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PubMed2002

Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia?

Dysfunctional beliefs and attitudes about sleep are presumed to play an important mediating role in perpetuating insomnia. The present study evaluated the impact of cognitive-behavioral and pharmacological treatments for insomnia on sleep-related beliefs and attitudes and the relationship between those changes and sleep improvements. The participants were older adults with chronic and primary insomnia. They received cognitive-behavior therapy (CBT), pharmacotherapy (PCT), combined CBT+PCT (COMB), or a medication placebo (PLA). In addition to daily sleep diaries and sleep laboratory measures, the participants completed the dysfunctional beliefs and attitudes about sleep scale (DBAS) at baseline and posttreatment, and at 3-, 12- and 24-month follow-up assessments. The results showed that CBT and COMB treatments produced greater improvements of beliefs and attitudes about sleep at posttreatment than PCT and PLA. Reductions of DBAS scores were significantly correlated with improvements of sleep efficiency as measured by daily sleep diaries and by polysomnography. In addition, more adaptive beliefs and attitudes about sleep at posttreatment were associated with better maintenance of sleep improvements at follow-ups. These findings highlight the importance of targeting sleep-related beliefs and attitudes in the treatment of insomnia.

Anti-Anxiety Agents↗

PubMedDate not supplied

Problem solving and problem orientation in generalized anxiety disorder.

The present study's main objective is to examine whether problem orientation and problem-solving skills differ according to generalized anxiety disorder (GAD) symptom level or clinical status (seeking help for GAD). Its secondary goal is to examine whether two cognitive variables (intolerance of uncertainty and beliefs about worry) vary according to GAD symptom level or clinical status. Three groups of subjects participated in the study: (a) nonclinical moderate worriers (N = 15), (b) nonclinical subjects meeting GAD criteria by questionnaire (N = 14), and (c) GAD patients (N = 14). Problem orientation and problem-solving skills were measured with the Social Problem-Solving Inventory (D'Zurilla & Nezu, 1990) and the Problem-Solving Inventory (Heppner & Petersen, 1982), whereas the cognitive variables were assessed with the Intolerance of Uncertainty questionnaire (Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994) and the Why Worry? questionnaire (Freeston, Rhéaume et al., 1994). The results show that problem orientation, intolerance of uncertainty, and beliefs about worry were similar in subjects meeting GAD criteria by questionnaire and GAD patients, whereas moderate worriers had different scores on these variables. Thus, these variables are more highly affected by GAD symptom level than by clinical status. The results also show that problem-solving skills were unaffected by symptom level and clinical status, thereby indicating that knowledge of problem-solving skills is unrelated to both GAD symptom level and GAD clinical status. The findings are discussed in terms of their theoretical and clinical implications.

Adult↗