted levels of insomnia severity in two separate hierarchical regression analyses. This preliminary evidence suggests that the IDWS is a valid and reliable scale to measure daytime worry in insomnia.     

Worry and Sleep Length Revisited: Worry,Sleep Length,and Sleep Disturbance Ascribed to Worry

The author administered university students (N = 222; 152 women, 70 men) the Worry Domains Questionnaire (F. Tallis, G. C. L. Davey, & A. Bond, 1994) and a newly constructed scale (the Sleep Disturbance Ascribed to Worry Scale) to measure sleep disturbance attributed to worry. To revisit previous studies (i.e., E. Hartmann, F. Baekeland, & G. R. Zwilling, 1972; S. J. H. McCann & L. L. Stewin, 1988) that suggested that sleep length was positively related to worry, the author also asked the students a question about habitual sleep length. The results indicated that worry and sleep disturbance attributed to worry were negatively related to sleep length. A regression analysis revealed that worry was significantly negatively related to habitual sleep length irrespective of sleep disturbance ascribed to worry.     

Psychological characteristics of elderly insomniacs

Sixty insomniacs, aged 60 years or over, fulfilling the DSM-IV criteria for primary insomnia, completed a set of questionnaires measuring psychological distress. These included the Sleep Impairment Index (SIM), the Symptom Check List 90-Revised (SCL-90-R), the Penn State Worry Questionnaire (PSWQ), the Toronto Alexithymia Scale-20 (TAS-20) and the Elders Life Stress Inventory (ELSI). The insomniacs were compared on these measures with two contrast groups, one of elderly good sleepers and one an elderly community sample. As norms were developed for the SCL-90-R and PSWQ, insomniacs were also contrasted with the norm groups on these measures. In general, the results indicated a higher level of psychological distress among insomniacs than among the good sleepers, while there were negligible differences between insomniacs and the community sample on most measures. Overall, elderly insomniacs scored higher on measures of worry compared with the other groups, followed by measures of somatization, obsessive-compulsion and depression. It is concluded that excessive worrying was the most characteristic feature of elderly insomniacs.     

Repetitive Thought and Self-Reported Sleep Disturbance

Repetitive thought has been focused upon as a transdiagnostic risk factor for depression, anxiety, and poor physical health. Among the forms of repetitive thought, rumination and worry are considered to play important roles in the onset and maintenance of insomnia. However, there have been few attempts to clarify the similarities, differences, and interaction between the functions of rumination and worry in sleep problems. Furthermore, no study has investigated the prospective relationships between these two forms of repetitive thought and sleep disturbance. In the present study, we examined the prospective associations between repetitive thought and subjective sleep quality, measured by a self-report questionnaire. A total of 208 undergraduates participated in a 2-wave longitudinal survey with an interval of 3 weeks between assessments. Hierarchical multiple regression analyses showed that baseline rumination predicted reduction in the follow-up assessment of subjective sleep quality, controlling for levels of depressive and anxious symptoms. This main effect of rumination was qualified by the levels of worry; for individuals with higher levels of worry, rumination was associated with greater reduction in subjective sleep quality. These results suggest that both rumination and worry have unique associations with sleep and that their interaction is especially important in sleep problems.     

A Multimethod Examination of the Effect of Insomnia Symptoms on Anxious Responding to a Social Stressor

A growing number of studies identify insomnia symptoms as a potential risk factor for the development of anxiety disorders. However, little research has examined potential mechanisms through which insomnia could confer increased risk for anxiety. A separate line of literature suggests sleep is necessary for adaptive emotional and behavioral responding to stressors, a potential mechanism linking insomnia symptoms to anxiety risk. To test whether insomnia symptoms affect emotional and behavioral responding to an anxiety-relevant stressor, the current study recruited a sample of 99 undergraduates with varying levels of insomnia symptoms. Participants completed self-report and psychophysiological measures before, during, and after an impromptu speech task. Results indicated that, after covarying for negative affectivity, increased insomnia symptoms were significantly associated with elevated anticipatory anxiety and skin conductance response prior to the speech, and increased skin conductance response, emotion regulation difficulties, and safety aid use during the speech. Taken together, results provide evidence for the notion that insomnia symptoms are associated with maladaptive emotional and behavioral responding to an anxiety-relevant stressor.     

原发性失眠患者的主客观睡眠特征研究

目的：了解原发性失眠患者的睡眠特点,探讨其主客观睡眠的异同点。方法：对15例原发性失眠患者、20例正常人的主观睡眠（PSQI）和客观睡眠（PSG）特点进行比较,对原发性失眠患者进行主观睡眠（PSQI）和客观睡眠（PSG）的比较。结果：原发性失眠的PSG多项指标（睡眠总时间、睡后觉醒次数、觉醒总时间、睡眠潜伏期、睡眠效率、觉睡比、睡眠维持率、REM睡眠时间和REM百分比、REM睡眠潜伏期和REM活动密度）等方面与正常对照有显著差异（p〈0.05或p〈0.01）;原发性失眠的PSQI多项指标（PSQI总分、睡眠效率、睡眠时间、睡眠潜伏期）方面与正常组对照差异显著（p〈0.01）。原发性失眠的PSQI和PSG在睡眠效率、实际睡眠时间、睡眠潜伏期方面存在显著差异（p〈0.01）。结论：原发性失眠患者的PSQI和PSG均存在一定程度的异常,原发性失眠患者有高估自己睡眠障碍的倾向。     

Use of the Sleep Assessment Device (Kelley and Lichstein, 1980) to validate insomniacs' self-report of sleep pattern

A comparison is presented of insomniacs' self-reported sleep pattern and objectively monitored sleep using the Sleep Assessment Device (SAD; Kelley & Lichstein, 1980). Analysis of 110 subject nights revealed modest but significant subjective overestimates of both sleep latency and sleep duration which were accounted for by the demands of the task (i.e., longer time periods are harder to estimate accurately). Correlations between self-report and SAD measures were, however, consistently high, suggesting that self-report may be a valid index of sleep disturbance. Results are discussed with reference to the clinician's task in evaluating sleep complaints.This research stury was supported by a grant from the Research Fund of Lanarkshire Health Board, Scotland.     

Effects of Rumination and Worry on Sleep

Recent research suggests that the stress-sleep relationship is mediated by pre-sleep arousal (PSA) and that cognitive arousal has a stronger mediating effect than somatic arousal; however, this has not been directly tested. Using multilevel moderated mediation, we compared the effects of cognitive arousal and somatic arousal within the stress-sleep relationship. We also assessed whether two forms of repetitive negative thought—rumination and worry—are similarly involved in the stress-sleep relationship. Data was collected from 178 participants across the United States via an online platform. Participants completed baseline self-report surveys examining rumination tendencies and worry tendencies. Over the course of 2 weeks, participants completed daily questionnaires assessing daily stress, PSA, and sleep quality. Results indicated that indirect effects from stress to sleep quality via PSA were statistically significant at low and high levels of rumination and worry, and people at high levels of rumination and worry had stronger relationships between stress and PSA. Across all models, cognitive arousal consistently accounted for more of the variance in the stress-sleep relationship as compared to somatic arousal. Implications for the cognitive behavioral treatment of insomnia are discussed.     

Test anxiety,self-evaluative worry,and sleep disturbance in college students

Abstract

The present research examined the extent to which sleep disturbance is involved in the experience of test anxiety. In Study 1, a sample of 80 subjects completed a trait measure of test anxiety and completed a sleep inventory with reference to the past 30 days. In Study 2, a sample of 188 subjects provided measures of trait and state test anxiety and completed a sleep inventory for the night preceding an actual test. The results of Study 1 and Study 2 confirmed that test anxiety is associated with self-reported sleep disturbance. In addition, the results of Study 2 showed that sleep disturbance is also associated with increased state test anxiety. Finally, it was found in Study 2 that sleep disturbance was not related to actual test performance. However, poorer test performance was associated with increased state and trait test anxiety. It is concluded that certain characteristics associated with test anxiety are stable and may be detected in evaluative and non-evaluative situations. The results are discussed with particular reference to their implications for the test anxiety construct itself as well as treatment strategies for the test-anxious student.     

Associations Between Psychological Factors and Nighttime/Daytime Symptomatology in Insomnia

Purpose: The aim of this study was to examine psychological factors in insomnia and the association between psychological mechanisms and nighttime and daytime symptoms. Methods: A cross-sectional examination in the general population was used. The study sample consisted of 1890 participants from the general population. The participants completed a survey on nighttime and daytime symptoms, health outcomes, and psychological factors. Results: Relative to poor and normal sleepers, the insomnia group had higher scores on worry, beliefs, physiologic arousal, monitoring/attentional bias, and safety behaviors than the other two groups, and the poor sleepers exhibited a similar pattern relative to the normal sleepers. High total wake time was associated with more worry, physiologic arousal, and safety behaviors (26.3% variance), low sleep restoration with more worry, unhelpful beliefs, and monitoring/attentional bias (28.2% variance), and low sleep quality with higher scores on all the psychological mechanisms (35.8% variance). Elevated daytime symptoms were related to more unhelpful beliefs and monitoring/attentional bias (44.3% variance). Conclusion: The findings indicate that psychological factors are linked to nighttime and daytime symptomatology in insomnia.     

Cross-Lagged Relationships Between Insomnia and Posttraumatic Stress Disorder in Treatment-Receiving Veterans

Insomnia is a risk factor for the development of posttraumatic stress disorder (PTSD) while it is also plausible that PTSD symptoms can maintain insomnia symptoms. The present study examined longitudinal bidirectional relationships between insomnia and PTSD symptoms in treatment-seeking veterans. Participants were 693 ex-serving members of the Australian Defence Force who participated in an accredited, hospital-based outpatient PTSD program. Participants completed self-reported assessments of PTSD and insomnia symptoms at four time points: intake, discharge, 3-month, and 9-months posttreatment follow-up.Cross-lagged pathway analyses indicated significant bi-directional pathways between insomnia symptoms and PTSD symptoms at most time points. A final cross-lagged model between insomnia symptoms and the PTSD symptom clusters indicated that the PTSD symptom paths on insomnia symptoms, between intake and discharge, were attributable to reexperiencing PTSD symptoms. In contrast, across posttreatment follow-up time points there were significant paths of insomnia symptoms on all PTSD symptom clusters except from insomnia at 3-months to avoidance symptom at 9-months. PTSD symptoms and insomnia symptoms have bidirectional associations over time that may lead to the mutual maintenance or exacerbation of each condition following PTSD treatment. Where residual insomnia symptoms are present post-treatment, a sleep-focussed intervention is indicated and a sequenced approach to treatment recommended.     

The utility of the Pittsburgh Sleep Quality Index in US military personnel

Sleep disturbances are endemic in military personnel with nonclinical populations averaging 6 hours of sleep. The Pittsburgh Sleep Quality Index (PSQI), however, has not been validated in this population. It is thus unknown if the PSQI can differentiate clinically significant sleep disorders from sleep disturbances resulting from military duties with restricted sleep periods. After a clinical evaluation and polysomnogram, participants (N = 148) were classified as having insomnia only, obstructive sleep apnea (OSA) only, comorbid insomnia and OSA (CIO), service-related illnesses only (SRI–; pain, depression, posttraumatic stress disorder, traumatic brain injury), and controls. Military personnel in the insomnia only, and the CIO groups had higher PSQI scores (13.5 ± 2.8 and 14.7 ± 3.5, respectively) compared to the controls (8.9 ± 3.9). A cut-off score of ≥10 was optimal (90% sensitivity and 69% specificity) for determining clinically significant insomnia (≥12 for CIO; 84% sensitivity, 77% specificity). In military personnel, a PSQI score >5 is not necessarily indicative of a clinically significant sleep disorder. The use of elevated cut-off PSQI scores are likely better suited to differentiate military personnel who require further clinical evaluation versus a more conservative sleep improvement protocol.     

Cognitive-behavioural Analysis and 1 reatment ot Insomnia

Abstract

Insomnia is a condition characterized by subjective complaints of insufficient sleep and poor daytime functioning. Objective measures of sleep and daytime functioning, however, seldom show evidence of a similar degree of dysfunction. Most insomniacs, for example, do not suffer from sleep deprivation or daytime sleepiness. This discrepancy between subjective and objective measures of sleep and daytime functioning suggests that cognitive factors may play a central role in persistent insomnia. In particular, it is argued that fears about insufficient sleep and its adverse daytime consequences tend to interfere with sleep, thereby causing a vicious cycle which serves to maintain the insomnia. It is also argued that perfectionist standards and other dysfunctional beliefs may predispose people to these kinds of fears. Finally, existing models for cognitive-behavioural treatment of insomnia are criticized for being almost exclusively focused on the night-time aspects of insomnia. If insomnia is maintained by various kinds of vicious cycles involving fears, beliefs, and standards with regard to daytime functioning, these daytime aspects of insomnia should receive more attention in cognitive-behavioural treatment.     

The Effects of Cognitive Behavioral Therapy for Insomnia on Multidimensional Perfectionism

Perfectionism is related to insomnia and objective markers of disturbed sleep. This study examined whether multidimensional perfectionism is related to dysfunctional beliefs about sleep, sleep-effort, pre-sleep arousal, and polysomnography-determined markers of sleep among individuals with insomnia. The effects of cognitive behavioral therapy for insomnia (CBT-I) on perfectionism was also examined. This was a secondary analysis of a randomized controlled trial on CBT-I. Forty-three insomnia patients were randomized to treatment (receiving CBT-I) or waitlist control groups. Sleep was recorded using polysomnography at baseline. Participants completed measures of perfectionism, dysfunctional beliefs about sleep, sleep-effort and pre-sleep arousal at baseline and posttreatment. Total perfectionism scores and doubts about action, concern over mistakes and personal standards were each significantly related to increased sleep effort, pre-sleep arousal and dysfunctional beliefs about sleep at baseline. Patients receiving treatment displayed increased total perfectionism scores posttreatment d = .49. In those receiving treatment, levels of organization d = .49 and parental expectations d = .47 were significantly increased posttreatment, relative to baseline. In line with the literature, our results confirm that perfectionism is related to insomnia. Here, insomnia was related to increased sleep effort, pre-sleep arousal and dysfunctional beliefs about sleep. The propensity to maintain a high standard of order and organization may be elevated following CBT-I, considering the treatment protocol expects patients to strictly adhere to a set of clearly defined rules. Levels of parental expectations may be increased following CBT-I since the patient-therapist-relationship may trigger implicit expectations in patients which are reminiscent of their relationship to their parents.     

Subjective Sleep Disturbances in Sexual Assault Survivors: Associations With Trauma and Posttraumatic Stress Disorder Symptom Severity

Prior work implicates sleep disturbance in the development and maintenance of posttraumatic stress disorder (PTSD). However, the majority of this literature has focused on combat veteran men, and limited work has examined links between sleep disturbance and PTSD symptoms in sexual assault survivors. This is a notable gap in the literature, as sexual trauma is disproportionately likely to result in PTSD and is more common in women. We sought to examine the relations between subjective sleep disturbance, sexual assault severity, and PTSD symptoms in a sample of sexual assault survivors with PTSD (PTSD+), without PTSD (PTSD-), and healthy controls. The sample (N = 60) completed the Insomnia Severity Index and prospectively monitored their sleep for 1 week using the Consensus Sleep Diary. The sexual assault survivors also completed the Sexual Experiences Survey and PTSD Checklist-5. Results of group comparisons found that the PTSD+ group reported significantly higher insomnia symptoms, longer sleep onset latency, more nocturnal awakenings, and lower sleep quality compared to the healthy control group and higher insomnia symptoms compared to the PTSD- group. Results of regression analyses in the sexual assault survivors found that insomnia symptoms and number of nocturnal awakenings were significantly associated with higher PTSD symptoms, and sexual assault severity was significantly associated with higher insomnia symptoms, longer sleep onset latency, and lower sleep quality. These findings highlight specific features of sleep disturbance that are linked to trauma and PTSD symptom severity among sexual assault survivors.     

大学生社会支持对睡眠质量的影响：多重中介模型的检验

以360名大学生为被试,采用匹兹堡睡眠质量指数量表、领悟社会支持量表、担忧问卷以及状态焦虑量表,考察了担忧、焦虑在社会支持和睡眠质量关系之间的多重中介作用。结果表明,复合式多重中介模型能够较好地解释焦虑和担忧在社会支持与睡眠质量之间所起的中介作用。     

Clarifying Heterogeneity of Daytime and Nighttime Symptoms of Posttraumatic Stress in Combat Veterans With Insomnia

Daytime and nighttime symptoms of posttraumatic stress disorder (PTSD) are common among combat veterans and military service members. However, there is a great deal of heterogeneity in how symptoms are expressed. Clarifying the heterogeneity of daytime and nighttime PTSD symptoms through exploratory clustering may generate hypotheses regarding ways to optimally match evidence-based treatments to PTSD symptom profiles. We used mixture modeling to reveal clusters based on 6 daytime and nighttime symptoms of 154 combat veterans with insomnia and varying levels of PTSD symptoms. Three clusters with increasing symptom severity were identified (n1 = 50, n2 = 70, n3 = 34). These results suggest that, among veterans with insomnia, PTSD symptoms tend to exist on a continuum of severity, rather than as a categorical PTSD diagnosis. Hypotheses regarding possible targeted treatment strategies for veterans within each identified cluster, as well as ways to generalize these methods to other groups within the military, are discussed.     

The effect of a delayed weekend sleep pattern on sleep and morning functioning

Abstract

It is a common practice for young adults to delay their weekend sleep schedule. The present study was designed to assess the effect of this sleep pattern on the sleep of Sunday night and the functioning of Monday morning. The sleep schedules of 30 young adults were manipulated for 2 consecutive weeks. In the Habitual-Sleep (HS) week, subjects followed their habitual sleep schedule throughout the week; in the Delayed-Sleep (DS) week, subjects' sleep schedule on Friday and Saturday nights were delayed by two hours. Compared to the HS week, subjects showed significantly lower subjective sleepiness near bedtime and trends of longer sleep onset latency on Sunday night in the DS week. In addition, there was both lowered cognitive performance and overall mood rating on Monday morning in the DS week. The delayed weekend sleep pattern contributes to Sunday night insomnia and the Monday morning “blues”.     

Multimedia Field Test: Digitalizing Better Sleep Using the Sleepio Program

The promise of online cognitive behavioral therapy for insomnia (CBT-I) and other sleep-related problems as an alternative to traditional face-to-face treatment rests upon the accessibility, ease-of-use, and effectiveness of these approaches. Here we provide a review of Sleepio, a digitalized, state-of-the-art CBT-I program for adults, informed by our personal experience with the program, available research, and information provided at the Sleepio website. The 6-week treatment program can be completed flexibly via web-based or mobile platform. Initial assessment of individual goals and baseline sleep patterns is used to build a personalized account comprised of four sections: Sleep Diary, Case File, Library, and Community. Sleepio uses evidence-based principles and practices, engaging content, and an easy-to-follow format. Unique features of the program including synchronization with compatible sleep tracking devices, multiple built-in user supports, and a 14-day money-back guarantee. Both statistical and clinically meaningful sleep improvements have been found in a large randomized controlled trial. Overall, Sleepio represents a model program for online CBT-I delivery.