ABSTRACT
Patients with panic disorder with agoraphobia (PDA) or generalized anxiety disorder (GAD) frequently also suffer from insomnia. However, the impact of cognitive-behavioral therapy (CBT) for anxiety disorders on insomnia has been understudied. Furthermore, comorbidity between anxiety disorders is common. Our main objective was to assess the impact of CBT for PDA or GAD on insomnia. In a quasi-experimental design, 86 participants with PDA and GAD received conventional CBT for their primary disorder or combined CBT for both disorders. Overall, CBTs had a significant impact on reducing insomnia symptoms (η = 0.58). However, among people with insomnia at pretest (67%), 33% still had an insomnia diagnosis, and the majority (63%) had clinically significant residual insomnia following treatment. In conclusion, the CBTs had a positive effect on the reduction of insomnia, but a significant proportion of participants still had insomnia problems following treatment. Clinicians should address insomnia during CBT for PDA and GAD.
Subject(s)
Agoraphobia/psychology , Agoraphobia/therapy , Anxiety Disorders/psychology , Anxiety Disorders/therapy , Cognitive Behavioral Therapy/methods , Panic Disorder/psychology , Panic Disorder/therapy , Sleep Initiation and Maintenance Disorders/psychology , Sleep Initiation and Maintenance Disorders/therapy , Adult , Cohort Studies , Combined Modality Therapy , Comorbidity , Female , Humans , Male , Middle Aged , Psychotropic Drugs/therapeutic use , Quebec , Treatment Outcome , Young AdultABSTRACT
INTRODUCTION: Concomitant anxiety and insomnia is a frequent problem encountered by mental health professionals. PRIMARY OBJECTIVE: To assess the impact of cognitive-behavior therapy for insomnia (CBT-I) on associated anxiety. METHOD: Systematic search for clinical trials of CBT-I in PsycInfo, Medline, and Proquest Dissertations and Theses. RESULTS: Of the 216 CBT-I trials reviewed, 72 (33.3%) reported data on anxiety. The combined effect size (ES) of CBT-I on anxiety was 0.406 [95% CI 0.318-0.493], indicating a small to moderate effect of CBT-I on concomitant anxiety. Anxiety and anxiety-related constructs were measured with 31 different questionnaires or questionnaire subscales, the majority of which were used only once in the sample of studies. CONCLUSIONS: CBT-I has only a moderate impact on anxiety in individuals who present insomnia with or without a comorbid anxiety disorder. A careful evaluation of residual anxiety should be conducted subsequent to CBT-I. Further research should focus on standardizing the assessment of anxiety in insomnia research.
Subject(s)
Anxiety/therapy , Cognitive Behavioral Therapy , Sleep Initiation and Maintenance Disorders/therapy , Anxiety/complications , Clinical Trials as Topic , Humans , Sleep Initiation and Maintenance Disorders/complications , Treatment OutcomeABSTRACT
INTRODUCTION: Sleep disturbances are present in approximately 70% of individuals with an anxiety disorder (AD). Treatments for AD may alleviate associated sleep problems, but empirical support for this view is sparse. OBJECTIVE: To assess state of knowledge about the impact of CBT for AD on sleep disturbances. METHOD: Systematic search for clinical trials of CBT for any AD in PsycINFO, MedLine, and Proquest Dissertations and Theses. RESULTS: Of 1205 studies, only 25 (2.07%) reported sleep data. The combined ES of CBT for AD on sleep was 0.527 [95%CI 0.306-0.748], indicating a moderate effect of anxiety treatment on concomitant sleep difficulties. The impact did not significantly differ according to study design, sleep variable or anxiety disorder. CONCLUSIONS: Although substantial amounts of research documented the efficacy of CBT for AD, very few reported its effect on concomitant sleep problems. Current state of knowledge does not permit definitive conclusions and future research is needed.
