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Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders.

Abstract

Insomnia is a pervasive problem for many patients suffering from medical and psychiatric conditions. Even when the comorbid disorders are successfully treated, insomnia often fails to remit. In addition to compromising quality of life, untreated insomnia may also aggravate and complicate recovery from the comorbid disease. Cognitive behavior therapy for insomnia (CBT-I) has an established efficacy for primary insomnia, but less is known about its efficacy for insomnia occurring in the context of medical and psychiatric conditions. The purpose of this article is to present a rationale for using CBT-I in medical and psychiatric disorders, review the extant outcome literature, highlight considerations for adapting CBT-I procedures in specific populations, and suggest directions for future research. Outcome studies were identified for CBT-I in mixed medical and psychiatric conditions, cancer, chronic pain, HIV, depression, posttraumatic stress disorder, and alcoholism. Other disorders discussed include: bipolar disorder, eating disorders, generalized anxiety, and obsessive compulsive disorder. The available data demonstrate moderate to large treatment effects (Cohen's d, range=0.35-2.2) and indicate that CBT-I is a promising treatment for individuals with medical and psychiatric comorbidity. Although the literature reviewed here is limited by a paucity of randomized, controlled studies, the available data suggest that by improving sleep, CBT-I might also indirectly improve medical and psychological endpoints. This review underscores the need for future research to test the efficacy of adaptations of CBT-I to disease specific conditions and symptoms.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Behavioral Medicine Research Laboratory and Clinic, 600 North Wolfe Street, Meyer 101, Baltimore, MD 21287-7101, United States. msmith62@jhmi.edu

    ,

    Source

    Clinical psychology review 25:5 2005 Jul pg 559-92

    MeSH

    Chronic Disease
    Clinical Trials as Topic
    Cognitive Behavioral Therapy
    Humans
    Mental Disorders
    Prognosis
    Quality of Life
    Sleep Initiation and Maintenance Disorders

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    15970367

    Citation

    Smith, Michael T., et al. "Cognitive Behavior Therapy for Chronic Insomnia Occurring Within the Context of Medical and Psychiatric Disorders." Clinical Psychology Review, vol. 25, no. 5, 2005, pp. 559-92.
    Smith MT, Huang MI, Manber R. Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. Clin Psychol Rev. 2005;25(5):559-92.
    Smith, M. T., Huang, M. I., & Manber, R. (2005). Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. Clinical Psychology Review, 25(5), pp. 559-92.
    Smith MT, Huang MI, Manber R. Cognitive Behavior Therapy for Chronic Insomnia Occurring Within the Context of Medical and Psychiatric Disorders. Clin Psychol Rev. 2005;25(5):559-92. PubMed PMID: 15970367.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. AU - Smith,Michael T, AU - Huang,Mary I, AU - Manber,Rachel, PY - 2005/6/23/pubmed PY - 2005/11/3/medline PY - 2005/6/23/entrez SP - 559 EP - 92 JF - Clinical psychology review JO - Clin Psychol Rev VL - 25 IS - 5 N2 - Insomnia is a pervasive problem for many patients suffering from medical and psychiatric conditions. Even when the comorbid disorders are successfully treated, insomnia often fails to remit. In addition to compromising quality of life, untreated insomnia may also aggravate and complicate recovery from the comorbid disease. Cognitive behavior therapy for insomnia (CBT-I) has an established efficacy for primary insomnia, but less is known about its efficacy for insomnia occurring in the context of medical and psychiatric conditions. The purpose of this article is to present a rationale for using CBT-I in medical and psychiatric disorders, review the extant outcome literature, highlight considerations for adapting CBT-I procedures in specific populations, and suggest directions for future research. Outcome studies were identified for CBT-I in mixed medical and psychiatric conditions, cancer, chronic pain, HIV, depression, posttraumatic stress disorder, and alcoholism. Other disorders discussed include: bipolar disorder, eating disorders, generalized anxiety, and obsessive compulsive disorder. The available data demonstrate moderate to large treatment effects (Cohen's d, range=0.35-2.2) and indicate that CBT-I is a promising treatment for individuals with medical and psychiatric comorbidity. Although the literature reviewed here is limited by a paucity of randomized, controlled studies, the available data suggest that by improving sleep, CBT-I might also indirectly improve medical and psychological endpoints. This review underscores the need for future research to test the efficacy of adaptations of CBT-I to disease specific conditions and symptoms. SN - 0272-7358 UR - https://www.unboundmedicine.com/medline/citation/15970367/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-7358(05)00030-9 DB - PRIME DP - Unbound Medicine ER -