Volume 28, Issue 2 (Summer 2022)                   IJPCP 2022, 28(2): 196-209 | Back to browse issues page

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Yarahmadi M, Hafezi F, Makvandi B. Effectiveness of Cognitive-Behavioral Therapy for Insomnia on Emotional Regulation and Dysfunctional Sleep Beliefs Among Insomnia Patients. IJPCP 2022; 28 (2) :196-209
URL: http://ijpcp.iums.ac.ir/article-1-3530-en.html
Effectiveness of Cognitive-Behavioral Therapy for Insomnia on Emotional Regulation and Dysfunctional Sleep Beliefs Among Insomnia Patients
Masoomeh Yarahmadi1 , Fariba Hafezi 2, Behnam Makvandi3
1- Department of Health Psychology, Khorramshahr International Branch, Islamic Azad University, Khorramshahr, Iran.
2- Department of Psychology, Faculty of Humanities, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran. , Febram315@yahoo.com
3- Department of Psychology, Faculty of Humanities, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran.
Keywords: Cognitive-behavioral therapy for insomnia, Emotional regulation, Dysfunctional sleep beliefs
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Introduction
The treatment of insomnia comprises considering its quality and intensity first and then searching for its causes to begin the treatment. Compared to pharmacotherapy, cognitive therapy is inexpensive and has fewer side effects. Recent findings on cognitive-behavioral therapy (CBT) strongly support this method for treating insomnia. Evidence indicates that this treatment is beneficial for primary insomnia and patients whose insomnia is caused by psychiatric disorders or chronic diseases. CBT for insomnia targets the maladaptive behaviors and thoughts that lead to insomnia or its progress. 
Accordingly, and considering the importance of regulating emotion and dysfunctional beliefs about sleep on individuals’ mental health and performance, this study aims to investigate the effects of CBT for insomnia on emotion regulation and dysfunctional beliefs about sleep in individuals with insomnia. The primary question of this study is as follows: does CBT affect the regulation of emotion and dysfunctional beliefs about sleep in individuals with insomnia? 
Methods
A case and control group were examined in this experimental study with pretest-post-test and follow-up. The statistical population included all the patients with insomnia who visited the sleep disorders laboratory of Rasoul Akram Hospital and two private clinics with psychiatrists with a sleep fellowship in Tehran City, Iran in 2020. The patients were selected through convenient sampling and were diagnosed with insomnia through the interview by the psychologist and the sleep medicine fellow according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Subsequently, of 36 patients with insomnia, 20 patients were randomly selected as the statistical sample, 10 were grouped in the case group (cognitive-behavioral therapy for insomnia [CBT-I]) and 10 in the control group.
Results
The frequency of male and female participants in the CBT-I group was 6 and 4, respectively, and the frequency for control group participants was 7 and 3, respectively. In addition, the participants in the CBT-I and the control group are shown in the following table based on their age. According to the results of the analysis of covariance (ANCOVA) test, controlled with the effect of pretest scores for the studied variables, the difference between the weighted mean of the two groups in both post-test and follow-up was statistically significant for all of the variables (Table 1).


Discussion
The ANCOVA results indicated that CBT-I influenced emotion regulation and dysfunctional beliefs about sleep in patients with insomnia. It significantly increased emotion regulation (P<0.05) and significantly decreased the dysfunctional beliefs about sleep (P<0.05). Moreover, the results showed a significant increase (P<0.05) in emotion regulation and a significant decrease (P<0.05) in the scores of dysfunctional sleep beliefs in patients with insomnia in the post-test and follow-up stages compared to the pretest. The literature review elaborated on the connection between this study and the previous research conducted on a similar subject. It should be noted that the results of this study were in line with the studies conducted by Vanek et al. (2020) [21], Gencarelli et al. (2020) [33], Yensusong (2021), Khazaei, and Zakiee (2019) [27], Hertenstein et al. (2019) [28], and Rezaei et al. (2016) [29]. 
Gencarelli et al. (2020) examined the relationship between action time, sleep intensity, and dysfunctional beliefs about sleep [33]. He demonstrated a negative correlation between sleep intensity and dysfunctional beliefs about sleep and reaction time. Sleep impacts emotion regulation in both normal individuals and those who suffer from mental disorders. Several studies have indicated a connection between pre-bed positive and negative emotion activation and amplification of sleep emotional excitement disrupting sleep. On the other hand, many studies have demonstrated that low-quality sleep and sleep deprivation negatively impact adults’ emotional functioning. 
Khazaei et al. (2019) studied the effectiveness of acceptance and commitment therapy (ACT) on emotion regulation and sleep quality problems in patients with chronic insomnia [27]. The results specified that ACT increased the sleep quality of patients with insomnia, and it also helped with emotion regulation problems.
Emotion regulation strategies are the activities that individuals employ to tackle stressful situations and unfortunate incidents. CBT is based on behavioral therapy, which stands at the heart of traditional psychotherapy and shows the therapists’ interest in restructuring cognition as an effective factor in emotions and behaviors. This training method aims to correct irrational opinions, dysfunctional beliefs, misinterpretations and cognitive biases, the sense of control over life, facilitating constructive self-talk, and underpinning coping skills. 
Studies have indicated that patients with insomnia reported more negative thoughts during night awakenings compared to individuals with normal sleep. Furthermore, pre-bed negative cognitions (for instance, thoughts about not sleeping) could lead to increased sleep problems. These pre-bed dysfunctional cognitions are called dysfunctional beliefs about sleep. Some researchers have focused on the intrusive thoughts during the night and others on the core beliefs and attitudes, potentially carrying an emotional load, about sleep deprivation during day and night.

Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval from the Ahvaz Branch, Islamic Azad University (IR.IAU.AHVAZ.REC.1399.051) and the ethical code of the Iranian Clinical Trials Registration  (IRCT) (IRCT20210714051894N1)

Funding
This article taken from the PhD Thesis Masoomeh Yarahmadi, Department of Health Psychology, Khorramshahr International Branch, Islamic Azad University and has no Financial Support. 

Authors contributions
Conceptualization, Research, Review, Editing and finalization: Masoomeh Yarahmadi. Supervision: Fariba Hafezi and Behnam Makvandi.

Conflicts of interest
The Authors Declared no Conflict of interest.

Acknowledgements
Hereby, as part of a doctoral thesis, the authors of this study thank all individuals who contributed to it, including the Research Deputy of the Persian Gulf Branch, Islamic Azad University and all participating patients with insomnia disorder. 
 

 
References
  1. Yi H, Shin K, Shin C. Development of the sleep quality scale. Journal of Sleep Research. 2006; 15(3):309-16. [DOI:10.1111/j.1365-2869.2006.00544.x] [PMID]
  2. Gruber Z, Cassoff J. The interplay between sleep and emotion regulation: Conceptual framework empirical evidence and future directions. Current Psychiatry Reports. 2014; 16(11):500. [DOI:10.1007/s11920-014-0500-x] [PMID]
  3. Bothelius K, Kyhle K, Espie CA, Broman J. Manual-guided cognitive-behavioural therapy for insomnia delivered by ordinary primary care personnel in general medical practice: A randomized controlled effectiveness trial. Journal of Sleep Research. 2013; 22(6):688-96. [DOI:10.1111/jsr.12067] [PMID]
  4. Daley M, Morin CM, LeBlanc M, Grégoire JP, Savard J. The economic burden of insomnia: Direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep. 2009; 32(5):44-65. [PMID] [PMCID]
  5. Ellis J G, Cushing T, Germain A. Treating acute insomnia: A randomized controlled trial of a “single-shot” of cognitive behavioral therapy for insomnia. Sleep. 2015; 38(6):971-8. [DOI:10.5665/sleep.4752] [PMID] [PMCID]
  6. Araujo T, Jarrin DC, Leanza Y, Vallieres A, Morin CM. Qualitative studies of insomnia: Current state of knowledge in the field. Sleep Medicine Reviews. 2017; 31:58-69. [DOI:10.1016/j.smrv.2016.01.003] [PMID] [PMCID]
  7. LeBlanc M, Beaulieu-Bonneau S, Mérette C, Savard J, Ivers H, Morin CM. Psychological and health related quality of life factors associated with insomnia in a population-based sample. Journal of Psychosomatic Research. 2007; 63(2):157-66. [DOI:10.1016/j.jpsychores.2007.03.004] [PMID]
  8. Schaie KW, Willis SL. Handbook of the psychology of aging.  Cambridge: Academic Press; 2010. [Link]
  9. Kryger MH, Roth T, Goldstein CA. Principles and practice of sleep medicine. Amsterdam: Elsevier; 2017. [Link]
  10. Bartlett D, Marshall N, Williams A, Grunstein R. Sleep health New South Wales: Chronic sleep restriction and daytime sleepiness. Internal Medicine Journal. 2010; 38(1):24-31. [DOI:10.1111/j.1445-5994.2007.01395.x] [PMID]
  11. Azimi M, Moradi A, Hasani J. [Effectiveness of cognitive behavioral therapy for insomnia (traditional and Internet-based) on everyday memory of people with insomnia and comorbid depression (Persian)]. Journal of Advances in Cognitive Sciences. 2019; 20(4):20-34. [Link]
  12. Ahmadvand A, Ebrahimi N, Ghoreyshi F , Mousavi S. [Prevalence of insominia among 18 years old poople and over in Kashan city in 2008 (Persian)]. Feyz. 2010; 13(4):313-20. [Link]
  13. Amizadeh M, Shamsadini A, Motamed S, Zeinadini Meimand N. Epidemiology of sleep disturbances among primary school students in Kerman, Iran, in 2019. Social Work in Public Health. 2021; 36(2):311-6. [DOI:10.1080/19371918.2021.1873886] [PMID]
  14. Jalali R, Mohammadi M, Vaisi-Raygan A, Salari N. The prevalence of sleep disorders among Iranian older adults: A systematic review and meta-analysis. Current Psychology. 2021; 41:8002-9.  [DOI:10.1007/s12144-020-01252-8]
  1. Edinger JD, Carney CE. Overcoming insomnia: A cognitive-behavioral therapy approach, therapist guide. Oxford: Oxford University Press; 2014. [DOI:10.1093/med:psych/9780199339389.001.0001]
  2. Smith MT, Perlis ML. Who is a candidate for cognitive-behavioral therapy for insomnia? Health Psychology. 2006; 25(1):15-9. [DOI:10.1037/0278-6133.25.1.15] [PMID]
  3. Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine. 2015; 163(3):191-204. [DOI:10.7326/M14-2841] [PMID]
  4. Fiorentino L, McQuaid JR, Liu L, Natarajan L, He F, Cornejo M, et L. Individual cognitive behavioral therapy for insomnia in breast cancer survivors: A randomized controlled crossover pilot study. Nature and Science of Sleep. 2010; 2:1-8. [DOI:10.2147/NSS.S8004] [PMID] [PMCID]
  5. Bootzin RR. Stimulus control treatment for insomnia. Proceedings of the American Psychological Association. 1927; 7:395-6.[Link]
  6. Song Y, Kelly MR, Fung CH, Dzierzewski JM, Grinberg AM, Mitchell MN, et al. Change in dysfunctional sleep-related beliefs is associated with changes in sleep and other health outcomes among older veterans with insomnia: Findings from a randomized controlled trial. Annals of Behavioral Medicine. 2022; 56(1):35-49. [DOI:10.1093/abm/kaab030] [PMID] [PMCID]
  7. Vanek J, Prasko J, Genzor S, Ociskova M, Holubova M, Sova M, et al. Insomnia and emotion regulation. Neuro Enocrinology Letters. 2020; 41(5):255-69. [PMID]
  8. Goli M. [The effectiveness of emotion regulation on reducing the level of bullying in preschool children [MSc thesis] (Persian)].Tehran: Allameh University; 2013. [Link]
  9. Bigdeli I, Najafi M, Rostami M. [Relationship between attachment styles, emotional regulation and resilience with psychological well-being in medical students (Persian)]. Iranian Journal of Medical Education. 2013; 13 (9):721-9. [Link]
  10. Atadokht A. [Sleep quality and its related factors in students (Persian)]. Journal of Health and Care. 2015; 17(1):9-18. [Link]
  11. Doos Alivand H, Gharaee B, Asgharnjad Farid A, Rzvani Far SH. [Psychometric properties of short form Persian version of the dysfunctional beliefs and attitudes about sleep scale (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2014; 20(3):264 -75. [Link]
  12. Akbari M, Roshan R, Shabani A, Fata L, Shairi MR, Zarghami F. Transdiagnostic treatment of cooccurrence of anxiety and depressive disorders based on repetitive negative thinking: A case series. Iranian Journal of Psychiatry. 2015; 10(3):200-11. [PMID] [PMCID]
  13. Khazaie H, Zakei A. [The effectiveness of acceptance and commitment-based therapy on emotion regulation and sleep quality problems in patients with chronic insomnia (Persian)]. Journal of Mazandaran University of Medical Sciences. 2019; 29(178):63-52. [Link]
  14. Hertenstein E, Feige B, Gmeiner T, Kienzler C, Spiegelhalder K, Johann A, et al. Insomnia as a predictor of mental disorders: A systematic review and meta-analysis. Sleep Medicine Reviews. 2019; 43:96-105. [DOI:10.1016/j.smrv.2018.10.006] [PMID]
  15. Rezaei M, Hojjat K, Hatami SA, Manadi Ziarat, H, Ein Beigi A. [The effectiveness of metacognitive therapy on patients with insomnia (Persian)]. Journal of North Khorasan University of Medical Sciences. 2015; 7(2):327-19. [DOI:10.29252/jnkums.7.2.319]
  16. Chen A, Hartse K, McDowell W, Davila D, Johnson S, Littner M, et al. Practice parameters for the evaluation of chronic insomnia. Sleep. 2013; 23(2):237-42. [Link]
  17. Morin C M, Vallières A, Ivers H. Dysfunctional beliefs and attitudes about sleep (DBAS): Validation of a brief version (DBAS-16). Sleep. 2007; 30(11):1547-54. [DOI:10.1093/sleep/30.11.1547] [PMID] [PMCID]
  18. Azimi M, Moradi A, Hassani, J. [The effectiveness of cognitive-behavioral therapy (face-to-face and online implementation) on strategies for emotional regulation of people with insomnia and depression (Persian)]. Journal of Psychological Health. 2017; 11(1):49-61. [DOI:10.29252/rph.11.1.49]
  19. Gencarelli AM, Zurlinden T, Nicoletta A, Winters A, Sorrell A, Corbett Q, et al. The relationship between raction time, insomnia severity, sleepiness and dysfunctional beliefs about sleep. Sleep. 2020; 43. [DOI:10.1093/sleep/zsaa056.155]

 
Type of Study: Original Research | Subject: Psychiatry and Psychology
Received: 2021/07/13 | Accepted: 2021/10/31 | Published: 2022/07/1
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