Elisabeth Hertenstein

ACBS World Conference, July 18th, 2015

Klinik für Psychiatrie und Psychotherapie

Acceptance and Commitment Therapy for

Insomnia

Acceptance and Commitment Therapy for

Insomnia

Why could ACT be effective for insomnia?

Why is a new insomnia treatment needed?

Our Pilot Study

Future Plans

Outline

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

3

Insomnia

Ohayon et al., 2002, Sleep Medicine ReviewsBaglioni et al. 2011, Journal of Affective Disorders

Chien et al. 2010, Journal of Sleep and Sleep Disorders Research

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

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ACT Core Assumptions...... and sleep

Espie et al., 2006, Sleep Medicine Reviews

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

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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).

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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“

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ACT Core Assumptions...... and sleep

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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

ACT Therapeutic Elements

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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

Evidence Based Insomnia TherapyBenzodiazepines

1 Riemann & Perlis, 2009, Sleep Medicine Reviews

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effective, but...

... average symptom improvement 50-60% 1

... 25% non-responders 1

... effects on quality of life rarely investigated and rather

small 2

Evidence Based Insomnia TherapyCognitive Behavioral Therapy

1 Harvey & Tang, 2003, Sleep Medicine Reviews2 Kyle et al., 2010, Sleep Medicine Reviews

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 StudyAims

sampleStarters/Completers 11/10m/w 5/5Age (years) 51.1±12.0insomnia duration (years) 24.2±11.2 experienced with CBT-I 11medication:Benzo./AD/none

 1/2/7

Pilot StudySample

T-1 T0ACT

6 sessions T1 T2

weeks-6 0 6 18

Pilot StudyDesign

( )* *

*

*

a b

Pilot StudyMain Results

Hertenstein et al., 2014, Psychother Psychosom

Pilot StudySubjective Treatment Satisfaction

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“

Future Plans

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

Acknowledgements