A Novel Group Cognitive Behavioral Therapy Approach to Adult Non-rapid Eye Movement Parasomnias.

David O'Regan,Allan H Young,Alexander Nesbitt,Ivana Rosenzweig,Hugh Selsick,Veena Kumari,Joerg Steier,Adam Birdseye,Paul R Stokes,Iain Duncan,Panagis Drakatos,Seán Higgins,Nazanin Biabani,Guy D Leschziner

doi:10.3389/fpsyt.2021.679272

Abstract

Background: Following the success of Cognitive Behavioral Therapy (CBT) for insomnia, there has been a growing recognition that similar treatment approaches might be equally beneficial for other major sleep disorders, including non-rapid eye movement (NREM) parasomnias. We have developed a novel, group-based, CBT-program for NREM parasomnias (CBT-NREMP), with the primary aim of reducing NREM parasomnia severity with relatively few treatment sessions.Methods: We investigated the effectiveness of CBT-NREMP in 46 retrospectively-identified patients, who completed five outpatient therapy sessions. The outcomes pre- and post- CBT-NREMP treatment on clinical measures of insomnia (Insomnia Severity Index), NREM parasomnias (Paris Arousal Disorders Severity Scale) and anxiety and depression (Hospital Anxiety and Depression Scale), were retrospectively collected and analyzed. In order to investigate the temporal stability of CBT-NREMP, we also assessed a subgroup of 8 patients during the 3 to 6 months follow-up period.Results: CBT-NREMP led to a reduction in clinical measures of NREM parasomnia, insomnia, and anxiety and depression severities [pre- vs. post-CBT-NREMP scores: P (Insomnia Severity Index) = 0.000054; P (Paris Arousal Disorders Severity Scale) = 0.00032; P (Hospital Anxiety and Depression Scale) = 0.037]. Improvements in clinical measures of NREM parasomnia and insomnia severities were similarly recorded for a subgroup of eight patients at follow-up, demonstrating that patients continued to improve post CBT-NREMP.Conclusion: Our findings suggest that group CBT-NREMP intervention is a safe, effective and promising treatment for NREM parasomnia, especially when precipitating and perpetuating factors are behaviorally and psychologically driven. Future randomized controlled trials are now required to robustly confirm these findings.

Highlights

Non-Rapid Eye Movement (NREM) parasomnias, or arousal disorders, are common in adults, where they represent a constellation of different unwanted behaviors and experiences, arising from or associated with sleep, for example from sleep walking to sexsomnia [1]
Patients were asked to complete baseline Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale (HADS), and Paris Arousal Disorders Severity Scale (PADSS) assessments prior to starting Cognitive Behavioral Therapy (CBT)-NREMP, and the same assessments were subsequently completed after the CBT-NREMP intervention (Tables 1, 2)
Further significant improvements were noted in clinical measures of insomnia (ISIPrevsPost: P = 0.000054; Table 2), which were reduced to clinical subthreshold values (Table 1), as well as in patients’ self-reported severity of anxiety and depressive symptoms (HADSPrevsPost: P = 0.037; Table 2)

Summary

Introduction

Non-Rapid Eye Movement (NREM) parasomnias, or arousal disorders, are common in adults, where they represent a constellation of different unwanted behaviors and experiences, arising from or associated with sleep, for example from sleep walking to sexsomnia [1]. Pharmacotherapy is frequently used in the treatment of NREM parasomnias [9]. It is not always effective or wanted by patients, often because of fear of side-effects and dependency [3]. Treatment success rates vary between different NREM parasomnia phenotypes, and polypharmacy may be required [9]. Even when pharmacotherapy is successful, NREM parasomnias can re-emerge following treatment cessation, if priming and precipitating factors remain unaddressed [11]. Following the success of Cognitive Behavioral Therapy (CBT) for insomnia, there has been a growing recognition that similar treatment approaches might be beneficial for other major sleep disorders, including non-rapid eye movement (NREM) parasomnias. We have developed a novel, group-based, CBT-program for NREM parasomnias (CBT-NREMP), with the primary aim of reducing NREM parasomnia severity with relatively few treatment sessions

Objectives

Methods

Results

Conclusion