Volume 24, Issue 2 (June & July 2021)
J Arak Uni Med Sci 2021, 24(2): 292-305 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Salmani B, Hasani J. Comparing the Effects of Cognitive-behavioral Therapy and Zolpidem 10 mg on Illness Perception and Sleep Efficiency in Individuals With Chronic Insomnia. J Arak Uni Med Sci 2021; 24 (2) :292-305
URL: http://jams.arakmu.ac.ir/article-1-6400-en.html
URL: http://jams.arakmu.ac.ir/article-1-6400-en.html
1- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran. , b.salmani1365@gmail.com
2- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran.
2- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran.
Abstract: (2466 Views)
Background & Aim: This study aimed at comparing efficacy of cognitive behavioral therapy, Zolpidem 10 mg, and waiting list group on illness perception and sleep efficiency in individuals with chronic insomnia disorder.
Materials & Methods: Participants included 74 (female = 43) individuals with chronic insomnia disorder who were recruited from 2018 December to 2020 February by purposive sampling (inclusive & exclusive criteria). Then, patients randomly allocated to one of the three conditions, including cognitive behavioral therapy (N=25), pharmacotherapy (Zolpidem 10 mg.; N=29), and the waiting list (N=20). All patients were assessed three times at pretreatment, post-treatment, and 3-month follow-up by the Persian version of Brief Illness Perception Questionnaire and Sleep Efficiency Index. The data were analyzed by mixed analysis of variance with Bonferroni post-hoc test and repeated measure analysis of variance.
Ethical Considerations: All stages of the research have been carried after taking supervising and approving of Kharazmi University's ethics in research committee.
Findings: The patients who received cognitive behavioral therapy compared to patients in waiting list group, obtained significantly lower scores in illness perception and sleep efficiency during post-treatment and 3-month follow-up. Efficacy of pharmacotherapy only observed during post-treatment but there were no significant differences between pharmacotherapy and waiting list patients during 3-month follow-up.
Conclusion: Cognitive behavioral therapy for insomnia reduced significantly illness perceptions and sleep efficiency during 3 months. All the treatment gains remain stable even 3 months later treatment ends. In addition, not receiving any treatment in waiting list and gradually discontinued the treatment in pharmacotherapy group leads to decreasing of sleep efficiency and increasing of illness perception.
Materials & Methods: Participants included 74 (female = 43) individuals with chronic insomnia disorder who were recruited from 2018 December to 2020 February by purposive sampling (inclusive & exclusive criteria). Then, patients randomly allocated to one of the three conditions, including cognitive behavioral therapy (N=25), pharmacotherapy (Zolpidem 10 mg.; N=29), and the waiting list (N=20). All patients were assessed three times at pretreatment, post-treatment, and 3-month follow-up by the Persian version of Brief Illness Perception Questionnaire and Sleep Efficiency Index. The data were analyzed by mixed analysis of variance with Bonferroni post-hoc test and repeated measure analysis of variance.
Ethical Considerations: All stages of the research have been carried after taking supervising and approving of Kharazmi University's ethics in research committee.
Findings: The patients who received cognitive behavioral therapy compared to patients in waiting list group, obtained significantly lower scores in illness perception and sleep efficiency during post-treatment and 3-month follow-up. Efficacy of pharmacotherapy only observed during post-treatment but there were no significant differences between pharmacotherapy and waiting list patients during 3-month follow-up.
Conclusion: Cognitive behavioral therapy for insomnia reduced significantly illness perceptions and sleep efficiency during 3 months. All the treatment gains remain stable even 3 months later treatment ends. In addition, not receiving any treatment in waiting list and gradually discontinued the treatment in pharmacotherapy group leads to decreasing of sleep efficiency and increasing of illness perception.
Keywords: Sleep initiation and maintenance disorders, Cognitive-Behavioral therapy, Illness perception, Sleep efficiency
References
1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th Ed. Arlington, VA: American Psychiatric Publishing. 2013. [DOI:10.1176/appi.books.9780890425596]
2. Cao XL, Wang SB, Zhong BL, et al. The prevalence of insomnia in the general population China: a meta-analysis. PLoS One. 2017; 12(2):e0170772. [DOI:10.1371/journal.pone.0170772]
3. Ting L, Malhorta A. Disorders of sleep: an overview. Prim Care. 2005; 32(2):305-18. [DOI:10.1016/j.pop.2005.02.004]
4. Finan PH, Smith, MT. The comorbidity of insomnia, chronic pain, and depression: dopamine as putative mechanism. Sleep Med Rev. 2013; 17:173-83. [DOI:10.1016/j.smrv.2012.03.003]
5. Drummond SPA, Walker M, Almklov E, Campos M, Anderson DE, Straus LD. Neural correlates of working memory performance in primary insomnia. Sleep. 2013; 36(9):1307-16. [DOI:10.5665/sleep.2952]
6. Daley M, Morin CM, LeBlanc M, Gregoire JP, Savard J. The economic burden of insomnia: direct and indirect costs for people with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep. 2009; 32(1):55-64.
7. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002; 6(2):97-111. [DOI:10.1053/smrv.2002.0186]
8. Ma ZR, Shi LJ, Deng, MH. Efficacy of cognitive behavioral therapy in children and adolescents with insomnia: a systematic review and meta-analysis. Braz J Med Biol Res. 2018; 51(6):e7070. [DOI:10.1590/1414-431x20187070]
9. Feuerstein S, Hodges SE, Keenaghan B, Bessette A, Forselius E, Morgan PT. Computerized cognitive behavioral therapy for insomnia a community health setting. J Clin Sleep Med. 2017; 13(2):267-74. [DOI:10.5664/jcsm.6460]
10. Mitchell MD, Gehrman P, Perlis M, Umscheid C. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Prac. 2012;13:40. [DOI:10.1186/1471-2296-13-40]
11. Mathews EE, Schmiege SJ, Cook PF, Berger AM, Aloia MS. Adherence to cognitive behavioral therapy for insomnia (CBTI) among women following primary breast cancer treatment: a pilot study. Behav Sleep Med. 2012; 10(3):2017-29. [DOI:10.1080/15402002.2012.666220]
12. Chen SL, Tsai JC, Chou KR. Illness perceptions and adherence to therapeutic regimens among patients with hypertension: a structural modelling approach. Int J Nurs Stud. 2011; 48(2):235-45. [DOI:10.1016/j.ijnurstu.2010.07.005]
13. Broadbent E, Donkin L, Stroh JC. Adherence to medications, diet, and exercise in diabetic patients. Diabetes Care. 2011; 34(2):338-40. [DOI:10.2337/dc10-1779]
14. Hsiao CY, Chang C, Chen CD. An investigation on illness perception and adherence among hypertensive patients. Kaohsiung J Med Sci. 2012; 28:442-7. [DOI:10.1016/j.kjms.2012.02.015]
15. Leventhal H, Phillips LA, Burns E. The Common Sense Model of self-regulation (CSM): a dynamic framework for understanding illness self-management. J Behav Med. 2016; 39(6):935-46. [DOI:10.1007/s10865-016-9782-2]
16. Espie CA, Barrie LM. Forgan GS. Comparative investigation of the psychophysiologic and idiopathic insomnia disorder phenotype: psychologic characteristics, patient's perspective, and implications for clinical management. Sleep. 2012; 35(3):385-93. [DOI:10.5665/sleep.1702]
17. Zalai D, Mcshane K, Sherman M, Fornadi K, Shapiro C, Carney C. Are you concern about your fatigue? Fatigue perceptions mediate the relationship between insomnia and fatigue related functional impairment in chronic hepatitis C infection. Sleep Med. 2013; 14(1):e312-13. [DOI:10.1016/j.sleep.2013.11.766]
18. Rasskazova E, Migunova Y, Tkhostov A. Illness representation in chronic insomnia: exploratory study of social and cultural beliefs in Russia. Sleep Med. 2017; 40(1):e223. [DOI:10.1016/j.sleep.2017.11.650]
19. Matthieu A, Gaudet M, Labrecque ME, Laurin AM, Mayer P, Jobin V. Sleep illness representation as a potential barriers to treatment adherence in obstructive sleep apnea: a pilot study. Sleep Med. 2011; 12(1):S78. [DOI:10.1016/S1389-9457(11)70287-8]
20. Zamora T, Deering K, Sarmiento K, Stepnowsky C. Obstructive sleep apnea illness perception relative to other common chronic conditions. Sleep. 2017; 40(1):A225. [DOI:10.1093/sleepj/zsx050.606]
21. Kristoffersen ES, Lundqvist C, Russell MB. Illness perception in people with primary and secondary chronic headache in the general population. J Psychosom Res. 2019; 116:83-92. [DOI:10.1016/j.jpsychores.2018.12.001]
22. Rizou I, Gucht VD, Papavasiliou A, Maes S. The contribution of illness perceptions to fatigue and sleep problems in youngsters with epilepsy. Eur J Paediatr Neuro. 2016; 20:93-99. [DOI:10.1016/j.ejpn.2015.10.001]
23. Morin CM, Leblanc M, Ivers, Behanger L, Merette C, Savard J. Monthly fluctuations of insomnia symptoms in a population-based sample. Sleep. 2014; 37(2):319-26. [DOI:10.5665/sleep.3406]
24. Roth T, Hull SG, Lankford DA, Rosenberg R, Scharf MB. Low-dose of sublingual Zolpidem tartrate is associated with dose-related improvement in sleep onset and duration in insomnia characterized by middle-of-the-night (MOTN) awakening. Sleep. 2008; 31(9): 1277-84.
25. Goodwin CJ. Research in Psychology: Method & Design. 6th ed. New York: Wiley; 2009.
26. Perlis ML, Jungquist CR, Smith MT, Posner D. Cognitive behavioral treatment of insomnia: a session by session guide. New York: Springer; 2005.
27. Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006; 60:3631-7. [DOI:10.1016/j.jpsychores.2005.10.020]
28. Bagherian R, BahramiEhsan H, Saneei H. Relationship between history of myocardial infarction and cognitive representation of myocardial infarction. [Persian]. J Res Psychol Health. 2008; 2(2):29-39.
29. Shrivastava D, Jung S, Saadat M, Sirohi R, Crewson K. How to interpret the results of a sleep study. J Community Hosp Intern Med Perspect. 2014; 4(5):1-4. [DOI:10.3402/jchimp.v4.24983]
30. Haynes J, Talbert M, Fox S, Close E. Cognitive behavioral therapy in the treatment of insomnia. South Med J. 2018; 111(2):75-80. [DOI:10.14423/SMJ.0000000000000769]
31. Perlis ML, Aloia M, Kuhn B. Behvioral treatments for sleep disorders: a comprehensive primer of behavioral sleep medicine treatment protocols. UK: Academic Press; 2011.
32. Harvey AG. A cognitive model of insomnia. Behav Res Ther. 2002; 40(8):869-93. [DOI:10.1016/S0005-7967(01)00061-4]
33. Bonnet MH, Arand DL. Hyperarousal and insomnia. Sleep Med Rev. 1997; 1 (2):97-108. [DOI:10.1016/S1087-0792(97)90012-5]
34. Bonnet MH, Arand DL. Hyperarousal and insomnia: state of the science. Sleep Med Rev. 2010; 14(1):9-15. [DOI:10.1016/j.smrv.2009.05.002]
35. Eidelman P, Talbot L, Ivers H, Belanger L, Morin CM, Harvey AG. Change in dysfunctional beliefs about sleep in behavior therapy, cognitive therapy, and cognitive behavioral therapy for insomnia. Behav Ther. 2016; 47(1):102-15. [DOI:10.1016/j.beth.2015.10.002]
36. Christensen SS, Frostholm L, Ornbol E, SchroderA. Changes in illness perceptions mediated the effect of cognitive behavioural therapy in severe functional somatic syndromes. J Psychosom Res. 2015; 78(4):363-70. [DOI:10.1016/j.jpsychores.2014.12.005]
37. Kay Stacey M, Attarian H. Advance in management of chronic insomnia. BMJ. 2016; 354: i2123. [DOI:10.1136/bmj.i2123]
38. Jani M, Salehi B, Aleyasin SA, Davoudi H. The effectiveness of cognitive behavioral group therapy on quality of life of cardiovascular patients. AMUJ. 2017; 20(120): 22-30
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
