Pre-sleep worry decrease by adding reading and guided imagery to insomnia treatment

Abstract

Introduction Worry is considered an important insomnia maintenance factor. There is an urge in researching new treatments for insomnia that target diminishing pre-sleep cognitive arousal or worry. Although reading is a popular method of getting to sleep, it is recommended in stimulus control not to read in bed. Guided imagery is considered a way of dealing with cognitive pre sleep arousal. Our aim is to compare the effect on pre-sleep worry from reading and guided imagery added to insomnia treatment. Materials and methods Eighty volunteer participants were divided in reading ( n = 42; 30 females; mean age = 52.1 years) and imagery ( n = 38; 27 females; mean age = 53.3 years) groups after two baseline weeks. Treatment lasted 3 weeks and after 4 weeks follow-up was made during one week. Pre-sleep arousal scale (PSAS) was measured at baseline, post treatment and follow-up. PSAS is a 16-item scale that measures separately the somatic and cognitive arousal associated with pre-sleep time. Treatment included lectures on sleep hygiene, dysfunctional beliefs and attitudes about sleep, microanalitic and cognitive models of insomnia and the role of worries in maintaining insomnia. Reading group was asked to read during 15 min before sleep a boring, or difficult or calming book. Imagery group received a 14 min CD with imagery instructions related to get rid of worries that disturbed sleep to be listened before sleep. The Federal University of Sao Paulo Ethics Committee approved the protocol, and all candidates signed the study consent form (#01677/04). Results The comparison shows that there is no difference between reading ( p = 0,977) and somatic ( p = 0,877) groups at baseline (B), post treatment (PT) and follow-up (FU) for the cognitive and somatic components. Compared to baseline, cognitive component at post treatment and follow-up decreased significantly ( p p = 0,233) and decreased at follow-up ( p = 0,001).When compared to post treatment, somatic component showed significant decrease at follow-up ( p = 0,003). Conclusion Reading and guided imagery added to insomnia treatment are useful tools in reducing pre-sleep arousal. However, both had a quicker effect on cognitive components, while effects on somatic components appeared just at follow-up. As thoughts and worry are very important in maintaining insomnia, reading and guided imagery added to the treatment may help to cope with cognitive arousal. Acknowledgements I acknowledge Dr. Charles Morin for his generous help.