The effectiveness of transdiagnostic cognitive behavioral therapy for comorbid insomnia: a case report
Objective: Similar cognitive and behavioral factors underlie and perpetuate insomnia and emotional disorders. This brief case report aims to evaluate the effectiveness of the Unified Protocol (UP), a transdiagnostic treatment designed to target emotional disorders in treating comorbid insomnia.
Method: The patient was a 32-year-old male, who met the DSM-IV-TR criteria for chronic insomnia, major depressive disorder, and generalized anxiety disorder. After 3 baseline weeks, the patient underwent 14 sessions of UP and was retested after a 1-month follow-up. Consensus Sleep Diary (CSD), Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI) were completed during baseline, treatment, and follow-up.
Results: The treatment led to improvements in sleep onset latency, time awake after sleep onset, terminal awakenings, sleep quality, and insomnia severity. These gains were maintained at 1-month follow-up.
Conclusion: UP is effective in improving different symptoms of chronic insomnia. Controlled clinical studies with more cases are required to investigate the effects of UP in the treatment of insomnia.
Ohayon MM. Insomnia: a ticking clock for depression? J Psychiat Res 2007; 41: 893-894.
Ohayon MM. Observation of the Natrual Evolution OF Insomnia in the American General Population Cohort. Sleep Med Clin 2009;4: 87-92.
Wilamowska ZA, Thompson-Hollands J, Fairholme CP, Ellard KK, Farchione TJ, Barlow DH. Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders. Depress Anxiety 2010; 27: 882-890.
Newby JM, McKinnon A, Kuyken W, Gilbody S, Dalgleish T. Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clin Psychol Rev 2015; 40: 91-110.
Barlow DH, Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Allen LB, et al. The unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York, NY: Oxford University Press; 2011.
Fairholme CP, Carl JR, Farchione TJ, Schonwetter SW. Transdiagnostic processes in emotional disorders and insomnia: results from a sample of adult outpatients with anxiety and mood disorders. Behav Res Ther 2012; 50: 522-528.
Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clin Psychol Rev 2010; 30: 217-237.
Gruber J, Eidelman P, Harvey AG. Transdiagnostic emotion regulation processes in bipolar disorder and insomnia. Behav Res Ther 2008; 46: 1096-1100.
Brown TA, Barlow DH. A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: implications for assessment and treatment. Psychol Assessment 2009; 21: 256-271.
Harvey CJ, Gehrman P, Espie CA. Who is predisposed to insomnia: a review of familial aggregation, stress-reactivity, personality and coping style. Sleep Med Rev 2014;18: 237-247.
Taylor S, Koch WJ, McNally RJ. How does anxiety sensitivity vary across the anxiety disorders? J Anxiety Disord 1992; 6: 249-259.
Cox BJ, Enns MW, Taylor S. The Effect of Rumination as a Mediator of Elevated Anxiety Sensitivity in Major Depression. Cognitive Ther Res 2001; 25: 525-534.
Babson KA, Trainor CD, Bunaciu L, Feldner MT. An Examination of Anxiety Sensitivity as a Moderator of the Relation Between Sleep Anticipatory Anxiety and Sleep Onset Latency. J Cogn Psychother 2008; 22: 258-270.
Bullis JR, Fortune MR, Farchione TJ, Barlow DH. A preliminary investigation of the long-term outcome of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Compr Psychiatry 2014; 55: 1920-1927.
Maia AC, Braga AA, Nunes CA, Nardi AE, Cardoso A. Transdiagnostic treatment using a unified protocol: application for patients with a range of comorbid mood and anxiety disorders. Trends Psychiatry Psychother 2013; 35: 134-140.
de Ornelas Maia AC, Nardi AE, Cardoso A. The utilization of unified protocols in behavioral cognitive therapy in transdiagnostic group subjects: A clinical trial. J Affect Disord 2015;172:179-183.
Ellard KK, Fairholme CP, Boisseau CL, Farchione TJ, Barlow DH. Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: Protocol Development and Initial Outcome Data. Cogn Behav Pract 2010; 17: 88-101.
First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV axis I disorders, clinician version (SCID-CV). Washington, D.C: American Psychiatric Press.; 1996.
Amini H, Sharifi V, Asadi SM, Mohammadi MR, Kaviani H, Semnani Y, et al. Validity of the Iranian Version of the Structured Clinical Interview for DSM-IV (SCID-I) In the Diagnosis of Psychiatric disorders [In Persian]. Payesh 2008; 7: 49-57.
Roth T, Zammit G, Kushida C, Doghramji K, Mathias SD, Wong JM, et al. A new questionnaire to detect sleep disorders. Sleep Med 2002; 3: 99-108.
Lichstein KL, Durrence HH, Taylor DJ, Bush AJ, Riedel BW. Quantitative criteria for insomnia. Behav Res Ther 2003; 41: 427-445.
Edinger JD, Bonnet MH, Bootzin RR, Doghramji K, Dorsey CM, Espie CA, et al. Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group. Sleep. 2004; 27: 1567-1596.
Carney CE, Buysse DJ, Ancoli-Israel S, Edinger JD, Krystal AD, Lichstein KL, et al. The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep 2012; 35: 287-302.
Morin CM. Insomnia, psychological assessment and management. New York: Guilford Press; 1994.
Yazdi Z, Sadeghniiat-Haghighi K, Zohal MA, Elmizadeh K. Validity and reliability of the Iranian version of the insomnia severity index. Malays J Med Sci. 2012; 19: 31–36.
Farrahi Moghaddam J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath 2012; 16: 79-82.
Buysse DJ, Reynolds CF, III, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.
Bullis JR, Sauer-Zavala S. The Unified Protocol for insomnia disorder. In: Farchione TJ, Barlow DH, editors. Applications of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. New York: Oxford University Press; in press.
Boisseau CL, Farchione TJ, Fairholme CP, Ellard KK, Barlow DH. The Development of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: A Case Study. Cogn Behav Pract 2010; 17: 102-113.
Fairholme CP, Nosen EL, Nillni YI, Schumacher JA, Tull MT, Coffey SF. Sleep disturbance and emotion dysregulation as transdiagnostic processes in a comorbid sample. Behav Res Ther 2013; 51: 540-546.