When Thinking Impairs Sleep : Trait, Daytime and Nighttime Repetitive Thinking in Insomnia

We like to thank Dorien van Baar, Lisette van Breen, Rachel Renet, Marlene Stone, Britt van Hest, and Noraly Dekkers for their help with the data acquisition.Peer reviewedPublisher PD

Sleep Difficulties Are Correlated with Emotional Problems following Loss and Residual Symptoms of Effective Prolonged Grief Disorder Treatment

There is preliminary evidence that poor sleep quality is associated with emotional problems following loss, including symptoms of prolonged grief disorder (PGD) and depression. We conducted two studies to improve existing knowledge about the role of sleep difficulties in recovery from loss. Study 1 that relied on self-reported data from a heterogeneous sample of 177 bereaved individuals replicated prior findings of a linkage between increased sleep difficulties and increased PGD severity. This study also suggested that sleep difficulties are more strongly associated with depression than with PGD. In Study 2, we examined whether prior evidence that sleep complaints are a residual symptom of PGD treatment could be replicated in a sample of 43 bereaved individuals who underwent cognitive behavioural therapy for PGD. Outcomes showed that, although sleep difficulties declined significantly during this cognitive behavioural therapy, after this therapy, over half of all patients still had sleep difficulties above the average sleep difficulties observed in the general Dutch population

Automated Dialogue Generation for Behavior Intervention on Mobile Devices

AbstractCommunication in the form of dialogues between a virtual coach and a human patient (coachee) is one of the pillars in an intervention app for smartphones. The virtual coach is considered as a cooperative partner that supports the individual with various exercises for a behavior intervention therapy. To perform its supportive behavior, the coach follows a certain interaction model and its requirements, such as alignment, mutual commitment and adaptation. In this paper, we propose E-Coach MarkUp Language (ECML), a standard XML specification for scripting discourses that define how the virtual coach maintains a dialogue with a coachee following the interaction model. The format of the language allows messages to be tailored at a fine-grained level. Each sentence is synthesized based on the inferred goals of the coaching process and the current beliefs of the user, incorporating everything that has been said previously in the conversation. The design enables inexpensive implementation on mobile devices for a flexible, seamless coaching dialogue. With expert-based evaluations, we validated the language using scenarios on implemented ECML in the field of insomnia therapy

Internet-Delivered Cognitive Behavioral Therapy for Insomnia:Tailoring Cognitive Behavioral Therapy for Insomnia for Patients with Chronic Insomnia

Chronic insomnia is preferably treated with cognitive behavioral therapy for insomnia (CBTI), but many insomnia sufferers receive medication instead, likely because of high costs, lack of knowledge about optimal insomnia treatment among physicians, and lack of CBTI-trained professionals in mental health care. A possible solution is to offer CBTI through the Internet: I-CBTI. I-CBTI is generally acceptable to patients and greatly improves insomnia symptoms. We review the state of knowledge around I-CBTI and its effects. CBTI's effectiveness is influenced by treatment characteristics and patient-specific factors. We review potential factors that help identify which patients may benefit from I-CBTI

Reminders make people adhere better to a self-help sleep intervention

The experiment presented in this paper investigated the effects of different kinds of reminders on adherence to automated parts of a cognitive behavioural therapy for insomnia (CBT-I) delivered via a mobile device. Previous studies report that computerized health interventions can be effective. However, treatment adherence is still an issue. Reminders are a simple technique that could improve adherence. A minimal intervention prototype in the realm of sleep treatment was developed to test the effects of reminders on adherence. Two prominent ways to determine the reminder-time are: a) ask users when they want to be reminded, and b) let an algorithm decide when to remind users. The prototype consisted of a sleep diary, a relaxation exercise and reminders. A within subject design was used in which the effect of reminders and two underlying principles were tested by 45 participants that all received the following three different conditions (in random order): a) event-based reminders b) time-based reminders c) no reminders. Both types of reminders improved adherence compared to no reminders. No differences were found between the two types of reminders. Opportunity and self-empowerment could partly mediate adherence to filling out the sleep diary, but not to the number of relaxation exercises conducted. Although the study focussed on CBT-I, we expect that designers of other computerized health interventions benefit from the tested opportunity and self-empowerment principles for reminders to improve adherence, as well

Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice: protocol of a pragmatic randomized controlled trial.

BACKGROUND: Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often. Offering CBT-I in an online format may increase access. Many studies have shown that online CBT for insomnia is effective. However, these studies have all been performed in general population samples recruited through media. This protocol article presents the design of a study aimed at establishing feasibility, effectiveness and cost-effectiveness of a guided online intervention (i-Sleep) for patients suffering from insomnia that seek help from their general practitioner as compared to care-as-usual. METHODS/DESIGN: In a pragmatic randomized controlled trial, adult patients with insomnia disorder recruited through general practices are randomized to a 5-session guided online treatment, which is called "i-Sleep", or to care-as-usual. Patients in the care-as-usual condition will be offered i-Sleep 6 months after inclusion. An ancillary clinician, known as the psychological well-being practitioner who works in the GP practice (PWP; in Dutch: POH-GGZ), will offer online support after every session. Our aim is to recruit one hundred and sixty patients. Questionnaires, a sleep diary and wrist actigraphy will be administered at baseline, post intervention (at 8 weeks), and at 6 months and 12 months follow-up. Effectiveness will be established using insomnia severity as the main outcome. Cost-effectiveness and cost-utility (using costs per quality adjusted life year (QALY) as outcome) will be conducted from a societal perspective. Secondary measures are: sleep diary, daytime consequences, fatigue, work and social adjustment, anxiety, alcohol use, depression and quality of life. DISCUSSION: The results of this trial will help establish whether online CBT-I is (cost-) effective and feasible in general practice as compared to care-as-usual. If it is, then quality of care might be increased because implementation of i-Sleep makes it easier to adhere to insomnia guidelines. Strengths and limitations are discussed. TRIAL REGISTRATION: Netherlands Trial register NTR 5202 (registered April 17(st) 2015)

The European Insomnia Guideline : An update on the diagnosis and treatment of insomnia 2023

Publisher Copyright: © 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).Peer reviewe

Etnische diversiteit, sociaal vertrouwen in de buurt en contact van allochtonen en autochtonen met buren. [Ethnic diversity, social trust in the neighbourhood and contact of migrants and natives with neighbours]

Putnam (2007) claims that in the short run ethnic diversity tends to reduce solidarity and social capital: in ethnically diverse neighborhoods, residents of all ethnicities tend to ‘hunker down’. Trust (even in one’s own ethnic group) is lower, altruism and community cooperation is more rare, friends fewer. This study replicates Putnam’s analysis for a West-European country. Furthermore, by including the ethnicity of the respondent’s neighbors, a sub-neighborhood level measure of ethnic diversity is added to the analyses. With data from the Netherlands (N=5,757), using multi-level regression, we confirm Putnam’s claim and find that the neighborhoods’ ethnic diversity as well as having neighbors of a different ethnicity, reduces trust in the neighborhood and lowers the quality of contact with the neighbors. However, we do not find these negative effects of neighborhoods’ or neighbors ethnic diversity on inter-ethnic trust. This holds for both for immigrants and native residents. A substantial part of the effect of neighborhoods’ ethnic diversity on trust can be explained by the higher propensity of having neighbors of a different ethnicity. We conclude that ethnic diversity can have a negative effect on trust in the neighborhood

Aandacht voor de Putnam-hypothese is in het geheel niet overdreven

De repliek van Mérove Gijsberts, Tom van der Meer en Jaco Dagevos op ons artikel 'Etnische diversiteit, sociaal vertrouwen in de buurt en contact van allochtonen en autochtonen met de buren' is interessant, omdat etnische diversiteit van buurten een onderwerp van betekenis is en zij belangrijke kritiekpunten aansnijden. Wij hopen in deze bijdrage te laten zien dat wij niet onterecht Amerikaanse resultaten generaliseren, dat hun gelijkstelling van etnische concentratie en diversiteit conceptueel verwarrender is dan ons gebruik van meerdere indicatoren voor sociaal vertrouwen, en dat wij het belang van contextkenmerken zoals etnische diversiteit niet overschat hebben