Top

Published in:

01-09-2014 | Sleep Disorders (P Gehrman, Section Editor)

Insomnia as a Transdiagnostic Process in Psychiatric Disorders

Authors: Emily A. Dolsen, Lauren D. Asarnow, Allison G. Harvey

Published in: Current Psychiatry Reports | Issue 9/2014

Abstract

Insomnia is a major public health concern, and is highly comorbid with a broad range of psychiatric disorders. Although insomnia has historically been considered a symptom of other disorders, this perspective has shifted. Epidemiological and experimental studies suggest that insomnia is related to the onset and course of several psychiatric disorders. Furthermore, several randomized controlled trials show that cognitive behavioral therapy for insomnia delivered to individuals who meet diagnostic criteria for insomnia and another psychiatric disorder improves the insomnia as well as the symptoms of the comorbid psychiatric disorder. Taken together, these results encompassing a range of methodologies have provided encouraging evidence and point toward insomnia as a transdiagnostic process in psychiatric disorders.

Ancoli-Israel S, Roth T. Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I. Sleep. 1999;22:S347–53.PubMed

Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6:97–111.PubMedCrossRef

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.CrossRef

Harvey AG. Insomnia: symptom or diagnosis? Clin Psychol Rev. 2001;21:1037–59.PubMedCrossRef

Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, et al. Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry Am Psychiatric Assoc. 2010;167:748–51.

Barlow DH, Allen LB, Choate ML. Toward a unified treatment for emotional disorders. Behav Ther. 2004;35:205–30.CrossRef

Mansell W, Harvey AG, Watkins E, Shafran R. Conceptual Foundations of the Transdiagnostic Approach to CBT. J. Cogn. Psychother. Springer, Berlin; 2009;23:6–19.

Harvey AG, Watkins E, Mansell W, Shafran R. Cognitive Behavioural Processes across Psychological Disorders: A Transdiagnostic Approach to Research and Treatment. Oxford University Press; 2004.

Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther. 2003;41:509–28.PubMedCrossRef

10.•

Titov N, Dear BF, Schwencke G, Andrews G, Johnston L, Craske MG, et al. Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial. Behav Res Ther. 2011;49(8):441–52. This study provides preliminary evidence for the use of a transdiagnostic internet cognitive behavioral therapy (iCBT) protocol for treating depression and anxiety disorders.PubMedCrossRef

11.

McManus F, Shafran R, Cooper Z. What does a transdiagnostic approach have to offer the treatment of anxiety disorders? Br J Clin Psychol. 2010;49:491–505.PubMedCrossRef

12.

Norton PJ. An open trial of a transdiagnostic cognitive-behavioral group therapy for anxiety disorder. Behav Ther. 2008;39:242–50.PubMedCrossRef

13.•

Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Thompson-Hollands J, Carl JR, et al. Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behav Ther. 2012;43(3):666–78. This randomized controlled trial demonstrates that the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) can effectively treat psychiatric disorders.PubMedPubMedCentralCrossRef

14.•

Ellard KK, Deckersbach T, Sylvia LG, Nierenberg AA, Barlow DH. Transdiagnostic treatment of bipolar disorder and comorbid anxiety with the unified protocol: a clinical replication series. Behav Modif. 2012;36(4):482–508. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) can treat bipolar disorder with comorbid anxiety.PubMedPubMedCentralCrossRef

15.

Bentall RP, Rowse G, Shryane N, Kinderman P, Howard R, Blackwood N, et al. The cognitive and affective structure of paranoid delusions: a transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression. Arch Gen Psychiatry. 2009;66:236–47.PubMedCrossRef

16.

Harvey AG. A transdiagnostic approach to treating sleep disturbance in psychiatric disorders. Cogn Behav Ther Routledge. 2009;38:35–42.CrossRef

17.

Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE. Cognitive behavioral therapy for treatment of chronic primary insomnia. JAMA Am Med Assoc. 2001;285:1856.CrossRef

18.

Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia:update of the recent evidence (1998-2004). Sleep. 2006;29:1398–414.PubMedCrossRef

19.

Manber R, Edinger JD, Gress JL, San Pedro-Salcedo MG, Kuo TF, Kalista T. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep. 2008;31:489–95.PubMedPubMedCentralCrossRef

20.••

Kaplan KA, Harvey AG. Behavioral treatment of insomnia in bipolar disorder. Am J Psychiatry. 2013;170(7):716–20. Sleep restriction and stimulus control can safely and effectively be used to treat insomnia in patients with bipolar disorder.PubMedPubMedCentralCrossRef

21.•

Harvey AG, Soehner AM, Kaplan KA, Hein K, Lee J, Kanady J, et al. Treating insomnia improves sleep, mood and functioning in bipolar disorder: A pilot randomized controlled trial. Presented at the 26th Annual Meeting of the American Academy of Sleep Medicine. 2012. This randomized controlled trial pilot study indicates that treating insomnia in bipolar disorder improves sleep, mood, and inter-episode functioning.

22.

Germain A, Shear MK, Hall M, Buysse DJ. Effects of a brief behavioral treatment for PTSD-related sleep disturbances: a pilot study. Behav Res Ther. 2007;45:627–32.PubMedCrossRef

23.•

Margolies SO, Rybarczyk B, Vrana SR, Leszczyszyn DJ, Lynch J. Efficacy of a cognitive-behavioral treatment for insomnia and nightmares in Afghanistan and Iraq veterans with PTSD. J Clin Psychol. 2013;69(10):1026–42. CBT-I combined with IRT reduces both insomnia and PTSD symptoms.PubMedCrossRef

24.••

Myers E, Startup H, Freeman D. Cognitive behavioural treatment of insomnia in individuals with persistent persecutory delusions: a pilot trial. J Behav Ther Exp Psychiatry. 2011;42(3):330–6. This pilot trial reports that CBT-I can reduce insomnia and persecutory delusions for patients with a psychotic disorder.PubMedPubMedCentralCrossRef

25.

Edinger JD, Means MK. Cognitive-behavioral therapy for primary insomnia. Clin Psychol Rev. 2005;25:539–58.PubMedCrossRef

26.

Morin CM, Culbert JP, Schwartz SM. Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry Am Psychiatric Assoc. 1994;151:1172–80.

27.

Bootzin RR. A stimulus control treatment for insomnia. Proceedings of the 80^th Annual Convention of the American Psychological Association. 1972.

28.

Spielman AJ, Saskin P, Thorpy MJ. Treatment of chronic insomnia by restriction of time in bed. Sleep. 1987;10(1):45–56.PubMed

29.

Morin CM, Kowatch RA, O’Shanick G. Sleep restriction for the inpatient treatment of insomnia. Sleep. 1990;13(2):183–6.PubMed

30.

Harvey AG. A cognitive model of insomnia. Behav Res Ther. 2002;40(8):869–93.PubMedCrossRef

31.

Harvey AG. A cognitive theory and therapy for chronic insomnia. J Cogn Psychother. 2005;19(1):41.CrossRef

32.

Morin CM. Insomnia: psychological assessment and management. Guilford Publications; 1993.

33.

Espie CA. The psychological treatment of insomnia. Wiley; 1991.

34.

Morin CM, Stone J, Trinkle D, Mercer J, Remsberg S. Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints. Psychol Aging. 1993;8(3):463–7.PubMedCrossRef

35.

Ree M, Harvey AG. Insomnia. In: Bennett-Levy J, Butler G, Fennell M, Hackman A, Mueller M, Westbrook D, editors. Oxford guide to behavioural experiments in cognitive therapy. Oxford: Oxford University Press; 2004. p. 287–305.CrossRef

36.••

Harvey AG, Bélanger L, Talbot L, Eidelman P, Beaulieu-Bonneau S, Fortier-Brochu É, et al. Comparative efficacy of behavior therapy, cognitive therapy, and cognitive behavior therapy for chronic insomnia: a randomized controlled trial. J Consult Clin Psychol. 2014. This study compared behavior therapy (BT) and cognitive therapy (CT) relative to cognitive behavior therapy (CBT) for persistent insomnia. The study reports that CBT is the treatment of choice for persistent insomnia, and that BT and CT are also effective.

37.•

Harvey AG, Murray G, Chandler RA, Soehner AM. Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms. Clin Psychol Rev. 2011;31(2):225–35. This paper reviews evidence that sleep disturbance is related to psychiatiric illness through emotion regulation interacting with genetics and dopaminergic and serotonergic function.PubMedCrossRef

38.

Harvey AG. Insomnia, psychiatric disorders, and the transdiagnostic perspective. Curr Dir Psychol Sci. 2008;17(5):299–303.CrossRef

39.

Riemann D, Perlis ML. The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Med Rev. 2009;13:205–14.PubMedCrossRef

40.

Smith MT, Perlis ML, Park A, Smith M, Pennington J, Giles DE, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry Am Psychiatric Assoc. 2002;159:5–11.

41.

NIH State-of-the-Science Conference Statement on Manifestations and Management of Chronic Insomnia in Adults. NIH Consens Sci Statements. 2005;22:1–30.

42.

Riemann D, Voderholzer U. Primary insomnia: a risk factor to develop depression? J Affect Disord. 2003;76:255–9.PubMedCrossRef

43.

Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. JAMA Am Med Assoc. 1989;262:1479.CrossRef

44.

Perlis ML, Smith LJ, Lyness JM, Matteson SR, Pigeon WR, Jungquist CR, et al. Insomnia as a risk factor for onset of depression in the elderly. Behav Sleep Med. 2006;4:104–13.PubMedCrossRef

45.

Liu X, Buysse DJ, Gentzler AL, Kiss E, Mayer L, Kapornai K, et al. Insomnia and hypersomnia associated with depressive phenomenology and comorbidity in childhood depression. Sleep. 2007;30:83–90.PubMedCrossRef

46.

Pigeon WR, Hegel M, Unützer J, Fan M-Y, Sateia MJ, Lyness JM, et al. Is insomnia a perpetuating factor for late-life depression in the IMPACT cohort? Sleep. 2008;31:481–8.PubMedPubMedCentralCrossRef

47.

Carney CE, Segal ZV, Edinger JD, Krystal AD. A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder. J Clin Psychiatry. 2007;68:254–60.PubMedCrossRef

48.••

Manber R, Bernert RA, Suh S, Nowakowski S, Siebern AT, Ong JC. CBT for insomnia in patients with high and low depressive symptom severity: adherence and clinical outcomes. J Clin Sleep Med. 2011;7(6):645–52. The effectiveness of CBT-I reducing symptoms of insomnia and depression is not differentially affected by depression severity.PubMedPubMedCentralCrossRef

49.

Monti JM, Monti D. Sleep disturbance in generalized anxiety disorder and its treatment. Sleep Med Rev. 2000;4:263–76.PubMedCrossRef

50.

Marcks BA, Weisberg RB, Edelen MO, Keller MB. The relationship between sleep disturbance and the course of anxiety disorders in primary care patients. Psychiatry Res. 2010;178:487–92.PubMedCrossRef

51.

Johnson EO, Roth T, Breslau N. The association of insomnia with anxiety disorders and depression: exploration of the direction of risk. J Psychiatr Res. 2006;40:700–8.PubMedCrossRef

52.

Jansson M, Linton SJ. The development of insomnia within the first year: a focus on worry. Br J Health Psychol. 2006;11:501–11.PubMedCrossRef

53.

Belleville G, Cousineau H, Levrier K, St-Pierre-Delorme M-E, Marchand A. The impact of cognitive-behavior therapy for anxiety disorders on concomitant sleep disturbances: a meta-analysis. J Anxiety Disord. 2010;24:379–86.PubMedCrossRef

54.••

Belleville G, Cousineau H, Levrier K, St-Pierre-Delorme M-È. Meta-analytic review of the impact of cognitive-behavior therapy for insomnia on concomitant anxiety. Clin Psychol Rev. 2011;31(4):638–52. A recent meta-analysis that examined the effect of CBT-I on anxiety symptoms and reported that CBT-I has a moderate impact on anxiety.PubMedCrossRef

55.

Winokur G, Clayton PJRT. Manic depressive illness. St. Louis: C. V. Mosby; 1969.

56.

Jackson A, Cavanagh J, Scott J. A systematic review of manic and depressive prodromes. J Affect Disord. 2003;74:209–17.PubMedCrossRef

57.

Colombo C, Benedetti F, Barbini B, Campori E, Smeraldi E. Rate of switch from depression into mania after therapeutic sleep deprivation in bipolar depression. Psychiatry Res. 1999;86:267–70.PubMedCrossRef

58.

Leibenluft E, Albert PS, Rosenthal NE, Wehr TA. Relationship between sleep and mood in patients with rapid-cycling bipolar disorder. Psychiatry Res. 1996;63:161–8.PubMedCrossRef

59.•

Talbot LS, Stone S, Gruber J, Hairston IS, Eidelman P, Harvey AG. A test of the bidirectional association between sleep and mood in bipolar disorder and insomnia. J Abnorm Psychol. 2012;121(1):39–50. This study provides support for a bidirectional relationship between sleep and daytime mood in bipolar disorder and insomnia.PubMedCrossRef

60.

Plante DT, Winkelman JW. Sleep disturbance in bipolar disorder: therapeutic implications. Am J Psychiatry Am Psychiatric Assoc. 2008;165:830–43.

61.

Nowlin-Finch NL, Altshuler LL, Szuba MP, Mintz J. Rapid resolution of first episodes of mania: sleep related? J Clin Psychiatry. 1994;55:26–9.PubMed

62.

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;25:559–92.PubMedCrossRef

63.

Ohayon MM, Shapiro CM. Sleep disturbances and psychiatric disorders associated with posttraumatic stress disorder in the general population. Compr Psychiatry. 2000;41:469–78.PubMedCrossRef

64.

Ross RJ, Ball WA, Sullivan KA, Caroff SN. Sleep disturbance as the hallmark of posttraumatic stress disorder. Am J Psychiatry. 1989;146:697–707.PubMedCrossRef

65.

Spoormaker VI, Montgomery P. Disturbed sleep in post-traumatic stress disorder: secondary symptom or core feature? Sleep Med Rev. 2008;12:169–84.PubMedCrossRef

66.•

Wright KM, Britt TW, Bliese PD, Adler AB, Picchioni D, Moore D. Insomnia as predictor versus outcome of PTSD and depression among Iraq combat veterans. J Clin Psychol. 2011;67(12):1240–58. Insomnia may be implicated in the development and course of posttraumatic stress disorder symptoms.PubMedCrossRef

67.

Krakow B, Haynes PL, Warner TD, Santana E, Melendrez D, Johnston L, et al. Nightmares, insomnia, and sleep-disordered breathing in fire evacuees seeking treatment for posttraumatic sleep disturbance. J Trauma Stress. 2004;17:257–68.PubMedCrossRef

68.

Zayfert C, DeViva JC. Residual insomnia following cognitive behavioral therapy for PTSD. J Trauma Stress. 2004;17:69–73.PubMedCrossRef

69.

Swanson LM, Favorite TK, Horin E, Arnedt JT. A combined group treatment for nightmares and insomnia in combat veterans: a pilot study. J Trauma Stress. 2009;22:639–42.PubMedCrossRef

70.•

Ulmer CS, Edinger JD, Calhoun PS. A multi-component cognitive-behavioral intervention for sleep disturbance in veterans with PTSD: a pilot study. J Clin Sleep Med. 2011;7(1):57–68. This pilot study reports that CBT-I targeting trauma-related sleep disturbance can reduce insomnia and posttraumatic stress disorder symptoms.PubMedPubMedCentralCrossRef

71.••

Germain A, Richardson R, Moul DE, Mammen O, Haas G, Forman SD, et al. Placebo-controlled comparison of prazosin and cognitive-behavioral treatments for sleep disturbances in US Military Veterans. J Psychosom Res. 2012;72(2):89–96. Both prazosin and a behavioral sleep intervention are related to improvement in insomnia and posttraumatic stress disorder symptoms.PubMedCrossRef

72.•

Palmese LB, DeGeorge PC, Ratliff JC, Srihari VH, Wexler BE, Krystal AD, et al. Insomnia is frequent in schizophrenia and associated with night eating and obesity. Schizophr Res. 2011;133(1-3):238–43. Insomnia is highly prevalent in schizophrenia and is related to lower quality of life, including obesity.PubMedPubMedCentralCrossRef

73.

Xiang Y-T, Weng Y-Z, Leung C-M, Tang W-K, Lai KYC, Ungvari GS. Prevalence and correlates of insomnia and its impact on quality of life in Chinese schizophrenia patients. Sleep. 2009;32:105–9.PubMedPubMedCentral

74.

Freeman D, Brugha T, Meltzer H, Jenkins R, Stahl D, Bebbington P. Persecutory ideation and insomnia: findings from the second British National Survey of Psychiatric Morbidity. J Psychiatr Res. 2010;44:1021–6.PubMedPubMedCentralCrossRef

75.•

Freeman D, Stahl D, McManus S, Meltzer H, Brugha T, Wiles N, et al. Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking. Soc Psychiatry Psychiatr Epidemiol. 2012;47(8):1195–203. Insomnia, as well as worry, anxiety and depression, are risk factors for developing paranoid thinking.PubMedCrossRef

76.

Chemerinski E, Ho B-C, Flaum M, Arndt S, Fleming F, Andreasen NC. Insomnia as a predictor for symptom worsening following antipsychotic withdrawal in schizophrenia. Compr Psychiatry. 2002;43:393–6.PubMedCrossRef

77.•

Baandrup L, Jennum P, Lublin H, Glenthoj B. Treatment options for residual insomnia in schizophrenia. Acta Psychiatr Scand. 2013;127(1):81–2. This discussion paper reports that residual insomnia is common after treatment for schizophrenia, and discusses possible treatment options.PubMedCrossRef

78.•

Freeman D, Startup H, Myers E, Harvey AG, Geddes J, Yu L-M, et al. The effects of using cognitive behavioural therapy to improve sleep for patients with delusions and hallucinations (the BEST study): study protocol for a randomized controlled trial. Trials. 2013;14:214. A plan for a large randomized controlled trial is outlined to test CBT-I to treat insomnia and symptoms of schizophrenia, which yielded positive results in a smaller trial reported by Myers, et al. [24].

Title: Insomnia as a Transdiagnostic Process in Psychiatric Disorders
Authors: Emily A. Dolsen
Lauren D. Asarnow
Allison G. Harvey
Publication date: 01-09-2014
Publisher: Springer US
Published in: Current Psychiatry Reports / Issue 9/2014
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI: https://doi.org/10.1007/s11920-014-0471-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Insomnia as a Transdiagnostic Process in Psychiatric Disorders

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 9/2014

Self-Management and Bipolar Disorder–A Clinician’s Guide to the Literature 2011-2014

Meta-Analytic Review of Psychological Interventions for Children Survivors of Natural and Man-Made Disasters

Disaster Media Coverage and Psychological Outcomes: Descriptive Findings in the Extant Research

Cognitive and Neuropsychiatric Impairments in Alzheimer's Disease: Current Treatment Strategies

Adolescents and the Internet: What Mental Health Clinicians Need to Know

Current Understanding of the Neurobiology and Longitudinal Course of Geriatric Depression