30.Insomnia And Anxiety

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30.Insomnia And Anxiety

 

 

CATEGORY: Psychiatry & Psychology 300 Courses

COURSE NUMBER: 30

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Syllabus

1 Anxiety and Insomnia: An Overview ……………………………………………… 1
What is Insomnia?…………………………………………………………………………… 2
Diagnostic Considerations for Insomnias…………………………………………… 3
The Case of Comorbid Insomnia: More Nosological Issues…………………. 4
Cognitive Behavioral Model of Insomnia and Anxiety …………………….. 7
Summary……………………………………………………………………………………….. 9
References……………………………………………………………………………………… 9
2 Considerations for Assessment ………………………………………………………. 13
Assessment of Sleep ……………………………………………………………………….. 13
Actigraphic Measurement of Sleep……………………………………………………. 15
Subjective Assessment of Sleep………………………………………………………… 15
Clinical Interview……………………………………………………………………………. 18
Self-report Measurement …………………………………………………………………. 18
Global Sleep Symptom Questionnaires………………………………………….. 18
Cognitive Insomnia Questionnaires……………………………………………….. 19
Behavioral Insomnia Questionnaires……………………………………………… 20
Daytime Insomnia Symptom Questionnaires ………………………………….. 20
Assessment of Anxiety ……………………………………………………………………. 21
Structured Interviews for Anxiety……………………………………………………… 22
Clinician-Administered Interviews for Anxiety ………………………………. 22
Clinician-Administered Interviews for Specific
Anxiety Disorders……………………………………………………………………….. 22
Self-Report Measures for Anxiety Symptoms…………………………………. 23
General Measures for Self-Reported Anxiety………………………………….. 23
Anxiety Disorder-Specific Self-Report Questionnaires…………………….. 24
Case Example 1: Generalized Anxiety Disorder and Insomnia……………… 26
Case Example 2: Sleep-Specific Worry ……………………………………………… 27
References……………………………………………………………………………………… 28
3 Anxiety Disorders and Accompanying Insomnia…………………………….. 33
Panic Disorder………………………………………………………………………………… 33
Generalized Anxiety Disorder ………………………………………………………….. 35
Posttraumatic Stress Disorder: PTSD………………………………………………… 37
Obsessive–Compulsive Disorder ………………………………………………………. 40
Social Phobia …………………………………………………………………………………. 42
Specific Phobias……………………………………………………………………………… 43
Summary……………………………………………………………………………………….. 45
References……………………………………………………………………………………… 45
4 Cognitive Behavior Therapy for Insomnia:
Treatment Considerations……………………………………………………………… 51
What is Cognitive Behavior Therapy and Who Can
Benefit from It?………………………………………………………………………………. 51
Cognitive Behavior Therapy Model…………………………………………………… 53
The Evidence Supporting CBT for Insomnia ……………………………………… 55
Treatment Delivery Issues………………………………………………………………… 56
References……………………………………………………………………………………… 59
5 Medication Considerations ……………………………………………………………. 63
Will Cognitive Behavior Insomnia Therapy
Work with Those Who Use Sleep Medications? …………………………………. 63
Prescription Hypnotics: Advantages and Disadvantages………………………. 65
Over-the-Counter Medications, Herbal Remedies,
and Alternative Treatments………………………………………………………………. 66
Antihistamine-Based Sleep Aids …………………………………………………… 67
Herbal Compounds and Dietary Supplements…………………………………. 68
Melatonin …………………………………………………………………………………… 68
Alcohol………………………………………………………………………………………. 69
Can Common Anxiety Medications Cause Insomnia Symptoms? …………. 70
Combining Sleep Medications with CBT for Insomnia ……………………….. 71
Sleep Medication Discontinuation Strategies……………………………………… 73
References……………………………………………………………………………………… 75
6 Behavioral Strategies for Managing Insomnia………………………………… 79
Assessing the Sleep Problem Using the Sleep Diary……………………………. 79
Setting the Stage for Treatment Recommendations:
The Role of Psychoeducation …………………………………………………………… 84
Presenting Behavioral Insomnia Treatment Recommendations…………….. 86
Addressing Sleep Hygiene Issues……………………………………………………… 89
The Value of Follow-Up Sessions……………………………………………………… 91
Assistance with TIB Changes…………………………………………………………… 92
Reviewing/Reinforcing Adherence……………………………………………………. 93
Trouble-Shooting Problems……………………………………………………………… 94
Case 1………………………………………………………………………………………… 95
Case 2………………………………………………………………………………………… 95
Case 3………………………………………………………………………………………… 96
References……………………………………………………………………………………… 97
7 Sleep-Related Cognitive Processes …………………………………………………. 99
Harvey’s (2002) Cognitive Model …………………………………………………….. 99
The Role of Thoughts ……………………………………………………………………… 100
Unwanted Repetitive Mental Activity…………………………………………….. 101
The Role of Distress………………………………………………………………………… 102
Beliefs in Insomnia …………………………………………………………………………. 102
Attention and the “Threat” of Sleep…………………………………………………… 103
The Role of Attributions………………………………………………………………….. 104
Maintaining the Status Quo ……………………………………………………………… 105
References……………………………………………………………………………………… 106
8 Cognitive Strategies for Managing Anxiety and Insomnia ………………. 109
Worry Management Strategies………………………………………………………….. 109
Constructive Worry Worksheet Example……………………………………………. 111
Cognitive Restructuring …………………………………………………………………… 112
Thought Record ……………………………………………………………………………… 113
Decreasing Safety Behaviors and Behavioral Experiments…………………… 117
Focus on Relapse Prevention ……………………………………………………………. 119
Action Plan for Addressing Insomnia………………………………………………… 119
Red Flags for a Possible Problem with Insomnia ………………………………… 120
What Tools Work for This Problem? …………………………………………………. 120
References……………………………………………………………………………………… 121
9 Other Issues in Managing the Sleep of Those with Anxiety……………… 123
Relaxation-Based Strategies …………………………………………………………….. 123
PMR Treatment Outline…………………………………………………………………… 126
Cognitive Behavioral Treatment of Nocturnal Panic ……………………………. 131
Craske’s Nocturnal Panic Protocol ……………………………………………………. 131
Treating Claustrophobia Associated with Sleep Apnea Treatment ………… 134
Dream/Nightmare Rescripting………………………………………………………….. 138
Is it Time for a Sleep Specialist Consultation? ……………………………………. 143
References……………………………………………………………………………………… 145
Index………………………………………………………………………………………………….. 149

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