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Cognitive behavioural therapy for anxiety disorders and insomnia: a commentary on future directions

Published online by Cambridge University Press:  30 July 2014

Kristin M. Aho ,
Scott M. Pickett  and
Timothy S. Hamill
Kristin M. Aho
Affiliation:
Department of Psychology, Oakland University, Rochester, MI, USA
Scott M. Pickett*
Affiliation:
Department of Psychology, Oakland University, Rochester, MI, USA
Timothy S. Hamill
Affiliation:
Department of Psychology, Oakland University, Rochester, MI, USA
*
*Author for correspondence: Dr S. M. Pickett, Department of Psychology, Oakland University, 209 Pryale Hall, 2200 N Squirrel Road, Rochester, MI 48309, USA ([email protected]).
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Abstract

Anxiety disorders and insomnia significantly impair daily functioning. Similar underlying mechanisms may account for the high comorbidity of both disorders, and respective treatments share pharmacological and behavioural features. This review suggests the utility of an integrated CBT approach in the treatment of generalized anxiety, post-traumatic stress, and panic disorders, and comorbid insomnia. Other anxiety disorders were not explored because current data are limited or inconsistent. A comprehensive, non-systematic review of the literature was conducted to evaluate the treatment of comorbid anxiety and insomnia disorders, and data reveal shared pharmacological and behavioural features of insomnia and anxiety disorders treatment. However, research demonstrates that CBT maintains successful treatment results longer than drug therapies. Despite similar treatment approaches, there is a paucity of research that explores integrated CBT approaches for comorbid anxiety and insomnia disorders. This review suggests that future research should assess the impact of combined therapeutic approaches on the simultaneous reduction of anxiety disorders, insomnia, and relapse rates.

Keywords

Anxiety disorderscognitive behavioural therapycombined treatmentinsomnia
Type
Practice article
Information
the Cognitive Behaviour Therapist , Volume 7 , December 2014 , e11
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2014 

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References

Abelson, JL, Khan, S, Liberzon, I, Young, EA (2007). HPA axis activity in patients with panic disorder: review and synthesis of four studies. Depression and Anxiety 24, 66–76.Google Scholar
ADAA (2012). Sleep disorders (http://www.adaa.org/understanding-anxiety/related-illnesses/sleep-disorders). Anxiety and Depression Association of America.Google Scholar
APA (2010). Anxiety disorders and effective treatment. (http://www.apa.org/helpcenter/anxiety-treatment.aspx). American Psychiatric Association.Google Scholar
APA (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn.Arlington, VA: American Psychiatric Publishing.Google Scholar
Archer, M, Brown, JSL, Idusohan, H, Coventry, S, Manoharan, A, Espie, CA (2009). The development and evaluation of a large-scale self-referral CBT-I intervention for men who have insomnia: an exploratory study. Behavioural and Cognitive Psychotherapy 37, 239–248.Google Scholar
Argyropoulos, SV, Wilson, SJ, Nutt, DJ (2008). The effects of antidepressant drugs and 5-HT1A agonists on human sleep. In: Serotonin and Sleep: Molecular, Functional and Clinical Aspects (ed. Monti, J. M., Pandi-Perumal, S. R. & Nutt, D. J.), pp. 569–585. Basel, Switzerland: Birkhauser.CrossRefGoogle Scholar
Babson, KA, Feldner, MT (2010). Temporal relations between sleep problems and both traumatic event exposure and PTSD: a critical review of the empirical literature. Journals of Anxiety Disorders 24, 1–15.Google Scholar
Baglioni, C, Spiegelhalder, K, Lombardo, C, Riemann, D (2010). Sleep and emotions: a focus on insomnia. Sleep Medicine Reviews 14, 227–238.Google Scholar
Baldwin, DS, Rafiq, R, Talat, B (2013). Overcoming barriers in the pharmacological treatment of anxiety disorders. Neuropsychiatry 3, 33–44.Google Scholar
Barlow, DH (2000). Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist 55, 1247–1263.Google Scholar
Barlow, DH, Rapee, RM, Brown, TA (1992). Behavioral treatment of generalized anxiety disorder. Behavior Therapy 23, 551–570.Google Scholar
Beck, AT, Emery, G, Greenberg, RL (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. New York, NY: Basic Books Inc.Google Scholar
Beck, JS (1995). Cognitive Therapy: Basics and Beyond. New York, NY: The Guilford Press.Google Scholar
Belanger, L, Morin, CM, Langlois, F, Ladouceur, R (2004). Insomnia and generalized anxiety disorder: Effects of cognitive behavior therapy for gad on insomnia symptoms. Journal of Anxiety Disorders 18, 561–571.Google Scholar
Bouton, ME, Mineka, S, Barlow, DH (2001). A modern learning-theory perspective on the etiology of panic disorder. Psychological Review 108, 4–22.CrossRefGoogle ScholarPubMed
Bradley, R, Greene, J, Russ, E, Dutra, L, Wester, D (2005). A multidimensional metal-analysis of psychotherapy for PTSD. American Journal of Psychiatry 162, 214–227.Google Scholar
Breslau, N, Roth, T, Rosenthal, L, Andreski, P (1996). Sleep disturbances and psychiatric disorders: a longitudinal epidemiological study of young adults. Biological Psychiatry 39, 411–418.Google Scholar
Buckner, JD, Bernert, RA, Cromer, KR, Joiner, TE, Schmidt, NB (2008). Social anxiety and insomnia: the mediating role of depressive symptoms. Depression and Anxiety 25, 124–130.Google Scholar
Bush, AL, Armento, MEA, Weiss, BJ, Rhoades, HM, Novy, DM, Wilson, NL, Kunik, ME, Stanley, MA (2012). The Pittsburgh Sleep Quality Index in older primary care patients with generalized anxiety disorder: psychometrics and outcomes following cognitive behavioral therapy. Psychiatry Research 199, 24–30.Google Scholar
Butler, AC, Chapman, JE, Forman, EM, Beck, AT (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical Psychology Review 26, 17–31.Google Scholar
Carney, CE, Edinger, JD (2010). Insomnia and Anxiety. New York, NY: Springer.Google Scholar
Clark, CP, Gillin, JC, Shahrokh, G (1995). Do differences in sleep architecture exist between depressives with comorbid simple phobia as compared with pure depressives? Journal of Affective Disorders 33, 251–255.Google Scholar
Covin, R, Ouimet, AJ, Seeds, PM, Dozois, DJA (2008). A meta-analysis of CBT for pathological worry among clients with GAD. Journal of Anxiety Disorders 22, 108–116.Google Scholar
Craske, MG, Golinello, D, Stein, MB, Roy-Byrne, P, Bystritsky, A, Sherbourne, C (2005). Does the addition of cognitive behavioral therapy improve panic disorder treatment outcome relative to medication alone in the primary-care setting? Psychological Medicine 35, 1645–1654.Google Scholar
Craske, MG, Tsao, JCI (2005). Assessment and treatment of nocturnal panic attacks. Sleep Medicine Reviews 9, 173–184.Google Scholar
Davey, GCL (1997). A conditioning model of phobias. In: Phobias: A Handbook of Theory, Research and Treatment (ed. Davey, G. C. L.), pp. 301–322. Chichester: Wiley.Google Scholar
Davis, JL, Wright, DC (2007). Randomized clinical trial for treatment of chronic nightmares in trauma-exposed adults. Journal of Traumatic Stress 20, 123–133.Google Scholar
Dupont, RL, Rice, DP, Miller, LS, Shiraki, SS, Rowland, CR, Harwood, HJ (1996). Economic costs of anxiety disorders. Anxiety 2, 167–172.Google Scholar
Edinger, JD, Olsen, MK, Stechuchak, KM, Means, MK, Lineberger, MD, Kirby, A, Carney, CE (2009). Cognitive behavioral therapy for patients with primary insomnia or insomnia associated predominantly with mixed psychiatric disorders: a randomized clinical trial. Sleep 32, 499–510.Google Scholar
Fava, M, Asnis, GM, Shrivastava, R, Lydiard, B, Bastani, B, Sheehan, D, Roth, T (2009). Zolpidem extended-release improves sleep and next-day symptoms in comorbid insomnia and generalized anxiety disorder. Journal of Clinical Psychopharmacology 29, 222–230.Google Scholar
Ford, DE, Kamerow, DB (1989). Epidemiological study of sleep disturbances and psychiatric disorders. An opportunity for prevention? Journal of the American Medical Association 262, 1479–1484.Google Scholar
Freedman, S, Adessky, R (2009). Cognitive behavior therapy for panic disorder. Israel Journal of Psychiatry & Related Sciences 46, 251–256.Google Scholar
Frueh, BC, Buckley, TC, Cusack, KJ, Kimble, MO, Grubaugh, AL, Turner, SM, Keane, TM (2004). Cognitive-behavioral treatment for PTSD among people with severe mental illness: a proposed treatment model. Journal of Psychiatric Practice 10, 26–38.Google Scholar
Fu, J, Li, P, Ouyang, X, Gu, C, Song, Z, Gao, J, Han, L, Feng, S, Tian, S, Hu, B (2007). Rapid eye movement sleep deprivation selectively impairs recall of fear extinction in hippocampus-independent tasks in rats. Neuroscience 144, 1186–1192.Google Scholar
Galovski, TE, Monson, C, Bruce, SE, Resick, PA (2009). Does cognitive-behavior therapy for PTSD improve perceived health and sleep impairment? Journal of Traumatic Stress 22, 197–204.Google Scholar
Gould, RA, Safren, SA, Washington, DO, Otto, MW (2004). A meta-analytic review of cognitive-behavioral treatments. In: Generalized Anxiety Disorder: Advances in Research and Practice (ed. Heimberg, R. G., Turk, C. L. & Mennin, D. S.), pp. 248–264. New York, NY: Guilford Press.Google Scholar
Graves, LA, Heller, EA, Pack, AI, Abel, T (2003). Sleep deprivation selectively impairs memory consolidation for contextual fear conditioning. Learning Memory 10, 168–176.Google Scholar
Gregory, AM, Caspi, A, Eley, TC, Moffitt, TE, O’Connor, TG, Poulton, R (2005). Prospective longitudinal associations between persistent sleep problems in childhood and anxiety and depression disorders in adulthood. Journal of Abnormal Child Psychology 33, 157–163.CrossRefGoogle ScholarPubMed
Gunter, RW, Whittal, ML (2010). Dissemination of cognitive-behavioral treatments for anxiety disorders: overcoming barriers and improving patient access. Clinical Psychology Review 30, 194–202.Google Scholar
Haby, MM, Donnelly, M, Corry, J, Vos, T (2006). Cognitive behavioral therapy for depression, panic disorder and generalized anxiety disorder: a meta-regression of factors that may predict outcome. Australian and New Zealand Journal of Psychiatry 40, 9–19.Google Scholar
Hajak, G (2001). Epidemiology of severe insomnia and its consequences in Germany. European Arichives of Pyschiatry and Clinical Neuroscience 251, 49–56.Google Scholar
Harvey, AG (2002). A cognitive model of insomnia. Behaviour Research and Therapy 40, 869–893.Google Scholar
Hu, P, Stylos-Allan, M, Walker, MP (2006). Sleep facilitates consolidation of emotional declarative memory. Psychological Science 17, 891–898.Google Scholar
Jansson, M, Linton, SJ (2006). The role of anxiety and depression in the development of insomnia: cross-sectional and prospective analyses. Psychology and Health 21, 383–397.Google Scholar
Jansson-Frojmark, M, Lindblom, K (2008). A bidirectional relationship between anxiety and depression, and insomnia? A prospective study in the general population. Journal of Psychosomatic Research 64, 443–449.Google Scholar
Katz, DA, McHorney, CA (2002). The relationship between insomnia and health-related quality of life in patients with chronic illness. Journal of Family Practice 51, 229–235.Google Scholar
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.Google Scholar
Kierlin, L (2008). Sleeping without a pill: nonpharmacologic treatments for insomnia. Journal of Psychiatric Practice 14, 403–407.Google Scholar
Koerner, N, Dugas, MJ, Savard, P, Gaudet, A, Turcotte, J, Marchand, A (2004). The economic burden of anxiety disorders in Canada. Canadian Psychology/Psychologie canadienne 45, 191–201.Google Scholar
Krakow, B, Sandoval, D, Schrader, R, Keuhne, B, McBride, L, Yau, CL, Tandberg, D (2001). Treatment of chronic nightmares in adjudicated adolescent girls in a residential facility. Journal of Adolescent Health 29, 94–100.Google Scholar
Labbate, LA, Johnson, MR, Lydiard, RB, Brawman-Mintzer, O, Emmanuel, N, Crawford, M, Kapp, R, Ballenger, JC (1997). Sleep deprivation in panic disorder and obsessive-compulsive disorder. Canadian Journal of Psychiatry 42, 982–983.Google Scholar
Labbate, LA, Johnson, MR, Lydiard, RB, Brawman-Mintzer, O, Emmanuel, N, Crawford, M, Kapp, R, Ballenger, JC (1998). Sleep deprivation in social phobia and generalized anxiety disorder. Biological Psychiatry 43, 840–842.Google Scholar
Lewis, V, Creamer, M, Failla, S (2009). Is poor sleep in veterans a function of post-traumatic stress disorder? Military Medicine 174, 948–951.Google Scholar
Marcks, BA, Weisberg, RB (2009). Co-occurrence of insomnia and anxiety disorders: a review of the literature. American Journal of Lifestyle Medicine 3, 300–309.Google Scholar
Margolies, SO, Rybarczyk, B, Vrana, SR, Leszczyszyn, DJ, Lynch, J (2013). Efficacy of a cognitive-behavioral treatment for insomnia and nightmares in Afghanistan and Iraq veterans with PTSD. Journal of Clinical Psychology 69, 1024–1042.Google Scholar
Marom, S, Hermesh, H (2003). Cognitive behavior therapy (CBT) in anxiety disorders. Israel Journal of Psychiatry and Related Sciences 40, 135–144.Google Scholar
Mellman, TA (2006). Sleep and anxiety disorders. Psychiatric Clinics of North America 29, 1047–1058.Google Scholar
Mellman, TA, Uhde, TW (1989). Sleep panic attacks: new clinical findings and theoretical implications. American Journal of Psychiatry 146, 1204–1207.Google Scholar
Monson, CM, Rodriguez, BF, Warner, R (2005). Cognitive-behavioral therapy for PTSD in the real world: do interpersonal relationships make a real difference? Journal of Clinical Psychology 61, 751–761.Google Scholar
Monti, JM, Monti, D (2000). Sleep disturbance in generalized anxiety disorder and its treatment. Sleep Medicine Reviews 4, 263–276.Google Scholar
Morgenthaler, T, Kramer, M, Alessi, C, Friedman, L, Boehlecke, B, Brown, T, Coleman, J, Kapur, V, Lee-Chiong, T, Owens, J, Pancer, J, Swick, T (2006). Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep 29, 1415–1419.Google Scholar
Morin, CM, Bootzin, RR, Buysse, DJ, Edinger, JD, Espie, CA, Lichstein, KL (2006). Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep 29, 1398–1414.Google Scholar
Morin, CM, Espie, CE (2004). Insomnia: A Clinical Guide to Assessment and Treatment. New York: Springer.Google Scholar
Okajima, I, Komada, Y, Inoue, Y (2011). A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep and Biological Rhythms 9, 24–34.Google Scholar
Olatunji, BO, Cisler, JM, Tolin, DF (2007). Quality of life in the anxiety disorders: a meta-analytic review. Clinical Psychology Review 27, 572–81.Google Scholar
Pace-Schott, EF, Milad, MR, Orr, SP, Rauch, SL, Stickgold, R, Pittman, RK (2009). Sleep promotes generalization of extinction of conditioned fear. Sleep 32, 19–26.Google Scholar
Papadimitriou, GN, Kerkhofs, M, Kempenaers, C, Mendlewicz, J (1988). EEG sleep studies in patients with generalized anxiety disorder. Psychiatry Research 26, 183–190.Google Scholar
Perlis, ML, Benson-Jungquist, C, Smith, MT, Posner, DA (2005). Cognitive Behavioral Treatment of Insomnia: A Session-by-Session Guide New York: Springer.Google Scholar
Ramsawh, HJ, Stein, MB, Belik, S, Jacobi, F, Sareen, J (2009). Relationship of anxiety disorders, sleep quality, and functional impairment in a community sample. Journal of Psychiatric Research 43, 926–933.Google Scholar
Raskind, MA, Peskind, ER, Hoff, DJ, Hart, KL, Holmes, HA, Warren, D, Shofer, J, O’Connell, J, Taylor, F, Gross, C, Rohde, K, McFall, ME (2007). A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biological Psychiatry 61, 928–934.Google Scholar
Raskind, MA, Peskind, ER, Kanter, ED, Petrie, EC, Radant, A, Thompson, CE, Dobie, DJ, Hoff, D, Rein, RJ, Straits-Tröster, K, Thomas, RG, McFall, MM (2003). Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study. American Journal of Psychiatry 160, 371–373.Google Scholar
Reynolds, CF, Shaw, DH, Newton, TF, Coble, PA, Kupfer, DJ (1983). EEG sleep in outpatients with generalized anxiety: a preliminary comparison with depressed outpatients. Psychiatry Research 8, 81–89.Google Scholar
Rothbaum, BO, Davis, M (2003). Applying learning principles to the treatment of post-trauma reactions. Annals of the New York Academy of Sciences 1008, 112–121.Google Scholar
Ruskin, DN, Liu, C, Dunn, KE, Bazan, NG, LaHoste, GJ (2004). Sleep deprivation impairs hippocampus-mediated contextual learning but not amygdala-mediated cued learning in rats. European Journal of Neuroscience 19, 3121–3124.Google Scholar
Schoenfeld, FB, DeViva, JC, Manber, R (2012). Treatment of sleep disturbances in posttraumatic stress disorder: a review. Journal of Rehabilitation Research & Development 49, 729–752.Google Scholar
Schutte-Rodin, S, Broch, L, Buysse, D, Dorsey, C, Sateia, M (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine 4, 487–504.Google Scholar
Silvestri, AJ (2005). REM sleep deprivation affects extinction of cued but not contextual fear conditioning. Physiology & Behavior 84, 343–349.Google Scholar
Simon, GE, Vonkorff, M (1997). Prevalence, burden, and treatment of insomnia in primary care. American Journal of Psychiatry 154, 1417–1423.Google Scholar
Singh, A, Ghazvini, P, Robertson, N, Massey, AJ, Kirksey, O, Honeywell, MS (2006). Sleep disturbances in patients with psychiatric illnesses. Journal of Pharmacy Practice 19, 369–378.Google Scholar
Smith, MT, Huang, MJ, Manber, R (2005). Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. Clinical Psychology Reviews 25, 559–592.Google Scholar
Smith, MT, Perlis, ML (2006). Who is a candidate for cognitive-behavioral therapy for insomnia? Health Psychology 25, 15–19.Google Scholar
Soehner, AM, Harvey, AG (2012). Prevalence and functional consequences of severe insomnia symptoms in mood and anxiety disorders: results from a nationally representative sample. Sleep 35, 1367–1375.Google Scholar
Stickgold, R, Walker, MP (2005). Sleep and memory: the ongoing debate.Sleep 28, 1225.Google Scholar
Swift, N, Stewart, R, Andiappan, M, Smith, A, Espie, CA, Brown, JS (2012). The effectiveness of community day-long CBT-I workshops for participants with insomnia symptoms: a randomized controlled trial. Journal of Sleep Research 21, 270–280.Google Scholar
Vincent, N, Lewycky, S (2009). Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia. Sleep 32, 807–815.Google Scholar
Vincent, N, Lionberg, C (2001). Treatment preference and patient satisfaction in chronic insomnia. Journal of Sleep and Sleep Disorders Research 24, 411–417.Google Scholar
Wagner, U, Gais, S, Born, J (2001). Emotional memory formation is enhanced across sleep intervals with high amounts of rapid eye movement sleep. Learning and Memory 8, 112–119.Google Scholar
Wells, A (1990). Panic disorder in association with relaxation induced anxiety: an attentional training approach to treatment. Behavior Therapy 21, 273–280.Google Scholar
Zambotti, MD, Covassin, N, De Min Tona, G, Sarlo, M, Stegagno, L (2011). Sleep onset and cardiovascular activity in primary insomnia. Journal of Sleep Research 20, 318–325.Google Scholar
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