Cognitive behavioral therapy showed to help with insomnia, even with other health conditions

A study shows that talk therapy, specifically cognitive behavioral therapy, helps people with insomnia, even if they have other health conditions.

Talk therapy may help treat insomnia in people with physical or mental health problems, a new study suggests.

With cognitive behavioral therapy, people talk with a therapist to identify the negative thoughts and feelings that cause them problems, and to learn ways to solve their problems, according to the U.S. National Institute of Mental Health.

Past studies have found cognitive behavioral therapy for insomnia can improve sleep. But, many of those studies didn't include people with psychiatric and medical conditions.

For the new study, researchers from Rush University Medical Center in Chicago looked at 37 previous studies. The research included nearly 2,200 people and looked at cognitive behavioral therapy for insomnia in people who had depression, alcoholism and post-traumatic stress disorder and/or with medical conditions such as cancer, chronic pain and fibromyalgia.

The new analysis showed that cognitive behavioral therapy for insomnia reduced insomnia symptoms and sleep disturbances. Twice as many people who received the therapy no longer had insomnia, compared to people who didn't have the therapy, the researchers said.

Cognitive behavioral therapy was also associated with positive effects on co-existing psychiatric and medical conditions, but it showed the strongest benefit with psychiatric disorders.

This may be due to a stronger link between psychiatric disorders and insomnia, the researchers said.

The findings provide support for using talk therapy as a treatment for insomnia in people who have other psychiatric conditions, study author Jason Ong, a behavioral sleep medicine specialist at Rush University Medical Center, and colleagues concluded in a university news release.

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Few children with ADHD get behavioral therapy

A study found that children who take ADHD medication get little psychotherapy or behavioral treatment to complement their medication.

Few children who take medication for attention-deficit/hyperactivity disorder (ADHD) also undergo behavioral therapy, and the rates vary six-fold across counties in the United States, a new study finds.

Medication alone can manage symptoms for many children with ADHD, but some do better if they also receive behavioral therapy (psychotherapy), the Rand Corp. researchers noted.

The researchers analyzed data in more than 1,500 counties across the United States that included more than 300,000 privately insured children, aged 17 and younger, who were prescribed ADHD drugs. Less than a quarter of them received any psychotherapy in the same year they took ADHD medications; 13 percent had at least four therapy visits, and seven percent had at least eight therapy sessions.

In some counties, fewer than 10 percent of kids taking ADHD drugs got behavioral therapy, according to the study, which was published as a research letter in the Sept. 22 issue of the journal JAMA Pediatrics.

Those who lived in counties with fewer licensed psychologists were less likely to receive psychotherapy while taking ADHD drugs, the data showed. But even in some counties where the number of psychologists were the same, the rates varied.

In California's Sacramento County, almost half the kids with ADHD received therapy along with drugs, compared to only about 20 percent of those in Florida's Miami-Dade County, the researchers noted.

"Treatment of ADHD in children generates lots of controversy, primarily because of potential for overuse and abuse of stimulant medications," study author Dr. Walid Gellad, an adjunct scientist at Rand, said in a news release from the nonprofit research organization.

"We wanted to find out among those who receive ADHD medications, how many are also receive billed psychotherapy services? The answer is few, but it actually depends on where you live," Gellad said.

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Link between insomnia and depression

This article discusses the link that exists between insomnia and depression.

We all have times when we feel blue. And there are nights when we just can’t sleep. But it seems that depression and insomnia are closely intertwined, exacerbating each other’s symptoms and complicating treatment.

Insomnia has long been viewed as a symptom of depression. At least 80 percent of depressed patients have trouble falling or staying asleep. An additional 15 percent report they sleep too much. Doctors believed that treating the depression would alleviate sleep problems at the same time.

New research indicates that curing insomnia may make depression treatments more effective. A study conducted by Colleen Carney at Ryerson University in Toronto found that 87 percent of subjects who resolved sleep issues using biweekly talk therapy also saw their depression improve after eight weeks of treatment. That’s twice the success rate of the subjects who didn’t better their sleep.

In 2008, Rachel Manber of Stanford found that 60 percent of patients receiving seven sessions of talk therapy plus an antidepressant fully recovered from their depression, compared to 33 percent who received the same medication and sleep hygiene counseling alone.

The kind of therapy used in these experiments is called cognitive behavioral therapy for insomnia, or CBT-I. The therapist instructs clients to establish and adhere to a regular sleep schedule, to get out of bed during periods of wakefulness, to avoid eating or use of electronics in bed and to eliminate daytime napping.

Insomnia may even predict the onset of depression. Sleep researcher Michael Perlis, Ph.D., has shown that sleep disturbances precede episodes of depression by about five weeks. And sleep disorders intensify over the course of a new depressive episode or relapse.

According to Perlis, associate professor of psychiatry and neuroscience at the University of Rochester, disordered sleep sets off a chain of disruptive symptoms that leads to fatigue, irritability, confusion and loss of memory, disinterest in social activities and lack of pleasure.

The subsequent sleep loss makes people more susceptible to depression and increases the likelihood of further episodes.

The good news is that both disorders are treatable regardless of which causes the other. The first step is to get a proper diagnosis in order to embark on the appropriate path.

ELIMINATING INSOMNIA

The National Sleep Foundation offers the following suggestions for overcoming insomnia:

• Keep a sleep diary. Include all pertinent data, such as the time you go to bed, number of times you wake up during the night, medications taken, amount of caffeine consumed during the day, number of naps and time spent exercising. You’ll quickly notice which actions support good sleep behavior and which ones cause disruptions.
• Eat light meals early in the evening. Heavy meals can cause discomfort. Spicy food may lead to heartburn.
• Steer clear of alcohol. Although alcohol is a sedative and may initially help you fall asleep, it disrupts sleep later in the night.
• Learn to relax. One simple technique is to lie quietly on your bed and systematically tense and relax various muscle groups in your body. You may also practice deep breathing, guided imagery or meditation.
• Evaluate your room. Make sure you have a clean, comfortable, quiet and dark sleep space. Use a sound machine or fan to block unwanted noise. Install blinds to close out streetlights and morning light.
• Wind down. Your body needs time to shift into sleep mode. Devote the hour before bedtime to calming activities, such as reading or taking a warm bath. You’ll be mentally and physically calmer. Your actions will signal your brain that it’s time to go to bed.
  
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Ways to treat insomnia

This article discusses insomnia and how to treat it.

Insomnia is difficulty getting to sleep or staying asleep for long enough for an individual to feel refreshed the next morning, even if one has had enough opportunity to sleep. Sleep is the natural state of unconsciousness that enables one’s body to rest. During such state, the body goes through various sleep stages in a cycle like drowsiness, light sleep, deep sleep and dreaming.  insomnia or in other word sleeplessness, is a sleep disorder which exhibits an inability to fall asleep or to stay asleep as long as desired.

Definition of normal sleep remains difficult since people differ on the basis of age, diet, environments and lifestyles – factors that play a role in determining the amount of sleep one need. Notably, insomnia is not the only sleep disorder although it is the most common sleep complaints; hence it at times becomes a symptom of another problem which differs from one person to another. insomnia can be classified as transient, acute or chronic.

Treatment of insomnia requires its cause for instance, if it is caused by an underlying medical condition or not.insomnia can be treated by the following means:

Ensuring good sleep hygiene

A general practitioner may assist you in knowing what to do in order to get sleep – also known as good sleep hygiene. Tips for good sleep hygiene include establishing set times for going to bed and waking up, making sure you relax before going to bed, ensuring a comfortable sleeping environment, avoiding a daytime nap, avoiding late night caffeine, nicotine and alcohol, avoiding exercise four hours to bedtime, avoiding eating a heavy meal late in the night, avoiding glancing at the clock all through the night and using the bedroom only when you want to sleep and sex.

If your insomnia lasts more than four weeks, your general practitioner may either recommend cognitive and behavioral treatments or short course of sleeping tablets for immediate relief.

Cognitive and behavioral treatments

This is aimed at changing unhelpful thoughts and behaviors that may be contributing to insomnia. This includes stimulus control therapy which helps remove factors that condition one’s mind to resist sleep, sleep restriction therapy – increasing the time one spends in bed by improving sleep, relaxation training to help you calm your mind and body through muscle relaxation, imagery and meditation, paradoxical intention which refers to letting go of any worry that keeps you awake and biofeedback – a method that allows the observation of biological signs like muscle tension and heart rate and shows you how to adjust them. CBT-I is at times performed by a specially trained general practitioner or a clinical psychologist.

Sleeping tablets

Sleeping tablets are drugs that promote sleep. They are usually used when you have a severe insomnia, to relieve short term insomnia and in case the above mentioned behavioral treatments prove ineffective. Doctors are mostly reluctant to administer sleeping tablets as they don’t treat the cause of insomnia and have side effects such as a feeling of hungover and daytime drowsiness. Examples of sleeping tablets are discussed below.

Benzodiazepines are tranquillizers that can lessen anxiety and encourage coolness, relaxation and sleep. This medicine should only be given to a person with severe insomnia or if it causes acute suffering as it makes that person sleepy and can also lead to dependency.

Z medicines are current kinds of medicines that work in a comparable way to benzodiazepines. Z medicines include zaleplon, zolpidem and zopiclone.

Zaleplon should be used in people with insomnia who have problem falling asleep and in lowest possible dose as it has side effects such as memory problems, painful periods in women, sleepiness, apathy, balance and coordination problems, concentration problems, changed sense of smell, dizziness and hallucinations.

Zolpidem is for unbearable insomnia causing severe stress. Its side effects are diarrhea, dizziness, nausea, vomiting, headaches, tiredness and sleep difficulty like sleep walking and stomach pains.

Zopiclone is for short-term treatment including waking up during the night, difficulty falling asleep causing severe distress. It should be used in its lowest possible dose as side effects include dry mouth, metallic taste in the mouth, sleepiness, dizziness, nausea, vomiting, drowsiness and headaches.

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An app to treat insomnia

A new phone app from the UK claims to treat insomnia more effectively than sleeping pills can.

We’ve all encountered apps capable of putting users to sleep, but that’s rarely their stated intention. Now one doctor has released a piece of software she claims will replace sleeping pills and help send insomniacs into a deep slumber.

Dr Kirstie Anderson, one of the UK’s foremost sleep experts, has made a career out of studying how humans nod off. Working with tech experts at Teeside University, Newcastle, she created an app called Sleepstation which she claimed is more effective than drugs.

She said: “I’m a neurologist that specializes in sleep disorders, there isn’t a great deal of us that work in sleep medicine. The most common sleep disorder is insomnia, which many of us will suffer from at some point in our lives.

“But the people who have chronic insomnia dread climbing the stairs and going to bed. It’s a life-altering condition that has a massive health and well-being impact.”

Her app uses Cognitive Behavioural Therapy (CBT) techniques to ensure a good night’s rest. Based on a recognized and effective treatment for insomnia, it shows users videos detailing the best ways to sleep and allows them to keep a diary .

“The CBT for insomnia program is a very good simple package with lots of research evidence for benefit,” Anderson continued. “It works at least as well as sleeping tablets, but without any of the side effects, and lasts for longer. Up to 80% of people who receive the treatment see improved sleep following the program.”

In clinical tests, more than 80 percent of insomniacs reported better sleep after using Sleepstation. Key to its success is the level of interactivity it offers. It is personalized for each user and changes its advice based on their sleep pattern. Insomniacs are first assessed by a doctor, before being supported remotely as they go through the CBT course, which is exactly the same one already offered by NHS staff.

If it’s money worries that are keeping you up at night, this app probably won’t help. At £59 ($100), it isn’t exactly the cheapest app on the market. But in the UK, the National Health Service are now prescribing it, meaning that insomniacs will be able to get it for free, or at a nominal cost.

“Between five to 10% of the population will have chronic insomnia at any stage and it affects other parts of a person’s wellbeing,” Anderson added. “If you’ve had a first bout of depression one of the most important risk factors for a second bout of depression is ongoing insomnia.

“The main treatment for insomnia at the moment is sleeping pills, with 10 million people taking then nationally. These pills come with a lot of side effects and little effect on chronic insomnia. Bearing this in mind SleepStation really could make a massive difference to potentially millions of people’s lives.”

SleepStation is not the first sleep app and is unlikely to be the last. Sleep As Android, for instance, and Sleep Cycle both monitor a snoozing person’s sleeping pattern and then wake them at the optimal point in the morning.SleepRate goes a step further by  shipping along with a heart rate monitor, which is strapped to an insomniac’s chest when they go to bed. A unique sleep plan is then drawn up based on the results. There are even apps which allows you to count sheep,  a distinctly old school method of getting your head down.

Nonetheless, Anderson’s link up with the NHS will give her app’s chances of success a clear boost, although it won’t help outside of the UK. With so many apps already on the market, Anderson had better make sure she’s not caught napping if she wants to beat the competition.

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How to help children with migraines

This article looks into how parents can help their children who have migraine headaches, and discusses the benefits of cognitive behavioral therapy.

Nearly 2% of the pediatric population suffer from chronic migraine. Yet, the Food and Drug Administration (FDA) has not approved a therapy for treatment of chronic migraine in children or adolescents. So, how does your child's neurologist or headache specialist treat your precious one's head pain?

One study in JAMA suggests a combination treatment regimen of both medical and behavioral therapy. Before reviewing this study, let's understand the basics of what a chronic migraine is.

What is a chronic migraine?

According to the second edition of the International Classification of Headache Disorders (ICHD-II), chronic migraine is defined as a migraine headache that occurs at least 15 days a month for more than 3 months. Additionally, the headaches of chronic migraineurs must have at least two of the following features:

• One-sided location
• Pulsating
• Moderate or severe intensity of pain
• Head pain is exacerbated by daily physical activity (i.e. walking around your home)

During a migraine attack, an individual must have at least one of the following:

• nausea and/or vomiting
• photophobia AND phonophobia

Study Overview

Purpose: To compare two regimens for treating children and adolescents with chronic migraines.

• Cognitive-Behavioral Therapy (CBT) + amitriptyline
• Health education + amitriptyline

Amitriptyline (Elavil)  is an tricyclic antidepressant that works by blocking the re-uptake of two neurotransmitters in the brain, serotonin and norepinephrine.  It is a sedating medication and typically taken at bedtime. It is FDA approved as a migraine preventive medication for adults.Cognitive-behavioral therapy entails learning how to identify headache triggers and cope with them in a more adaptive, less stressful manner.

Methods: 135 children and adolescents, between the ages of 10 and 17, who suffered from chronic migraine and scored greater than 20 on the Pediatric Migraine Disability Assessment Score (PedMIDAS) participated in the study.

The participants were randomly assigned to either the CBT + amitriptyline group or the health education + amitriptyline group. Each participant underwent 8 weekly therapy sessions that were one-hour in duration. The participants and their parents were blinded as to whether they were receiving CBT versus health education during these sessions. All of the participants were given a dose of amitriptyline of 1mg/kg/day at dinner time. The children and adolescents were allowed to take medication for acute migraine abortion, like NSAIDs and triptans. They were not allowed to use them for more than 3 times per week. Finally, the participants maintained a headache diary to record various headache measures such as headache occurrence, duration, and associated symptoms.

Results: The two main outcomes measured were number of days per month of headache occurrence and headache disability. By 20 weeks, participants in the CBT + amitriptyline group achieved a ≥50%percent reduction in days with headache when compared to the health education + amitriptyline group (66% versus 36%). This also held true at the 12 month follow-up, with 86% in the CBT + amitriptyline group having a ≥50% reduction in headache frequency versus 69% of the health education + amitriptyline group.

In terms of migraine disability, by the 12 month follow-up, 88% of the CBT + amitriptyline participants had a PedMIDAS of less than 20 points versus 76% of the headache education + amitriptyline group.

What Does This Mean?

The use of cognitive-behavioral therapy with amitriptyline in children and adolescents with chronic migraine reduced migraine frequency and disability, when compared to health education with amitriptyline. This suggests that CBT be considered as a reasonable and effective treatment for chronic migraine in the pediatric population.

If your child suffers from chronic migraine, discuss the use of a behavioral intervention, like CBT, with his or her healthcare provider so you can be an informed parent and remain proactive in your child's health.

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Study: Treating youth anxiety has long lasting benefits

A study shows that treating youth anxiety has many beneficial long-lasting benefits for the child. - JR

A study published in the March 2014 issue of the Journal of the American Academy of Child and Adolescent Psychiatry found that the majority of youth with moderate to severe anxiety disorders responded well to acute treatment with cognitive behavioral therapy (CBT), medication (sertraline), or a combination of both. They maintained positive treatment response over a 6 month follow-up period with the help of monthly booster sessions.

As part of the NIMH Child/Adolescent Anxiety Multimodal Study (CAMS), a group of researchers led by Dr. John Piacentini of the UCLA Semel Institute for Neuroscience and Human Behavior, followed 412 children and adolescents ages 7-17 after they completed 12 weeks of acute treatment. Treatment responders were offered 6 additional monthly booster sessions, with those initially on medication continuing this treatment; all youth, regardless of status at week 12, were re-evaluated 3 and 6 months later by trained clinicians. Twenty-seven percent of study participants also reported receiving outside (e.g. nonstudy) psychotherapy and/or medication for mental health symptoms over the 6 month follow-up period.

The study found that over 80% of youth rated as positive responders to one of the three CAMS treatments at Week 12 were also rated as responders at both the 3 and 6 month follow-up evaluations. Conversely, only 5% of youth who received combined CBT plus sertraline, and 15-16% of youth receiving either CBT-only or sertraline-only, failed to achieve responder status at any time during the study. Youth in the combined CBT+sertraline group showed greater treatment benefits on some but not all outcome measures and used less nonstudy treatments than those in the CBT-only and sertraline-only groups.

Collectively, anxiety disorders are the most common mental disorders in children and adolescents. Often overlooked, severe anxiety can significantly impair children's school, social, and family functioning, and if untreated, can increase the risk of depression, alcohol and substance abuse, and occupational difficulties in adulthood.

CAMS is the largest randomized controlled comparative treatment trial for child/adolescent anxiety disorders ever conducted. Participants were recruited at six regionally dispersed sites throughout the United States (UCLA, Duke University, Columbia University/New York University, Johns Hopkins University, Temple University, and the Western Psychiatric Institute and Clinics/University of Pittsburgh) and randomly assigned to 12 weeks of treatment with cognitive behavioral therapy (Coping cat), the selective serotonin reuptake-inhibiting [SSRI] medication sertraline, cognitive behavioral therapy combined with sertraline, or pill placebo. All participants had moderate to severe separation anxiety disorder, generalized anxiety disorder or social phobia, with most having multiple anxiety or other mental health disorders..

"The results of this study provide further evidence of the benefits of cognitive behavioral therapy and SSRI medication, alone or in combination, for treating clinically significant anxiety in children and adolescents," said Dr. Piacentini. "A separate project by the CAMS researchers is now gathering information on how study participants are doing up to 10 years after study participation."

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Study: Cognitive behavioral therapy can help kids with migraines

A study shows that symptoms of chronic migraines in children are reduced with cognitive behavioral therapy (CBT).

Among children and adolescents with chronic migraine, the use of cognitive behavioral therapy (CBT) resulted in greater reductions in headache frequency and migraine-related disability compared with headache education, according to a study appearing in the December 25 issue of JAMA.

"In adults, more than 2 percent of the population has chronic migraine and in children and adolescents the prevalence is up to 1.75 percent. In pediatric patients who seek care in headache specialty clinics, up to 69 percent have chronic migraine; however, there are no interventions approved by the U.S. Food and Drug Administration for the treatment of chronic migraine in young persons. As a result, current clinical practice is not evidence-based and quite variable," according to background information in the article.

Scott W. Powers, Ph.D., of Cincinnati Children's Hospital Medical Center, and colleagues randomized 135 participants (79 percent female) 10 to 17 years of age diagnosed with chronic migraine (≥ 15 days with headache/month) and a Pediatric Migraine Disability Assessment Score (PedMIDAS) greater than 20 points (disability score range: 0-10 for little to none, 11-30 for mild, 31-50 for moderate, >50 for severe) to CBT (n = 64) or headache education (n = 71). The study was conducted in the Headache Center at Cincinnati Children's Hospital between October 2006 and September 2012; 129 participants completed 20-week follow-up and 124 completed 12-month follow-up. The interventions consisted of 10 CBT or 10 headache education sessions involving equivalent time and therapist attention; CBT included training in pain coping, modified to include a biofeedback component. Each group received amitriptyline; follow-up visits were conducted at 3, 6, 9, and 12 months.

On average, at the beginning of the trial, participants reported 21 of 28 days with a headache and a PedMIDAS of 68 points, indicating a severe grade of disability. From pretreatment to posttreatment, CBT resulted in a decrease of 11.5 headache days vs. 6.8 days with headache education. At 12-month follow-up, 86 percent of CBT participants had a 50 percent or greater reduction in days with headache vs. 69 percent of the headache education group; 88 percent of CBT participants had a PedMIDAS of less than 20 points (mild to no disability) vs. 76 percent of the headache education group.

"Now that there is strong evidence for CBT in headache management, it should be routinely offered [to younger people] as a first-line treatment for chronic migraine along with medications and not only as an add-on if medications are not found to be sufficiently effective. Also, CBT should be made more accessible to patients by inclusion as a covered service by health insurance as well as testing of alternate formats of delivery, such as using online or mobile formats, which can be offered as an option if in-person visits are a barrier," the authors write.

System barriers may affect the likelihood of CBT being implemented as a first-line treatment for pediatric chronic migraine, writes Mark Connelly, Ph.D., of Children's Mercy Hospitals and Clinics, Kansas City, in an accompanying editorial.

"Creative means of delivering CBT for pediatric chronic migraine (e.g., via telehealth or Internet-based programs, using behavioral health consultants in primary care offices) will be necessary for reducing current access and referral barriers that could be encountered by many families and physicians. Widening the availability of interdisciplinary models of training and treatment delivery also will be important for helping ensure that children with chronic migraine routinely receive combination therapies rather than being referred for psychological therapy only after other approaches fail."

"Ideally with the efforts of the health care community and other relevant stakeholders, the suggestion by Powers et al to consider CBT along with medication as a first-line treatment for chronic migraine in children will be implemented into practice well before the typical translation gap. Additional studies are warranted, however, to identify methods of preventing chronic migraine development and to determine the medications and combination therapies that further maximize improvements in health and quality of life outcomes for children and adolescents with chronic migraine."

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