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
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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
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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
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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaGVrbGV0b248L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFy
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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. 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