Efficacy of cognitive behavioral therapy with or without metacognitive techniques and Zolpidem 10 mg. for people with chronic insomnia disorder

Authors
Behzad Salmani 1
Jaafar Hasani 2
Hamid Reza Hasan Abadi 2
Shahram Mohammad Khani 2
1 Department of clinical psychology, Faculty of Psychology and Educatin, Kharazmi University, Tehran, Iran
2 Kharazmi University
10.52547/rph.13.1.1
Abstract
The aim of this study was to evaluate the efficacy of cognitive behavioral therapy (CBT) with or without metacognitive techniques and Zolpidem (10 mg) for people with chronic insomnia disorder. After assessing eligibility criteria, six patients included four female and two male entered the study. All patients allocated randomly to three treatments (CBT, CBT+ & Zolpidem 10 mg.) and assessed 6 times by research instruments. Results were analyzed by recovery percent, clinical significant index, effect size and diagnostic recovery. Results of the study showed that during post-treatment and 1-month & 3-months follow-up, patients who received CBT+ have higher rate of recovery in sleep efficiency and sleep quality than other patients. In terms of insomnia severity, CBT & CBT+ have no significant difference but both were superior to patients who received Zolpidem 10 mg. Also, patients who received Zolpidem (10 mg) failure to keep treatment achievements in follow-up. Adding metacognitive techniques to CBT increased its efficacy. Findings of this study could regard as a pilot information about new ways for raising efficacy of cognitive behavioral therapy for chronic insomnia disorder.
Keywords
Chronic insomnia disorder
cognitive behavioral therapy
metacognitive techniques
Zolpidem
1. American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
2. Finan PH, Smith MT. The comorbidity of insomnia, chronic pain, and depression: dopamine as putative mechanism. Sleep Med Rev 2013; 17: 173-83.
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.
5. Wong MM, Brower KJ, Craun, EA. Insomnia symptoms and suicidality in the national comorbidity survey-adolescent supplement. J Psychiatr Res 2016; 81 1-8.
6. Sohner AM., Kaplan KA, Harvey AG. Insomnia comorbid to severe psychiatric illness. Sleep Med Clin 2013; 8(3): 361-71.
7. Reddy MS, Chakrabarty A. Comorbid insomnia. Indian J Psychol Med 2011; 33(1): 1-4.
8. Taylor D, Gehrman P, Dautovich N, Lichstein K, McCrae C. Handbook of Insomnia. London: Springer Healthcare; 2014.
9. Bootzin RR, Perlis ML. Stimulus control therapy. In: Perlis M, Aloia ML, Kuhn B. Behavioral treatments for sleep disorders: a comprehensive primer of behavioral sleep medicine treatment protocols. New York: Academic Press; 2011. p. 21-30.
10. Perlis ML, Jungquist CR, Smith MT, Posner D. Cognitive behavioral treatment of insomnia: a session by session guide. New York: Springer; 2005.
11. 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.
12. Palagini L, Piarulli A, Menicucci D, Cheli E, Lia E, Bergamasco M, et al. Metacognitive beliefs relate specially to sleep quality in primary insomnia: a pilot study. Sleep Med 2014; 15(8): 918-22.
13. Wells A. Metacognitive Therapy for Anxiety Depression. New York: Guilford Press; 2008.
14. 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: 42-8.
15. 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.
16. 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.
17. Ong JC, Ulmer CS, Manber R. Improving sleep with mindfulness and acceptance: a metacognitive model of insomnia. Behav Res Ther 2012; 50: 651-60.
18. Gulec M, Selvi Y, Boysan M, Aydin A, Besiroglu L, Agargun MY. Ongoing or re-emerging subjective insomnia symptoms after full-partial remission or recovery of magor depressive disorder mainly with the selective serotonin reuptake inhibitors and risk of relapse or recurrence: a 52-week follow-up study. J Affect Disord 2011; 134 (1-3): 257-65.
19. 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.
20. Morin CM. Insomnia: Psychological Assessment and Management. New York: Guilford Press; 1993.
21. Bastien CH, Vallieres A, Morin CM. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med 2001; 2(4): 297-307.
22. Buysse DJ, Reynolds I, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28(2): 193-213.
23. Heydari AR, Ehteshamzadeh P, Maraashi M. Relationship between insomnia severity, sleep quality, sleepiness, and disorder in mental health with educational performance in girls. Iran J Women and Culture; 1(4): 65-76. [Persian]
24. Olive ML, Smith BW. Effect size calculations and single subject designs. J Educ Psychol 2005; 25(2-3): 313-24.
25. Ingram RE, Hayes A, Scott W. Empirically Supported Treatments: A Clinical Analysis. In: Synder CR, Ingram RE. Handbook of Psychological Changes: Psychotherapy Processes & Practice for the 21st century. Hoboken, NJ: John Wiley & Sons; 2000.
26. Spielman AJ, Yang CM, Glovinsky PB. Insomnia: sleep restriction therapy. In: Sateia MJ, Buysse DJ. Insomnia: Diagnosis and Treatment . London: Informa Healthcare; 2011. p. 77-89.
27. Miller CB, Espie CA, Epstein DR, Friedman L, Morin CM, Pigeon WR, et al. The evidence base of sleep restriction therapy for treating insomnia disorder. Sleep Med Rev 2014; 18(5): 415-24.
28. Kylie SD, Miller CB, Rogers Z, Siriwardena AN, MacMahon KM, Espie CA. Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: implications for the clinical management of insomnia disorder. Sleep 2014; 37(2): 229-37.
29. Cappelletti S, Daria P, Sani G, Aromatario M. Caffeine: cognitive and physical performance enhancer or psychoactive drug? Curr Neuropharmacol 2015; 13(1): 71-88.
30. Harvey AG. A cognitive model of insomnia. Behav Res Ther 2002; 40(8): 869-93.
31. 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.
32. Saeedi Dehaghani S, Babapour Kheiraddin J, Esmailpour K. Comparing metacognitions among people with or without chronic fatigue. Iran J Res Psychol Health 2016; 10(2): 68-74. [Persian]
33. Baerjee M, Cavanagh K, Strauss C. Barriers to mindfulness: a path analytic model exploring the role of rumination and worry in predicting psychological and physical engagement in an online mindfulness-based intervention. Mindfulness 2018; 9(3): 980-92.
34. Neubauer DN, Pandi-Perumal SR, Spence DW, Buttoo K, Monti JM. Pharmacotherapy of insomnia. J Cent Nerv Syst Dis 2018; 10: 1-7.
35. Monti JM, Spence DW, Buttoo K, Pandi-Perumal SR. Zolpidem's use for insomnia. Asian J Psychiatr 2017; 25: 79-90.
36. Bain KT, Holmes HM, Beers MH, Maio V, Handler SM, Pauker SG. Discontinuing medications: a novel approach for revising prescribing stages of the medication-use process. J Am Geriatr Soc 2008; 56(10): 1946-52.
37. MacFarlane J, Morin CM, Montplaisir J. Hypnotics in insomnia: the experience of Zolpidem. Clin Ther 2014; 36(11): 1676-701.
38. Krystal AD, Erman M, Zammit GK, Soubrane C, Roth T. Long-term efficacy and safety of Zolpidem extended-release 12.5 mg, administered 3 to 7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Sleep 2008; 31(1): 79-90.
39. Nezu AM, Nezu CM. Evidence-ased outcome research: A practical guide to conducting randomized controlled trials for psychosocial interventions. Oxford: Oxford University Press; 2008.
40. Kazdin, AE. Evidence-based treatment and practice: new opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. Am Psychol 2008; 63(3): 146-59.
41. Shrivastava D, Jung S, Saadat M, Sirohi R, Crewson K. How to interpret the results of a sleep study. J Community Hosp Inten Med Perspect 2014; 4(5): 1-4.
42. Haynes J, Talbert M, Fox S, Close E. Cognitive behavioral therapy in treatment of insomnia. South Med J 2018; 111(2): 75-80.