Variables associated with reductions in insomnia severity among acutely suicidal patients receiving brief cognitive behavioral therapy for suicide prevention

2019 ◽  
Vol 252 ◽  
pp. 230-236 ◽  
Author(s):  
Erika M. Roberge ◽  
Craig J. Bryan ◽  
Alan Peterson ◽  
M. David Rudd
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Suicide Prevention ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Suicidal Patients ◽  
Insomnia Severity

scholarly journals Cognitive behavioral therapy for insomnia among young adults who are actively drinking: a randomized pilot trial

SLEEP ◽  
2020 ◽  
Author(s):  
Mary Beth Miller ◽  
Chelsea B Deroche ◽  
Lindsey K Freeman ◽  
Chan Jeong Park ◽  
Nicole A Hall ◽  
...  
Keyword(s):  
Young Adults ◽  
Alcohol Use ◽  
Cognitive Behavioral Therapy ◽  
Binge Drinking ◽  
Behavioral Therapy ◽  
Pilot Trial ◽  
Cognitive Behavioral ◽  
Wrist Actigraphy ◽  
Insomnia Severity

Abstract Study Objectives More than half of young adults at risk for alcohol-related harm report symptoms of insomnia. Insomnia symptoms, in turn, have been associated with alcohol-related problems. Yet one of the first-line treatments for insomnia (Cognitive Behavioral Therapy for Insomnia or CBT-I) has not been tested among individuals who are actively drinking. This study tested (1) the feasibility and short-term efficacy of CBT-I among binge-drinking young adults with insomnia and (2) improvement in insomnia as a predictor of improvement in alcohol use outcomes. Methods Young adults (ages 18–30 years, 75% female, 73% college students) who met criteria for Insomnia Disorder and reported 1+ binge drinking episode (4/5+ drinks for women/men) in the past month were randomly assigned to 5 weekly sessions of CBT-I (n = 28) or single-session sleep hygiene (SH, n = 28). All participants wore wrist actigraphy and completed daily sleep surveys for 7+ days at baseline, posttreatment, and 1-month follow-up. Results Of those randomized, 43 (77%) completed posttreatment (19 CBT-I, 24 SH) and 48 (86%) completed 1-month follow-up (23 CBT-I, 25 SH). CBT-I participants reported greater posttreatment decreases in insomnia severity than those in SH (56% vs. 32% reduction in symptoms). CBT-I did not have a direct effect on alcohol use outcomes; however, mediation models indicated that CBT-I influenced change in alcohol-related consequences indirectly through its influence on posttreatment insomnia severity. Conclusions CBT-I is a viable intervention among individuals who are actively drinking. Research examining improvement in insomnia as a mechanism for improvement in alcohol-related consequences is warranted. Trial Registration U.S. National Library of Medicine, https://clinicaltrials.gov/ct2/show/NCT03627832, registration #NCT03627832

scholarly journals Weekly Self-Ratings of Treatment Involvement and Their Relation to Symptom Reduction in Internet Cognitive Behavioral Therapy for Insomnia

2020 ◽  
Author(s):  
Martin Kraepelien ◽  
Kerstin Blom ◽  
Susanna Jernelöv ◽  
Viktor Kaldo
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Treatment Effects ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Control Treatment ◽  
Knowledge Gain ◽  
Ctrl Group ◽  
Subjective Knowledge ◽  
Homework Quality ◽  
Insomnia Severity

Abstract Background Treatment involvement, including involvement with written material as well as homework assignments, has previously been associated with better outcomes in cognitive behavioral therapy, but there is a lack of knowledge on which specific aspects of involvement that are the most promising for use as predictors of treatment effects. Methods The objective of this study was to use a battery of weekly self-rated questions regarding different aspects of participant involvement during 8 weeks of either guided internet cognitive behavioral therapy for insomnia (ICBT-i, n = 73), or an active internet-delivered control treatment also including homework (ICBT-ctrl, n = 75), to predict reductions in insomnia severity after treatment. The markers of involvement were single questions on amount of time spent on treatment, amount of text read, amount of subjective knowledge gained and index scores of homework quantity (based on ratings of how many times specific techniques were used) and homework quality (based on ratings of the understanding, used as intended, and helpfulness of each specific technique). Results While none of the markers predicted reductions in insomnia severity for participants in the ICBT-ctrl group, text read, subjective knowledge gain, and homework quality predicted larger reductions in insomnia severity for participants in ICBT-i. Amount of subjective knowledge gained was a particularly useful marker in the ICBT-i group, since weekly ratings from the first half of treatment sufficed to explain a rather large proportion of variance in insomnia severity post treatment (14%). Conclusions The results strengthen subjective knowledge gain as a candidate for use as a predictor of treatment effects in ICBT-i.

scholarly journals A blended eHealth intervention for insomnia following acquired brain injury study protocol for a randomized controlled trial

2020 ◽  
Author(s):  
Marthe Ford ◽  
Gert J. Geurtsen ◽  
Erny Groet ◽  
Coen A.M. Van Bennekom ◽  
Eus J.W. Van Someren
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Behavioral Therapy ◽  
Cognitive Functioning ◽  
Behavioral Therapy ◽  
Acquired Brain Injury ◽  
Cognitive Behavioral ◽  
Face To Face ◽  
Trial Register ◽  
Insomnia Severity

Abstract Background: Up to a third of stroke patients and patients with traumatic brain injury suffer from insomnia, including problems to fall asleep or stay asleep at night. Insomnia may exacerbate other brain damage-related problems, for example regarding cognitive functioning and emotional well-being, may lead to poorer quality of life, and may complicate recovery processes. Cognitive behavioral therapy for insomnia, delivered face-to-face or online, is found to be effective in the general population. However, despite the high prevalence and serious consequences of insomnia following acquired brain injury, studies on the efficacy of face-to-face cognitive behavioral treatment in this population are scarce, and this applies even more for studies on online cognitive behavioral therapy. Therefore, this study aims to evaluate the efficacy of a newly developed guided online cognitive behavioral therapy for insomnia following acquired brain injury.Methods: A multicenter, prospective, randomized, open-label, blinded end point study (PROBE) will be conducted, in which 48 patients diagnosed with stroke or traumatic brain injury, and insomnia will be randomly allocated to the online cognitive behavioral therapy for insomnia treatment group or the treatment as usual group. The treatment consists of 6 online cognitive behavioral therapy sessions given on a weekly basis and personalized feedback after each session, combined with 2 face-to-face sessions. Outcomes will be assessed at baseline, immediately after the intervention period and at 6 weeks follow up. The primary outcome is the insomnia severity assessed with the insomnia severity index. Secondary outcome measures include sleep quality, sleep features derived from the sleep diary, fatigue, anxiety and depression, subjective cognitive functioning and societal participation.Discussion: This study will provide insight on the efficacy of online cognitive behavioral therapy for insomnia following stroke and traumatic brain injury.Trial Register: Netherlands Trial Register, NTR7082, 12 March 2018

scholarly journals The Implementation and Effectiveness of Digital Cognitive Behavioral Therapy for Insomnia in Primary Care: A Pilot Study

2021 ◽  
Vol 2 ◽  
pp. 263348952110536
Author(s):  
Eric D.A. Hermes ◽  
Robert A. Rosenheck ◽  
Laura Burrone ◽  
Greg Dante ◽  
Carrie Lukens ◽  
...  
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Cognitive Behavioral Therapy ◽  
Clinical Outcomes ◽  
Implementation Strategy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Low Intensity ◽  
Phone Calls ◽  
Insomnia Severity

Background Digital interventions delivering Cognitive Behavioral Therapy for insomnia (Digital CBTi) may increase utilization of effective care for a common and serious condition. A low-intensity implementation strategy may facilitate digital CBTi use in healthcare settings. This pilot study assessed the feasibility of implementing a digital CBTi in Veterans Health Administration (VA) primary care through iterative modifications to a low-intensity implementation strategy, while evaluating clinical outcomes of a specific digital CBTi program. Methods A self-directed digital CBTi was implemented in the primary care clinics of a single VA facility using a cohort trial design that iteratively modified an implementation strategy over three 8-month phases. The phase 1 implementation strategy included (1) provider education; (2) point-of-care information via pamphlets; and (3) provider referral to digital CBTi through phone calls or messages. Phases 2 and 3 maintained these activities, while (1) adding a clinic-based coach who performed initial patient education and follow-up support contacts, (2) providing additional recruitment pathways, and (3) integrating the referral mechanism into provider workflow. Implementation outcomes included provider adoption, patient adoption, and acceptability. Clinical outcomes (insomnia severity, depression severity, and sedative hypnotic use) were compared among enrollees at baseline and 10 weeks. Results Across all phases 66 providers (48.9%) made 153 referrals, representing 0.38% of unique clinic patients. Of referrals, 77 (50.3%) enrolled in the study, 45 (29.4%) engaged in the program, and 24 (15.7%) completed it. Provider and patient adoption did not differ meaningfully across phases. Among enrollees, digital CBTi was acceptable and the Insomnia Severity Index decreased by 4.3 points (t = 6.41, p < 0.001) and 13 (18.6%) reached remission. The mean number of weakly sedative-hypnotic doses decreased by 2.2 (35.5%) (t = 2.39, p < 0.02). Conclusions Digital CBTi implementation in VA primary care is feasible using low-intensity implementation strategy, resulting in improved clinical outcomes for users. However, iterative implementation strategy modifications did not improve adoption. The trial was registered at clinicaltrials.gov (NCT03151083).

scholarly journals Efficacy of Online Versus In-Person Cognitive Behavioral Therapy for Insomnia

2020 ◽  
Vol 3 ◽  
Author(s):  
Emily Wilson ◽  
Aaron Roberts
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Clinical Decision Making ◽  
Behavioral Therapy ◽  
Adult Population ◽  
Severity Index ◽  
The United States ◽  
Cognitive Behavioral ◽  
Control Group ◽  
Insomnia Severity ◽  
Over Time

Background and Hypothesis: Up to 30% of the adult population may suffer from insomnia symptoms. Insomnia not only diminishes the individual’s quality of life, but also has a broad financial impact, costing the United States over $100 billion per year. Systemic barriers limit access to cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment for insomnia. However, newly developed internet CBT-I (iCBT-I) programs, if effective, may reduce this disparity. In this study, we hypothesized that there is no difference in the efficacy of the experimental iCBT-I and the control CBT-I interventions in reducing insomnia severity over time.    Project Methods: A projected 120 participants will be recruited for this non-inferiority prospective cohort study. 60 patients will be assigned to each arm of the study (CBT-I and iCBT-I). The control group will attend 6 in-person CBT-I sessions over 6 weeks. The experimental group will complete the iCBT-I program Go! To Sleep over 6 weeks. Participants will complete the Insomnia Severity Index (ISI) before and after treatment, as well as 3, 6, and 12 months after finishing the program. The Kruskal-Wallis statistical test will utilize ISI data to compare efficacy of the interventions over time.     Results: Based on previous literature, the projected results of this study align with the hypothesis that there will be no difference in efficacy of the CBT-I and iCBT-I interventions over time.    Potential Impact: If indeed there is no difference in effectiveness between the iCBT-I program and in-person CBT-I, this result would have implications in clinical decision-making. Improved access to iCBT-I may reduce prescriptions for addictive pharmacologic treatments, as well as offer an inexpensive, convenient, and effective treatment for insomnia. Future studies could compare efficacy of iCBT-I in patients with co-morbidities, such as anxiety or depression.  

scholarly journals Suicidal behavior: theoretic model and practical implications in cognitive-behavioral therapy

2016 ◽  
Vol 24 (3) ◽  
pp. 144-163 ◽  
Author(s):  
A.B. Kholmogorova
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Suicide Prevention ◽  
Suicidal Behavior ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Theoretic Model ◽  
History Of Development ◽  
Psychosocial Model ◽  
History Of ◽  
Further Development

The article presents the data on suicide incidence in Russian Federation. The author discusses the necessity of developing prevention programs and carrying out complex team-based specialist work to ensure safe environment at schools. It is noted that prevention and postvention methods should be scientifically grounded. History of development of a special psychotherapeutic cognitive-behavioral protocol for suicide prevention and postvention is presented. The author examines the problem of diathesis (predisposition) to suicidal behavior and formulates the main principles of cognitive-behavioral psychotherapy of patients predisposed to suicidal behavior. Key stages of cognitive-behavioral therapy of suicidal behavior, techniques and approaches to working with such clients are described. Various targets that should be taken into account during crisis interventions are discussed. The article presents empirical research data of the effectiveness of cognitive psychotherapy of suicidal behavior and the results of the empirical study of factors of suicidal behavior in students based on multi-factor psychosocial model of affective spectrum disorders. It is emphasized that individual psychotherapy should be combined with other methods of suicide prevention and postvention. Perspectives of further development of methods of working with suicidal behavior are outlined.

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