Archive for the ‘American Psychological Association’ Category

Insomnia-Electronic-Cigarettes

An insomnia therapy that scientists just reported could double the effectiveness of depression treatment is not widely available nor particularly well understood by psychiatrists or the public. The American Board of Sleep Medicine has certified just 400 practitioners in the United States to administer it, and they are sparse, even in big cities.

That may change soon, however. Four rigorous studies of the treatment are nearing completion and due to be reported in coming months. In the past year, the American Psychological Association recognized sleep psychology as a specialty, and the Department of Veterans Affairs began a program to train about 600 sleep specialists. So-called insomnia disorder is defined as at least three months of poor sleep that causes problems at work, at home or in relationships.

The need is great: Depression is the most common mood disorder, affecting some 18 million Americans in any given year, and most have insomnia.

“I think it’s increasingly likely that this kind of sleep therapy will be used as a possible complement to standard care,” said Dr. John M. Oldham, chief of staff at the Menninger Clinic in Houston. “We are the court of last resort for the most difficult-to-treat patients, and I think sleep problems have been extremely underrecognized as a critical factor.”

The treatment, known as cognitive behavioral therapy for insomnia, or CBT-I, is not widely available. Most insurers cover it, and the rates for private practitioners are roughly the same as for any psychotherapy, ranging from $100 to $250 an hour, depending on the therapist.

“There aren’t many of us doing this therapy,” said Shelby Harris, the director of the behavioral sleep medicine program at Montefiore Medical Center in the Bronx, who also has a private practice in Tarrytown, N.Y. “I feel like we all know each other.”

According to preliminary results, one of the four studies has found that when CBT-I cures insomnia — it does so 40 percent to 50 percent of the time, previous work suggests — it powerfully complements the effect of antidepressant drugs.

“There’s been a huge recognition that insomnia cuts across a wide variety of medical disorders, and there’s a need to address it,” said Michael T. Smith, a professor at the Johns Hopkins School of Medicine and president of the Society of Behavioral Sleep Medicine.

The therapy is easy to teach, said Colleen Carney, director of the sleep and depression lab at Ryerson University in Toronto, whose presentation at a conference of the Association for Behavioral and Cognitive Therapies in Nashville on Saturday raised hopes for depression treatment. “In the study we did, I trained students to administer the therapy,” she said in an interview, “and the patients in the study got just four sessions.”

CBT-I is not a single technique but a collection of complementary ideas. Some date to the 1970s, others are more recent. One is called stimulus control, which involves breaking the association between being in bed and activities like watching television or eating. Another is sleep restriction: setting a regular “sleep window” and working to stick to it. The therapist typically has patients track their efforts on a standardized form called a sleep diary. Patients record bedtimes and when they wake up each day, as well as their perceptions about quality of sleep and number of awakenings. To this the therapist might add common-sense advice like reducing caffeine and alcohol intake, and making sure the bedroom is dark and quiet.

Those three elements — stimulus control, restriction and common sense — can do the trick for many patients. For those who need more, the therapist applies cognitive therapy — a means of challenging self-defeating assumptions. Patients fill out a standard questionnaire that asks how strongly they agree with statements like: “Without an adequate night’s sleep, I can hardly function the next day”; “I believe insomnia is the result of a chemical imbalance”; and “Medication is probably the only solution to sleeplessness.” In sessions, people learn to challenge those beliefs, using evidence from their own experiences.

“If someone has the belief that if they don’t sleep, they’ll somehow fail the next day, I’ll ask, ‘What does failure mean? You’ll be slower at work, not get everything done, not make dinner?’ ” Dr. Harris said. “Then we’ll look at the 300 nights they didn’t sleep well over the past few years and find out they managed; it might not have been as pleasant as they liked, but they did not fail. That’s how we challenge those kinds of thoughts.”

Dr. Aaron T. Beck, an emeritus professor of psychiatry at the University of Pennsylvania who is recognized as the father of cognitive therapy for mental disorders, said the techniques were just as applicable to sleep problems. “In fact, I have used it myself when I occasionally have insomnia,” he said by email.

In short-term studies of a month or two, CBT-I has been about as effective as prescription sleeping pills. But it appears to have more staying power. “There’s no data to show that if you take a sleeping pill — and then stop taking it — that you’ll still be good six months later,” said Jack Edinger, a professor at National Jewish Health in Denver and an author, with Dr. Carney, of “Overcoming Insomnia: A Cognitive-Behavioral Therapy Approach.”

“It might happen, but those certainly aren’t the people who come through my door,” he said.

Dr. Edinger and others say that those who respond well to CBT-I usually do so quickly — in an average of four sessions, and rarely more than eight. “You’re not going to break the bank doing this stuff; it’s not a marriage,” he said. “You do it for a fixed amount of time, and then you’re done. Once you’ve got the skills, they don’t go away.”

http://www.nytimes.com/2013/11/24/health/sleep-therapy-is-expected-to-gain-a-wider-role-in-depression-treatment.html?partner=rss&emc=rss&_r=0

Pessimism-vs_-optimism-350x262
Older people who have low expectations for a satisfying future may be more likely to live longer, healthier lives than those who see brighter days ahead, according to new research published by the American Psychological Association.

“Our findings revealed that being overly optimistic in predicting a better future was associated with a greater risk of disability and death within the following decade,” said lead author Frieder R. Lang, PhD, of the University of Erlangen-Nuremberg in Germany. “Pessimism about the future may encourage people to live more carefully, taking health and safety precautions.” The study was published online in the journal Psychology and Aging.

Lang and colleagues examined data collected from 1993 to 2003 for the national German Socio-Economic Panel, an annual survey of private households consisting of approximately 40,000 people 18 to 96 years old. The researchers divided the data according to age groups: 18 to 39 years old, 40 to 64 years old and 65 years old and above. Through mostly in-person interviews, respondents were asked to rate how satisfied they were with their lives and how satisfied they thought they would be in five years.

Five years after the first interview, 43 percent of the oldest group had underestimated their future life satisfaction, 25 percent had predicted accurately and 32 percent had overestimated, according to the study. Based on the average level of change in life satisfaction over time for this group, each increase in overestimating future life satisfaction was related to a 9.5 percent increase in reporting disabilities and a 10 percent increased risk of death, the analysis revealed.

Because a darker outlook on the future is often more realistic, older adults’ predictions of their future satisfaction may be more accurate, according to the study. In contrast, the youngest group had the sunniest outlook while the middle-aged adults made the most accurate predictions, but became more pessimistic over time.

“Unexpectedly, we also found that stable and good health and income were associated with expecting a greater decline compared with those in poor health or with low incomes,” Lang said. “Moreover, we found that higher income was related to a greater risk of disability.”

The researchers measured the respondents’ current and future life satisfaction on a scale of 0 to 10 and determined accuracy in predicting life satisfaction by measuring the difference between anticipated life satisfaction reported in 1993 and actual life satisfaction reported in 1998. They analyzed the data to determine age differences in estimated life satisfaction; accuracy in predicting life satisfaction; age, gender and income differences in the accuracy of predicting life satisfaction; and rates of disability and death reported between 1999 and 2010. Other factors, such as illness, medical treatment or personal losses, may have driven health outcomes, the study said.

The findings do not contradict theories that unrealistic optimism about the future can sometimes help people feel better when they are facing inevitable negative outcomes, such as terminal disease, according to the authors. “We argue, though, that the outcomes of optimistic, accurate or pessimistic forecasts may depend on age and available resources,” Lang said. “These findings shed new light on how our perspectives can either help or hinder us in taking actions that can help improve our chances of a long healthy life.”

http://www.sciencedaily.com/releases/2013/02/130227101929.htm