Attribution, cognition and psychopathology in persistent Insomnia Disorder: outcome and mediation analysis from a randomized placebo-controlled trial of online cognitive behavioral therapy

Espie, C., Kyle, S. D., Miller, C. B., Ong, J., Hames, P. and Fleming, L. (2014) Attribution, cognition and psychopathology in persistent Insomnia Disorder: outcome and mediation analysis from a randomized placebo-controlled trial of online cognitive behavioral therapy. Sleep Medicine, 15(8), pp. 913-917. (doi: 10.1016/j.sleep.2014.03.001)

[img]
Preview
Text
92974.pdf - Accepted Version

377kB

Publisher's URL: http://dx.doi.org/10.1016/j.sleep.2014.03.001

Abstract

Objectives: Insomnia patients complain that mental events keep them awake. This study investigates how cognitive behavioral therapy (CBT) affects such events, and considers how attributional, cognitive, and psychpathological symptoms may mediate sleep improvement.<p></p> Method: Pragmatic, parallel group randomized controlled trial of 164 adults (120 F: [mean 49y (18–78y)] meeting DSM-5 criteria for Insomnia Disorder, assigned to CBT (n=55; 40F), Imagery Relief Therapy (IRT placebo; n=55; 42F) or Treatment as Usual (TAU; n=54; 38F). CBT/IRT comprised 6 online sessions delivered by an animated therapist, with automated web/email support. CBT users had access to a moderated community. TAU comprised ‘usual care’. Participants completed the Sleep Disturbance Questionnaire (SDQ), Glasgow Content of Thoughts Inventory (GCTI), Depression Anxiety and Stress Scales (DASS) and Sleep Condition Indicator (SCI) at baseline, post-treatment and 8 weeks follow-up.<p></p> Results: The sample was characterised by mental arousal, notably ‘trying too hard’ to sleep (SDQ), and by ‘sleep and sleeplessness’ and ‘rehearsal and planning’ thoughts (GCTI). Treatment effects were observed for all SDQ domains (e.g. CBT v. IRT: d=.76 for ‘trying too hard’). CBT was also superior to IRT on the GCTI (e.g. ‘rehearsal and planning’, d=.62; ‘sleep and sleeplessness’, d=.74). CBT v. TAU comparisons yielded larger effects whereas placebo effects (IRT v. TAU) were small to moderate. Hierarchical regression demonstrated partial mediation of SCI improvement by attributional and cognitive factors (R2 =21-27%) following CBT. Improvement in Sleep Efficiency appears to be independent of such factors.<p></p> Conclusion: Online CBT modifies sleep-related attributions, night-time thought content and psychopathology. This process partly mediates improvement in DSM-5 defined insomnia.

Item Type:Articles
Additional Information:NOTICE: this is the author’s version of a work that was accepted for publication in Sleep Medicine. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Sleep Medicine, [15, 8, (August 2014)] DOI 10.1016/j.sleep.2014.03.001
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Espie, Professor Colin and Fleming, Dr Leanne
Authors: Espie, C., Kyle, S. D., Miller, C. B., Ong, J., Hames, P., and Fleming, L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
Journal Name:Sleep Medicine
Publisher:Elsevier
ISSN:1389-9457
ISSN (Online):1878-5506
Copyright Holders:Copyright © 2014 Elsevier
First Published:First published in Sleep Medicine 15(8):913-917
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

University Staff: Request a correction | Enlighten Editors: Update this record