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Developing a cognitive behavioral therapy manual for delayed sleep wake phase disorder: CBT for DSWPD - A treatment manual
Department of Psychology, Stockholm University, Stockholm, Stockholms Universitet, Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
2016 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, no 6, 518-532 p.Article in journal (Refereed) Published
Abstract [en]

This article reports the development of a treatment protocol, based on cognitive behavioral therapy (CBT) principles, for delayed sleep–wake phase disorder (DSWPD). The protocol consists of psycho-education, presenting a CBT model for DSWPD, case formulation, motivational interviewing, registering sleep in a diary, strategies to improve the rhythm of sleep and wakefulness, relaxation training, cognitive restructuring, strategies to cope with daytime symptoms, constructing an individualized CBT program, and learning how to deal with relapses. Qualitative data, focusing on how the patients perceived the protocol, were collected within the realm of a trial exploring the efficacy of the protocol. These findings highlighted several advantages but also disadvantages of the therapy. It is our hope that this paper might act as a platform for further clinical work and future research efforts in patients with DSWPD.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2016. Vol. 45, no 6, 518-532 p.
National Category
Neurosciences
Identifiers
URN: urn:nbn:se:uu:diva-298761DOI: 10.1080/16506073.2016.1207096OAI: oai:DiVA.org:uu-298761DiVA: diva2:947172
Available from: 2016-07-07 Created: 2016-07-07 Last updated: 2016-09-02Bibliographically approved
In thesis
1. Delayed Sleep Phase Disorder: Prevalence, Diagnostic aspects, Associated factors and Treatment concepts
Open this publication in new window or tab >>Delayed Sleep Phase Disorder: Prevalence, Diagnostic aspects, Associated factors and Treatment concepts
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Delayed sleep phase disorder (DSPD) is the most common circadian rhythm sleep disorder. Persons with DSPD have great difficulties falling asleep and waking up at conventional times. To diagnose DSPD this delayed sleep-wake rhythm should cause social impairment and distress for the individual. Evening melatonin and morning bright light are the recommended treatments. The overall aim of this thesis was to evaluate at-home treatment with Light therapy (LT) and the feasibility of adding cognitive behavior therapy (CBT) to LT in DSPD, furthermore prevalence, diagnostic aspects and associated factors were investigated.

Study I included 673 randomly selected individuals aged 16–26 years. The prevalence of DSPD was 4.0%. Unemployment (defined as an absence of educational or work activities) and an elevated level of anxiety were associated with DSPD.

In study II, dim light melatonin onset (DLMO) was measured in healthy adults. Time for DLMO DLMO (Mean±SD) was 20:58±55 minutes.

Studies III, IV, and V present results from a randomized controlled trial examining the feasibility of CBT as an additive treatment to LT with scheduled rise times, in persons with DSPD. Sleep onset and sleep offset was significantly advanced from baseline (03:00±1:20; 10:22±2:02 respectively) to the end of LT (01:27±1:41; 08:05±1:29, p<0.001 respectively). This advancement was predicted by consistent daily usage of the LT-lamp. At the follow-ups after LT and CBT or LT alone, sleep onset remained stable, sleep offset was delayed, and sleep difficulties were further improved, but there was no significant group interaction over time. There was a significant group interaction over time in the severity of anxiety and depressive symptoms, both in favor of the LT+CBT group.

Conclusively, DSPD was common among adolescents and young adults and it was associated with unemployment and elevated levels of anxiety. DLMO appeared in the expected time range in healthy working adults. At-home treatment with LT with scheduled rise times advanced sleep-wake rhythm and improved sleep difficulties in DSPD. Even though sleep-wake rhythm was not further advanced or better preserved in the participants that received LT+CBT compared to LT alone, the addition of CBT to the treatment regimen was feasible and well accepted.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 70 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1243
Keyword
delayed sleep phase disorder, prevalence, diagnostic aspects, associated factors, light therapy and cognitive behavior therapy
National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-299887 (URN)978-91-554-9645-6 (ISBN)
External cooperation:
Public defence
2016-09-29, Gunnesalen, Akademiska sjukhuset ingång 10, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2016-09-07 Created: 2016-07-29 Last updated: 2016-09-13

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