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  • 1.
    Blom, Kerstin
    et al.
    Karolinska Institutet.
    Jernelov, Susanna
    Karolinska Institutet.
    Ruck, Christian
    Karolinska Institutet.
    Lindefors, Nils
    Karolinska Institutet.
    Kaldo, Viktor
    Karolinska Institutet.
    Three-Year Follow-Up Comparing Cognitive Behavioral Therapy for Depression to Cognitive Behavioral Therapy for Insomnia, for Patients With Both Diagnoses2017In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 40, no 8, article id UNSP zsx108Article in journal (Refereed)
    Abstract [en]

    This 3-year follow-up compared insomnia treatment to depression treatment for patients with both diagnoses. Forty-three participants were randomized to either treatment, in the form of Internet-delivered therapist-guided cognitive behavior therapy (CBT), and 37 (86%) participants provided primary outcome data at the 3-year follow-up. After 3 years, reductions on depression severity were similar in both groups (between-group effect size, d = 0.33, p =.45), while the insomnia treatment had superior effects on insomnia severity (d = 0.66, p <.05). Overall, insomnia treatment was thus more beneficial than depression treatment. The implication for practitioners, supported by previous research, is that patients with co-occurring depression and insomnia should be offered CBT for insomnia, in addition to medication or psychological treatment for depression.

  • 2.
    Blom, Kerstin
    et al.
    Karolinska Institutet.
    Jernelov, Susanna
    Karolinska Institutet.
    Ruck, Christian
    Karolinska Institutet.
    Lindefors, Nils
    Karolinska Institutet.
    Kaldo, Viktor
    Karolinska Institutet.
    Three-Year Follow-Up of Insomnia and Hypnotics after Controlled Internet Treatment for Insomnia2016In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 39, no 6, p. 1267-1274, article id PII sp-00663-15Article in journal (Refereed)
    Abstract [en]

    Study Objectives: To investigate the long-term effects of therapist-guided Internet-based insomnia treatment on insomnia severity and sleep medication use, compared with active control. Methods: This study was an 8 week randomized controlled trial with follow-up posttreatment and at 6, 12, and 36 months, set at the Internet Psychiatry Clinic, Stockholm, Sweden. Participants were 148 media-recruited nondepressed adults with insomnia. Interventions were Guided Internet-based cognitive behavioral therapy for insomnia (ICBT-i) or active control treatment (ICBT-ctrl). Primary outcome was insomnia severity, measured with the Insomnia Severity Index. Secondary outcomes were sleep medication use and use of other treatments. Results: The large pretreatment to posttreatment improvements in insomnia severity of the ICBT-i group were maintained during follow-up. ICBT-ctrl exhibited significantly less improvement posttreatment (between-Cohen d = 0.85), but after 12 and 36 months, there was no longer a significant difference. The within-group effect sizes from pretreatment to the 36-months follow-up were 1.6 (ICBT-i) and 1.7 (ICBT-ctrl), and 74% of the interviewed participants no longer had insomnia diagnosis after 36 mo. ICBT-ctrl used significantly more sleep medication (P = 0.017) and underwent significantly more other insomnia treatments (P < 0.001) during the follow-up period. Conclusions: The large improvements in the ICBT-i group were maintained after 36 months, corroborating that CBT for insomnia has long-term effects. After 36 months, the groups did not differ in insomnia severity, but ICBT-ctrl had used more sleep medication and undergone more other additional insomnia treatments during the follow-up period.

  • 3.
    Blom, Kerstin
    et al.
    Karolinska Institutet.
    Jerneov, Susanna
    Karolinska Institutet.
    Kraepelien, Martin
    Karolinska Institutet.
    Bergdahl, Malin Olseni
    Karolinska Institutet.
    Jungmarker, Kristina
    Karolinska Institutet.
    Ankartjärn, Linda
    Karolinska Institutet.
    Lindefors, Nils
    Karolinska Institutet.
    Kaldo, Viktor
    Karolinska Institutet.
    Internet Treatment Addressing either Insomnia or Depression, for Patients with both Diagnoses: A Randomized Trial2015In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 38, no 2, p. 267-277Article in journal (Refereed)
    Abstract [en]

    Study Objectives: To compare treatment effects when patients with insomnia and depression receive treatment for either insomnia or depression. Design: A 9-w randomized controlled trial with 6- and 12-mo follow-up. Setting: Internet Psychiatry Clinic, Stockholm, Sweden. Participants: Forty-three adults in whom comorbid insomnia and depression were diagnosed, recruited via media and assessed by psychiatrists. Interventions: Guided Internet-delivered cognitive behavior therapy (ICBT) for either insomnia or depression. Measurements and Results: Primary outcome measures were symptom self-rating scales (Insomnia Severity Index [ISI] and the Montgomery Asberg Depression Rating Scale [MADRS-S]), assessed before and after treatment with follow-up after 6 and 12 mo. The participants' use of sleep medication and need for further treatment after completion of ICBT was also investigated. The insomnia treatment was more effective than the depression treatment in reducing insomnia severity during treatment (P = 0.05), and equally effective in reducing depression severity. Group differences in insomnia severity were maintained during the 12-mo follow-up period. Post treatment, participants receiving treatment for insomnia had significantly less self-rated need for further insomnia treatment (P < 0.001) and used less sleep medication (P < 0.05) than participants receiving treatment for depression. The need for depression treatment was similar in both groups. Conclusions: In this study, Internet-delivered treatment with cognitive behavior therapy (ICBT) for insomnia was more effective than ICBT for depression for patients with both diagnoses. This indicates, in line with previous research, that insomnia when comorbid with depression is not merely a symptom of depression, but needs specific treatment.

  • 4.
    Bothelius, Kristoffer
    et al.
    Uppsala University.
    Jernelov, Susanna
    Karolinska Institutet.
    Fredrikson, Mats
    Uppsala University.
    McCracken, Lance M.
    Kings Coll London, UK.
    Kaldo, Viktor
    Karolinska Institutet.
    Measuring Acceptance of Sleep Difficulties: The Development of the Sleep Problem Acceptance Questionnaire2015In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 38, no 11, p. 1815-1822Article in journal (Refereed)
    Abstract [en]

    Study Objectives: Acceptance may be an important therapeutic process in sleep medicine, but valid psychometric instruments measuring acceptance related to sleep difficulties are lacking. The purpose of this study was to develop a measure of acceptance in insomnia, and to examine its factor structure as well as construct validity. Design: In a cross-sectional design, a principal component analysis for item reduction was conducted on a first sample (A) and a confirmatory factor analysis on a second sample (B). Construct validity was tested on a combined sample (C). Setting: Questionnaire items were derived from a measure of acceptance in chronic pain, and data were gathered through screening or available from pretreatment assessments in four insomnia treatment trials, administered online, via bibliotherapy and in primary care. Participants: Adults with insomnia: 372 in sample A and 215 in sample B. Sample C (n = 820) included sample A and B with another 233 participants added. Measures: Construct validity was assessed through relations with established acceptance and sleep scales. Results: The principal component analysis presented a two-factor solution with eight items, explaining 65.9% of the total variance. The confirmatory factor analysis supported the solution. Acceptance of sleep problems was more closely related to subjective symptoms and consequences of insomnia than to diary description of sleep, or to acceptance of general private events. Conclusions: The Sleep Problem Acceptance Questionnaire (SPAQ), containing the subscales "Activity Engagement" and "Willingness", is a valid tool to assess acceptance of insomnia.

  • 5.
    Lancee, Jaap
    et al.
    Univ Amsterdam, Netherlands.
    van Straten, Annemieke
    Vrije Univ Amsterdam, Netherlands.
    Morina, Nexhmedin
    Univ Amsterdam, Netherlands.
    Kaldo, Viktor
    Karolinska Institutet.
    Kamphuis, Jan H.
    Univ Amsterdam, Netherlands.
    Guided Online or Face-to-Face Cognitive Behavioral Treatment for Insomnia: A Randomized Wait-List Controlled Trial2016In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 39, no 1, p. 183-191Article in journal (Refereed)
    Abstract [en]

    Study Objectives: To compare the efficacy of guided online and individual face-to-face cognitive behavioral treatment for insomnia (CBT-I) to a wait-list condition. Methods: A randomized controlled trial comparing three conditions: guided online; face-to-face; wait-list. Posttest measurements were administered to all conditions, along with 3-and 6-mo follow-up assessments to the online and face-to-face conditions. Ninety media-recruited participants meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for insomnia were randomly allocated to either guided online CBT-I (n = 30), individual face-to-face CBT-I (n = 30), or wait-list (n = 30). Results: At post-assessment, the online (Cohen d = 1.2) and face-to-face (Cohen d = 2.3) intervention groups showed significantly larger treatment effects than the wait-list group on insomnia severity (insomnia severity index). Large treatment effects were also found for the sleep diary estimates (except for total sleep time), and anxiety and depression measures (for depression only in the face-to-face condition). Face-to-face treatment yielded a statistically larger treatment effect (Cohen d = 0.9) on insomnia severity than the online condition at all time points. In addition, a moderate differential effect size favoring face-to-face treatment emerged at the 3-and 6-mo follow-up on all sleep diary estimates. Face-to-face treatment further outperformed online treatment on depression and anxiety outcomes. Conclusions: These data show superior performance of face-to-face treatment relative to online treatment. Yet, our results also suggest that online treatment may offer a potentially cost-effective alternative to and complement face-to-face treatment.

  • 6.
    Söderström, Marie
    et al.
    Karolinska Institutet.
    Ekstedt, Mirjam
    Karolinska Institutet.
    Åkerstedt, Torbjörn
    Karolinska Institutet.
    Nilsson, Jens
    Karolinska Institutet.
    Axelsson, John
    Karolinska Institutet.
    Sleep and sleepiness in young individuals with high burnout scores2004In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 27, no 7, p. 1369-1377Article in journal (Refereed)
    Abstract [en]

    Study Objectives: Burnout is a growing health problem in Western society. This study aimed to investigate sleep in subjects scoring high on burnout but still at work. The purpose was also to study the diurnal pattern of sleepiness, as well as ratings of work stress and mood in groups with different burnout scores.

    Design: Sleep was recorded in 2 groups (high vs low on burnout) during 2 nights; 1 before a workday and 1 before a day off, in a balanced order. Sleepiness ratings as well as daytime diary ratings were analyzed for the workday and the day off after the sleep recordings.

    Setting: The polysomnographic recordings were made in the subjects' home.

    Participants: Twenty-four healthy individuals (14 women and 10 men) between the ages of 24 and 43 years participated.

    Interventions: N/A.

    Measurements and Results: A higher frequency of arousals during sleep (Workday: high burnout = 12 +/- 1 per hour, low burnout = 8 +/- 1 per hour; Day off: high burnout = 12 2 per hour, low burnout = 8 +/- 1 per hour), and more subjective awakening problems were found in the high-burnout group. The diurnal pattern of sleepiness indicated that the high-burnout group did not recover in the same way as did the low-burnout group on the day off. Indicators of impaired recovery were also seen within the high-burnout group as a higher degree of bringing work home and working on weekends, as well as more complaints of work interfering with leisure time.

    Conclusions: Young subjects with high burnout scores, but who are still working, show more arousals during sleep and an absence of reduced sleepiness during days off.

1 - 6 of 6
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