Klinik fr Psychiatrie und Psychotherapie Acceptance and Commitment

Klinik für Psychiatrie und Psychotherapie Acceptance and Commitment Therapy for Insomnia Elisabeth Hertenstein ACBS World Conference, July 18 th, 2015

Outline § Why could ACT be effective for insomnia? § Why is a new insomnia treatment needed? § Our Pilot Study § Future Plans

Insomnia Sleep complaint § Sleep onset, sleep maintenance, early awakening § Three times per week, ≥ three months Daytime impairment § Fatigue § Reduced concentration § Mood disturbance § prevalence of insomnia 10%, primary insomnia 2– 4% § insomnia is a risk factor for mental and somatic disorders Ohayon et al. , 2002, Sleep Medicine Reviews Baglioni et al. 2011, Journal of Affective Disorders Chien et al. 2010, Journal of Sleep and Sleep Disorders Research 3

ACT Core Assumptions. . . and sleep Human behavior is over-regulated by inflexible cognition. falling asleep can hardly be described verbally falling asleep is an „automatic“ process sleep is inhibited by attention, intention and effort 1 Espie et al. , 2006, Sleep Medicine Reviews 4

ACT Core Assumptions. . . and sleep Contact with actual experience is often lost. patients with insomnia overestimate their wake time potentially overestimate daytime impairment ruminate over the past and the future 5

ACT Core Assumptions. . . and sleep Humans spend too much time avoiding what they fear and too little time approaching what they appreciate. Patients with insomnia avoid valued acitivities in order to sleep better (e. g. evening appointments). 6

ACT Core Assumptions. . . and sleep Pragmatism: evaluate thoughts in terms of their helpfulness, not in terms of true or false. Patients with insomnia often have dysfunctional thoughts that are not totally wrong, but unhelpful when trying to fall asleep: § „I will be less productive if I don‘t get enough sleep“ § „Sleep loss is bad for my health“ 7

ACT Therapeutic Elements § establish contact with actual experience mindfulness § stop fighting what cannot be changed acceptance § find out what YOU want your life to be like values § shape your life according to your values commitment 8

Evidence Based Insomnia Therapy Benzodiazepines § effective, but. . . §. . . only evidence-based for short-term treatment (< 4 weeks) 1 §. . . risk of undesired side effects: § tolerance, dependence § sedation § complex sleep-related behaviors § falls 1 Riemann & Perlis, 2009, Sleep Medicine Reviews 9

Evidence Based Insomnia Therapy Cognitive Behavioral Therapy § effective, but. . . §. . . average symptom improvement 50 -60% 1 §. . . 25% non-responders 1 §. . . effects on quality of life rarely investigated and rather small 2 1 Harvey & Tang, 2003, Sleep Medicine Reviews 2 Kyle et al. , 2010, Sleep Medicine Reviews 10

Pilot Study Aims § Test the feasibility of ACT as a group treatment in patients with primary insomnia § Collect preliminary efficacy data for subjective sleep quality & sleep related quality of life

Pilot Study Sample sample Starters/Completers m/w Age (years) insomnia duration (years) experienced with CBT-I medication: Benzo. /AD/none 11/10 5/5 51. 1± 12. 0 24. 2± 11. 2 11 1/2/7

Pilot Study Design T-1 T 0 -6 0 ACT 6 sessions T 1 T 2 6 18 weeks

Pilot Study Main Results ( ) * * a b Hertenstein et al. , 2014, Psychother Psychosom

Pilot Study Subjective Treatment Satisfaction

Future Plans § test the efficacy of ACT for insomnia in a larger randomized trial § combine ACT with elements of CBTI § focus on quality of life as an outcome § extend the target group, including patients with „insomnia disorder“

Acknowledgements Christoph Nissen, Dieter Riemann, Nicola Thiel, Marianne Lüking, Anne Katrin Külz, Elisabeth Schramm, Chiara Baglioni, Kai Spiegelhalder, Bernd Feige, Bernd Tritschler, Mathias Berger FAZIT Stiftung