A Pilot Randomized Controlled Trial of the Effects of Cognitive-Behavioral Therapy for Insomnia on Sleep and Daytime Functioning in College Students

The purpose of this study was to pilot test if cognitive behavioral therapy for insomnia (CBT-I) is an effective intervention for insomnia and daytime functioning in college students. College students’ developmental stage and lifestyle are significantly different than the general adult population, yet there have been no studies of CBT-I in this age group.     

The Effect of Support on Internet-Delivered Treatment for Insomnia: Does Baseline Depression Severity Matter?

Internet-delivered cognitive-behavioral treatment is effective for insomnia. However, little is known about the beneficial effects of support. Recently we demonstrated that motivational support moderately improved the effects of Internet-delivered treatment for insomnia. In the present study, we tested whether depressive symptoms at baseline moderate the effect of support on Internet-delivered treatment for insomnia. We performed a multilevel intention-to-treat analysis on 262 participants in a randomized controlled trial. We found that baseline depressive symptoms moderated the effect of support on sleep efficiency, total sleep time, and sleep onset latency (but not on wake after sleep onset, number of nightly awakenings, or the Insomnia Severity Index). This means that for these variables, people with high levels of depressive symptoms benefit from support, whereas people with low levels of depressive symptoms improve regardless of support. The data show that baseline depression severity plays an important role in the way Internet treatments need to be delivered. These findings open up opportunities to personalize the support offered in Internet-delivered treatments.     

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.     

睡眠对恐惧学习的影响及其认知神经机制

睡眠问题可能会诱发恐惧相关情绪障碍(焦虑、创伤性应激障碍、恐怖症等),研究睡眠影响恐惧学习的认知神经机制,有助于增强对恐惧相关情绪障碍的预测、诊断和治疗。以往研究表明睡眠剥夺影响恐惧习得和消退主要是通过抑制vmPFC活动,阻碍其与杏仁核的功能连接,从而导致恐惧习得增强或是消退学习受损。进一步研究发现睡眠不同阶段对恐惧学习相关脑区有独特的影响:剥夺(缺乏)快速眼动睡眠会抑制vmPFC活动、增强杏仁核、海马激活,导致恐惧习得增强,消退学习受损,此外边缘皮层的功能连接减少破坏了记忆巩固(恐惧记忆和消退记忆);而慢波睡眠主要与海马变化有关,慢波睡眠期间进行目标记忆重激活可促进恐惧消退学习。未来研究需要增加睡眠影响恐惧泛化的神经机制研究、及昼夜节律中断对恐惧消退的影响,以及关注动物睡眠研究向人类睡眠研究转化中存在的问题。     

Adapting Brief CBT-I for Depressed Adolescents: A Case Illustration of the Sleeping Better Program

Disturbed sleep is a common symptom of depression in adolescents, but this symptom is not often targeted in psychological therapies for depression. Although the causal relationship between sleep and depression is unclear, there is increasing evidence that in adults, Cognitive Behavioral Therapy for Insomnia (CBT-I) improves sleep problems and reduces symptoms of depression; however, there has been little investigation of using this approach with adolescents. This article describes the adaptation of brief CBT-I for adolescents with depression. A single case study is reported to illustrate the use of the Sleeping Better program. Adaptations for adolescents include increased emphasis on engagement of the young person and the inclusion of parents in treatment. The treatment program was acceptable to the adolescent and parent, and treatment outcome, as indicated by sleep diaries and standardized measures of depression and anxiety, was positive. Further evaluation of the Sleeping Better program is needed to establish if it is an effective low-intensity intervention for sleep problems in adolescents who have depression or anxiety.     

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.     

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.     

Book Reviews

Research has shown that those with insomnia focus primarily on their sleep as a cause of daytime fatigue rather than the multitude of other possible causes of fatigue. This can create sleep-related anxiety and further perpetuate the sleep disturbance. In order to lessen the increased focus on sleep, the present study investigated whether people could learn to consider other attributions for fatigue via an information-based manipulation. Undergraduate students (N = 88) were randomized to two information groups: They either received information about common factors that could explain daytime fatigue (the fatigue information condition) or received generic sleep-related information (the control condition). Each group was tested pre- and post-intervention. Fatigue information participants were significantly more likely to consider non-sleep-related attributions for fatigue at post-intervention, relative to control participants. These results demonstrate that attributions for fatigue may be amenable to change via an information-based intervention; thus, this research explores a preliminary step toward investigating refinements to insomnia treatments.