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.     

Examining the relation between PTSD and insomnia on aggression

Posttraumatic stress disorder (PTSD) symptoms and poor sleep have been identified as potential causals factor in aggression, violence, and impulsive behavior. Given the high cost of aggression to society and public health, identifying modifiable factors related to aggression, such as insomnia, may guide treatment strategies to help decrease aggression. Participants were 143 Veterans seeking treatment for PTSD at a VA outpatient PTSD clinic. Linear and logistic regression analyses were used to examine the relation between PTSD and insomnia on aggression. Results from bivariate analyses indicated that while both PTSD and insomnia severity were associated with higher aggression scores independently, when PTSD and insomnia were examined together, PTSD severity was the only significant predictor of aggression. Interaction effects yielded nonsignificant results suggesting that poor sleep did not moderate the PTSD and aggression relation. Results suggest that addressing PTSD symptoms as a first treatment target may be more important for decreasing risk for aggression than targeting insomnia. More research is needed to understand whether treating PTSD and insomnia reduces aggression in Veterans.     

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.     

Behandling av en ormfobi med fading

En fallstudie av en ormfobi presenteras. Behandlingen skedde med hjälp av fading som innebär att diabilder utnyttjas som stimulusmaterial. Före och efter behandlingen gjordes kontinuerliga mätningar av fobiskt beteende på alia tre responssystemen (overt motoriskt, kognitivt, fysiologiskt). Resultaten visade att de fobiska symtomen utsläcktes på alia tre systemen, dock till olika grad. I diskussionen konstateras att fading verkar vara ett alternativ till mera traditionella metoder vid behandling av smådjursfobier. Slutligen diskuterades begränsningar med studien vad gäller generalitet etc.     

Efficacy of a Therapist-Assisted Self-Help Internet-Based Intervention Targeting PTSD,Depression, and Insomnia Symptoms After a Disaster: A Randomized Controlled Trial

This study aimed at evaluating the efficacy of an online CBT intervention with limited therapist contact targeting a range of posttraumatic symptoms among evacuees from the 2016 Fort McMurray wildfires.One hundred and thirty-six residents of Fort McMurray who reported either moderate PTSD symptoms (PCL-5 ≥ 23) or mild PTSD symptoms (PCL-5 ≥ 10) with moderate depression (PHQ-9 ≥ 10) or subthreshold insomnia symptoms (ISI ≥ 8) were randomized either to a treatment (n = 69) or a waitlist condition (n = 67). Participants were on average 45 years old, and mostly identified as White (82%) and as women (76%). Primary outcomes were PTSD, depression, and insomnia symptoms. Secondary outcomes were anxiety symptoms and disability. Significant Assessment Time × Treatment Condition interactions were observed on all outcomes, indicating that access to the treatment led to a decrease in posttraumatic stress (F[1,117.04] = 12.128, p = .001; d = .519, 95% CI = .142–.895), depression (F[1,118.29] = 9.978, p = .002; d = .519, 95% CI = .141–.898) insomnia (F[1,117.60] = 4.574, p = .035; d = .512, 95% CI = .132–.892), and anxiety (F[1,119.64] = 5.465, p = .021; d = .421, 95% CI = .044–.797) symptom severity and disability (F[1,111.55] = 7.015, p = .009; d = .582, 95% CI = .200–.963). Larger effect sizes (d = 0.823–1.075) were observed in participants who completed at least half of the treatment. The RESILIENT online treatment platform was successful to provide access to specialized evidence-based mental health care after a disaster.     

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.     

Trajectories of sleep problems among adolescents after the Wenchuan earthquake: the role of posttraumatic stress disorder symptoms

Objective: We examined the trajectories of sleep problems in adolescents after the Wenchuan earthquake, and assessed predictors such as posttraumatic stress disorder symptoms. Methods: We surveyed adolescents at 1, 1.5, 2, and 2.5 years after the Wenchuan earthquake. In total, 391 adolescents completed self-report questionnaires. Results: We identified five latent sleep problem trajectories, specifically, U-shaped (3.8%), low-stable (68.0%), high-stable (10.8%), increasing (8.7%), and decreasing (8.7%) trajectories. Additionally, we found that posttraumatic stress disorder hyper-arousal symptoms were more frequent in individuals who had non-low-stable trajectories. Adolescents in the U-shaped group were less likely to have intrusive symptoms. Conclusion: After natural disasters, consequent sleep problems in adolescents do not remain stable over time, and sleep problem trajectories had considerable heterogeneity.     

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.     

小学生创伤后应激障碍对睡眠问题的影响:积极认知的调节作用

本研究采用创伤暴露程度问卷、儿童创伤后应激障碍症状量表、应对方式问卷和儿童行为问题核查表对汶川地震30个月后844名小学生进行调查,探讨汶川地震后小学生的创伤后应激障碍(PTSD)、积极认知与睡眠问题之间的关系。结果表明,PTSD对睡眠问题具有正向预测作用,积极认知对睡眠问题的预测作用不显著。调节效应的检验结果发现,积极认知调节着PTSD及其回避性症状对睡眠问题的影响,具体表现为PTSD及其回避性症状对睡眠问题的预测作用随着积极认知水平的增加而降低,但是积极认知分别在PTSD的闯入性症状和警觉性增高症状与睡眠问题的关系之间不起调节作用。     

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.     

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.     

循证医学与个体化治疗的共存和矛盾

从人体个体差异的绝对性出发,论述了个体化治疗与循证医学共存的必然性及两者之间的矛盾。循证医学的结论可通过对大量个体化治疗病例的循证研究而不断刷新,从而更好地指导个体化治疗,这是解决两者矛盾的途径。