American Psychological Association

Supplemental MaterialsA Randomized Controlled Trial of Cognitive Behavioral Therapy for Insomnia: An Effective Treatment for Co-morbid Insomnia and Depressionby D. K. Ashworth et al., 2015, Journal of Counseling Psychology of CBT-I intervention: CBT-I was delivered across 4 sessions in the following structure:Session 1 focused on sleep education (why people sleep, sleep stages, sleep throughout the lifetime, circadian rhythms, homeostatic pressure, sleep inertia, and a model of insomnia). This education provided participants with basic knowledge of sleep, rationale for sleep scheduling, and research evidence to challenge unhelpful beliefs about sleep. Sleep hygiene recommendations were provided to educate participants about environmental factors that can influence their sleep and to help participants identify three areas that they wanted to target for homework. Although not sufficient on their own, sleep hygiene recommendations are considered helpful as part of CBT-I multimodal treatment, especially when tailored to the individual ADDIN EN.CITE <EndNote><Cite><Author>Ebben</Author><Year>2009</Year><RecNum>7651</RecNum><DisplayText>(Ebben & Spielman, 2009)</DisplayText><record><rec-number>7651</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7651</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ebben, M. R.</author><author>Spielman, A. J.</author></authors></contributors><auth-address>Department of Neurology and Neuroscience, Center for Sleep Medicine, Weill Medical College of Cornell University, 525 East 68th Street, Room k-615, New York, NY, 10065, USA. Mae2001@med.cornell.edu</auth-address><titles><title>Non-pharmacological treatments for insomnia</title><secondary-title>J Behav Med</secondary-title><alt-title>Journal of Behavioral Medicine</alt-title></titles><periodical><full-title>J Behav Med</full-title><abbr-1>Journal of behavioral medicine</abbr-1></periodical><alt-periodical><full-title>J Behav Med</full-title><abbr-1>Journal of behavioral medicine</abbr-1></alt-periodical><pages>244-54</pages><volume>32</volume><number>3</number><edition>2009/01/27</edition><keywords><keyword>Behavior Therapy/*methods</keyword><keyword>Biofeedback, Psychology</keyword><keyword>Cognitive Therapy</keyword><keyword>Comorbidity</keyword><keyword>Humans</keyword><keyword>Models, Psychological</keyword><keyword>Prevalence</keyword><keyword>Relaxation Therapy</keyword><keyword>Sleep Disorders, Circadian Rhythm/diagnosis</keyword><keyword>Sleep Initiation and Maintenance Disorders/diagnosis/epidemiology/*therapy</keyword></keywords><dates><year>2009</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1573-3521 (Electronic)0160-7715 (Linking)</isbn><accession-num>19169804</accession-num><work-type>Review</work-type><urls><related-urls><url>;(Ebben & Spielman, 2009). Relaxation was also introduced via a diaphragmatic breathing exercise. As there is support for several relaxation techniques, a different relaxation technique was introduced in each session that was consistent with the theme of the session (1 – education; 2 – behavior; 3 – cognitive; 4 – relapse prevention) with the aim of reducing pre-sleep arousal levels ADDIN EN.CITE <EndNote><Cite><Author>Edinger</Author><Year>2005</Year><RecNum>7653</RecNum><DisplayText>(Edinger & Means, 2005)</DisplayText><record><rec-number>7653</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7653</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Edinger, J. D.</author><author>Means, M. K.</author></authors></contributors><auth-address>Department of Veterans Affairs and Duke University Medical Centers, Durham, NC, USA. jack.edinger@duke.edu</auth-address><titles><title>Cognitive-behavioral therapy for primary insomnia</title><secondary-title>Clin Psychol Rev</secondary-title><alt-title>Clinical psychology review</alt-title></titles><periodical><full-title>Clin Psychol Rev</full-title></periodical><alt-periodical><full-title>Clinical Psychology Review</full-title></alt-periodical><pages>539-58</pages><volume>25</volume><number>5</number><edition>2005/06/14</edition><keywords><keyword>Cognitive Therapy/*methods</keyword><keyword>Humans</keyword><keyword>Patient Satisfaction</keyword><keyword>Sleep Initiation and Maintenance Disorders/etiology/*therapy</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2005</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>0272-7358 (Print)0272-7358 (Linking)</isbn><accession-num>15951083</accession-num><work-type>Review</work-type><urls><related-urls><url>;(Edinger & Means, 2005). Session 2 focused on the behavioral interventions for insomnia with the most empirical support, including stimulus control ADDIN EN.CITE <EndNote><Cite><Author>Bootzin</Author><Year>1972</Year><RecNum>7670</RecNum><DisplayText>(Bootzin, 1972)</DisplayText><record><rec-number>7670</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7670</key></foreign-keys><ref-type name="Conference Proceedings">10</ref-type><contributors><authors><author>Bootzin, R.</author></authors></contributors><titles><title>Stimulus control treatment for insomnia.</title><secondary-title>Proceedings of the 80th Annual Convention of the American Psychological Association</secondary-title></titles><pages>395-396</pages><volume>7</volume><dates><year>1972</year></dates><urls></urls></record></Cite></EndNote>(Bootzin, 1972) and sleep restriction ADDIN EN.CITE <EndNote><Cite><Author>Spielman</Author><Year>1987</Year><RecNum>7671</RecNum><DisplayText>(Spielman, Saskin, & Thorpy, 1987)</DisplayText><record><rec-number>7671</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7671</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Spielman, A. J.</author><author>Saskin, P.</author><author>Thorpy, M. J.</author></authors></contributors><titles><title>Treatment of chronic insomnia by restriction of time in bed</title><secondary-title>Sleep</secondary-title><alt-title>Sleep</alt-title></titles><periodical><full-title>Sleep</full-title></periodical><alt-periodical><full-title>Sleep</full-title></alt-periodical><pages>45-56</pages><volume>10</volume><number>1</number><edition>1987/02/01</edition><keywords><keyword>Analysis of Variance</keyword><keyword>*Bed Rest</keyword><keyword>Electroencephalography</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Questionnaires</keyword><keyword>Sleep/physiology</keyword><keyword>*Sleep Deprivation</keyword><keyword>Sleep Initiation and Maintenance Disorders/psychology/*therapy</keyword><keyword>Time Factors</keyword></keywords><dates><year>1987</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0161-8105 (Print)0161-8105 (Linking)</isbn><accession-num>3563247</accession-num><urls><related-urls><url>;(Spielman, Saskin, & Thorpy, 1987). Together, stimulus control and sleep restriction are the greatest predictors in ongoing sleep improvement by 12-month follow-up ADDIN EN.CITE <EndNote><Cite><Author>Harvey</Author><Year>2002</Year><RecNum>7672</RecNum><DisplayText>(Harvey & Payne, 2002)</DisplayText><record><rec-number>7672</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7672</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Harvey, A. G.</author><author>Payne, S.</author></authors></contributors><auth-address>Department of Experimental Psychology, University of Oxford, UK. allison.harvey@psy.ox.ac.uk</auth-address><titles><title>The management of unwanted pre-sleep thoughts in insomnia: distraction with imagery versus general distraction</title><secondary-title>Behav Res Ther</secondary-title><alt-title>Behaviour research and therapy</alt-title></titles><periodical><full-title>Behav Res Ther</full-title></periodical><alt-periodical><full-title>Behaviour Research and Therapy</full-title></alt-periodical><pages>267-77</pages><volume>40</volume><number>3</number><edition>2002/02/28</edition><keywords><keyword>Adult</keyword><keyword>Cognition/*physiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Imagery (Psychotherapy)/*methods</keyword><keyword>Sampling Studies</keyword><keyword>Sleep/physiology</keyword><keyword>Sleep Initiation and Maintenance Disorders/psychology/*therapy</keyword></keywords><dates><year>2002</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0005-7967 (Print)0005-7967 (Linking)</isbn><accession-num>11863237</accession-num><work-type>Clinical TrialComparative StudyControlled Clinical Trial</work-type><urls><related-urls><url>;(Harvey & Payne, 2002). A progressive muscle relaxation exercise ADDIN EN.CITE <EndNote><Cite><Author>Bernstein</Author><Year>2000</Year><RecNum>7667</RecNum><DisplayText>(Bernstein, Borkovec, & Hazlett-Stevens, 2000)</DisplayText><record><rec-number>7667</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7667</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Bernstein, D.A.</author><author>Borkovec, T.D.</author><author>Hazlett-Stevens, H.</author></authors></contributors><titles><title>New directions in progressive relaxation training: A guidebook for helping professionals</title></titles><dates><year>2000</year></dates><pub-location>Westport, CT</pub-location><publisher> Praeger Publishers</publisher><urls></urls></record></Cite></EndNote>(Bernstein, Borkovec, & Hazlett-Stevens, 2000) was conducted to target somatic hyper arousal, and a constructive worry worksheet ADDIN EN.CITE <EndNote><Cite><Author>Edinger</Author><Year>2008</Year><RecNum>7673</RecNum><DisplayText>(Edinger & Carney, 2008)</DisplayText><record><rec-number>7673</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7673</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Edinger, J. D.</author><author>Carney, C. E.</author></authors></contributors><titles><title>Overcoming Insomnia: A Cognitive-behavioral Therapy Approach Therapist Guide</title></titles><dates><year>2008</year></dates><publisher>Oxford University Press</publisher><urls></urls></record></Cite></EndNote>(Edinger & Carney, 2008) was assigned for homework. Session 3 focused on cognitive interventions for insomnia, including constructive worry, unhelpful thinking patterns in insomnia ADDIN EN.CITE <EndNote><Cite><Author>Edinger</Author><Year>2008</Year><RecNum>7673</RecNum><DisplayText>(Edinger & Carney, 2008)</DisplayText><record><rec-number>7673</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7673</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Edinger, J. D.</author><author>Carney, C. E.</author></authors></contributors><titles><title>Overcoming Insomnia: A Cognitive-behavioral Therapy Approach Therapist Guide</title></titles><dates><year>2008</year></dates><publisher>Oxford University Press</publisher><urls></urls></record></Cite></EndNote>(Edinger & Carney, 2008), and cognitive restructuring of dysfunctional beliefs about sleep ADDIN EN.CITE <EndNote><Cite><Author>Morin</Author><Year>1993</Year><RecNum>7658</RecNum><DisplayText>(Morin, 1993)</DisplayText><record><rec-number>7658</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7658</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Morin, C. M.</author></authors></contributors><titles><title>Insomnia: Psychological assessment and management</title></titles><dates><year>1993</year></dates><pub-location>New York</pub-location><publisher>Guildford Press</publisher><urls></urls></record></Cite></EndNote>(Morin, 1993). Improvements in sleep related cognitions (as measured by reductions in dysfunctional beliefs about sleep) predict lower likelihood of relapse. An imagery ADDIN EN.CITE <EndNote><Cite><Author>Morin</Author><Year>1987</Year><RecNum>7668</RecNum><DisplayText>(Morin & Azrin, 1987)</DisplayText><record><rec-number>7668</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7668</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Morin, C. M.</author><author>Azrin, N. H.</author></authors></contributors><titles><title>Stimulus control and imagery training in treating sleep-maintenance insomnia</title><secondary-title>J Consult Clin Psychol</secondary-title><alt-title>Journal of consulting and clinical psychology</alt-title></titles><periodical><full-title>J Consult Clin Psychol</full-title></periodical><alt-periodical><full-title>Journal of Consulting and Clinical Psychology</full-title></alt-periodical><pages>260-2</pages><volume>55</volume><number>2</number><edition>1987/04/01</edition><keywords><keyword>Behavior Therapy/*methods</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>*Imagination</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Sleep Initiation and Maintenance Disorders/*therapy</keyword></keywords><dates><year>1987</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0022-006X (Print)0022-006X (Linking)</isbn><accession-num>3571683</accession-num><urls><related-urls><url>;(Morin & Azrin, 1987) relaxation exercise was conducted to target cognitive hyper-arousal. Thinking in the form of images has been found to resolve worry more effectively than thinking in the form of words PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5OZWxzb248L0F1dGhvcj48WWVhcj4yMDAyPC9ZZWFyPjxS

ZWNOdW0+NzY2OTwvUmVjTnVtPjxEaXNwbGF5VGV4dD4oTmVsc29uICZhbXA7IEhhcnZleSwgMjAw

Mik8L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+NzY2OTwvcmVjLW51bWJlcj48Zm9y

ZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InBwemQydDJhbnN4NTB0ZXIydzhwdHp4bDB0

dzVmOXdzMHJ3eiI+NzY2OTwva2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3Vy

bmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+

TmVsc29uLCBKLjwvYXV0aG9yPjxhdXRob3I+SGFydmV5LCBBLiBHLjwvYXV0aG9yPjwvYXV0aG9y

cz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRlcGFydG1lbnQgb2YgRXhwZXJpbWVudGFs

IFBzeWNob2xvZ3ksIFVuaXZlcnNpdHkgb2YgT3hmb3JkLCBVbml0ZWQgS2luZ2RvbS48L2F1dGgt

YWRkcmVzcz48dGl0bGVzPjx0aXRsZT5UaGUgZGlmZmVyZW50aWFsIGZ1bmN0aW9ucyBvZiBpbWFn

ZXJ5IGFuZCB2ZXJiYWwgdGhvdWdodCBpbiBpbnNvbW5pYTwvdGl0bGU+PHNlY29uZGFyeS10aXRs

ZT5KIEFibm9ybSBQc3ljaG9sPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5Kb3VybmFsIG9m

IEFibm9ybWFsIFBzeWNob2xvZ3k8L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVs

bC10aXRsZT5KIEFibm9ybSBQc3ljaG9sPC9mdWxsLXRpdGxlPjxhYmJyLTE+Sm91cm5hbCBvZiBh

Ym5vcm1hbCBwc3ljaG9sb2d5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48

ZnVsbC10aXRsZT5KIEFibm9ybSBQc3ljaG9sPC9mdWxsLXRpdGxlPjxhYmJyLTE+Sm91cm5hbCBv

ZiBhYm5vcm1hbCBwc3ljaG9sb2d5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+NjY1

LTk8L3BhZ2VzPjx2b2x1bWU+MTExPC92b2x1bWU+PG51bWJlcj40PC9udW1iZXI+PGVkaXRpb24+

MjAwMi8xMS8xNDwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtl

eXdvcmQ+QW54aWV0eS9wc3ljaG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29y

ZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+KkltYWdlcnkgKFBzeWNob3RoZXJh

cHkpPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+UHN5Y2hpYXRyaWMg

U3RhdHVzIFJhdGluZyBTY2FsZXM8L2tleXdvcmQ+PGtleXdvcmQ+U2xlZXAgSW5pdGlhdGlvbiBh

bmQgTWFpbnRlbmFuY2UgRGlzb3JkZXJzLypwc3ljaG9sb2d5Lyp0aGVyYXB5PC9rZXl3b3JkPjxr

ZXl3b3JkPlN0cmVzcywgUHN5Y2hvbG9naWNhbC9wc3ljaG9sb2d5PC9rZXl3b3JkPjxrZXl3b3Jk

PlN0dWRlbnRzL3BzeWNob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+VGhpbmtpbmcvKnBoeXNpb2xv

Z3k8L2tleXdvcmQ+PGtleXdvcmQ+VGltZSBGYWN0b3JzPC9rZXl3b3JkPjxrZXl3b3JkPlZlcmJh

bCBCZWhhdmlvci8qcGh5c2lvbG9neTwva2V5d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4y

MDAyPC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+Tm92PC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+

PGlzYm4+MDAyMS04NDNYIChQcmludCkmI3hEOzAwMjEtODQzWCAoTGlua2luZyk8L2lzYm4+PGFj

Y2Vzc2lvbi1udW0+MTI0Mjg3ODA8L2FjY2Vzc2lvbi1udW0+PHdvcmstdHlwZT5SZXNlYXJjaCBT

dXBwb3J0LCBOb24tVS5TLiBHb3YmYXBvczt0PC93b3JrLXR5cGU+PHVybHM+PHJlbGF0ZWQtdXJs

cz48dXJsPmh0dHA6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9wdWJtZWQvMTI0Mjg3ODA8L3VybD48

dXJsPmh0dHA6Ly9ncmFwaGljcy50eC5vdmlkLmNvbS9vdmZ0cGRmcy9GUERETkNNQ0pIQUhOQjAw

L2ZzMDQ3L292ZnQvbGl2ZS9ndjAyNC8wMDAwNDQ2OC8wMDAwNDQ2OC0yMDAyMTEwMDAtMDAwMTQu

cGRmPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwv

cmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5OZWxzb248L0F1dGhvcj48WWVhcj4yMDAyPC9ZZWFyPjxS

ZWNOdW0+NzY2OTwvUmVjTnVtPjxEaXNwbGF5VGV4dD4oTmVsc29uICZhbXA7IEhhcnZleSwgMjAw

Mik8L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+NzY2OTwvcmVjLW51bWJlcj48Zm9y

ZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InBwemQydDJhbnN4NTB0ZXIydzhwdHp4bDB0

dzVmOXdzMHJ3eiI+NzY2OTwva2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3Vy

bmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+

TmVsc29uLCBKLjwvYXV0aG9yPjxhdXRob3I+SGFydmV5LCBBLiBHLjwvYXV0aG9yPjwvYXV0aG9y

cz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRlcGFydG1lbnQgb2YgRXhwZXJpbWVudGFs

IFBzeWNob2xvZ3ksIFVuaXZlcnNpdHkgb2YgT3hmb3JkLCBVbml0ZWQgS2luZ2RvbS48L2F1dGgt

YWRkcmVzcz48dGl0bGVzPjx0aXRsZT5UaGUgZGlmZmVyZW50aWFsIGZ1bmN0aW9ucyBvZiBpbWFn

ZXJ5IGFuZCB2ZXJiYWwgdGhvdWdodCBpbiBpbnNvbW5pYTwvdGl0bGU+PHNlY29uZGFyeS10aXRs

ZT5KIEFibm9ybSBQc3ljaG9sPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5Kb3VybmFsIG9m

IEFibm9ybWFsIFBzeWNob2xvZ3k8L2FsdC10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVs

bC10aXRsZT5KIEFibm9ybSBQc3ljaG9sPC9mdWxsLXRpdGxlPjxhYmJyLTE+Sm91cm5hbCBvZiBh

Ym5vcm1hbCBwc3ljaG9sb2d5PC9hYmJyLTE+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48

ZnVsbC10aXRsZT5KIEFibm9ybSBQc3ljaG9sPC9mdWxsLXRpdGxlPjxhYmJyLTE+Sm91cm5hbCBv

ZiBhYm5vcm1hbCBwc3ljaG9sb2d5PC9hYmJyLTE+PC9hbHQtcGVyaW9kaWNhbD48cGFnZXM+NjY1

LTk8L3BhZ2VzPjx2b2x1bWU+MTExPC92b2x1bWU+PG51bWJlcj40PC9udW1iZXI+PGVkaXRpb24+

MjAwMi8xMS8xNDwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+PGtl

eXdvcmQ+QW54aWV0eS9wc3ljaG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29y

ZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+KkltYWdlcnkgKFBzeWNob3RoZXJh

cHkpPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+UHN5Y2hpYXRyaWMg

U3RhdHVzIFJhdGluZyBTY2FsZXM8L2tleXdvcmQ+PGtleXdvcmQ+U2xlZXAgSW5pdGlhdGlvbiBh

bmQgTWFpbnRlbmFuY2UgRGlzb3JkZXJzLypwc3ljaG9sb2d5Lyp0aGVyYXB5PC9rZXl3b3JkPjxr

ZXl3b3JkPlN0cmVzcywgUHN5Y2hvbG9naWNhbC9wc3ljaG9sb2d5PC9rZXl3b3JkPjxrZXl3b3Jk

PlN0dWRlbnRzL3BzeWNob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+VGhpbmtpbmcvKnBoeXNpb2xv

Z3k8L2tleXdvcmQ+PGtleXdvcmQ+VGltZSBGYWN0b3JzPC9rZXl3b3JkPjxrZXl3b3JkPlZlcmJh

bCBCZWhhdmlvci8qcGh5c2lvbG9neTwva2V5d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4y

MDAyPC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+Tm92PC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+

PGlzYm4+MDAyMS04NDNYIChQcmludCkmI3hEOzAwMjEtODQzWCAoTGlua2luZyk8L2lzYm4+PGFj

Y2Vzc2lvbi1udW0+MTI0Mjg3ODA8L2FjY2Vzc2lvbi1udW0+PHdvcmstdHlwZT5SZXNlYXJjaCBT

dXBwb3J0LCBOb24tVS5TLiBHb3YmYXBvczt0PC93b3JrLXR5cGU+PHVybHM+PHJlbGF0ZWQtdXJs

cz48dXJsPmh0dHA6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9wdWJtZWQvMTI0Mjg3ODA8L3VybD48

dXJsPmh0dHA6Ly9ncmFwaGljcy50eC5vdmlkLmNvbS9vdmZ0cGRmcy9GUERETkNNQ0pIQUhOQjAw

L2ZzMDQ3L292ZnQvbGl2ZS9ndjAyNC8wMDAwNDQ2OC8wMDAwNDQ2OC0yMDAyMTEwMDAtMDAwMTQu

cGRmPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwv

cmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==

ADDIN EN.CITE.DATA (Nelson & Harvey, 2002). Cognitive arousal is also ten times more likely to be cited as the major cause of insomnia than somatic arousal ADDIN EN.CITE <EndNote><Cite><Author>Lichstein</Author><Year>1980</Year><RecNum>7675</RecNum><DisplayText>(Lichstein & Rosenthal, 1980)</DisplayText><record><rec-number>7675</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7675</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lichstein, K. L.</author><author>Rosenthal, T. L.</author></authors></contributors><titles><title>Insomniacs' perceptions of cognitive versus somatic determinants of sleep disturbance</title><secondary-title>J Abnorm Psychol</secondary-title><alt-title>Journal of Abnormal Psychology</alt-title></titles><periodical><full-title>J Abnorm Psychol</full-title><abbr-1>Journal of abnormal psychology</abbr-1></periodical><alt-periodical><full-title>J Abnorm Psychol</full-title><abbr-1>Journal of abnormal psychology</abbr-1></alt-periodical><pages>105-7</pages><volume>89</volume><number>1</number><edition>1980/02/01</edition><keywords><keyword>Adult</keyword><keyword>Arousal</keyword><keyword>*Cognition</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Psychophysiologic Disorders/*psychology</keyword><keyword>Sleep Initiation and Maintenance Disorders/*psychology</keyword></keywords><dates><year>1980</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0021-843X (Print)0021-843X (Linking)</isbn><accession-num>7365114</accession-num><urls><related-urls><url>;(Lichstein & Rosenthal, 1980). A thought record ADDIN EN.CITE <EndNote><Cite><Author>Edinger</Author><Year>2008</Year><RecNum>7673</RecNum><DisplayText>(Edinger & Carney, 2008)</DisplayText><record><rec-number>7673</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7673</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Edinger, J. D.</author><author>Carney, C. E.</author></authors></contributors><titles><title>Overcoming Insomnia: A Cognitive-behavioral Therapy Approach Therapist Guide</title></titles><dates><year>2008</year></dates><publisher>Oxford University Press</publisher><urls></urls></record></Cite></EndNote>(Edinger & Carney, 2008) was assigned for homework. Session 4 focused on promoting long-term gains, including troubleshooting common lingering concerns ADDIN EN.CITE <EndNote><Cite><Author>Edinger</Author><Year>2008</Year><RecNum>7673</RecNum><DisplayText>(Edinger & Carney, 2008)</DisplayText><record><rec-number>7673</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7673</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Edinger, J. D.</author><author>Carney, C. E.</author></authors></contributors><titles><title>Overcoming Insomnia: A Cognitive-behavioral Therapy Approach Therapist Guide</title></titles><dates><year>2008</year></dates><publisher>Oxford University Press</publisher><urls></urls></record></Cite></EndNote>(Edinger & Carney, 2008), self-management ADDIN EN.CITE <EndNote><Cite><Author>Lundh</Author><Year>2000</Year><RecNum>12488</RecNum><DisplayText>(Lundh, 2000)</DisplayText><record><rec-number>12488</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">12488</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lundh, Lars-Gunnar</author></authors></contributors><titles><title>An Integrative Model for the Analysis and Treatment of Insomnia</title><secondary-title>Scandinavian Journal of Behaviour Therapy</secondary-title></titles><periodical><full-title>Scandinavian Journal of Behaviour Therapy</full-title></periodical><pages>118-126</pages><volume>29</volume><number>3-4</number><dates><year>2000</year><pub-dates><date>2000/01/01</date></pub-dates></dates><publisher>Routledge</publisher><isbn>0284-5717</isbn><urls><related-urls><url>;(Lundh, 2000), relapse prevention for insomnia ADDIN EN.CITE <EndNote><Cite><Author>Smith</Author><Year>2005</Year><RecNum>12489</RecNum><DisplayText>(Smith & Posner, 2005)</DisplayText><record><rec-number>12489</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">12489</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Smith, M. T.</author><author>Posner, D. A.</author></authors></contributors><titles><title>Cognitive behavioral treatment of insomnia: A session-by-session guide</title></titles><volume>1</volume><dates><year>2005</year></dates><publisher>Springer</publisher><isbn>0387291806</isbn><urls></urls></record></Cite></EndNote>(Smith & Posner, 2005), and a breathing-to-connect mindfulness exercise ADDIN EN.CITE <EndNote><Cite><Author>Harris</Author><Year>2009</Year><RecNum>12490</RecNum><DisplayText>(Harris, 2008, 2009)</DisplayText><record><rec-number>12490</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">12490</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Harris, Russ</author></authors></contributors><titles><title>ACT made simple</title><secondary-title>New Harbinger</secondary-title></titles><periodical><full-title>New Harbinger</full-title></periodical><dates><year>2009</year></dates><urls></urls></record></Cite><Cite><Author>Harris</Author><Year>2008</Year><RecNum>12491</RecNum><record><rec-number>12491</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">12491</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Harris, Russ</author></authors></contributors><titles><title>The happiness trap: How to stop struggling and start living</title></titles><dates><year>2008</year></dates><publisher>Shambhala Publications</publisher><isbn>0834821044</isbn><urls></urls></record></Cite></EndNote>(Harris, 2008, 2009). Mindfulness can effectively improve insomnia ADDIN EN.CITE <EndNote><Cite><Author>Ong</Author><Year>2008</Year><RecNum>12156</RecNum><DisplayText>(Ong, Shapiro, & Manber, 2008)</DisplayText><record><rec-number>12156</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">12156</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ong, J. C.</author><author>Shapiro, S. L.</author><author>Manber, R.</author></authors></contributors><auth-address>Ong, JCStanford Univ, Med Ctr, Dept Psychiat & Behav Sci, 401 Quarry Rd,Suite 3301, Stanford, CA 94305 USAStanford Univ, Med Ctr, Dept Psychiat & Behav Sci, 401 Quarry Rd,Suite 3301, Stanford, CA 94305 USAStanford Univ, Med Ctr, Dept Psychiat & Behav Sci, Stanford, CA 94305 USASanta Clara Univ, Dept Counseling Psychol, Santa Clara, CA 95053 USA</auth-address><titles><title>Combining mindfulness meditation with cognitive-behavior therapy for insomnia: A treatment-development study</title><secondary-title>Behavior Therapy</secondary-title><alt-title>Behav Ther</alt-title></titles><periodical><full-title>Behav Ther</full-title><abbr-1>Behavior therapy</abbr-1></periodical><alt-periodical><full-title>Behav Ther</full-title><abbr-1>Behavior therapy</abbr-1></alt-periodical><pages>171-182</pages><volume>39</volume><number>2</number><keywords><keyword>randomized controlled-trial</keyword><keyword>stress reduction</keyword><keyword>dysfunctional beliefs</keyword><keyword>older-adults</keyword><keyword>sleep</keyword><keyword>intervention</keyword><keyword>hyperarousal</keyword><keyword>attitudes</keyword><keyword>criteria</keyword><keyword>health</keyword></keywords><dates><year>2008</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0005-7894</isbn><accession-num>WOS:000257419100007</accession-num><urls><related-urls><url><Go to ISI>://WOS:000257419100007</url></related-urls></urls><electronic-resource-num>DOI 10.1016/j.beth.2007.07.002</electronic-resource-num><language>English</language></record></Cite></EndNote>(Ong, Shapiro, & Manber, 2008) and has been shown to prevent depressive relapse following remission of symptoms ADDIN EN.CITE <EndNote><Cite><Author>Ma</Author><Year>2004</Year><RecNum>7707</RecNum><DisplayText>(Ma & Teasdale, 2004)</DisplayText><record><rec-number>7707</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7707</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ma, S. H.</author><author>Teasdale, J. D.</author></authors></contributors><auth-address>Medical Research Council, Cognition & Brain Sciences Unit, Cambridge, United Kingdom.</auth-address><titles><title>Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects</title><secondary-title>J Consult Clin Psychol</secondary-title><alt-title>Journal of consulting and clinical psychology</alt-title></titles><periodical><full-title>J Consult Clin Psychol</full-title></periodical><alt-periodical><full-title>Journal of Consulting and Clinical Psychology</full-title></alt-periodical><pages>31-40</pages><volume>72</volume><number>1</number><edition>2004/02/06</edition><keywords><keyword>*Attitude to Health</keyword><keyword>Cognitive Therapy/*methods</keyword><keyword>Depressive Disorder, Major/diagnosis/psychology/*therapy</keyword><keyword>Diagnostic and Statistical Manual of Mental Disorders</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Recurrence/prevention & control</keyword><keyword>Severity of Illness Index</keyword></keywords><dates><year>2004</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0022-006X (Print)0022-006X (Linking)</isbn><accession-num>14756612</accession-num><work-type>Clinical TrialRandomized Controlled Trial</work-type><urls><related-urls><url>;(Ma & Teasdale, 2004). Additional techniques that may be helpful were also included to target specific ongoing perpetuating factors. These included autogenic relaxation if elevated pre-sleep arousal was still a concern, cognitive control ADDIN EN.CITE <EndNote><Cite><Author>Morin</Author><Year>2003</Year><RecNum>7685</RecNum><DisplayText>(Morin & Espie, 2003)</DisplayText><record><rec-number>7685</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7685</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Morin, C. M.</author><author>Espie, C. A.</author></authors></contributors><titles><title>Insomnia: A clinical guide to assessment and treatment</title></titles><dates><year>2003</year></dates><pub-location>New York</pub-location><publisher>Kluwer Academic/Plenum Publishers</publisher><urls></urls></record></Cite></EndNote>(Morin & Espie, 2003) and articulatory suppression ADDIN EN.CITE <EndNote><Cite><Author>Levey</Author><Year>1991</Year><RecNum>12244</RecNum><DisplayText>(Levey, Aldaz, Watts, & Coyle, 1991)</DisplayText><record><rec-number>12244</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">12244</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Levey, A. B.</author><author>Aldaz, J. A.</author><author>Watts, F. N.</author><author>Coyle, K.</author></authors></contributors><auth-address>Mrc Appl Psychol Unit,15 Chaucer Rd,Cambridge Cb2 2ef,England</auth-address><titles><title>Articulatory Suppression and the Treatment of Insomnia</title><secondary-title>Behaviour Research and Therapy</secondary-title><alt-title>Behav Res Ther</alt-title></titles><periodical><full-title>Behaviour Research and Therapy</full-title></periodical><alt-periodical><full-title>Behav Res Ther</full-title></alt-periodical><pages>85-89</pages><volume>29</volume><number>1</number><keywords><keyword>sleep-onset insomnia</keyword><keyword>paradoxical intention</keyword></keywords><dates><year>1991</year></dates><isbn>0005-7967</isbn><accession-num>WOS:A1991EV53700009</accession-num><urls><related-urls><url><Go to ISI>://WOS:A1991EV53700009</url></related-urls></urls><language>English</language></record></Cite></EndNote>(Levey, Aldaz, Watts, & Coyle, 1991) if racing thoughts at night remained problematic, and paradoxical intention ADDIN EN.CITE <EndNote><Cite><Author>Morin</Author><Year>1993</Year><RecNum>7658</RecNum><DisplayText>(Morin, 1993)</DisplayText><record><rec-number>7658</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7658</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Morin, C. M.</author></authors></contributors><titles><title>Insomnia: Psychological assessment and management</title></titles><dates><year>1993</year></dates><pub-location>New York</pub-location><publisher>Guildford Press</publisher><urls></urls></record></Cite></EndNote>(Morin, 1993) if elevated sleep effort was making sleep initiation difficult. Any negative discrepancies between how participants believed they slept (subjective sleep measures) and how they actually slept (objective sleep measures) were discussed with the aim of reducing unhelpful sleep state misperception. Details of secondary outcome measures: The PSQI ADDIN EN.CITE <EndNote><Cite><Author>Buysse</Author><Year>1989</Year><RecNum>4043</RecNum><DisplayText>(Buysse, Reynolds, Monk, Berman, & Kupfer, 1989)</DisplayText><record><rec-number>4043</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">4043</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Buysse, D. J.</author><author>Reynolds, C. F., 3rd</author><author>Monk, T. H.</author><author>Berman, S. R.</author><author>Kupfer, D. J.</author></authors></contributors><auth-address>Department of Psychiatry, University of Pittsburgh School of Medicine, PA.</auth-address><titles><title>The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research</title><secondary-title>Psychiatry Res</secondary-title></titles><periodical><full-title>Psychiatry Research</full-title><abbr-1>Psychiatry Res</abbr-1></periodical><pages>193-213</pages><volume>28</volume><number>2</number><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Depression/*psychology</keyword><keyword>Female</keyword><keyword>Human</keyword><keyword>Male</keyword><keyword>Middle Age</keyword><keyword>*Psychological Tests</keyword><keyword>Psychometrics</keyword><keyword>Sleep Initiation and Maintenance Disorders/*diagnosis/psychology</keyword><keyword>*Sleep Stages</keyword><keyword>Support, U.S. Gov't, P.H.S.</keyword></keywords><dates><year>1989</year><pub-dates><date>May</date></pub-dates></dates><accession-num>2748771</accession-num><urls><related-urls><url>;(Buysse, Reynolds, Monk, Berman, & Kupfer, 1989) consists of 24 questions over 11 items, and produces 7 domain scores and a total score measuring average self-rated sleep quality over the previous month. Total scores range from 0-21, with 5 or under considered to be good sleep quality, and 6 or above interpreted as poor sleep quality ADDIN EN.CITE <EndNote><Cite><Author>Buysse</Author><Year>1989</Year><RecNum>4043</RecNum><DisplayText>(Buysse et al., 1989)</DisplayText><record><rec-number>4043</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">4043</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Buysse, D. J.</author><author>Reynolds, C. F., 3rd</author><author>Monk, T. H.</author><author>Berman, S. R.</author><author>Kupfer, D. J.</author></authors></contributors><auth-address>Department of Psychiatry, University of Pittsburgh School of Medicine, PA.</auth-address><titles><title>The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research</title><secondary-title>Psychiatry Res</secondary-title></titles><periodical><full-title>Psychiatry Research</full-title><abbr-1>Psychiatry Res</abbr-1></periodical><pages>193-213</pages><volume>28</volume><number>2</number><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Depression/*psychology</keyword><keyword>Female</keyword><keyword>Human</keyword><keyword>Male</keyword><keyword>Middle Age</keyword><keyword>*Psychological Tests</keyword><keyword>Psychometrics</keyword><keyword>Sleep Initiation and Maintenance Disorders/*diagnosis/psychology</keyword><keyword>*Sleep Stages</keyword><keyword>Support, U.S. Gov't, P.H.S.</keyword></keywords><dates><year>1989</year><pub-dates><date>May</date></pub-dates></dates><accession-num>2748771</accession-num><urls><related-urls><url>;(Buysse et al., 1989). The DASS-21 ADDIN EN.CITE <EndNote><Cite><Author>Lovibond</Author><Year>1995</Year><RecNum>7680</RecNum><DisplayText>(Lovibond & Lovibond, 1995)</DisplayText><record><rec-number>7680</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7680</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lovibond, P. F.</author><author>Lovibond, S. H.</author></authors></contributors><auth-address>School of Psychology, University of New South Wales, Sydney, Australia.</auth-address><titles><title>The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories</title><secondary-title>Behav Res Ther</secondary-title><alt-title>Behaviour research and therapy</alt-title></titles><periodical><full-title>Behav Res Ther</full-title></periodical><alt-periodical><full-title>Behaviour Research and Therapy</full-title></alt-periodical><pages>335-43</pages><volume>33</volume><number>3</number><edition>1995/03/01</edition><keywords><keyword>Adult</keyword><keyword>Anxiety/diagnosis/*psychology</keyword><keyword>Depression/diagnosis/*psychology</keyword><keyword>Discriminant Analysis</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Personality Inventory/*statistics & numerical data</keyword><keyword>Psychometrics</keyword><keyword>Reference Values</keyword><keyword>Stress, Psychological/*complications</keyword></keywords><dates><year>1995</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0005-7967 (Print)0005-7967 (Linking)</isbn><accession-num>7726811</accession-num><work-type>Comparative StudyResearch Support, Non-U.S. Gov't</work-type><urls><related-urls><url>;(Lovibond & Lovibond, 1995) consists of three separate 7-item self-rated scales that aim to delineate the core features of depression, anxiety (DASS-A) and stress. DASS-A scores range from 0-42, with higher scores indicating a greater level of anxiety severity ADDIN EN.CITE <EndNote><Cite><Author>Lovibond</Author><Year>1995</Year><RecNum>7680</RecNum><DisplayText>(Lovibond & Lovibond, 1995)</DisplayText><record><rec-number>7680</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7680</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lovibond, P. F.</author><author>Lovibond, S. H.</author></authors></contributors><auth-address>School of Psychology, University of New South Wales, Sydney, Australia.</auth-address><titles><title>The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories</title><secondary-title>Behav Res Ther</secondary-title><alt-title>Behaviour research and therapy</alt-title></titles><periodical><full-title>Behav Res Ther</full-title></periodical><alt-periodical><full-title>Behaviour Research and Therapy</full-title></alt-periodical><pages>335-43</pages><volume>33</volume><number>3</number><edition>1995/03/01</edition><keywords><keyword>Adult</keyword><keyword>Anxiety/diagnosis/*psychology</keyword><keyword>Depression/diagnosis/*psychology</keyword><keyword>Discriminant Analysis</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Personality Inventory/*statistics & numerical data</keyword><keyword>Psychometrics</keyword><keyword>Reference Values</keyword><keyword>Stress, Psychological/*complications</keyword></keywords><dates><year>1995</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0005-7967 (Print)0005-7967 (Linking)</isbn><accession-num>7726811</accession-num><work-type>Comparative StudyResearch Support, Non-U.S. Gov't</work-type><urls><related-urls><url>;(Lovibond & Lovibond, 1995). The FSS ADDIN EN.CITE <EndNote><Cite><Author>Krupp</Author><Year>1989</Year><RecNum>7079</RecNum><DisplayText>(Krupp, LaRocca, Muir-Nash, & Steinberg, 1989)</DisplayText><record><rec-number>7079</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7079</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Krupp, L. B.</author><author>LaRocca, N. G.</author><author>Muir-Nash, J.</author><author>Steinberg, A. D.</author></authors></contributors><auth-address>Department of Neurology, State University of New York, Stony Brook 11794-8121.</auth-address><titles><title>The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus</title><secondary-title>Arch Neurol</secondary-title></titles><periodical><full-title>Arch Neurol</full-title></periodical><pages>1121-3</pages><volume>46</volume><number>10</number><edition>1989/10/01</edition><keywords><keyword>Adult</keyword><keyword>Disability Evaluation</keyword><keyword>Fatigue/*classification/etiology</keyword><keyword>Humans</keyword><keyword>Lupus Erythematosus, Systemic/*complications</keyword><keyword>Multiple Sclerosis/*complications</keyword><keyword>Neurologic Examination/methods</keyword><keyword>*Severity of Illness Index</keyword></keywords><dates><year>1989</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>0003-9942 (Print)0003-9942 (Linking)</isbn><accession-num>2803071</accession-num><urls><related-urls><url>;(Krupp, LaRocca, Muir-Nash, & Steinberg, 1989) is a 9 item self-rated scale that asked the participant how much they agreed with each fatigue related statement. Overall FSS ratings range from 9-63, with higher scores indicating a greater level of functional impairment or distress as a result of fatigue ADDIN EN.CITE <EndNote><Cite><Author>Krupp</Author><Year>1989</Year><RecNum>7079</RecNum><DisplayText>(Krupp et al., 1989)</DisplayText><record><rec-number>7079</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7079</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Krupp, L. B.</author><author>LaRocca, N. G.</author><author>Muir-Nash, J.</author><author>Steinberg, A. D.</author></authors></contributors><auth-address>Department of Neurology, State University of New York, Stony Brook 11794-8121.</auth-address><titles><title>The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus</title><secondary-title>Arch Neurol</secondary-title></titles><periodical><full-title>Arch Neurol</full-title></periodical><pages>1121-3</pages><volume>46</volume><number>10</number><edition>1989/10/01</edition><keywords><keyword>Adult</keyword><keyword>Disability Evaluation</keyword><keyword>Fatigue/*classification/etiology</keyword><keyword>Humans</keyword><keyword>Lupus Erythematosus, Systemic/*complications</keyword><keyword>Multiple Sclerosis/*complications</keyword><keyword>Neurologic Examination/methods</keyword><keyword>*Severity of Illness Index</keyword></keywords><dates><year>1989</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>0003-9942 (Print)0003-9942 (Linking)</isbn><accession-num>2803071</accession-num><urls><related-urls><url>;(Krupp et al., 1989). The ESS ADDIN EN.CITE <EndNote><Cite><Author>Johns</Author><Year>1991</Year><RecNum>14594</RecNum><DisplayText>(Johns, 1991)</DisplayText><record><rec-number>14594</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">14594</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Johns, Murray W</author></authors></contributors><titles><title>A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale</title><secondary-title>Sleep</secondary-title></titles><periodical><full-title>Sleep</full-title></periodical><pages>540-545</pages><volume>14</volume><number>6</number><keywords><keyword>Sleepiness</keyword><keyword>sleep propensity</keyword><keyword>insomnia</keyword><keyword>ESS</keyword></keywords><dates><year>1991</year></dates><urls><related-urls><url>;(Johns, 1991) is an 8 item self-rated scale that asks participants how likely they would be to doze off or fall asleep in several common everyday situations. Overall ESS scores range from 0-24, with scores above 10 indicating excessive daytime sleepiness. Scores above 13 are also considered to be highly indicative of sleep apnea, restless leg syndrome or periodic limb movement disorder ADDIN EN.CITE <EndNote><Cite><Author>Johns</Author><Year>1991</Year><RecNum>14594</RecNum><DisplayText>(Johns, 1991)</DisplayText><record><rec-number>14594</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">14594</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Johns, Murray W</author></authors></contributors><titles><title>A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale</title><secondary-title>Sleep</secondary-title></titles><periodical><full-title>Sleep</full-title></periodical><pages>540-545</pages><volume>14</volume><number>6</number><keywords><keyword>Sleepiness</keyword><keyword>sleep propensity</keyword><keyword>insomnia</keyword><keyword>ESS</keyword></keywords><dates><year>1991</year></dates><urls><related-urls><url>;(Johns, 1991), and participants who remained above this threshold at the follow-up assessment were informed of their results and encouraged to discuss these findings with a general practitioner or sleep specialist.The sleep diary provided a visual depiction of sleep-related behaviours, which made it easier to assess adherence to different behavioural interventions for CBT-I participants and provide individualised feedback in session. The sleep diary was modified by asking participants four additional questions each day to obtain more specific data on their bedtime (BT), time taken to fall asleep (SOL), duration of night-time awakenings (WASO), and rising time (RT). This also made it possible to calculate subjective time in bed (TIB = difference between BT and RT), TST (= TIB - SOL - WASO) and sleep efficiency (= TST / TIB, expressed as a percentage of time in bed asleep) for later data analysis.Secondary outcome measures resultsThe CBT-I intervention was more effective at improving sleep quality, anxiety severity and fatigue severity in comparison to the self-help CBT-I intervention (Figure 5). Significant effect of treatment group was observed for PSQI (p < .001), DASS-A (p < .001), and FSS (p < .001). No significant treatment group effect was found for daytime sleepiness (p = .23) and no interaction effects between treatment group and time were found for any of the secondary outcome measures.Figure S5. Mean ± SEM group (CBT-I, self-help CBT-I) sleep quality (PSQI), anxiety severity (DASS-A), fatigue severity (FSS) and daytime sleepiness (ESS) ratings at baseline (week 0), post-treatment (week 8), and 3-month follow up (week 20). Treatment phase is indicated by the dotted lines (week 2 through to week 8). ** = p < .001.Secondary Outcome Measures DiscussionCBT-I was more effective than self-help CBT-I at improving anxiety. Previous findings support anxiety reductions through CBT-I in individuals with co-morbid insomnia, depression and anxiety ADDIN EN.CITE <EndNote><Cite><Author>Maroti</Author><Year>2011</Year><RecNum>7727</RecNum><DisplayText>(Maroti et al., 2011)</DisplayText><record><rec-number>7727</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7727</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Maroti, D.</author><author>Folkeson, P.</author><author>Jansson-Frojmark, M.</author><author>Linton, S. J.</author></authors></contributors><auth-address>Jansson-Frojmark, MUniv Orebro, Sch Law Psychol & Social Work, Ctr Hlth & Med Psychol CHAMP, SE-70182 Orebro, SwedenUniv Orebro, Sch Law Psychol & Social Work, Ctr Hlth & Med Psychol CHAMP, SE-70182 Orebro, Sweden</auth-address><titles><title>Does treating insomnia with cognitive-behavioural therapy influence comorbid anxiety and depression? An exploratory multiple baseline design with four patients</title><secondary-title>Behav Change</secondary-title></titles><periodical><full-title>Behav Change</full-title></periodical><pages>195-205</pages><volume>28</volume><number>4</number><keywords><keyword>insomnia</keyword><keyword>cognitive behaviour therapy</keyword><keyword>comorbidity</keyword><keyword>anxiety</keyword><keyword>depression</keyword><keyword>psychometric properties</keyword><keyword>disorders</keyword><keyword>trial</keyword><keyword>questionnaire</keyword><keyword>medication</keyword><keyword>inventory</keyword><keyword>adults</keyword></keywords><dates><year>2011</year></dates><isbn>0813-4839</isbn><accession-num>ISI:000298337000003</accession-num><urls><related-urls><url><Go to ISI>://000298337000003</url></related-urls></urls><language>English</language></record></Cite></EndNote>(Maroti et al., 2011). Depression has been found to mediate the relationship between social anxiety and insomnia ADDIN EN.CITE <EndNote><Cite><Author>Buckner</Author><Year>2008</Year><RecNum>12134</RecNum><DisplayText>(Buckner, Bernert, Cromer, Joiner, & Schmidt, 2008)</DisplayText><record><rec-number>12134</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">12134</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Buckner, J. D.</author><author>Bernert, R. A.</author><author>Cromer, K. R.</author><author>Joiner, T. E.</author><author>Schmidt, N. B.</author></authors></contributors><auth-address>Department of Psychology, Florida State University, Tallahassee, Florida 32306-1270, USA.</auth-address><titles><title>Social anxiety and insomnia: the mediating role of depressive symptoms</title><secondary-title>Depress Anxiety</secondary-title></titles><periodical><full-title>Depress Anxiety</full-title><abbr-1>Depression and anxiety</abbr-1></periodical><pages>124-30</pages><volume>25</volume><number>2</number><edition>2007/03/07</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Attitude to Health</keyword><keyword>Comorbidity</keyword><keyword>Cross-Sectional Studies</keyword><keyword>Depression/diagnosis/epidemiology/*psychology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Personality Inventory/statistics & numerical data</keyword><keyword>Phobic Disorders/diagnosis/epidemiology/*psychology</keyword><keyword>Psychometrics</keyword><keyword>Risk Factors</keyword><keyword>Sleep Initiation and Maintenance Disorders/diagnosis/epidemiology/*psychology</keyword><keyword>Students/psychology/statistics & numerical data</keyword></keywords><dates><year>2008</year></dates><isbn>1091-4269 (Print)1091-4269 (Linking)</isbn><accession-num>17340615</accession-num><urls><related-urls><url>;(Buckner, Bernert, Cromer, Joiner, & Schmidt, 2008), so reductions in depression and insomnia through CBT-I could improve anxiety by reducing distress, dissatisfaction with sleep, and concern of daytime functional impairment. Relaxation exercises, which are included in CBT-I to target hyper-arousal symptoms, have also been found to consistently reduce anxiety symptoms ADDIN EN.CITE <EndNote><Cite><Author>Manzoni</Author><Year>2008</Year><RecNum>12136</RecNum><DisplayText>(Manzoni, Pagnini, Castelnuovo, & Molinari, 2008)</DisplayText><record><rec-number>12136</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">12136</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Manzoni, G. M.</author><author>Pagnini, F.</author><author>Castelnuovo, G.</author><author>Molinari, E.</author></authors></contributors><auth-address>Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, San Giuseppe Hospital, Verbania, Italy. gm.manzoni@auxologico.it</auth-address><titles><title>Relaxation training for anxiety: a ten-years systematic review with meta-analysis</title><secondary-title>BMC Psychiatry</secondary-title></titles><periodical><full-title>BMC Psychiatry</full-title></periodical><pages>41</pages><volume>8</volume><edition>2008/06/04</edition><keywords><keyword>Anxiety/*therapy</keyword><keyword>Clinical Trials as Topic</keyword><keyword>Humans</keyword><keyword>Meditation</keyword><keyword>Patient Selection</keyword><keyword>*Relaxation Therapy/classification</keyword><keyword>Research Design</keyword></keywords><dates><year>2008</year></dates><isbn>1471-244X (Electronic)1471-244X (Linking)</isbn><accession-num>18518981</accession-num><urls><related-urls><url> [pii]</electronic-resource-num><language>eng</language></record></Cite></EndNote>(Manzoni, Pagnini, Castelnuovo, & Molinari, 2008). The ongoing reductions in anxiety by follow-up reduce the risk of future insomnia relapse, as anxiety has been found to predict later insomnia onset ADDIN EN.CITE <EndNote><Cite><Author>Johnson</Author><Year>2006</Year><RecNum>7642</RecNum><DisplayText>(Johnson et al., 2006)</DisplayText><record><rec-number>7642</rec-number><foreign-keys><key app="EN" db-id="ppzd2t2ansx50ter2w8ptzxl0tw5f9ws0rwz">7642</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Johnson, E. O.</author><author>Roth, T.</author><author>Breslau, N.</author></authors></contributors><auth-address>Behavioral Health Epidemiology Program, Triangle Institute International, PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC, USA. ejohnson@</auth-address><titles><title>The association of insomnia with anxiety disorders and depression: exploration of the direction of risk</title><secondary-title>J Psychiatr Res</secondary-title></titles><periodical><full-title>J Psychiatr Res</full-title><abbr-1>Journal of psychiatric research</abbr-1></periodical><pages>700-8</pages><volume>40</volume><number>8</number><keywords><keyword>Adolescent</keyword><keyword>Anxiety Disorders/diagnosis/*epidemiology</keyword><keyword>Demography</keyword><keyword>Depressive Disorder, Major/diagnosis/*epidemiology</keyword><keyword>Diagnostic and Statistical Manual of Mental Disorders</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Prevalence</keyword><keyword>Risk Factors</keyword><keyword>Severity of Illness Index</keyword><keyword>Sleep Initiation and Maintenance Disorders/*epidemiology</keyword></keywords><dates><year>2006</year><pub-dates><date>Dec</date></pub-dates></dates><accession-num>16978649</accession-num><urls><related-urls><url> </url></related-urls></urls></record></Cite></EndNote>(Johnson et al., 2006).In terms of daytime symptoms, CBT-I resulted in improved self-reported fatigue but not sleepiness. This is consistent with the view that fatigue, rather than sleepiness, better reflects the daytime impairments experienced by insomnia patients PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGVrbGV0b248L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFy

PjxSZWNOdW0+MTQwOTE8L1JlY051bT48RGlzcGxheVRleHQ+KFNoZWtsZXRvbiwgUm9nZXJzLCAm

YW1wOyBSYWphcmF0bmFtLCAyMDEwKTwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4x

NDA5MTwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InBwemQy

dDJhbnN4NTB0ZXIydzhwdHp4bDB0dzVmOXdzMHJ3eiI+MTQwOTE8L2tleT48L2ZvcmVpZ24ta2V5

cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1

dG9ycz48YXV0aG9ycz48YXV0aG9yPlNoZWtsZXRvbiwgSi4gQS48L2F1dGhvcj48YXV0aG9yPlJv

Z2VycywgTi4gTC48L2F1dGhvcj48YXV0aG9yPlJhamFyYXRuYW0sIFMuIE0uIFcuPC9hdXRob3I+

PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+U2Nob29sIG9mIFBzeWNob2xv

Z3ksIFBzeWNoaWF0cnkgYW5kIFBzeWNob2xvZ2ljYWwgTWVkaWNpbmUsIE1vbmFzaCBVbml2ZXJz

aXR5LCBCdWlsZGluZyAxNywgQ2xheXRvbiBDYW1wdXMsIFZpYy4gMzgwMCwgQXVzdHJhbGlhJiN4

RDtCcmFpbiBhbmQgTWluZCBSZXNlYXJjaCBJbnN0aXR1dGUsIFVuaXZlcnNpdHkgb2YgU3lkbmV5

LCBDYW1wZXJkb3duLCBOU1cgMjA1MCwgQXVzdHJhbGlhPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48

dGl0bGU+U2VhcmNoaW5nIGZvciB0aGUgZGF5dGltZSBpbXBhaXJtZW50cyBvZiBwcmltYXJ5IGlu

c29tbmlhPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPlNsZWVwIE1lZGljaW5lIFJldmlld3M8L3Nl

Y29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5TbGVlcCBNZWRp

Y2luZSBSZXZpZXdzPC9mdWxsLXRpdGxlPjxhYmJyLTE+U2xlZXAgTWVkIFJldjwvYWJici0xPjwv

cGVyaW9kaWNhbD48cGFnZXM+NDctNjA8L3BhZ2VzPjx2b2x1bWU+MTQ8L3ZvbHVtZT48bnVtYmVy

PjE8L251bWJlcj48a2V5d29yZHM+PGtleXdvcmQ+QWxlcnRuZXNzPC9rZXl3b3JkPjxrZXl3b3Jk

PkF0dGVudGlvbjwva2V5d29yZD48a2V5d29yZD5Db2duaXRpdmU8L2tleXdvcmQ+PGtleXdvcmQ+

SW5zb21uaWE8L2tleXdvcmQ+PGtleXdvcmQ+TWVtb3J5PC9rZXl3b3JkPjxrZXl3b3JkPk5ldXJv

YmVoYXZpb3VyYWw8L2tleXdvcmQ+PGtleXdvcmQ+U2xlZXBpbmVzczwva2V5d29yZD48a2V5d29y

ZD5hdHRlbnRpb24gZGlzdHVyYmFuY2U8L2tleXdvcmQ+PGtleXdvcmQ+Y2xpbmljYWwgZmVhdHVy

ZTwva2V5d29yZD48a2V5d29yZD5jb2duaXRpb248L2tleXdvcmQ+PGtleXdvcmQ+Y29nbml0aXZl

IGRlZmVjdDwva2V5d29yZD48a2V5d29yZD5kYXl0aW1lIHNvbW5vbGVuY2U8L2tleXdvcmQ+PGtl

eXdvcmQ+ZGlhZ25vc3RpYyBhbmQgc3RhdGlzdGljYWwgbWFudWFsIG9mIG1lbnRhbCBkaXNvcmRl

cnM8L2tleXdvcmQ+PGtleXdvcmQ+ZGlhZ25vc3RpYyB0ZXN0PC9rZXl3b3JkPjxrZXl3b3JkPmZh

dGlndWU8L2tleXdvcmQ+PGtleXdvcmQ+aHVtYW48L2tleXdvcmQ+PGtleXdvcmQ+am9iIHN0cmVz

czwva2V5d29yZD48a2V5d29yZD5sZWFybmluZyBkaXNvcmRlcjwva2V5d29yZD48a2V5d29yZD5t

ZW1vcnkgZGlzb3JkZXI8L2tleXdvcmQ+PGtleXdvcmQ+bWVudGFsIHN0cmVzczwva2V5d29yZD48

a2V5d29yZD5wYXRob3BoeXNpb2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+cG9seXNvbW5vZ3JhcGh5

PC9rZXl3b3JkPjxrZXl3b3JkPnBzeWNob21vdG9yIGRpc29yZGVyPC9rZXl3b3JkPjxrZXl3b3Jk

PnJldmlldzwva2V5d29yZD48a2V5d29yZD5zbGVlcCBkZXByaXZhdGlvbjwva2V5d29yZD48a2V5

d29yZD50YXNrIHBlcmZvcm1hbmNlPC9rZXl3b3JkPjxrZXl3b3JkPndvcmtpbmcgbWVtb3J5PC9r

ZXl3b3JkPjxrZXl3b3JkPkJyYWluPC9rZXl3b3JkPjxrZXl3b3JkPkNpcmNhZGlhbiBSaHl0aG08

L2tleXdvcmQ+PGtleXdvcmQ+RGlzb3JkZXJzIG9mIEV4Y2Vzc2l2ZSBTb21ub2xlbmNlPC9rZXl3

b3JkPjxrZXl3b3JkPkVsZWN0cm9lbmNlcGhhbG9ncmFwaHk8L2tleXdvcmQ+PGtleXdvcmQ+SHVt

YW5zPC9rZXl3b3JkPjxrZXl3b3JkPk1lbW9yeSwgU2hvcnQtVGVybTwva2V5d29yZD48a2V5d29y

ZD5Qc3ljaG9tb3RvciBQZXJmb3JtYW5jZTwva2V5d29yZD48a2V5d29yZD5TbGVlcCBJbml0aWF0

aW9uIGFuZCBNYWludGVuYW5jZSBEaXNvcmRlcnM8L2tleXdvcmQ+PGtleXdvcmQ+VGltZSBGYWN0

b3JzPC9rZXl3b3JkPjxrZXl3b3JkPldha2VmdWxuZXNzPC9rZXl3b3JkPjwva2V5d29yZHM+PGRh

dGVzPjx5ZWFyPjIwMTA8L3llYXI+PC9kYXRlcz48aXNibj4xMDg3MDc5MiAoSVNTTik8L2lzYm4+

PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHA6Ly93d3cuc2NvcHVzLmNvbS9pbndhcmQvcmVj

b3JkLnVybD9laWQ9Mi1zMi4wLTcyNjQ5MDk4MjE0JmFtcDtwYXJ0bmVySUQ9NDAmYW1wO21kNT01

YjExOWZiMjhmNDBkYjU2N2M2MDUyN2UyZmNlZjc0NjwvdXJsPjx1cmw+aHR0cDovL2FjLmVscy1j

ZG4uY29tL1MxMDg3MDc5MjA5MDAwNDgzLzEtczIuMC1TMTA4NzA3OTIwOTAwMDQ4My1tYWluLnBk

Zj9fdGlkPTk5MTQ2OTJlLWFlNjgtMTFlMy05NjY5LTAwMDAwYWFjYjM1ZiZhbXA7YWNkbmF0PTEz

OTUxMjUxODJfZjAwNmEwYTNkNzQ4MWJjNmI0MWNiMThiOGFkMTI5NzI8L3VybD48L3JlbGF0ZWQt

dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMTYvai5zbXJ2LjIwMDku

MDYuMDAxPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48L0NpdGU+PC9FbmROb3Rl

PgAA

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGVrbGV0b248L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFy

PjxSZWNOdW0+MTQwOTE8L1JlY051bT48RGlzcGxheVRleHQ+KFNoZWtsZXRvbiwgUm9nZXJzLCAm

YW1wOyBSYWphcmF0bmFtLCAyMDEwKTwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4x

NDA5MTwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9InBwemQy

dDJhbnN4NTB0ZXIydzhwdHp4bDB0dzVmOXdzMHJ3eiI+MTQwOTE8L2tleT48L2ZvcmVpZ24ta2V5

cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1

dG9ycz48YXV0aG9ycz48YXV0aG9yPlNoZWtsZXRvbiwgSi4gQS48L2F1dGhvcj48YXV0aG9yPlJv

Z2VycywgTi4gTC48L2F1dGhvcj48YXV0aG9yPlJhamFyYXRuYW0sIFMuIE0uIFcuPC9hdXRob3I+

PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+U2Nob29sIG9mIFBzeWNob2xv

Z3ksIFBzeWNoaWF0cnkgYW5kIFBzeWNob2xvZ2ljYWwgTWVkaWNpbmUsIE1vbmFzaCBVbml2ZXJz

aXR5LCBCdWlsZGluZyAxNywgQ2xheXRvbiBDYW1wdXMsIFZpYy4gMzgwMCwgQXVzdHJhbGlhJiN4

RDtCcmFpbiBhbmQgTWluZCBSZXNlYXJjaCBJbnN0aXR1dGUsIFVuaXZlcnNpdHkgb2YgU3lkbmV5

LCBDYW1wZXJkb3duLCBOU1cgMjA1MCwgQXVzdHJhbGlhPC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48

dGl0bGU+U2VhcmNoaW5nIGZvciB0aGUgZGF5dGltZSBpbXBhaXJtZW50cyBvZiBwcmltYXJ5IGlu

c29tbmlhPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPlNsZWVwIE1lZGljaW5lIFJldmlld3M8L3Nl

Y29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5TbGVlcCBNZWRp

Y2luZSBSZXZpZXdzPC9mdWxsLXRpdGxlPjxhYmJyLTE+U2xlZXAgTWVkIFJldjwvYWJici0xPjwv

cGVyaW9kaWNhbD48cGFnZXM+NDctNjA8L3BhZ2VzPjx2b2x1bWU+MTQ8L3ZvbHVtZT48bnVtYmVy

PjE8L251bWJlcj48a2V5d29yZHM+PGtleXdvcmQ+QWxlcnRuZXNzPC9rZXl3b3JkPjxrZXl3b3Jk

PkF0dGVudGlvbjwva2V5d29yZD48a2V5d29yZD5Db2duaXRpdmU8L2tleXdvcmQ+PGtleXdvcmQ+

SW5zb21uaWE8L2tleXdvcmQ+PGtleXdvcmQ+TWVtb3J5PC9rZXl3b3JkPjxrZXl3b3JkPk5ldXJv

YmVoYXZpb3VyYWw8L2tleXdvcmQ+PGtleXdvcmQ+U2xlZXBpbmVzczwva2V5d29yZD48a2V5d29y

ZD5hdHRlbnRpb24gZGlzdHVyYmFuY2U8L2tleXdvcmQ+PGtleXdvcmQ+Y2xpbmljYWwgZmVhdHVy

ZTwva2V5d29yZD48a2V5d29yZD5jb2duaXRpb248L2tleXdvcmQ+PGtleXdvcmQ+Y29nbml0aXZl

IGRlZmVjdDwva2V5d29yZD48a2V5d29yZD5kYXl0aW1lIHNvbW5vbGVuY2U8L2tleXdvcmQ+PGtl

eXdvcmQ+ZGlhZ25vc3RpYyBhbmQgc3RhdGlzdGljYWwgbWFudWFsIG9mIG1lbnRhbCBkaXNvcmRl

cnM8L2tleXdvcmQ+PGtleXdvcmQ+ZGlhZ25vc3RpYyB0ZXN0PC9rZXl3b3JkPjxrZXl3b3JkPmZh

dGlndWU8L2tleXdvcmQ+PGtleXdvcmQ+aHVtYW48L2tleXdvcmQ+PGtleXdvcmQ+am9iIHN0cmVz

czwva2V5d29yZD48a2V5d29yZD5sZWFybmluZyBkaXNvcmRlcjwva2V5d29yZD48a2V5d29yZD5t

ZW1vcnkgZGlzb3JkZXI8L2tleXdvcmQ+PGtleXdvcmQ+bWVudGFsIHN0cmVzczwva2V5d29yZD48

a2V5d29yZD5wYXRob3BoeXNpb2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+cG9seXNvbW5vZ3JhcGh5

PC9rZXl3b3JkPjxrZXl3b3JkPnBzeWNob21vdG9yIGRpc29yZGVyPC9rZXl3b3JkPjxrZXl3b3Jk

PnJldmlldzwva2V5d29yZD48a2V5d29yZD5zbGVlcCBkZXByaXZhdGlvbjwva2V5d29yZD48a2V5

d29yZD50YXNrIHBlcmZvcm1hbmNlPC9rZXl3b3JkPjxrZXl3b3JkPndvcmtpbmcgbWVtb3J5PC9r

ZXl3b3JkPjxrZXl3b3JkPkJyYWluPC9rZXl3b3JkPjxrZXl3b3JkPkNpcmNhZGlhbiBSaHl0aG08

L2tleXdvcmQ+PGtleXdvcmQ+RGlzb3JkZXJzIG9mIEV4Y2Vzc2l2ZSBTb21ub2xlbmNlPC9rZXl3

b3JkPjxrZXl3b3JkPkVsZWN0cm9lbmNlcGhhbG9ncmFwaHk8L2tleXdvcmQ+PGtleXdvcmQ+SHVt

YW5zPC9rZXl3b3JkPjxrZXl3b3JkPk1lbW9yeSwgU2hvcnQtVGVybTwva2V5d29yZD48a2V5d29y

ZD5Qc3ljaG9tb3RvciBQZXJmb3JtYW5jZTwva2V5d29yZD48a2V5d29yZD5TbGVlcCBJbml0aWF0

aW9uIGFuZCBNYWludGVuYW5jZSBEaXNvcmRlcnM8L2tleXdvcmQ+PGtleXdvcmQ+VGltZSBGYWN0

b3JzPC9rZXl3b3JkPjxrZXl3b3JkPldha2VmdWxuZXNzPC9rZXl3b3JkPjwva2V5d29yZHM+PGRh

dGVzPjx5ZWFyPjIwMTA8L3llYXI+PC9kYXRlcz48aXNibj4xMDg3MDc5MiAoSVNTTik8L2lzYm4+

PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHA6Ly93d3cuc2NvcHVzLmNvbS9pbndhcmQvcmVj

b3JkLnVybD9laWQ9Mi1zMi4wLTcyNjQ5MDk4MjE0JmFtcDtwYXJ0bmVySUQ9NDAmYW1wO21kNT01

YjExOWZiMjhmNDBkYjU2N2M2MDUyN2UyZmNlZjc0NjwvdXJsPjx1cmw+aHR0cDovL2FjLmVscy1j

ZG4uY29tL1MxMDg3MDc5MjA5MDAwNDgzLzEtczIuMC1TMTA4NzA3OTIwOTAwMDQ4My1tYWluLnBk

Zj9fdGlkPTk5MTQ2OTJlLWFlNjgtMTFlMy05NjY5LTAwMDAwYWFjYjM1ZiZhbXA7YWNkbmF0PTEz

OTUxMjUxODJfZjAwNmEwYTNkNzQ4MWJjNmI0MWNiMThiOGFkMTI5NzI8L3VybD48L3JlbGF0ZWQt

dXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMTYvai5zbXJ2LjIwMDku

MDYuMDAxPC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48L0NpdGU+PC9FbmROb3Rl

PgAA

ADDIN EN.CITE.DATA (Shekleton, Rogers, & Rajaratnam, 2010). It was recently shown that individuals with primary insomnia report higher levels of fatigue compared to healthy controls, but similar levels of daytime sleepiness PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGVrbGV0b248L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy

PjxSZWNOdW0+MTQwOTA8L1JlY051bT48RGlzcGxheVRleHQ+KFNoZWtsZXRvbiBldCBhbC4sIDIw

MTMpPC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjE0MDkwPC9yZWMtbnVtYmVyPjxm

b3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0icHB6ZDJ0MmFuc3g1MHRlcjJ3OHB0enhs

MHR3NWY5d3Mwcnd6Ij4xNDA5MDwva2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJK

b3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRo

b3I+U2hla2xldG9uLCBKLiBBLjwvYXV0aG9yPjxhdXRob3I+UmFqYXJhdG5hbSwgUy4gTS4gVy48

L2F1dGhvcj48YXV0aG9yPkdvb2xleSwgSi4gSi48L2F1dGhvcj48YXV0aG9yPlZhbiBSZWVuLCBF

LjwvYXV0aG9yPjxhdXRob3I+Q3plaXNsZXIsIEMuIEEuPC9hdXRob3I+PGF1dGhvcj5Mb2NrbGV5

LCBTLiBXLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRp

dmlzaW9uIG9mIFNsZWVwIE1lZGljaW5lLCBEZXBhcnRtZW50IG9mIE1lZGljaW5lLCBCcmlnaGFt

IGFuZCBXb21lbiZhcG9zO3MgSG9zcGl0YWwsIEJvc3RvbiwgTUEsIFVuaXRlZCBTdGF0ZXMmI3hE

O0RpdmlzaW9uIG9mIFNsZWVwIE1lZGljaW5lLCBEZXBhcnRtZW50IG9mIE1lZGljaW5lLCBIYXJ2

YXJkIE1lZGljYWwgU2Nob29sLCBCb3N0b24sIE1BLCBVbml0ZWQgU3RhdGVzJiN4RDtTY2hvb2wg

b2YgUHN5Y2hvbG9neSBhbmQgUHN5Y2hpYXRyeSwgTW9uYXNoIFVuaXZlcnNpdHksIE1lbGJvdXJu

ZSwgVklDLCBBdXN0cmFsaWE8L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5JbXByb3ZlZCBu

ZXVyb2JlaGF2aW9yYWwgcGVyZm9ybWFuY2UgZHVyaW5nIHRoZSB3YWtlIG1haW50ZW5hbmNlIHpv

bmU8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+Sm91cm5hbCBvZiBDbGluaWNhbCBTbGVlcCBNZWRp

Y2luZTwvc2Vjb25kYXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkpv

dXJuYWwgb2YgQ2xpbmljYWwgU2xlZXAgTWVkaWNpbmU8L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2Fs

PjxwYWdlcz4zNTMtMzYyPC9wYWdlcz48dm9sdW1lPjk8L3ZvbHVtZT48bnVtYmVyPjQ8L251bWJl

cj48a2V5d29yZHM+PGtleXdvcmQ+Q2lyY2FkaWFuPC9rZXl3b3JkPjxrZXl3b3JkPkNvZ25pdGlv

bjwva2V5d29yZD48a2V5d29yZD5ETE1PPC9rZXl3b3JkPjxrZXl3b3JkPk1lbGF0b25pbjwva2V5

d29yZD48a2V5d29yZD5QZXJmb3JtYW5jZTwva2V5d29yZD48a2V5d29yZD5QVlQ8L2tleXdvcmQ+

PGtleXdvcmQ+U2xlZXAgcmVndWxhdGlvbjwva2V5d29yZD48a2V5d29yZD5Ud28tcHJvY2VzcyBt

b2RlbDwva2V5d29yZD48a2V5d29yZD5hZHVsdDwva2V5d29yZD48a2V5d29yZD5hbGVydG5lc3M8

L2tleXdvcmQ+PGtleXdvcmQ+YXJ0aWNsZTwva2V5d29yZD48a2V5d29yZD5jb250cm9sbGVkIHN0

dWR5PC9rZXl3b3JkPjxrZXl3b3JkPmZlbWFsZTwva2V5d29yZD48a2V5d29yZD5ob3Jtb25lIGJs

b29kIGxldmVsPC9rZXl3b3JkPjxrZXl3b3JkPmh1bWFuPC9rZXl3b3JkPjxrZXl3b3JkPmh1bWFu

IGV4cGVyaW1lbnQ8L2tleXdvcmQ+PGtleXdvcmQ+bWFsZTwva2V5d29yZD48a2V5d29yZD5tZW50

YWwgcGVyZm9ybWFuY2U8L2tleXdvcmQ+PGtleXdvcmQ+bm9ybWFsIGh1bWFuPC9rZXl3b3JkPjxr

ZXl3b3JkPnJlYWN0aW9uIHRpbWU8L2tleXdvcmQ+PGtleXdvcmQ+c2xlZXAgZGVwcml2YXRpb248

L2tleXdvcmQ+PGtleXdvcmQ+c2xlZXAgd2FraW5nIGN5Y2xlPC9rZXl3b3JkPjxrZXl3b3JkPndh

a2VmdWxuZXNzPC9rZXl3b3JkPjxrZXl3b3JkPkFkb2xlc2NlbnQ8L2tleXdvcmQ+PGtleXdvcmQ+

Q2lyY2FkaWFuIFJoeXRobTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdv

cmQ+UG9seXNvbW5vZ3JhcGh5PC9rZXl3b3JkPjxrZXl3b3JkPlBzeWNob21vdG9yIFBlcmZvcm1h

bmNlPC9rZXl3b3JkPjxrZXl3b3JkPlNsZWVwIFN0YWdlczwva2V5d29yZD48a2V5d29yZD5Zb3Vu

ZyBBZHVsdDwva2V5d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDEzPC95ZWFyPjwvZGF0

ZXM+PGlzYm4+MTU1MDkzODkgKElTU04pPC9pc2JuPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5o

dHRwOi8vd3d3LnNjb3B1cy5jb20vaW53YXJkL3JlY29yZC51cmw/ZWlkPTItczIuMC04NDg3ODA3

NTEzMSZhbXA7cGFydG5lcklEPTQwJmFtcDttZDU9YWI4NmRiOWU4NzU2M2FmMzE0YTNlMGJmMzk0

MGU4ZjA8L3VybD48L3JlbGF0ZWQtdXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVt

PjEwLjU2NjQvamNzbS4yNTg4PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48L0Np

dGU+PC9FbmROb3RlPgB=

ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGVrbGV0b248L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy

PjxSZWNOdW0+MTQwOTA8L1JlY051bT48RGlzcGxheVRleHQ+KFNoZWtsZXRvbiBldCBhbC4sIDIw

MTMpPC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjE0MDkwPC9yZWMtbnVtYmVyPjxm

b3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0icHB6ZDJ0MmFuc3g1MHRlcjJ3OHB0enhs

MHR3NWY5d3Mwcnd6Ij4xNDA5MDwva2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJK

b3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRo

b3I+U2hla2xldG9uLCBKLiBBLjwvYXV0aG9yPjxhdXRob3I+UmFqYXJhdG5hbSwgUy4gTS4gVy48

L2F1dGhvcj48YXV0aG9yPkdvb2xleSwgSi4gSi48L2F1dGhvcj48YXV0aG9yPlZhbiBSZWVuLCBF

LjwvYXV0aG9yPjxhdXRob3I+Q3plaXNsZXIsIEMuIEEuPC9hdXRob3I+PGF1dGhvcj5Mb2NrbGV5

LCBTLiBXLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRp

dmlzaW9uIG9mIFNsZWVwIE1lZGljaW5lLCBEZXBhcnRtZW50IG9mIE1lZGljaW5lLCBCcmlnaGFt

IGFuZCBXb21lbiZhcG9zO3MgSG9zcGl0YWwsIEJvc3RvbiwgTUEsIFVuaXRlZCBTdGF0ZXMmI3hE

O0RpdmlzaW9uIG9mIFNsZWVwIE1lZGljaW5lLCBEZXBhcnRtZW50IG9mIE1lZGljaW5lLCBIYXJ2

YXJkIE1lZGljYWwgU2Nob29sLCBCb3N0b24sIE1BLCBVbml0ZWQgU3RhdGVzJiN4RDtTY2hvb2wg

b2YgUHN5Y2hvbG9neSBhbmQgUHN5Y2hpYXRyeSwgTW9uYXNoIFVuaXZlcnNpdHksIE1lbGJvdXJu

ZSwgVklDLCBBdXN0cmFsaWE8L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5JbXByb3ZlZCBu

ZXVyb2JlaGF2aW9yYWwgcGVyZm9ybWFuY2UgZHVyaW5nIHRoZSB3YWtlIG1haW50ZW5hbmNlIHpv

bmU8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+Sm91cm5hbCBvZiBDbGluaWNhbCBTbGVlcCBNZWRp

Y2luZTwvc2Vjb25kYXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkpv

dXJuYWwgb2YgQ2xpbmljYWwgU2xlZXAgTWVkaWNpbmU8L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2Fs

PjxwYWdlcz4zNTMtMzYyPC9wYWdlcz48dm9sdW1lPjk8L3ZvbHVtZT48bnVtYmVyPjQ8L251bWJl

cj48a2V5d29yZHM+PGtleXdvcmQ+Q2lyY2FkaWFuPC9rZXl3b3JkPjxrZXl3b3JkPkNvZ25pdGlv

bjwva2V5d29yZD48a2V5d29yZD5ETE1PPC9rZXl3b3JkPjxrZXl3b3JkPk1lbGF0b25pbjwva2V5

d29yZD48a2V5d29yZD5QZXJmb3JtYW5jZTwva2V5d29yZD48a2V5d29yZD5QVlQ8L2tleXdvcmQ+

PGtleXdvcmQ+U2xlZXAgcmVndWxhdGlvbjwva2V5d29yZD48a2V5d29yZD5Ud28tcHJvY2VzcyBt

b2RlbDwva2V5d29yZD48a2V5d29yZD5hZHVsdDwva2V5d29yZD48a2V5d29yZD5hbGVydG5lc3M8

L2tleXdvcmQ+PGtleXdvcmQ+YXJ0aWNsZTwva2V5d29yZD48a2V5d29yZD5jb250cm9sbGVkIHN0

dWR5PC9rZXl3b3JkPjxrZXl3b3JkPmZlbWFsZTwva2V5d29yZD48a2V5d29yZD5ob3Jtb25lIGJs

b29kIGxldmVsPC9rZXl3b3JkPjxrZXl3b3JkPmh1bWFuPC9rZXl3b3JkPjxrZXl3b3JkPmh1bWFu

IGV4cGVyaW1lbnQ8L2tleXdvcmQ+PGtleXdvcmQ+bWFsZTwva2V5d29yZD48a2V5d29yZD5tZW50

YWwgcGVyZm9ybWFuY2U8L2tleXdvcmQ+PGtleXdvcmQ+bm9ybWFsIGh1bWFuPC9rZXl3b3JkPjxr

ZXl3b3JkPnJlYWN0aW9uIHRpbWU8L2tleXdvcmQ+PGtleXdvcmQ+c2xlZXAgZGVwcml2YXRpb248

L2tleXdvcmQ+PGtleXdvcmQ+c2xlZXAgd2FraW5nIGN5Y2xlPC9rZXl3b3JkPjxrZXl3b3JkPndh

a2VmdWxuZXNzPC9rZXl3b3JkPjxrZXl3b3JkPkFkb2xlc2NlbnQ8L2tleXdvcmQ+PGtleXdvcmQ+

Q2lyY2FkaWFuIFJoeXRobTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdv

cmQ+UG9seXNvbW5vZ3JhcGh5PC9rZXl3b3JkPjxrZXl3b3JkPlBzeWNob21vdG9yIFBlcmZvcm1h

bmNlPC9rZXl3b3JkPjxrZXl3b3JkPlNsZWVwIFN0YWdlczwva2V5d29yZD48a2V5d29yZD5Zb3Vu

ZyBBZHVsdDwva2V5d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDEzPC95ZWFyPjwvZGF0

ZXM+PGlzYm4+MTU1MDkzODkgKElTU04pPC9pc2JuPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5o

dHRwOi8vd3d3LnNjb3B1cy5jb20vaW53YXJkL3JlY29yZC51cmw/ZWlkPTItczIuMC04NDg3ODA3

NTEzMSZhbXA7cGFydG5lcklEPTQwJmFtcDttZDU9YWI4NmRiOWU4NzU2M2FmMzE0YTNlMGJmMzk0

MGU4ZjA8L3VybD48L3JlbGF0ZWQtdXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVt

PjEwLjU2NjQvamNzbS4yNTg4PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48L3JlY29yZD48L0Np

dGU+PC9FbmROb3RlPgB=

ADDIN EN.CITE.DATA (Shekleton et al., 2013). Therefore, an intervention that targets insomnia would be expected to relieve daytime fatigue symptoms.Differences between groups on all outcome measures at baseline, post-treatment and 3-month follow-up assessmentsMeasureBaselinePost-treatmentFollow-upCBT-Imean (SEM)Self-help CBT-I mean (SEM)Mean difference (95% CI)pCBT-I mean (SEM)Self-help CBT-I mean (SEM)Mean difference (95% CI)pdCBT-Imean (SEM)Self-help CBT-Imean (SEM)Mean difference (95% CI)pdBDI-II26.62 (1.90)28.20 (1.77)1.58 (-3.69 – 6.85).558.29 (1.85)21.80 (2.88)13.51(6.60 – 20.37)< .0011.248.83 (1.82)22.61 (1.87)13.78 (8.50 – 19.06)< .0011.65ISI18.95 (0.77)18.30 (1.12)-0.65 (-3.37 – 2.07).637.81 (1.35)13.75 (1.51)5.94(1.85 – 10.03)< .010.925.50 (0.77)14.39 (1.28)8.89 (5.90 – 11.88)< .0011.87PSQI12.71 (0.66)12.65 (0.77)-0.06 (-2.11 – 1.98).956.05 (.61)9.90 (0.82)3.85(1.81 – 5.90)< .0011.195.00 (0.57)10.06 (0.72)5.06 (3.22 – 6.90)< .0011.73DASS-A12.95 (2.15)15.90 (1.99)2.95 (-2.98 – 8.88).325.24 (1.54)13.00 (1.87)7.76(2.88 – 12.64)< .0051.005.44 (1.57)14.89 (1.52)9.45 (5.03 – 13.86)< .0011.35ESS10.43 (1.37)9.10 (1.32)-1.33 (-5.18 – 2.52).497.33 (1.22)6.90 (1.01)-0.43(-3.65 – 2.78).790.087.10 (1.23)8.28(0.79)1.17 (-1.81 – 4.16).430.25FSS45.43 (2.76)42.55 (3.08)-2.88 (-11.23 – 5.47).4932.10 (3.29)40.20 (2.75)8.11(-.62 – 16.83).070.5930.83 (3.07)42.94 (2.49)12.11 (4.08 – 20.14)< .0050.96Subjective SOL (min)62.01 (9.30)50.99 (9.06)-11.01 (-37.30 – 15.27).4025.23 (2.60)32.96 (4.35)7.73(-2.41 – 17.87).130.4824.27 (3.10)36.23 (4.67)11.96 (0.72 – 23.20)< .050.67Objective SOL (min)33.29 (3.95)33.78 (6.70)0.49 (-15.07 – 16.05).9515.02 (2.00)22.74 (3.82)7.72(-0.88 – 16.31).080.56-----Subjective SE (%)75.91 (1.98)79.20 (2.09)-3.29 (-9.10 – 2.52).2687.65 (1.34)82.93 (1.74)4.72(0.31 - 9.13)< .050.6789.89 (0.86)82.66 (1.88)7.23(3.11 - 11.35).0011.10Objective SE (%)76.98 (1.53)76.02 (2.02)0.97 (-4.13 – 6.06).7083.25 (1.30)78.41 (1.72)4.84(0.50 - 9.18)< .050.70-----Subjective TST (min)393.24 (9.93)398.55 (16.26)-5.31 (-43.43 – 32.81).78426.38 (10.58)400.84 (10.64)25.54(-4.81 – 55.89).100.53438.75 (10.17)399.36 (12.82)39.39 (6.47 – 72.31)< .050.75Objective TST (min)399.12 (8.72)395.10 (11.90)4.03 (-25.61 – 33.66).79396.32 (10.46)367.99 (9.23)28.33(-0.02 – 56.68).050.63-----Abbreviations: BDI-II Beck Depression Inventory-II; ISI Insomnia Severity Index; PSQI Pittsburgh Sleep Quality Index; DASS-A Depression Anxiety Stress Scales-Anxiety; ESS Epworth Sleepiness Scale; FSS Fatigue Severity Scale; SOL sleep onset latency; SE sleep efficiency; TST total sleep time; CBT-I cognitive behavioral therapy for insomnia; SEM standard error of the mean; CI confidence interval. References ADDIN EN.REFLIST Bernstein, D. A., Borkovec, T. D., & Hazlett-Stevens, H. (2000). New directions in progressive relaxation training: A guidebook for helping professionals. Westport, CT: Praeger Publishers.Bootzin, R. (1972). Stimulus control treatment for insomnia. Paper presented at the Proceedings of the 80th Annual Convention of the American Psychological Association.Buckner, J. D., Bernert, R. A., Cromer, K. R., Joiner, T. E., & Schmidt, N. B. (2008). Social anxiety and insomnia: the mediating role of depressive symptoms. Depress Anxiety, 25(2), 124-130.Buysse, D. J., Reynolds, C. F., 3rd, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213.Ebben, M. R., & Spielman, A. J. (2009). Non-pharmacological treatments for insomnia. J Behav Med, 32(3), 244-254.Edinger, J. D., & Carney, C. E. (2008). Overcoming Insomnia: A Cognitive-behavioral Therapy Approach Therapist Guide: Oxford University Press.Edinger, J. D., & Means, M. K. (2005). Cognitive-behavioral therapy for primary insomnia. Clin Psychol Rev, 25(5), 539-558.Harris, R. (2008). The happiness trap: How to stop struggling and start living: Shambhala Publications.Harris, R. (2009). ACT made simple. New Harbinger.Harvey, A. G., & Payne, S. (2002). The management of unwanted pre-sleep thoughts in insomnia: distraction with imagery versus general distraction. Behav Res Ther, 40(3), 267-277.Johns, M. W. (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep, 14(6), 540-545.Johnson, E. O., Roth, T., & Breslau, N. (2006). The association of insomnia with anxiety disorders and depression: exploration of the direction of risk. J Psychiatr Res, 40(8), 700-708.Krupp, L. B., LaRocca, N. G., Muir-Nash, J., & Steinberg, A. D. (1989). The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol, 46(10), 1121-1123.Levey, A. B., Aldaz, J. A., Watts, F. N., & Coyle, K. (1991). Articulatory Suppression and the Treatment of Insomnia. Behaviour Research and Therapy, 29(1), 85-89.Lichstein, K. L., & Rosenthal, T. L. (1980). Insomniacs' perceptions of cognitive versus somatic determinants of sleep disturbance. J Abnorm Psychol, 89(1), 105-107.Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther, 33(3), 335-343.Lundh, L.-G. (2000). An Integrative Model for the Analysis and Treatment of Insomnia. Scandinavian Journal of Behaviour Therapy, 29(3-4), 118-126.Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J Consult Clin Psychol, 72(1), 31-40.Manzoni, G. M., Pagnini, F., Castelnuovo, G., & Molinari, E. (2008). Relaxation training for anxiety: a ten-years systematic review with meta-analysis. BMC Psychiatry, 8, 41.Maroti, D., Folkeson, P., Jansson-Frojmark, M., & Linton, S. J. (2011). Does treating insomnia with cognitive-behavioural therapy influence comorbid anxiety and depression? An exploratory multiple baseline design with four patients. Behav Change, 28(4), 195-205.Morin, C. M. (1993). Insomnia: Psychological assessment and management. New York: Guildford Press.Morin, C. M., & Azrin, N. H. (1987). Stimulus control and imagery training in treating sleep-maintenance insomnia. J Consult Clin Psychol, 55(2), 260-262.Morin, C. M., & Espie, C. A. (2003). Insomnia: A clinical guide to assessment and treatment. New York: Kluwer Academic/Plenum Publishers.Nelson, J., & Harvey, A. G. (2002). The differential functions of imagery and verbal thought in insomnia. J Abnorm Psychol, 111(4), 665-669.Ong, J. C., Shapiro, S. L., & Manber, R. (2008). Combining mindfulness meditation with cognitive-behavior therapy for insomnia: A treatment-development study. Behav Ther, 39(2), 171-182.Shekleton, J. A., Rajaratnam, S. M. W., Gooley, J. J., Van Reen, E., Czeisler, C. A., & Lockley, S. W. (2013). Improved neurobehavioral performance during the wake maintenance zone. Journal of Clinical Sleep Medicine, 9(4), 353-362.Shekleton, J. A., Rogers, N. L., & Rajaratnam, S. M. W. (2010). Searching for the daytime impairments of primary insomnia. Sleep Medicine Reviews, 14(1), 47-60.Smith, M. T., & Posner, D. A. (2005). Cognitive behavioral treatment of insomnia: A session-by-session guide (Vol. 1): Springer.Spielman, A. J., Saskin, P., & Thorpy, M. J. (1987). Treatment of chronic insomnia by restriction of time in bed. Sleep, 10(1), 45-56. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

To fulfill the demand for quickly locating and searching documents.

It is intelligent file search solution for home and business.

Literature Lottery

To fulfill the demand for quickly locating and searching documents.

Related download

Related searches