Title

Relationships between sleep belief changes and behavior changes within an occupational therapy led cognitive behavioral therapy for insomnia program

1

Location

Pre-function area and Great Room 1B

Start Time

19-10-2017 7:00 PM

End Time

19-10-2017 9:00 PM

Session Type

Poster

Abstract

Statement of purpose: We sought to explore relationships between sleep beliefs change and behavior (occupation) change in military veterans in college with service connected injuries. These veterans had chronic insomnia and completed a safe and effective occupational therapy (OT) led cognitive behavioral therapy for insomnia (CBT-I) program (Eakman et al., 2017). Specifically, we investigated how sleep belief changes were related to changes in occupations within a CBT-I treatment program as persons are instructed to go to bed and wake at times prescribed by the therapist. Such understanding could contribute to improved behavioral (occupation) adherence to CBT-I resulting in greater improvements in sleep quality. Cognitive and behavioral models of chronic insomnia (Carney & Edinger, 2006), CBT-I intervention theories (Perlis, et al., 2008), and the organismic integration theory of intrinsic and extrinsic control (Ryan & Deci, 2000) guided study design and interpretation.

Method: This in-process mixed method study included 21 military veterans in college with chronic insomnia who completed a 7-week OT led CBT-I program; 18 of these veterans then participated in a one-hour semi-structured interview. Pre- post-test quantitative data were collected on 10 dysfunctional sleep beliefs (Espie, et al., 2000) and t-tests evaluated sleep belief change. A-priori codes based upon interview questions (e.g., occupation to adhere) and the above models/ theories (e.g. circadian rhythm) were applied to interview transcripts. De novo codes and higher-order thematic development followed upon consensus of a team of three researchers.

Results: Each of the 10 sleep beliefs changed in response to the CBT-I program (p < .05; Cohen’s d range .68 – 2.18) (e.g., from “agree” to “somewhat disagree” that poor sleep disrupts activities the next day). Higher-order thematic development indicated occupations can be intentionally and routinely employed prior to a prescribed bedtime and following a prescribed wake time as participants adhere to therapist prescriptions within a CBT-I program. The intentional application of occupations accompanied sleep belief changes, and followed an apparent developmental trajectory from extrinsically controlled motivation (e.g., “I just do what she tells me”) to intrinsically controlled motivation (e.g., “I know what I need to do to get good sleep”). Participants’ understanding of chronic insomnia, circadian rhythm, and sleep drive processes contributed to change through modifying sleep beliefs and adopting new routines of occupation.

Discussion: This study deepens understanding of how shaping beliefs about occupations and sleep can lead to the adoption of novel routines of occupations capable of fostering improved sleep quality.

References

Carney, C. E., & Edinger, J. D. (2006). Identifying critical beliefs about sleep in primary insomnia. Sleep, 29(4), 444-453.

Eakman, A. M., Schmid, A., Henry, K. L., Rolle, N. R., Schelly, C., Grupe, C.E., & Burns, J. (2017). Restoring Effective Sleep Tranquility (REST): A feasibility and pilot study. British Journal of Occupational Therapy. in press, DOI: 10.1177/0308022617691538

Espie, C. A., Inglis, S. J., Harvey, L., & Tessier, S. (2000). Insomniacs' attributions: Psychometric properties of the Dysfunctional Beliefs and Attitudes about Sleep Scale and the Sleep Disturbance Questionnaire. Journal of Psychosomatic Research, 48(2), 141-148.

Perlis, M. L., Jungquist, C., Smith, M. T., & Posner, D. (2008). Cognitive Behavioral Treatment of Insomnia: A session-by-session guide. New York, NY: Springer Science+Business Media, LLC.

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68-78.

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Oct 19th, 7:00 PM Oct 19th, 9:00 PM

Relationships between sleep belief changes and behavior changes within an occupational therapy led cognitive behavioral therapy for insomnia program

Pre-function area and Great Room 1B

Statement of purpose: We sought to explore relationships between sleep beliefs change and behavior (occupation) change in military veterans in college with service connected injuries. These veterans had chronic insomnia and completed a safe and effective occupational therapy (OT) led cognitive behavioral therapy for insomnia (CBT-I) program (Eakman et al., 2017). Specifically, we investigated how sleep belief changes were related to changes in occupations within a CBT-I treatment program as persons are instructed to go to bed and wake at times prescribed by the therapist. Such understanding could contribute to improved behavioral (occupation) adherence to CBT-I resulting in greater improvements in sleep quality. Cognitive and behavioral models of chronic insomnia (Carney & Edinger, 2006), CBT-I intervention theories (Perlis, et al., 2008), and the organismic integration theory of intrinsic and extrinsic control (Ryan & Deci, 2000) guided study design and interpretation.

Method: This in-process mixed method study included 21 military veterans in college with chronic insomnia who completed a 7-week OT led CBT-I program; 18 of these veterans then participated in a one-hour semi-structured interview. Pre- post-test quantitative data were collected on 10 dysfunctional sleep beliefs (Espie, et al., 2000) and t-tests evaluated sleep belief change. A-priori codes based upon interview questions (e.g., occupation to adhere) and the above models/ theories (e.g. circadian rhythm) were applied to interview transcripts. De novo codes and higher-order thematic development followed upon consensus of a team of three researchers.

Results: Each of the 10 sleep beliefs changed in response to the CBT-I program (p < .05; Cohen’s d range .68 – 2.18) (e.g., from “agree” to “somewhat disagree” that poor sleep disrupts activities the next day). Higher-order thematic development indicated occupations can be intentionally and routinely employed prior to a prescribed bedtime and following a prescribed wake time as participants adhere to therapist prescriptions within a CBT-I program. The intentional application of occupations accompanied sleep belief changes, and followed an apparent developmental trajectory from extrinsically controlled motivation (e.g., “I just do what she tells me”) to intrinsically controlled motivation (e.g., “I know what I need to do to get good sleep”). Participants’ understanding of chronic insomnia, circadian rhythm, and sleep drive processes contributed to change through modifying sleep beliefs and adopting new routines of occupation.

Discussion: This study deepens understanding of how shaping beliefs about occupations and sleep can lead to the adoption of novel routines of occupations capable of fostering improved sleep quality.