:: Volume 23, Issue 4 (Bimonthly 2019) ::
Feyz Med Sci J 2019, 23(4): 415-432 Back to browse issues page
Compatibility between biological and psychological hyperarousal in response to cognitive behavior therapy (with or without metacognitive techniques) in patients with chronic insomnia disorder: A multiple baselines single case
Behzad Salmani , Jaafar Hasani * , Afshin Ahmadvand , Shahram Mohammadkhani , Hamid Reza Hassan-Abadi
Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, I.R. Iran. , hasanimehr57@khu.ac.ir
Abstract:   (3235 Views)
Background: Hyperarousal is one of the main pathological mechanism in chronic insomnia. This study aimed to comparing biological and psychological hyperarousal in response to cognitive behavior therapy (with or without metacognitive techniques) in insomnia patients.
Materials and Methods: After taking diagnostic assessment and checking inclusive and exclusive criteria, four patients (1 male and 3 female; age 21-34) were allocated to two condition, cognitive behavior therapy (CBT) and cognitive behavior therapy with metacognitive techniques (CBT+). All of the patients were assessed six times by indirect calorimeter, pre-sleep arousal scale, and sleep efficiency (SE). The data were analyzed using clinical significant (recovery percent), effect size, and diagnostic recovery.
Results: In initial sessions (session 1 to 3), we observed a little compatibility between the biological and psychological hyperarousal. As sessions of CBT or CBT+ proceed, compatibility between the biological and psychological hyperarousal increased. In addition, in post-treatment and 3 month follow-up, both the interventions decreased hyperarousal significantly. Effect sizes were between 0.74 to 1.93. Furthermore, sleep efficiency of all the patients in the post-treatment and 3-month follow-up was between 89 to 94 and 88 to 90, respectively.
Conclusion: Unlike few initial sessions, compatibility between the biological and psychological hyperarousal increased at the post-treatment and 3-month follow-up. Both the treatments can decrease the hyperarousal and increase the sleep efficiency significantly.
Keywords: Insomnia, Hyperarousal, Cognitive behavior therapy, Metacognitive techniques, Response to treatment, Sleep efficiency
Full-Text [PDF 382 kb]   (1137 Downloads)    
Type of Study: Research | Subject: General
Received: 2018/12/10 | Revised: 2019/10/8 | Accepted: 2019/05/11 | Published: 2019/09/30
References
1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013. p. 362-68.
2. Araujo WB, Jarrin DC, Leanza Y, Vallieres A, Morin CM. Qualitative studies of insomnia: current state of knowledge in the field. Sleep Med Rev 2016; 31: 58-69.
3. World Health Organization. The ICD-10 classification of mental and behavioral disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 2007.
4. American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic and Coding Manual. 3rd ed. Darien IL: American Academy of Sleep Medicine; 2014. p. 150-59.
5. Taylor D, Gehrman P, Dautovich N, Lichstein K McCrae C. Handbook of Insomnia. London, UK: Springer Healthcare; 2014. p. 102-220.
6. Pillai V, Roth T, Drake CL. The nature of stable insomnia phenotypes. Sleep 2015; 38(1): 127-38.
7. Colten HR, Altevogt BC. Sleep disorders and sleep deprivation: an unmet public health problem. Washington, DC: The National Academies Press; 2006.
8. Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 2011; 135(1-3): 9-10.
9. Fortier-Brochu E, Morin CM. Cognitive impairment in individuals with insomnia: clinical significant and correlates. Sleep 2014; 37(11): 1787-98.
10. Miyata S, Noda A, Iwamoto K, Kawano N, Okuda M, Ozaki N. Poor sleep quality impairs cognitive performance in older adults. J Sleep Res 2013; 22(5): 535-41.
11. Fortier-Brochu E, Beaulieu-Bonneau S, Ivers H, Morin CM. Insomnia and daytime cognitive performance: a meta-analysis. Sleep Med Rev 2012; 16: 83-94.
12. Blackwell T, Yaffe K, Ancoli-Israel S, Redline S, Ensrud KE, Stefanick ML, et al. Association of sleep characteristics and cognition in older community-dwelling men: the MrOS sleep study. Sleep 2011; 34(10): 1347-56.
13. Baron KG, Perlis ML, Nowakowski S, Smitt MT, Jungquist CR, Orff HJ. Cognitive behavioral therapy for insomnia. In Attarian HP. Clinical handbook of insomnia. 3rd ed. Chicago, IL: Spinger International Publishing; 2017. p. 75-96.
14. Perlis ML, Jungquist CR, Smith MT, Posner D. Cognitive behavioral treatment of insomnia: a session by session guide. New York: Springer; 2005. p. 10-190.
15. Sharma MP, Andrade C. Behavioral interventions for insomnia: theory and practice. Indian J Psychiatry 2012; 54(4): 359-66.
16. Manber R, Carney CE. Treatment Plans and Interventions for Insomnia: A Case Formulation Approach. 1st ed. New York: Guilford Press; 2015. p. 81-140.
17. De Bruin EJ, Bogels SM, Oort FJ, Meijer AM. Efficacy of cognitive behavioral therapy for insomnia in adolescents: a randomized controlled trial with internet therapy, group therapy and a waiting list condition. Sleep 2015; 38(12): 1913-26.
18. Freeman D, Waite F, Startup H, Myers E, Lister R, Mclnerney J, et al. Efficacy of cognitive behavioral therapy for sleep improvement in patients with persistent delusions and hallucinations (BEST): a prospective, assessor-blind, & randomized controlled pilot trial. Lancet Psychiatry 2015; 2(11): 975-83.
19. Gregory AM, Cox J, Crawford MR, Holland J, Haravey AG, Eley TC, et al. Dysfunctional beliefs and attitudes about sleep in children. J Sleep Res 2009; 18(4): 422-26.
20. Palagini L, Ong JC, Riemann D. The mediating role of sleep related metacognitive processes in trait and pre-sleep state hyperarousal in insomnia disorder. J Psychosom Res 2017; 99: 59-65.
21. Palagini L, Mauri M, Dell'Osso L, Riemann D, Drake CL. Trait and pre-sleep-state-dependent arousal in insomnia disorder: what role may stress reactivity and sleep-related metacognitions play? A pilot study. Sleep Med 2016a; 25: 42-48.
22. Palagini L, Bruno RM, Paolo T, Caccavale L, Gronchi A, Mauri M, et al. Association between stress-related sleep reactivity and metacognitive beliefs about sleep in insomnia: preliminary results. Behav Sleep Med 2016b; 14(6): 636-49.
23. Doos Ali Vand H, Gharraee B, Asgharnejad Farid AA, Ghaleh Bandi MF. Prediction of insomnia severity based on cognitive, metacognitive and emotional variables in college students. Explore 2014; 10(4): 233-40.
24. Ong JC, Ulmer CS, Manber R. Improving sleep with mindfulness and acceptance: a metacognitive model of insomnia. Behav Res Ther 2012; 50: 651-60.
25. Briton WB, Shapiro SL, Penn PE, Bootzin RR. Treating insomnia with minsfulness-based stress reduction. Sleep 2003; 26: a309.
26. Heidenreich T, Tuin I, Pflug B, Michal M, Michalak J. Mindfulness-based cognitive therapy for persistent insomnia: a pilot study. Psychother Psychosom 2006; 75(3): 188-9.
27. Ong JC, Shapiro SL, Manber R. Combining mindfulness mediation with cognitive-behavior therapy for insomnia: a treatment-development study. Behav Ther 2008; 39(2): 171-82.
28. Wells A, Matthews G. Modeling cognition in emotional disorder: the S-REF model. Behav Res Ther 1996; 34(11/12): 881-8.
29. Normann N, van Emmerik AP, Morina N. The efficacy of metacognitive therapy for anxiety and depression: a meta-analytic review. Depress Anxiety 2014; 31: 402-11.
30. Salmani B, Hasani J, Mohammad-Khani S, Karami GR. The efficacy of metacognitive therapy on metacognitive beliefs, metaworry, and signs and symptoms of patients with generalized anxiety disorder. Feyz 2014; 18(5): 429-40. [in Persian]
31. Wells A, King P. Metacognitive therapy for generalized anxiety disorder: an open trial. J Behav Ther Exp Psychiatry 2006; 37(3): 206-12.
32. Wells A, Matthews G. Attention and Emotion: A Clinical Perspective. Hove, UK: Erlbaum. 1994.
33. Wells A. Metacognitive Therapy for Anxiety Depression. New York: Guilford Press; 2009. p. 55-250.
34. Rezaie L, Fobian AD, McCall WV, Khazaie H. Paradoxical insomnia and subjective-objective sleep discrepancy: a review. Sleep Med Rev 2018; 40: 196-202.
35. Kay DB, Buysse DJ, Germain A, Hall M, Monk TH. Subjective-objective sleep discrepancy among older adults: associations with insomnia diagnosis and insomnia treatment. J Sleep Res 2015; 24(1): 32-9.
36. Gross CR, Kreitzer MJ, Reilly-Spong M, Wall M, Winbush NY, Patterson R, et al. Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: a randomized controlled clinical trial. Explore 2011; 7(2): 76-87.
37. Briton WB, Haynes PL, Fridel KW, Bootzin, RR. Polysomnographic and subjective profiles of sleep continuity before and after mindfulness-based cognitive therapy in partially remitted depression. Psychosom Med 2010; 72(6): 539-48.
38. McCall C, McCall WV. Comparison of actigraphy with polysomnography and sleep logs in depressed insomniacs. J Sleep Res 2012; 21(1): 122-7.
39. Wong SH, Ng BY. Review of sleep studies of patients with chronic insomnia at a sleep disorder unit. Singapore Med J 2015; 56(6): 317-23.
40. Hauri PJ, Wisbey J. Wrist actigraphy in insomnia. Sleep 1992; 15(4): 293-301.
41. Spaeth AM, Dinges DF, Goel N. Resting metabolic rate varies by race and by sleep duration. Obesity 2015; 23(12): 2349-56.
42. Bonnet MH, Arand DL. Hyperarousal and insomnia: state of science. Sleep Med Rev 2017; 14: 9-15.
43. Chapman JL, Comas M, Hoyos CM, Bartlett DJ, Grunstein RR, Gordon CJ. Is metabolic rate increased in insomnia disorder? a systematic review. Front Endocrinol 2018; 9: 1-7.
44. Morin CM, Leblanc M, Ivers H, Belanger L, Merette C, Savard J, et al. Monthly fluctuations of insomnia symptoms in a population-based sample. Sleep 2014; 37(2): 319-26.
45. Pavlidou E, Petridis D, Tolia M, Tsoukalas N, Poultsidi A, Fasoulas A, et al. Estimating the agreement between the metabolic rate calculated from prediction equations and from a portable indirect calorimetry device: an effort to develop a new equation for predicting resting metabolic rate. Nutr Metab (Lond) 2018; 15: 41-50.
46. Aliasgharzadeh S, Mahdavi R, Asghari Jafarabadi M, Namazi N. Comparison of indirect calorimetry and predictive equation in estimating resting metabolic rate in underweight females. Iran J Public Health 2015; 44(6): 822-9.
47. Nejatinamini S, Hoseini S, Rahimifroushani A. Evaluation of metabolic rate and body composition in overweight, obese and normal individuals. Iranian J Metabol Lip Dis 2010; 11(3): 321-29. [in Persian]
48. Nicassio PM, Mendlowitz DR, Fussell JJ, Petras L. The phenomenology of the pre-sleep state: the development of the pre-sleep arousal scale. Behav Res Ther 1985; 23(3): 263-71.
49. Shahzadi N, Ijaz T. Reliability and validity of pre-sleep arousal scale for Pakistani university students. FWU J Soc Sci 2014; 8(1): 78-82.
50. Hantsoo L, Khou BA, White CN, Ong JC. Gender and cognitive emotional factors as predictors of pre-sleep arousal and trait hyperarousal in insomnia. J Psychosom Res 2013; 74(4): 283-9.
51. Busk PL, Serlin RC. Meta-analysis for single case research. In: Kratochwill TR, Levin JR. (Eds.). (1992). Single-case research design and analysis: New directions for psychology and education. Hillsdale, NJ, US: Lawrence Erlbaum Associates, Inc; 1992.
52. Olive ML, Smith BW. Effect size calculations and single subject designs. Edu Psychol 2005; 25(2-3): 313-24.
53. Hegdes LV, Pustejovsky JE, Shadish, WR. A standardized mean difference effect size for single case designs. Res Synth Methods 2012; 3: 224-29.
54. Ramos RW, Arvelo ADA, Ramos RW, Gomez JP. Hyperarousal in insomnia. Sleep Med 2013; 14(1): e240-e1.
55. [55] Edinger JD, Olsen MK, Stechuchak KM, Means MK, Lineberger MD, Kirby A, et al. Cognitive behavioral therapy for patients with primary insomnia or insomnia associated predominantly with mixed psychiatric disorders: a randomized controlled trial. Sleep 2009; 32(4): 499-510.
56. Belanger L, Harvey A, Fortier-Brochu E, Beaulieu-Bunneau S, Eidelman P, Talbot L. Impact of comorbidity of insomnia on treatment response following cognitive behavioral therapy, behavior therapy, and cognitive therapy. Sleep Med 2013; 14(1): e39.
57. Belanger L, Harvey A, Fortier-Brochu E, Beaulieu-Bunneau S, Eidelman P, Talbot L. et al. Impact of comorbid anxiety and depression disorders on treatment response to cognitive behavior therapy for insomnia. J Consult Clin Psychol 2016; 84(8): 659-67.
58. Van de Laar M, Pevernagie D, Mierlo PV, Overeem S. Psychiatrics comorbidity and aspect of cognitive coping negatively predict outcome in cognitive behavioral treatment of psychophysiological insomnia. Behav Sleep Med 2015; 13: 140-56.
59. Buysee DJ, Germain A, Hall M, Monk TH, Nofzinger EA. A neurobiological model of insomnia. Drug Discov Today Dis Models 2011, 8(4): 129-37.
60. Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Nonpharmacologic treatment of chronic insomnia: an American academy of sleep medicine. Sleep 1999; 22(8): 1134-56.
61. Baillargeon L, Demers M, Ladouceur R. Stimulus control: nonpharmacologic treatment for insomnia. Can Fam Physician 1998; 44: 73-9.
62. Harvey AG. A cognitive model of insomnia. Behav Res Ther 2002; 40(8): 869-93.
63. Carney CE, Harris AL, Falco A, Edinger JD. The relationship between insomnia symptoms, mood, and rumination about insomnia symptoms. J Clin Sleep Med 2013; 15(9): 567-75.
64. Fallon K, Elley CR, Fernando A, Lee AC, Aroll B. Simplified sleep restriction for insomnia in general practice: a randomized controlled trial. Br J Gen Pract 2015; 65(637): e508-e15.
65. Posner D, Gehrman PR. Sleep hygiene. In Perlis M, Aloia ML, Kuhn B. Behavioral treatments for sleep disorders: a comprehensive primer of behavioral sleep medicine treatment protocols. 1st ed. New York: Academic Press; 2010. p. 31-43.
66. Harvey AG, Eidelman P. Intervention to reduce unhelpful beliefs about sleep. In Perlis M, Aloia ML, Kuhn B. Behavioral treatments for sleep disorders: a comprehensive primer of behavioral sleep medicine treatment protocols. 1st ed. New York: Academic Press; 2010. p. 45-54.
67. Kalmbach DA, Cuamatzi AS, Tonnu CV, Tran KM, Anderson JR, Roth T, et al. Hyperarousal and sleep reactivity in insomnia: current insights. Nat Sci Sleep 2018; 10: 193-201.
68. Hirose A, Terauchi M, Akiyoshi M, Kato K, Kubata T. Subjective insomnia is associated with low sleep efficiency and fatigue in middle-aged women. Climacteric: J Inter Meno Soc 2016; 19(4): 369-74.
69. Williams J, Roth A, Vatthauer K, McCrae C. Cognitive behavioral treatment of insomnia. Chest 2013; 143(2): 554-65.
70. Goodwin CJ. Research in Psychology: Method & Design. 6th ed. New York: Wiley; 2009. p. 407.17.
71. Solomom SJ, Kurzer MS, Calloway DH. Menstrual cycle and basal metabolic rate in women. Am J Clin Nutr 1982; 36: 6111-6.


XML   Persian Abstract   Print



Creative Commons License
This open access journal is licensed under a Creative Commons Attribution-NonCommercial ۴.۰ International License. CC BY-NC ۴. Design and publishing by Kashan University of Medical Sciences.
Copyright ۲۰۲۳© Feyz Medical Sciences Journal. All rights reserved.
Volume 23, Issue 4 (Bimonthly 2019) Back to browse issues page