Sleep-Related Safety Behaviors and Dysfunctional Beliefs Mediate the Efficacy of Online CBT for Insomnia: A Randomized Controlled Trial

Cognitive Behaviour Therapy

Volumn 44, Issue 5, 2015, Pages 406-422

  Lancee, Jaap ^a   Eisma, Maarten C ^b   van Straten, Annemieke ^a   Kamphuis, Jan H ^a  

^a UNIVERSITY OF AMSTERDAM   (Netherlands)

^b UTRECHT UNIVERSITY   (Netherlands)

Author keywords

beliefs; CBT; insomnia; online; safety behaviors

Indexed keywords

ADAPTIVE BEHAVIOR; ADULT; ANXIETY; ATTITUDE TO HEALTH; COGNITIVE THERAPY; COMPUTER ASSISTED THERAPY; CONTROLLED STUDY; DEFENSE MECHANISM; DEPRESSION; FEMALE; HUMAN; INTERNET; MALE; MIDDLE AGED; PROCEDURES; PSYCHOLOGY; RANDOMIZED CONTROLLED TRIAL; SLEEP INITIATION AND MAINTENANCE DISORDERS; TREATMENT OUTCOME;

ADAPTATION, PSYCHOLOGICAL; ADULT; ANXIETY; ATTITUDE TO HEALTH; COGNITIVE THERAPY; DEFENSE MECHANISMS; DEPRESSION; FEMALE; HUMANS; INTERNET; MALE; MIDDLE AGED; SLEEP INITIATION AND MAINTENANCE DISORDERS; THERAPY, COMPUTER-ASSISTED; TREATMENT OUTCOME;

EID: 84941806795     PISSN: 16506073     EISSN: 16512316     Source Type: Journal    
DOI: 10.1080/16506073.2015.1026386     Document Type: Article

References (74)

1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
2. C.Baglioni,, G.Battagliese,, B.Feige,, K.Spiegelhalder,, C.Nissen,, U.Voderholzer,, …, & D.Riemann, (2011). Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders, 135(1–3), 10–19. doi:10.1016/j.jad.2011.01.011.
3. C.H.Bastien,, A.Vallières,, & C.M.Morin, (2001). Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Medicine, 2, 297–307. doi:10.1016/S1389-9457(00)00065-4.
4. J.Bouma,, A.V.Ranchor,, R.Sanderman,, & E.van Sonderen, (1995). Het meten van symptomen van depressie met de CES-D: Een handleiding [Dutch translation of the Epidemiological Studies-Depression scale]. Groningen: Noordelijk Centrum voor Gezondheidsvraagstukken.
5. D.J.Buysse,, S.Ancoli-Israel,, J.D.Edinger,, K.L.Lichstein,, & C.M.Morin, (2006). Recommendations for a standard research assessment of insomnia. Sleep, 29, 1155–1173.
6. C.E.Carney,, D.J.Buysse,, S.Ancoli-Israel,, J.D.Edinger,, A.D.Krystal,, K.L.Lichstein,, & C.M.Morin, (2012). The consensus sleep diary: Standardizing prospective sleep self-monitoring. Sleep, 35, 287–302. doi:10.5665/sleep.1642.
7. S.K.Cheng,, & J.Dizon, (2012). Computerised cognitive behavioural therapy for insomnia: A systematic review and meta-analysis. Psychotherapy and Psychosomatics, 81, 206–216. doi:10.1159/000335379.
8. D.M.Clark, (1999). Anxiety disorders: Why they persist and how to treat them. Behaviour Research and Therapy, 37(Suppl 1), S5–S27.
9. J.Cohen, (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York, NY: Lawrence Erlbaum Associates.
10. M.Daley,, C.M.Morin,, M.LeBlanc,, J.P.Gregoire,, & J.Savard, (2009). The economic burden of insomnia: Direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep, 32, 55–64.
11. J.D.Edinger,, W.K.Wohlgemuth,, R.A.Radtke,, G.R.Marsh,, & R.E.Quillian, (2001). Does cognitive-behavioral insomnia therapy alter dysfunctional beliefs about sleep? Sleep, 24, 591–599.
12. C.A.Espie,, S.J.Inglis,, & L.Harvey, (2001). Predicting clinically significant response to cognitive behavior therapy for chronic insomnia in general medical practice: Analysis of outcome data at 12 months posttreatment. Journal of Consulting and Clinical Psychology, 69, 58–66. doi:10.1037//0022-006X.69.1.58.
13. C.A.Espie,, S.D.Kyle,, P.Hames,, E.Cyhlarova,, & M.Benzeval, (2012). The daytime impact of DSM-5 insomnia disorder: Comparative analysis of insomnia subtypes from the Great British Sleep Survey. Journal of Clinical Psychiatry, 73, e1478–e1484. doi:10.4088/JCP.12m07954.
14. C.A.Espie,, S.D.Kyle,, C.B.Miller,, J.Ong,, P.Hames,, & L.Fleming, (2014). Attribution, cognition and psychopathology in persistent insomnia disorder: Outcome and mediation analysis from a randomized placebo-controlled trial of online cognitive behavioural therapy. Sleep Medicine, 15, 913–917. doi:10.1016/j.sleep.2014.03.001.
15. C.A.Espie,, S.D.Kyle,, C.Williams,, J.C.Ong,, N.J.Douglas,, P.Hames,, & J.S.Brown, (2012). A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep, 35, 769–781. doi:10.5665/sleep.1872.
16. J.Glass,, K.L.Lanctot,, N.Herrmann,, B.A.Sproule,, & U.E.Busto, (2005). Sedative hypnotics in older people with insomnia: Meta-analysis of risks and benefits. British Medical Journal, 331, 1169–1173. doi:10.1136/bmj.38623.768588.47.
17. J.A.Gosling,, P.J.Batterham,, & H.Christensen, (2012). Cognitive-behavioural factors that predict sleep disturbance 4 years later. Journal of Psychosomatic Research, 73, 424–429. doi:10.1016/j.jpsychores.2012.08.011.
18. A.G.Harvey, (2002a). A cognitive model of insomnia. Behaviour Research and Therapy, 40, 869–893. doi:10.1016/S0005-7967(01)00061-4.
19. A.G.Harvey, (2002b). Identifying safety behaviors in insomnia. The Journal of Nervous and Mental Disease, 190, 16–21.
20. A.G.Harvey,, L.Belanger,, L.Talbot,, P.Eidelman,, S.Beaulieu-Bonneau,, E.Fortier-Brochu,, …, & C.M.Morin, (2014). Comparative efficacy of behavior therapy, cognitive therapy, and cognitive behavior therapy for chronic insomnia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 82, 670–683. doi:10.1037/a0036606.
21. A.G.Harvey,, & P.Eidelman, (2011). Intervention to reduce safety behavior. In M.L.Perlis, M.Aloia, & B.Kuhn (Eds.), Behavioral treatments in sleep disorders (pp. 97–105). London: Elsevier.
22. A.G.Harvey,, A.L.Sharpley,, M.J.Ree,, K.Stinson,, & D.M.Clark, (2007). An open trial of cognitive therapy for chronic insomnia. Behaviour Research and Therapy, 45, 2491–2501. doi:10.1016/j.brat.2007.04.007.
23. A.F.Hayes, (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Press.
24. F.Y.Ho,, K.F.Chung,, W.F.Yeung,, T.H.Ng,, K.S.Kwan,, K.P.Yung,, & S.K.Cheng, (2014). Self-help cognitive-behavioral therapy for insomnia: A meta-analysis of randomized controlled trials. Sleep Medicine Reviews. doi:10.1016/j.smrv.2014.06.010.
25. H.K.Hood,, C.E.Carney,, & A.L.Harris, (2011). Rethinking safety behaviors in insomnia: Examining the perceived utility of sleep-related safety behaviors. Behavior Therapy, 42, 644–654. doi:10.1016/j.beth.2011.02.004.
26. J.J.Hox, (2002). Multilevel analysis: Techniques and applications. Mahwah, NJ: Lawrence Erlbaum Associates.
27. M.R.Irwin,, J.C.Cole,, & P.M.Nicassio, (2006). Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychology, 25, 3–14. doi:10.1037/0278-6133.25.1.3.
28. M.Jansson-Frojmark,, A.G.Harvey,, A.Norell-Clarke,, & S.J.Linton, (2012). Associations between psychological factors and nighttime/daytime symptomatology in insomnia. Cognitive Behaviour Therapy, 41, 273–287. doi:10.1080/16506073.2012.672454.
29. M.Jansson-Frojmark,, & S.J.Linton, (2008). The role of sleep-related beliefs to improvement in early cognitive behavioral therapy for insomnia. Cognitive Behaviour Therapy, 37, 5–13. doi:10.1080/16506070801907013.
30. S.Jernelov,, M.Lekander,, K.Blom,, S.Rydh,, B.Ljotsson,, J.Axelsson,, & V.Kaldo, (2012). Efficacy of a behavioral self-help treatment with or without therapist guidance for co-morbid and primary insomnia—A randomized controlled trial. BMC Psychiatry, 12, 5. doi:10.1186/1471-244X-12-5.
31. J.H.Kamphuis,, & M.J.Telch, (1998). Assessment of strategies to manage or avoid anxiety among panic disorder patients: The Texas Safety Maneuver Scale. Clinical Psychology and Psychotherapy, 5, 177–186.
32. S.D.Kyle,, K.Morgan,, & C.Espie, (2010). Insomnia and health-related quality of life. Sleep Medicine Review, 14, 69–82. doi:10.1016/j.smrv.2009.07.004.
33. J.Lancee,, & J.H.Kamphuis, (in preparation). Validation of the Dutch sleep-related behaviors questionnaire and dysfunctional beliefs and attitudes about sleep scale.
34. J.Lancee,, M.J.Sorbi,, M.C.Eisma,, A.van Straten,, & J.van den Bout, (2014). The effect of support on internet-delivered treatment for insomnia: Does baseline depression severity matter? Behavior Therapy, 45, 507–516. doi:10.1016/j.beth.2014.02.012.
35. J.Lancee,, J.van den Bout,, M.J.Sorbi,, & A.van Straten, (2013). E-mail support improves the effectiveness of internet-delivered self-help treatment for insomnia: A randomized trial. Behaviour Research and Therapy, 51, 797–805. 10.1016/j.brat.2013.09.004.
36. J.Lancee,, J.van den Bout,, A.van Straten,, & V.I.Spoormaker, (2012). Internet-delivered or mailed self-help treatment for insomnia? A randomized waiting-list controlled trial. Behaviour Research and Therapy, 50, 22–29. doi:10.1016/j.brat.2011.09.012.
37. M.LeBlanc,, S.Beaulieu-Bonneau,, C.Merette,, J.Savard,, H.Ivers,, & C.M.Morin, (2007). Psychological and health-related quality of life factors associated with insomnia in a population-based sample. Journal of Psychosomatic Research, 63, 157–166. doi:10.1016/j.jpsychores.2007.03.004.
38. H.C.Levy,, & A.S.Radomsky, (2014). Safety behaviour enhances the acceptability of exposure. Cognitive Behaviour Therapy, 43, 83–92. doi:10.1080/16506073.2013.819376.
39. D.P.MacKinnon,, A.J.Fairchild,, & M.S.Fritz, (2007). Mediation analysis. Annual Review of Psychology, 58, 593–614. doi:10.1146/annurev.psych.58.110405.085542.
40. L.Mallon,, J.E.Broman,, & J.Hetta, (2002). Sleep complaints predict coronary artery disease mortality in males: A 12-year follow-up study of a middle-aged Swedish population. Journal of Internal Medicine, 251, 207–216.
41. L.Mallon,, J.E.Broman,, & J.Hetta, (2005). High incidence of diabetes in men with sleep complaints or short sleep duration: A 12-year follow-up study of a middle-aged population. Diabetes Care, 28, 2762–2767.
42. C.M.Morin, (1993). Insomnia: Psychological assessment and management. New York, NY: Guilford Press.
43. C.M.Morin,, G.Belleville,, L.Belanger,, & H.Ivers, (2011). The insomnia severity index: Psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep, 34, 601–608.
44. C.M.Morin,, F.Blais,, & J.Savard, (2002). Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia? Behaviour Research and Therapy, 40, 741–752. doi:10.1016/S0005-7967(01)00055-9.
45. C.M.Morin,, R.R.Bootzin,, D.J.Buysse,, J.D.Edinger,, C.A.Espie,, & K.L.Lichstein, (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998–2004). Sleep, 29, 1398–1414.
46. C.M.Morin,, & C.A.Espie, (2003). Insomnia: A clinical guide to assessment and treatment. New York, NY: Springer.
47. C.M.Morin,, P.J.Hauri,, C.A.Espie,, A.J.Spielman,, D.J.Buysse,, & R.R.Bootzin, (1999). Nonpharmacologic treatment of chronic insomnia: An American academy of sleep medicine review. Sleep, 22, 1–23.
48. C.M.Morin,, A.Vallieres,, & H.Ivers, (2007). Dysfunctional beliefs and attitudes about sleep (DBAS): Validation of a brief version (DBAS-16). Sleep, 30, 1547–1554.
49. S.B.Morris, (2008). Estimating effect sizes from pretest-posttest-control group designs. Organizational Research Methods, 11, 364–386. doi:10.1177/1094428106291059.
50. M.M.Ohayon, (2002). Epidemiology of insomnia: What we know and what we still need to learn. Sleep Medicine Reviews, 6, 97–111. doi:10.1053/smrv.2002.0186.
51. I.Okajima,, S.Nakajima,, M.Ochi,, & Y.Inoue, (2014). Reducing dysfunctional beliefs about sleep does not significantly improve insomnia in cognitive behavioral therapy. PLos ONE, 9, e102565. doi:10.1371/journal.pone.0102565.
52. L.S.Radloff, (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. doi:10.1177/014662167700100306.
53. M.J.Ree,, & A.G.Harvey, (2004). Investigating safety behaviours in insomnia: The development of the Sleep-Related Behaviours Questionnaire (SRBQ). Behaviour Change, 21, 26–36.
54. D.Rieman,, & M.L.Perlis, (2009). The treatments of chronic insomnia: A review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Medicine Reviews, 13, 205–214. doi:10.1016/j.smrv.2008.06.001.
55. L.M.Ritterband,, F.P.Thorndike,, L.A.Gonder-Frederick,, J.C.Magree,, E.T.Bailey,, D.K.Saylor,, & C.M.Morin, (2009). Efficacy of an internet-based behavioral intervention for adults with insomnia. Archives of General Psychiatry, 66, 692–698. doi:10.1001/archgenpsychiatry.2009.66.
56. T.Roth,, & C.Drake, (2004). Evolution of insomnia: Current status and future direction. Sleep Medicine, 5(Suppl 1), S23–S30. doi:10.1016/S1389-9457(04)90004-4.
57. A.Rozental,, G.Andersson,, J.Boettcher,, D.D.Ebert,, P.Cuijpers,, C.Knaevelsrud,, …, & P.Carlbring, (2014). Consensus statement on defining and measuring negative effects of internet interventions. Internet Interventions, 1, 12–19. doi:10.1016/j.invent.2014.02.001.
58. P.Salkovskis, (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 19, 6–19. doi:10.1017/S0141347300011472.
59. D.R.Schwartz,, & C.E.Carney, (2012). Mediators of cognitive-behavioral therapy for insomnia: a review of randomized controlled trials and secondary analysis studies. Clinical Psychology Review, 32, 664–675. doi:10.1016/j.cpr.2012.06.006.
60. T.S.Smith,, M.L.Perlis,, A.Park,, M.S.Smith,, J.Y.Pennington,, D.E.Giles,, & D.J.Buysse, (2002). Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. American Journal of Psychiatry, 159, 5–11.
61. P.Spinhoven,, J.Ormel,, P.P.Sloekers,, G.I.Kempen,, A.E.Speckens,, & A.M.Van Hemert, (1997). A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychological Medicine, 27, 363–370. doi:10.1017/S0033291796004382.
62. V.I.Spoormaker,, I.Verbeek,, J.van den Bout,, & E.C.Klip, (2005). Initial validation of the SLEEP-50 questionnaire. Behavioral Sleep Medicine, 3, 227–246. doi:10.1207/s15402010bsm0304_4.
63. J.A.Sterne,, I.R.White,, J.B.Carlin,, M.Spratt,, P.Royston,, M.G.Kenward,, …, & J.R.Carpenter, (2009). Multiple imputation for missing data in epidemiological and clinical research: Potentials and pitfalls. British Medical Journal, 338. doi:10.1136/bmj.b2393.
64. M.Suka,, K.Yoshida,, & H.Sugimori, (2003). Persistent insomnia is a predictor of hypertension in Japanese male workers. Journal of Occupational Health, 45, 344–350.
65. D.J.Taylor,, K.L.Lichstein,, H.H.Durrence,, B.W.Reidel,, & A.J.Bush, (2005). Epidemiology of insomnia, depression, and anxiety. Sleep, 28, 1457–1464.
66. F.P.Thorndike,, P.Carlbring,, F.L.Smyth,, J.C.Magee,, L.A.Gonder-Frederick,, L.-G.Ost,, & L.M.Ritterband, (2009). Web-based measurement: Effect of completing single or multiple items per webpage. Computers in Human Behavior, 25, 393–401.
67. F.P.Thorndike,, L.M.Ritterband,, D.K.Saylor,, J.C.Magee,, L.A.Gonder-Frederick,, & C.M.Morin, (2011). Validation of the insomnia severity index as a web-based measure. Behavioral Sleep Medicine, 9, 216–223. doi:10.1080/15402002.2011.606766.
68. A.van Straten,, & P.Cuijpers, (2009). Self-help therapy for insomnia: A meta-analysis. Sleep Medicine Reviews, 13, 61–71. doi:10.1016/j.smrv.2008.04.006.
69. A.van Straten,, J.Emmelkamp,, J.de Wit,, J.Lancee,, G.Andersson,, E.J.W.Someren,, & P.Cuijpers, (2014). Guided internet-delivered cognitive behavioral treatment for insomnia: A randomized trial. Psychological Medicine, 44, 1521–1532.
70. I.Verbeek,, & E.C.Klip, (2005). Slapeloosheid. Amsterdam: Boom Hulpboek.
71. A.N.Vgontzas,, D.Liao,, E.O.Bixler,, G.P.Chrousos,, & A.Vela-Bueno, (2009). Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep, 32, 491–497.
72. N.Vincent,, & K.Walsh, (2013). Hyperarousal, sleep scheduling, and time awake in bed as mediators of outcome in computerized cognitive-behavioral therapy (cCBT) for insomnia. Behaviour Research and Therapy, 51, 161–166. doi:10.1016/j.brat.2012.12.003.
73. J.Woodley,, & S.Smith, (2006). Safety behaviors and dysfunctional beliefs about sleep: Testing a cognitive model of the maintenance of insomnia. Journal of Psychosomatic Research, 60, 551–557. doi:10.1016/j.jpsychores.2006.03.002.
74. A.S.Zigmond,, & R.P.Snaith, (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.