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T-D-007 COGNITIVE-BEHAVIORAL THERAPY FOR INSOMNIA CO-MORBIDWITH HEARING IMPAIRMENT: A RANDOMIZED CONTROLLED TRIAL
S60
T-D-006
Abstracts of 4th International Congress of WASM & 5th Conference of CSS / Sleep Medicine 12, Suppl. 1 (2011) S1–S130
CLINICAL EFFECTIVENESS TRIAL OF MEDICAL-ADMINISTERED SMALL-GROUP COGNITIVE BEHAVIOR THERAPY FOR PRIMARY INSOMNIA IN GENERAL PRACTICE
Márcio W. Soares 1 , Julie C.N. Soares 1 , Fernando M.J. Vieira 1 , Luciano H. Lehmkuhl 2 , Pablo Moritz 2 , Lucila B.F. Prado 1 , Luciane B.C. Carvalho 1 , Gilmar F. Do Prado 1. 1 UNIFESP, Brazil; 2 SOMED, Brazil Introduction and Objectives: Insomnia is very common in general practice however it has a difficult management. This study investigates the clinical effectiveness and adherence of applying cognitive behavior therapy (CBT) methods for insomnia in primary care. Materials and Methods: A prospective, multicentric design was employed. It used general medical practice patients. Sixty eight adults (mean age, 47 years) were assigned to receive CBT (n=18; 50 women). CBT comprised 3 sessions which included sleep hygiene education delivered individually by a sleep medical doctor. The aim of the CBT treatment was the use of weariness to prevent hyper-alert status. There were two options of inducing weariness: Ironing and phone book memorizing. They should be used before sleep time. Results: Assessments were completed at baseline, two weeks after treatment, and six weeks follow-up visits. Sleep outcomes were accessed by sleep diary, and clinical visits. CBT was associated with improvements in selfreported sleep latency, wakefulness after sleep onset, and sleep efficiency. Improvements were partly sustained at follow up. Absenteeism was not a common issue among patients. CBT was associated with significant positive changes in mood and sleep satisfaction. Comorbid mental health difficulties had no impact in the sleep improvement after CBT. Conclusion: This study suggests that it is possible and useful to deliver CBT for insomnia using weariness as an easy tool in general medical practice. Further research is required to consider the possibilities of increasing adherence to CBT in primary healthcare. Acknowledgements: To Gilmar Fernandes do Prado and his family for friendship and scientific support
T-D-008
Lan Hong, Yingna Lin, Fang Wang. Guang’anmen Hospital, China Academy of Chinese Medical Sciences, China Introduction and Objectives: To analyze the common psychological symptoms of 1320 patients with insomnia from Guang’anmen Hospital, China Academy of Chinese Medical Sciences. Materials and Methods: The results of Minnesota Multiphasic Personality Inventory (MMPI) of 1320 cases with insomnia enrolled in the Guang’anmen Hospital, China Academy of Chinese Medical Sciences from 2002 to 2009 were analyzed retrospectively. Results: The factor scores of depression, anxiety, neuroticism, hysteria, hypochondriasis, epileptic personality, distress, worry, stress, psychasthenia, ill health, complaints of health, impotence, fatigue, headache, autoblame, autopunition, autotomy, work worry, social withdrawal, school discomfort, seeking instruction, traffic accident, ominous prognosis were higher than normal values for China. The factor scores of optimism, academic success, social responsibility and self-strength were lower than normal values for China. Conclusion: Depression, anxiety, hypochondriasis, hysteria and epileptic personality, low self-strength and high dependence are the common personality basis of Chinese patients with insomnia. Stress from social, school, work and physical diseases are the causes. The risk for suicide of insomnia increased significantly, a matter for serious attention. Besides sleep disorders, insomnia often accompanies many somatic symptoms, such as fatigue, headache and sexual dysfunction, etc. These symptoms may contribute to causing the insomnia. Insomnia can also cause these symptoms. Acknowledgements: The Mechanism of TCM Relaxation Induction to Treat Insomnia: National Nature Science Fund Project (National Natural Science Foundation of China): grant number 81072854
T-D-009 T-D-007
COGNITIVE-BEHAVIORAL THERAPY FOR INSOMNIA CO-MORBID WITH HEARING IMPAIRMENT: A RANDOMIZED CONTROLLED TRIAL
Markus Jansson-Fröjmark, Steven Linton, Ida Flink, Annika Norell-Clarke. Center for Health and Medical Psychology, School of Law, Psychology, and Social Work, Sweden Introduction and Objectives: Based on research showing that sleep complaints are common among individuals with hearing impairment, the purpose was to examine the effects of cognitive behavior therapy for insomnia in patients with insomnia co-morbid with hearing impairment. Materials and Methods: A randomized controlled design was used with a three-month follow-up. Thirty-two patients with insomnia co-morbid with hearing impairment were recruited from audiology clinics and randomized to either cognitive behavior therapy (CBT-I) or a wait-list condition (WLC). The primary outcome was insomnia severity. Secondary outcomes were sleep diary parameters, dysfunction, anxiety, and depression. Results: While neither CBT nor WLC led to improvements on anxiety and depression, CBT was superior to WLC on the remaining outcomes. Compared to WLC, CBT resulted in lower insomnia severity at post-treatment and at follow-up (d = 1.18-1.56). Relative to WLC, CBT also led, at both assessment points, to reduced sleep onset latency (d = 1.07-1.18) and wake after sleep onset (d = 0.94-1.05) and increased sleep restoration (d = 1.03-1.07) and sleep quality (d = 0.91-1.16). Both groups increased their total sleep time, but no significant group difference emerged. Compared to WLC, CBT resulted in higher function at both assessment points (d = 0.81-0.96). Based on the Insomnia Severity Index, more CBT (53-77%) than WLC participants (0-7%) were treatment responders. Also, more CBT (24%) than WLC participants (0%) remitted. Conclusion: In patients with insomnia co-morbid with hearing impairment, cognitive behavioral therapy aimed at reducing insomnia symptomatology was effective in decreasing insomnia severity, subjective sleep parameters, and dysfunction. Acknowledgements: We would like to express our appreciation to the Swedish funding agency for funding and to the two clinics for recruitment.
COMMON PSYCHOLOGICAL SYMPTOMS OF 1320 PATIENTS WITH INSOMNIA FROM GUANG’ANMEN HOSPITAL, CHINA ACADEMY OF CHINESE MEDICAL SCIENCES
COMORBID DEPRESSION AND INSOMNIA: WHO SEEKS WHICH TREATMENT?
Andrea Harris 1 , Taryn Moss 1 , Colleen Carney 1 , Joey Friedman 1 , Colin Shapiro 2 . 1 Ryerson University, Canada; 2 Toronto Western Hospital, Canada Introduction and Objectives: Individuals presenting with comorbid Major Depressive Disorder (MDD) and insomnia comprise a diverse group. Whereas insomnia was originally considered to be a mere symptom of depression, it is now regarded as a common independent disorder that warrants its own treatment. Given this previously held bias towards exclusive treatment of depression, it is unclear who is motivated to receive treatment primarily for their depression or their sleep. This study examines differences amongst those with MDD and insomnia who present for depression treatment (CBT-D) or for insomnia treatment (CBT-I). Materials and Methods: Participants (N=28) met diagnoses of MDD and research diagnostic criteria for insomnia, and were matched on sex and age. One group presented for a CBT-D study, and the other presented for a study of CBT–I for those with MDD. We examined group differences among depression severity, maladaptive sleep beliefs, sleep medication status, antidepressant status, and the presence/absence of comorbid conditions. Results: CBT-D patients had significantly higher depression scores (p=0.048), and were more likely to be taking antidepressants (p=0.042) than CBT-I patients. Individuals seeking CBT-I had significantly greater maladaptive sleep beliefs than those in CBT-D (p=0.022). There were no group differences on sleep medication status or the presence of other disorders. Conclusion: Individuals seeking depression treatment were more depressed and more likely to receive antidepressant medication, whereas insomnia treatment seekers reported elevated levels of maladaptive sleep beliefs. This suggests some degree of appropriate patient self-selection for depressionfocused versus sleep-focused treatment amongst this group. Since clinicians may make diagnostic errors in favour of treating depression, perhaps patients have something to tell us about which problem is more troublesome for them. Future studies should investigate whether this apparent selfselection has any treatment utility (i.e., whether those who perceive their main problem as sleep actually do better in sleep-focused treatment). Acknowledgements: R01 MH76856-02
T-D-006
Abstracts of 4th International Congress of WASM & 5th Conference of CSS / Sleep Medicine 12, Suppl. 1 (2011) S1–S130
CLINICAL EFFECTIVENESS TRIAL OF MEDICAL-ADMINISTERED SMALL-GROUP COGNITIVE BEHAVIOR THERAPY FOR PRIMARY INSOMNIA IN GENERAL PRACTICE
Márcio W. Soares 1 , Julie C.N. Soares 1 , Fernando M.J. Vieira 1 , Luciano H. Lehmkuhl 2 , Pablo Moritz 2 , Lucila B.F. Prado 1 , Luciane B.C. Carvalho 1 , Gilmar F. Do Prado 1. 1 UNIFESP, Brazil; 2 SOMED, Brazil Introduction and Objectives: Insomnia is very common in general practice however it has a difficult management. This study investigates the clinical effectiveness and adherence of applying cognitive behavior therapy (CBT) methods for insomnia in primary care. Materials and Methods: A prospective, multicentric design was employed. It used general medical practice patients. Sixty eight adults (mean age, 47 years) were assigned to receive CBT (n=18; 50 women). CBT comprised 3 sessions which included sleep hygiene education delivered individually by a sleep medical doctor. The aim of the CBT treatment was the use of weariness to prevent hyper-alert status. There were two options of inducing weariness: Ironing and phone book memorizing. They should be used before sleep time. Results: Assessments were completed at baseline, two weeks after treatment, and six weeks follow-up visits. Sleep outcomes were accessed by sleep diary, and clinical visits. CBT was associated with improvements in selfreported sleep latency, wakefulness after sleep onset, and sleep efficiency. Improvements were partly sustained at follow up. Absenteeism was not a common issue among patients. CBT was associated with significant positive changes in mood and sleep satisfaction. Comorbid mental health difficulties had no impact in the sleep improvement after CBT. Conclusion: This study suggests that it is possible and useful to deliver CBT for insomnia using weariness as an easy tool in general medical practice. Further research is required to consider the possibilities of increasing adherence to CBT in primary healthcare. Acknowledgements: To Gilmar Fernandes do Prado and his family for friendship and scientific support
T-D-008
Lan Hong, Yingna Lin, Fang Wang. Guang’anmen Hospital, China Academy of Chinese Medical Sciences, China Introduction and Objectives: To analyze the common psychological symptoms of 1320 patients with insomnia from Guang’anmen Hospital, China Academy of Chinese Medical Sciences. Materials and Methods: The results of Minnesota Multiphasic Personality Inventory (MMPI) of 1320 cases with insomnia enrolled in the Guang’anmen Hospital, China Academy of Chinese Medical Sciences from 2002 to 2009 were analyzed retrospectively. Results: The factor scores of depression, anxiety, neuroticism, hysteria, hypochondriasis, epileptic personality, distress, worry, stress, psychasthenia, ill health, complaints of health, impotence, fatigue, headache, autoblame, autopunition, autotomy, work worry, social withdrawal, school discomfort, seeking instruction, traffic accident, ominous prognosis were higher than normal values for China. The factor scores of optimism, academic success, social responsibility and self-strength were lower than normal values for China. Conclusion: Depression, anxiety, hypochondriasis, hysteria and epileptic personality, low self-strength and high dependence are the common personality basis of Chinese patients with insomnia. Stress from social, school, work and physical diseases are the causes. The risk for suicide of insomnia increased significantly, a matter for serious attention. Besides sleep disorders, insomnia often accompanies many somatic symptoms, such as fatigue, headache and sexual dysfunction, etc. These symptoms may contribute to causing the insomnia. Insomnia can also cause these symptoms. Acknowledgements: The Mechanism of TCM Relaxation Induction to Treat Insomnia: National Nature Science Fund Project (National Natural Science Foundation of China): grant number 81072854
T-D-009 T-D-007
COGNITIVE-BEHAVIORAL THERAPY FOR INSOMNIA CO-MORBID WITH HEARING IMPAIRMENT: A RANDOMIZED CONTROLLED TRIAL
Markus Jansson-Fröjmark, Steven Linton, Ida Flink, Annika Norell-Clarke. Center for Health and Medical Psychology, School of Law, Psychology, and Social Work, Sweden Introduction and Objectives: Based on research showing that sleep complaints are common among individuals with hearing impairment, the purpose was to examine the effects of cognitive behavior therapy for insomnia in patients with insomnia co-morbid with hearing impairment. Materials and Methods: A randomized controlled design was used with a three-month follow-up. Thirty-two patients with insomnia co-morbid with hearing impairment were recruited from audiology clinics and randomized to either cognitive behavior therapy (CBT-I) or a wait-list condition (WLC). The primary outcome was insomnia severity. Secondary outcomes were sleep diary parameters, dysfunction, anxiety, and depression. Results: While neither CBT nor WLC led to improvements on anxiety and depression, CBT was superior to WLC on the remaining outcomes. Compared to WLC, CBT resulted in lower insomnia severity at post-treatment and at follow-up (d = 1.18-1.56). Relative to WLC, CBT also led, at both assessment points, to reduced sleep onset latency (d = 1.07-1.18) and wake after sleep onset (d = 0.94-1.05) and increased sleep restoration (d = 1.03-1.07) and sleep quality (d = 0.91-1.16). Both groups increased their total sleep time, but no significant group difference emerged. Compared to WLC, CBT resulted in higher function at both assessment points (d = 0.81-0.96). Based on the Insomnia Severity Index, more CBT (53-77%) than WLC participants (0-7%) were treatment responders. Also, more CBT (24%) than WLC participants (0%) remitted. Conclusion: In patients with insomnia co-morbid with hearing impairment, cognitive behavioral therapy aimed at reducing insomnia symptomatology was effective in decreasing insomnia severity, subjective sleep parameters, and dysfunction. Acknowledgements: We would like to express our appreciation to the Swedish funding agency for funding and to the two clinics for recruitment.
COMMON PSYCHOLOGICAL SYMPTOMS OF 1320 PATIENTS WITH INSOMNIA FROM GUANG’ANMEN HOSPITAL, CHINA ACADEMY OF CHINESE MEDICAL SCIENCES
COMORBID DEPRESSION AND INSOMNIA: WHO SEEKS WHICH TREATMENT?
Andrea Harris 1 , Taryn Moss 1 , Colleen Carney 1 , Joey Friedman 1 , Colin Shapiro 2 . 1 Ryerson University, Canada; 2 Toronto Western Hospital, Canada Introduction and Objectives: Individuals presenting with comorbid Major Depressive Disorder (MDD) and insomnia comprise a diverse group. Whereas insomnia was originally considered to be a mere symptom of depression, it is now regarded as a common independent disorder that warrants its own treatment. Given this previously held bias towards exclusive treatment of depression, it is unclear who is motivated to receive treatment primarily for their depression or their sleep. This study examines differences amongst those with MDD and insomnia who present for depression treatment (CBT-D) or for insomnia treatment (CBT-I). Materials and Methods: Participants (N=28) met diagnoses of MDD and research diagnostic criteria for insomnia, and were matched on sex and age. One group presented for a CBT-D study, and the other presented for a study of CBT–I for those with MDD. We examined group differences among depression severity, maladaptive sleep beliefs, sleep medication status, antidepressant status, and the presence/absence of comorbid conditions. Results: CBT-D patients had significantly higher depression scores (p=0.048), and were more likely to be taking antidepressants (p=0.042) than CBT-I patients. Individuals seeking CBT-I had significantly greater maladaptive sleep beliefs than those in CBT-D (p=0.022). There were no group differences on sleep medication status or the presence of other disorders. Conclusion: Individuals seeking depression treatment were more depressed and more likely to receive antidepressant medication, whereas insomnia treatment seekers reported elevated levels of maladaptive sleep beliefs. This suggests some degree of appropriate patient self-selection for depressionfocused versus sleep-focused treatment amongst this group. Since clinicians may make diagnostic errors in favour of treating depression, perhaps patients have something to tell us about which problem is more troublesome for them. Future studies should investigate whether this apparent selfselection has any treatment utility (i.e., whether those who perceive their main problem as sleep actually do better in sleep-focused treatment). Acknowledgements: R01 MH76856-02