Category: Adult Anxiety - GAD
Insomnia management is not typically addressed in the treatment for GAD; however, data from pharmacological studies have shown that treating insomnia as an adjunct to GAD treatment can lead to better improvements in sleep and anxiety. Integrating cognitive-behaviour strategies to reduce insomnia to a psychotherapy of GAD has yet to be tested. The objective of the present study was to assess the impact of incorporating insomnia management strategies to cognitive-behaviour therapy (CBT) for GAD on sleep, anxiety and therapy processes (cognitions, avoidance, emotion regulation).
Upon confirmation of eligibility and the completion of the baseline assessment, 49 participants with GAD (41 female; mean age 32.0 years, SD = 8.77) were randomly assigned to CBT for GAD, either alone (CBT GAD) or with insomnia management strategies (CBT GAD + insomnia). The two treatments consisted of 12 weekly 50-minute individual sessions. Eligibility was assessed with the Anxiety Disorders Interview Schedule. Measures of symptoms included the Penn State Worry Questionnaire, the Worry and Anxiety Questionnaire, the Beck Anxiety Inventory, the Beck Depression Inventory – II, and the Insomnia Severity Index. Measures of processes included the Intolerance to Uncertainty Scale, the Cognitive Avoidance Questionnaire, the Negative Problem Orientation Questionnaire, the Why Worry – II, and the Difficulties in Emotion Regulation Scale. Questionnaires were completed pre- and post-treatment, as well as 3 and 6 months after treatment.
Significant post-treatment improvements were observed in both conditions on all five measures of symptoms and on all five measures of process. Further improvements were observed at the 3-month follow-up on worry tendencies, GAD symptom severity, intolerance to uncertainty and negative problem orientation. Only three significant Condition X Time interactions were observed, on anxiety symptom severity, negative problem orientation and difficulties in emotion regulation, suggesting that participants from both conditions improved from pre- to posttreatment, but that only those receiving CBT GAD + Insomnia further improved in the follow-up assessments.
Decreases in worries, GAD symptoms and insomnia were observed after CBT for GAD, whether or not it included insomnia management strategies. This suggested that CBT for GAD may be sufficient to address insomnia symptoms in GAD. However, the addition of insomnia management strategies may help in optimizing the effect of GAD treatment on problem orientation and emotion regulation, which in turn may lead to an additional benefit on anxiety symptoms. Further studies are needed to explore the impact of CBT for insomnia on problem-solving skills and emotion regulation.