| 1. |
- Baglioni, Chiara, et al.
(author)
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The European Academy for Cognitive Behavioural Therapy for Insomnia : An initiative of the European Insomnia Network to promote implementation and dissemination of treatment
- 2020
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In: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 29:2
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Journal article (peer-reviewed)abstract
- Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT-I) should be the first-line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT-I Academy that would enable a Europe-wide system of standardized CBT-I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT-I, preconditions for health professionals to teach CBT-I, the way in which CBT-I should be taught, who should be taught CBT-I and to whom CBT-I should be administered. Furthermore, diverse aspects of CBT-I care and delivery were discussed and incorporated into a stepped-care model for insomnia.
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| 2. |
- Blom, Kerstin, et al.
(author)
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Facilitating and hindering factors in Internet-delivered treatment for insomnia and depression
- 2016
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In: Internet Interventions. - : Elsevier. - 2214-7829. ; 4, s. 51-60
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Journal article (peer-reviewed)abstract
- Insomnia and depression is a common and debilitating comorbidity, and treatment is usually given mainly for depression. Guided Internet-based cognitive behavioral therapy for insomnia (ICBT-i) was, in a recent study on which this report is based, found superior to a treatment for depression (ICBT-d) for this patient group, but many patients did not reach remission.
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| 3. |
- Broström, Anders, et al.
(author)
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Quality of life among patients with restless legs syndrome : A systematic review and meta-analysis
- 2024
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In: Journal of clinical neuroscience. - : Elsevier. - 0967-5868 .- 1532-2653. ; 122, s. 80-91
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Research review (peer-reviewed)abstract
- Objective: The primary aim was to estimate the pooled mean score of quality of life (QoL) (total, mental and physical health components) among patients with Restless Legs Syndrome (RLS).Secondary aims were to assess: (I) QoL differences for RLS vs. control groups, (II) heterogeneity and possible sources; and (III) moderating variables.Methods: Studies identified in PubMed, Scopus, Web of Science, and ProQuest between January 2000 and December 2022 were included. Methodological quality was assessed with Newcastle Ottawa Scale. The protocol was pre-registered (PROSPERO, CRD42023387318).Results: Twenty-seven studies (20121 participants, 12 countries) were included. The corrected pooled estimated mean score of QoL was 47.92 (27 studies, CI 95 %: 43.11 to 52.72, range 0–100, i.e., low–high QoL) and was marginally affected by publication year (increased 0.89 by each year, p = 0.12). The corrected pooled estimated mean score of the mental health component was 47.32 (17 studies, 95 % CI: 43.12 to 51.51, range 0–100) and influenced by RLS instrument (decreased with recent versions, p = 0.05). The corrected pooled estimated mean score of the physical health component was 39.08 (17 studies, 95 % CI: 33.05 to 45.10, range 0–100), with no statistically significant moderator. The pooled estimated QoL scores were statistically significantly lower in RLS patients compared to control groups with standardized mean difference (SMD) of −0.78, −0.57 and −0.50 respectively for overall QoL (24 studies), physical and mental health components (14 studies). Total QoL SMD was affected by proportion of women.Conclusion: Low QoL was revealed among RLS patients, which was statistically significantly reduced compared to control groups.
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| 4. |
- Edmonds, M., et al.
(author)
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Treating comorbid insomnia in patients enrolled in therapist-assisted transdiagnostic internet-delivered cognitive behaviour therapy for anxiety and depression : A randomized controlled trial
- 2024
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In: Internet Interventions. - : Elsevier. - 2214-7829. ; 35
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Journal article (peer-reviewed)abstract
- Transdiagnostic Internet-delivered cognitive behaviour therapy (ICBT) for patients experiencing anxiety and depression can produce large improvements in symptoms. Comorbid insomnia is common among individuals seeking treatment for anxiety and depression, yet transdiagnostic ICBT rarely targets insomnia and many ICBT patients report that symptoms of insomnia remain after treatment. This trial explored the impact of including a brief intervention for insomnia alongside an existing transdiagnostic ICBT course that included brief weekly therapist assistance. Patients were randomly assigned to receive either the Standard transdiagnostic (n = 75) or a Sleep-Enhanced course (n = 142), which included information on sleep restriction and stimulus control. Intentto-treat analyses using generalized estimating equation (GEE) showed significant, large reductions in all primary outcomes (insomnia: d = 0.96, 95 % CI [0.68, 1.24]; depression: d = 1.04, 95 % CI [0.76, 1.33]; and anxiety: d = 1.23, 95 % CI [0.94, 1.52]) from pre-treatment to post-treatment, with changes maintained at 3-months. Patients assigned to the Sleep-Enhanced course reported larger reductions in insomnia than patients in the Standard transdiagnostic course (Cohen's d = 0.31, 95 % CI [0.034, 0.60]) at post-treatment but no significant betweengroup differences in any of the primary outcomes were found at follow-up. Patient-reported adherence to sleep restriction guidelines (p = .03), but not stimulus control instructions (p = .84) was associated with greater reductions in insomnia symptoms during the course. Overall, patients who received the Sleep-Enhanced course were satisfied with the materials and most patients reported making sleep behaviour changes. The trial results demonstrate that including a brief intervention targeting insomnia can be beneficial for many patients who enroll in ICBT primarily for symptoms related to anxiety and depression.
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| 5. |
- Jernelöv, Susanna, et al.
(author)
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Effects and clinical feasibility of a behavioral treatment for sleep problems in adult attention deficit hyperactivity disorder (ADHD) : a pragmatic within-group pilot evaluation
- 2019
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In: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 19, s. 1-12
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Journal article (peer-reviewed)abstract
- BackgroundSleep disturbances, including insomnia, are common in adult Attention Deficit Hyperactivity Disorder (ADHD). Treatment of choice for insomnia is cognitive behavioral therapy (CBT-i), but evidence is lacking for CBT-i in patients with ADHD.The purpose of this study was to investigate if patients with insomnia and other sleep problems, at a specialist clinic for ADHD, benefit from a group delivered behavioral treatment based on CBT-i; whether insomnia severity improves following this treatment.MethodsThis pragmatic within-group pilot study with a pre to post and three-month follow-up design was set at a specialist psychiatric out-patient clinic for adult ADHD.As an adjunct to care-as-usual at the clinic, a CBT-i-based group treatment targeting several sleep problems prevalent in the ADHD-population, was offered as 10 weekly 90-min group sessions and scheduled telephone support.All outcome measures were subjectively reported by participants. Data analyzed with dependent t-tests according to intent-to-treat.ResultsNineteen patients (37 [SD 13.7] years; 68% female) with ADHD and subjectively reported sleep problems provided informed consent and pre-treatment measures. Patients had suffered from sleep problems for 15.3 [SD 13.4] years, 42% used sleep medications, 79% used stimulant medication(s).At post-treatment, insomnia severity (Insomnia Severity Index; score range 0-28) had improved with 4.5 points (95% CI, 2.06-6.99, p=.002), at 3months with 6.8 points (95% CI, 4.71-8.91, p<.0001) from pre-treatment.ConclusionsCBT-i adjusted for ADHD is promising for improving insomnia severity in adult patients at specialist psychiatric out-patient clinics, who suffer from ADHD and sleep disturbances.Trial registrationStudy registered with the Regional ethical review board in Stockholm, January 13th 2016, Study id: 2015/2078-31/1. Study registered retrospectively with Clinicaltrials.org, February 21st 2019, ID: NCT03852966.
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| 6. |
- Jernelöv, Susanna, et al.
(author)
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Efficacy of a behavioral self-help treatment with or without therapist guidance for co-morbid and primary insomnia - a randomized controlled trial
- 2012
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In: BMC Psychiatry. - 1471-244X. ; :12
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Journal article (peer-reviewed)abstract
- BackgroundCognitive behavioral therapy is treatment of choice for insomnia, but availability is scarce. Self-help can increase availability at low cost, but evidence for its efficacy is limited, especially for the typical insomnia patient with co-morbid problems. We hypothesized that a cognitive behaviorally based self-help book is effective to treat insomnia in individuals, also with co-morbid problems, and that the effect is enhanced by adding brief therapist telephone support.MethodsVolunteer sample; 133 media-recruited adults with insomnia. History of sleep difficulties (mean [SD]) 11.8 [12.0] years. 92.5% had co-morbid problems (e.g. allergy, pain, and depression). Parallel randomized (block-randomization, n ≥ 21) controlled "open label" trial; three groups-bibliotherapy with (n = 44) and without (n = 45) therapist support, and waiting list control (n = 44). Assessments before and after treatment, and at three-month follow-up. Intervention was six weeks of bibliotherapeutic self-help, with established cognitive behavioral methods including sleep restriction, stimulus control, and cognitive restructuring. Therapist support was a 15-minute structured telephone call scheduled weekly. Main outcome measures were sleep diary data, and the Insomnia Severity Index.ResultsIntention-to-treat analyses of 133 participants showed significant improvements in both self-help groups from pre to post treatment compared to waiting list. For example, treatment with and without support gave shorter sleep onset latency (improvement minutes [95% Confidence Interval], 35.4 [24.2 to 46.6], and 20.6 [10.6 to 30.6] respectively), and support gave a higher remission rate (defined as ISI score below 8; 61.4%), than bibliotherapy alone (24.4%, p's < .001). Improvements were not seen in the control group (sleep onset latency 4.6 minutes shorter [-1.5 to 10.7], and remission rate 2.3%). Self-help groups maintained gains at three-month follow-up.ConclusionsParticipants receiving self-help for insomnia benefited markedly. Self-help, especially if therapist-supported, has considerable potential to be as effective as individual treatment at lower cost, also for individuals with co-morbid problems.
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| 7. |
- Jernelöv, Susanna
(author)
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Stress, sleep, and allergy
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Allergic diseases have recently increased dramatically in the western world, now affecting about 30% of the Swedish population. The reasons for this increase are unclear, but some of the suspects are behavioral factors, such as stress and sleep. Problems with stress are also common today, and stress may change the set-points for the functioning of the body, for instance in the immune system. Sleep, on the other hand, is important for recuperation, and disturbed sleep acts a stressor in itself. Allergic patients often report stressful situations to cause allergic symptom exacerbations, and experience increased fatigue and disturbed sleep, especially when exposed to allergen. However, most aspects of the relations between stress, sleep, and allergy are still obscure. Therefore, this thesis aimed at increasing the understanding of these links. The thesis is based on three studies. The first is a quasi-experimental study of medical students with or without atopy, who were observed at two occasions, i.e. during a calmer study period and during a potentially stressful examination period (papers I & II). Assessments included blood sampling, lung function testing, and questionnaires and diaries on allergic and psychological symptoms and sleep. The results show that both atopic and non-atopic students increased ratings of stress and negative mood, had altered sleep patterns and changes in immune parameters, e.g. a marked increase in regulatory T-cells, during examination. Atopic participants also showed specific responses to stress, such as a shift towards T-helper 2 dominance, increased anxiety and disturbed sleep. Despite these changes, allergic symptoms were not affected. Paper III is based on a prospective epidemiological study, using parent report questionnaire data on aspects of disturbed sleep and allergy from the Twin Study of Child and Adolescent Development (TCHAD). Controlling for confounding effects of several factors, including gender, birth weight, and socioeconomic status, results from this study show that being overtired in childhood (age 8-9) predicts development of rhinitis in adolescence (age 13-14), but also that having asthma in childhood is predictive of becoming overtired in adolescence. Controlling for gender only, it also replicates findings from cross sectional studies of associations between allergy and disturbed sleep. The findings from paper I-III suggest that treatment of sleeping problems that are comorbid with e.g. allergies is an important issue. Therefore, paper IV is a randomized controlled trial of the efficacy of a CBT-based self-help treatment for insomnia with comorbid problems, including allergy. Assessments with questionnaires and sleep diaries took place at pre-treatment, post-treatment and three-month follow-up. The study shows that participants in the treatment groups display much improved sleep, and that the sleep of allergic individuals improved to the same extent as that of non-allergic individuals, despite co-existing allergic symptoms. In conclusion, stress is involved in allergy relevant immune changes, and the cumulative negative effects of stress (i.e. allostatic load) seem to be increased in atopic individuals as compared to non-atopics. The results thus speak for stress as a co-factor in an allergic reaction when exposed to allergen. Aspects of disturbed sleep may be involved in the development of allergy and vice versa, but disturbed sleep, also in individuals with allergy, can be treated efficiently with a CBT-based self-help treatment. The results of the thesis confirm a link between stress, sleep, and allergy, and suggest future studies to test if successful treatment of stress and sleep may decrease symptom expression or even diminish the risk for developing allergic disease.
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| 8. |
- Jernelöv, Susanna, et al.
(author)
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Treatment feasibility and preliminary evaluation of group-delivered cognitive behavioral therapy for insomnia adapted for patients with bipolar and related disorders : A pragmatic within-group study
- 2022
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In: Journal of Affective Disorders Reports. - : Elsevier BV. - 2666-9153. ; 7
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Journal article (peer-reviewed)abstract
- Background: Sleep disturbances, including insomnia, are common in bipolar disorder. Treatment of choice for insomnia is cognitive behavioral therapy (CBT-i), but evidence for CBT-i in patients with bipolar disorder is scarce. We investigated a group delivered treatment based on CBT-I; treatment feasibility in patients with bipolar and related disorders, and improvement in insomnia severity following treatment.Methods: This pragmatic within-group evaluation with a pre to post and three-month follow-up design was set at two psychiatric out-patient clinics specialized in bipolar and related disorders. As an adjunct to care-as-usual, the treatment was offered as six two-hour group sessions over eight weeks. Data were analyzed with intent-to-treat using hierarchical linear mixed models.Results: Thirty-four patients (48 [range 19–72] years; 68% female) with bipolar and related disorders and sleep problems provided informed consent. Patients had suffered from sleep problems for 12.7 [range 0.3–65] years, 97% used sleep medications, 91% medicated for their primary disorder. Patient interest, attendance, dropout, satisfaction, credibility, and adverse events met feasibility criteria, and therapists endorsed the manual. Post-treatment, insomnia severity (Insomnia Severity Index; score range 0–28) had improved with 6.1 points (95% CI, 3.27–8.93, g = 1.11, p = 0.0001) and at three months with 7.0 points (95% CI, 4.03–9.97, g = 1.26, p < 0.0001) from pre-treatment.Limitations: Lack of control group and no control for care-as-usual content.Conclusions: CBT-i adjusted for bipolar disorder delivered as a group treatment is promising for improving insomnia severity in patients with bipolar and related disorders and disturbed sleep.
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| 9. |
- Jernelöv, Susanna, et al.
(author)
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Treatment feasibility of a digital tool for brief self-help behavioural therapy for insomnia (FastAsleep)
- 2022
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In: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 32:2
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Journal article (peer-reviewed)abstract
- Cognitive behavioural therapy for insomnia is efficacious and recommended for insomnia, but availability is scarce. Cognitive behavioural therapy for insomnia self-help interventions could increase availability, especially if unguided. Optimizing cognitive behavioural therapy for insomnia methods and system user-friendliness, we developed a short, digital, self-help programme-FastAsleep-based on the behavioural components of sleep restriction and stimulus control. This study investigated its feasibility and preliminary effects. Thirty media-recruited participants with moderate to severe insomnia were assessed via telephone before using FastAsleep for 4 weeks, and were interviewed afterwards. Self-ratings with web questionnaires were conducted at screening, pre-, mid- and post-treatment, and at 3-month follow-up. Primary outcomes were feasibility (credibility, adherence, system user-friendliness and adverse effects), and secondary outcomes were changes in symptom severity (insomnia, depression and anxiety). Adherence was generally high, participants' feasibility ratings were favourable, and adverse effects matched previously reported levels for cognitive behavioural therapy for insomnia. Symptoms of insomnia decreased after the treatment period (Hedge's g = 1.79, 95% confidence interval = 1.20-2.39), as did symptoms of depression and anxiety. FastAsleep can be considered feasible and promising for alleviating insomnia symptoms among patients fit for self-care. Future controlled trials are needed to establish the efficacy of FastAsleep and its suitability in a stepped care model.
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| 10. |
- Jernelöv, Susanna, et al.
(author)
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Very long-term outcome of cognitive behavioral therapy for insomnia : one- and ten-year follow-up of a randomized controlled trial
- 2022
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In: Cognitive Behaviour Therapy. - : Taylor & Francis Group. - 1650-6073 .- 1651-2316. ; 51:1, s. 72-88
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Journal article (peer-reviewed)abstract
- Insomnia is a common and chronic disorder, and cognitive behavioral therapy (CBT) is the recommended treatment. Very long-term follow-ups of CBT are very rare, and this study aimed to investigate if improvements were stable one and ten years after CBT for insomnia (CBT-i). Based on a three-armed randomized controlled trial of bibliotherapeutic CBT-i, participants received an insomnia-specific self-help book and were randomized to therapist guidance, no guidance, or a waitlist receiving unguided treatment after a delay. Six weeks of treatment was given to 133 participants diagnosed with insomnia disorder. After one and ten years, participants were assessed with self-reports and interviews. Improvements were statistically significant and well maintained at one- and ten-year follow-ups. Average Insomnia Severity Index score [95%CI] was 18.3 [17.7-18.8] at baseline, 10.1 [9.3-10.9] at post-treatment, 9.2 [8.4-10.0] at one- and 10.7 [9.6-11.8] at ten-year follow-up, and 64% and 66% of participants no longer fulfilled criteria for an insomnia diagnosis at one and ten years, respectively. Positive effects of CBT were still present after ten years. Insomnia severity remained low, and two-thirds of participants no longer fulfilled criteria for an insomnia diagnosis. This extends previous findings of CBT, further confirming it as the treatment of choice for insomnia.
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