Cognitive-behavioral therapy of insomnia: A clinical case series study of patients with co-morbid disorders and using hypnotic medications

Cognitive-behavioral therapy for insomnia (CBTi) has demonstrated considerable efficacy within randomized clinical trials and case-series designs. This case-series study in a community sleep medicine clinic assessed the effectiveness of an eight-session CBTi protocol chronic insomnia patients who were allowed to continue their use of hypnotics (intent-to-treat n = 48), administered by a clinical psychology doctoral student receiving training and supervision in CBTi by a behavioral sleep medicine certified clinician. Outcome measures included daily sleep diaries, self-report measures on insomnia severity, dysfunctional beliefs and attitudes about sleep, daytime sleepiness, as well as medication usage. Patients showed significant improvements in sleep onset latency, wake time after sleep onset, sleep efficiency, insomnia severity, and dysfunctional sleep beliefs from pre- to post-treatment. No changes were seen in daytime sleepiness - patients were not excessively sleepy either before or after treatment. Use of sleep medication declined significantly from 87.5% pre-treatment to 54% post-treatment, despite no active efforts to encourage patients to withdraw. Results demonstrate that a CBTi conducted in a community sleep medicine clinic with patients not required to discontinue sleep-related medications can have similar effects as therapy delivered among those not on medication.     

A cross-modal weapon focus effect: The influence of a weapon's presence on memory for auditory information

To examine whether a weapon's presence impairs witnesses' memory for auditory information (as it impairs memory for visual information), we conducted two experiments in which undergraduates watched one version of a videotape depicting a male target who held either a weapon or a neutral object and conversed with a female character. The semantic content of his remarks was either easy or difficult to comprehend. The weapon's presence did not affect voice identification accuracy or memory for the target's vocal characteristics (e.g., pitch, loudness, speech rate) but did worsen memory for semantic content in the Difficult Comprehension condition. Our results can be explained by multiple resource models of attention, which propose separate resource “pools” for different sensory modalities.     

Are delusional contents replayed during dreams?

The relationship between dream content and waking life experiences remains difficult to decipher. However, some neurobiological findings suggest that dreaming can, at least in part, be considered epiphenomenal to ongoing memory consolidation processes in sleep. Both abnormalities in sleep architecture and impairment in memory consolidation mechanisms are thought to be involved in the development of psychosis. The objective of this study was to assess the continuity between delusional contents and dreams in acutely psychotic patients. Ten patients with a single fixed and recurring delusional content were asked to report their dreams during an acute psychotic break. Sixteen judges with four different levels of acquaintance to the specific content of the patients’ delusions were asked to group the dreams, expecting that fragments of the delusional thought would guide the task. A mathematical index (f, t) was developed in order to compare correct groupings between the four groups of judges. Most judges grouped the dreams slightly above chance level and no relevant differences could be found between the four groups [F(3, 12) = 1.297; p = n.s.]. Scoring of dreams for specific delusional themes suggested a continuity in terms of dream and waking mentation for two contents (Grandiosity and Religion). These findings seem to suggest that at least some delusional contents recur within patients’ dreams. Future studies will need to determine whether such continuity reflects ongoing consolidation processes that are relevant to current theories of delusion formation and stabilization.     

Poorer sleep quality is associated with lower emotion-regulation ability in a laboratory paradigm

Theoretical models suggest a positive relationship between sleep quality and individuals' ability to regulate emotion. However, few studies have empirically tested this hypothesised link using standardised laboratory measures of emotion-regulation ability. The present research examined the relationship between sleep quality and the ability to implement a type of emotion regulation that has particularly important implications for psychological health: cognitive reappraisal (cognitively reframing an emotional event so as to dampen its impact). To do so, 156 participants (86 male) reported on their past week's sleep quality. Their ability to implement cognitive reappraisal (CRA) was then measured with a standardised laboratory challenge. Participants with poorer self-reported sleep quality exhibited lower CRA, even after controlling for fourteen potential key confounds (e.g., age, negative affect, mood disorder symptoms, stress). This finding is consistent with the idea that poorer sleep quality impairs individuals' ability to engage in the crucial task of regulating negative emotions.     

Psychotic dream-related aggression: A critical review and proposal

The relationship among parasomnias, sleep-related violence (SRV), and psychosis has neither been reported nor studied. The authors introduce the phenomenon of psychotic dream-related aggression (PDRA) and, through a review of the research on manifest dreams, the continuity of thinking across the sleep–wake cycle, and SRV, argue for its inclusion alongside the parasomnias of DSM-IV. Five cases are presented that illustrate this phenomenon, usually a male diagnosed with paranoid schizophrenia whose violent act toward another was closely associated with the manifest content of his nocturnal dreams and his inability to test reality. Differential diagnostic criteria are proposed to separate PDRA from other parasomnias that may be related to violence. Treatment and forensic implications are discussed.     

State work engagement and state affect: Similar yet distinct concepts

State work engagement (SWE), a multidimensional construct of work-related well-being, was originally conceptualized as a trait, but diary studies have revealed substantial within-person fluctuations. Given that SWE is conceptualized as a work-related affective-motivational construct, the question arises as to whether SWE can be differentiated from other affective constructs. Thus, the goal of the present study was to compare SWE and state affect with respect to their degree of within-person variability and to examine their distinct relationships with health and performance variables (i.e., sleep quality and job performance). Fifty-two employees (44% female) participated in the study, which included 3 assessments per day over the course of 2 weeks. Our results revealed that energetic arousal and tense arousal fluctuated more strongly within days than vigor and absorption. Multilevel analyses demonstrated that high sleep quality predicted higher state affect but not higher SWE. In addition, vigor exhibited an inverted U-shaped relation with performance. In sum, SWE as a time-varying construct showed some overlap with state affect but also demonstrated discriminant validity.     

Consolidation of novel word learning in native English-speaking adults

Sleep has been shown to improve the retention of newly learned words. However, most methodologies have used artificial or foreign language stimuli, with learning limited to word/novel word or word/image pairs. Such stimuli differ from many word-learning scenarios in which definition strings are learned with novel words. Thus, we examined sleep's benefit on learning new words within a native language by using very low-frequency words. Participants learned 45 low-frequency English words and, at subsequent recall, attempted to recall the words when given the corresponding definitions. Participants either learned in the morning with recall in the evening (wake group), or learned in the evening with recall the following morning (sleep group). Performance change across the delay was significantly better in the sleep than the wake group. Additionally, the Levenshtein distance, a measure of correctness of the typed word compared with the target word, became significantly worse following wake, whereas sleep protected correctness of recall. Polysomnographic data from a subsample of participants suggested that rapid eye movement (REM) sleep may be particularly important for this benefit. These results lend further support for sleep's function on semantic learning even for word/definition pairs within a native language.