Telehealth-delivered CBT-I programme enhanced by acceptance and commitment therapy for insomnia and hypnotic dependence: A pilot randomized controlled trial.

Cognitive behavioural therapy for insomnia is the recommended treatment for chronic insomnia. However, up to a quarter of patients dropout from cognitive behavioural therapy for insomnia programmes. Acceptance, mindfulness and values-based actions may constitute complementary therapeutic tools to cognitive behavioural therapy for insomnia. The current study sought to evaluate the efficacy of a remotely delivered programme combining the main components of cognitive behavioural therapy for insomnia (sleep restriction and stimulus control) with the third-wave cognitive behavioural therapy acceptance and commitment therapy in adults with chronic insomnia and hypnotic dependence on insomnia symptoms and quality of life. Thirty-two participants were enrolled in a pilot randomized controlled trial: half of them were assigned to a 3-month waiting list before receiving the four "acceptance and commitment therapy-enhanced cognitive behavioural therapy for insomnia" treatment sessions using videoconference. The primary outcome was sleep quality as measured by the Insomnia Severity Index and the Pittsburgh Sleep Quality Index. All participants also filled out questionnaires about quality of life, use of hypnotics, depression and anxiety, acceptance, mindfulness, thought suppression, as well as a sleep diary at baseline, post-treatment and 6-month follow-up. A large effect size was found for Insomnia Severity Index and Pittsburgh Sleep Quality Index, but also daytime improvements, with increased quality of life and acceptance at post-treatment endpoint in acceptance and commitment therapy-enhanced cognitive behavioural therapy for insomnia participants. Improvement in Insomnia Severity Index and Pittsburgh Sleep Quality Index was maintained at the 6-month follow-up. Wait-list participants increased their use of hypnotics, whereas acceptance and commitment therapy-enhanced cognitive behavioural therapy for insomnia participants evidenced reduced use of them. This pilot study suggests that web-based cognitive behavioural therapy for insomnia incorporating acceptance and commitment therapy processes may be an efficient option to treat chronic insomnia and hypnotic dependence.

[Third wave therapies in the treatment of obsessional compulsive disorder : applying acceptance and commitment therapy]. / Les thérapies de troisième vague dans le traitement du trouble obsessionnel-compulsif : Application de la thérapie d'acceptation et d'engagement.

In terms of prevalence, Obsessive compulsive disorder is the 4th ranked psychiatric disorder. Current treatments include 1st and 2nd wave cognitive behavioural therapies involving exposure and cognitive restructuring. However, 3rd wave therapies such as mindfulness and acceptance and commitment therapy (ACT) are also increasingly recognized as treatments of choice. The current article describes the underlying theory of ACT including relational frame theory, its clinical target: experiential avoidance, its main processes and a tool for the delivery of ACT to patients, the matrix. Rather than aiming to restructure problematic thoughts and evaluations, ACT seeks to train psychological flexibility, the ability to distance from problematic thoughts and accept uncomfortable emotion in the service of engaging personally valued actions. This can help move patient behaviour away from the aversive control of anxiety and obsessions and toward the appetitive control of personal values. The application of ACT to OCD is illustrated by a successful case study.

Cognitive Behavioral Therapy and Acceptance and Commitment Therapy for the Discontinuation of Long-Term Benzodiazepine Use in Insomnia and Anxiety Disorders.

Benzodiazepines have proven to be highly effective for treating insomnia and anxiety. Although considered safe when taken for a short period of time, a major risk-benefit dilemma arises in the context of long-term use, relating to addiction, withdrawal symptoms, and potential side effects. For these reasons, benzodiazepines are not recommended for treating chronic sleep disorders, anxiety disorders, nor for people over the age of 65, and withdrawal among long-term users is a public health issue. Indeed, only 5% of patients manage to discontinue using these drugs on their own. Even with the help of a general practitioner, this rate does not exceed 25 to 30% of patients, of which approximately 7% manage to remain drug-free in the long term. Cognitive Behavioral Therapies (CBT) offer a crucial solution to this problem, having been shown to increase abstinence success to 70-80%. This article examines traditional and novel CBT techniques in this regard, such as Acceptance and Commitment Therapy, which address both the underlying condition (insomnia/anxiety) and the substance-related disorder. The theoretical framework and evidence supporting the use of these approaches are reviewed. Finally, current research gaps are discussed, and key research perspectives are proposed.

A Randomized Controlled Trial of Multiple Versions of an Acceptance and Commitment Therapy Matrix App for Well-Being.

Mobile apps may be useful in teaching psychological skills in a high-frequency, low-intensity intervention. The acceptance and commitment therapy (ACT) matrix is a visual tool to help develop psychological flexibility by categorizing moment-to-moment experience and is well suited to a mobile app. This pilot study tested the effects of a simple and complex version of a novel app using the ACT matrix in two distinct samples: help-seeking individuals (n = 35) and students receiving SONA credit (n = 63). Findings indicated no differences between app conditions and a waitlist condition in the SONA credit sample. However, in the help-seeking sample, improvements were found on well-being and valued action in participants who used the app, with greater improvements and app adoption for those using a complex version with additional skills. A mobile app based on the ACT matrix has benefits for help-seeking individuals, but supplementary features may be necessary to support consistent use and benefits.

Cortical dynamics of word recognition.

While functional neuroimaging studies have helped elucidate major regions implicated in word recognition, much less is known about the dynamics of the associated activations or the actual neural processes of their functional network. We used intracerebral electroencephalography recordings in 10 patients with epilepsy to directly measure neural activity in the temporal and frontal lobes during written words' recognition, predominantly in the left hemisphere. The patients were presented visually with consonant strings, pseudo-words, and words and performed a hierarchical paradigm contrasting semantic processes (living vs. nonliving word categorization task), phonological processes (rhyme decision task on pseudo-words), and visual processes (visual analysis of consonant strings). Stimuli triggered a cascade of modulations in the gamma-band (>40 Hz) with reproducible timing and task-sensitivity throughout the functional reading network: the earliest gamma-band activations were observed for all stimuli in the mesial basal temporal lobe at 150 ms, reaching the word form area in the mid fusiform gyrus at 200 ms, evidencing a superiority effect for word-like stimuli. Peaks of gamma-band activations were then observed for word-like stimuli after 400 ms in the anterior and middle portion of the superior temporal gyrus (BA 38 and BA 22 respectively), in the pars triangularis of Broca's area for the semantic task (BAs 45 and 47), and in the pars opercularis for the phonological task (BA 44). Concurrently, we observed a two-pronged effect in the prefrontal cortex (BAs 9 and 46), with nonspecific sustained dorsal activation related to sustained attention and, more ventrally, a strong reflex deactivation around 500 ms, possibly due to semantic working memory reset.

Emotional facial expression detection in the peripheral visual field.

BACKGROUND: In everyday life, signals of danger, such as aversive facial expressions, usually appear in the peripheral visual field. Although facial expression processing in central vision has been extensively studied, this processing in peripheral vision has been poorly studied. METHODOLOGY/PRINCIPAL FINDINGS: Using behavioral measures, we explored the human ability to detect fear and disgust vs. neutral expressions and compared it to the ability to discriminate between genders at eccentricities up to 40°. Responses were faster for the detection of emotion compared to gender. Emotion was detected from fearful faces up to 40° of eccentricity. CONCLUSIONS: Our results demonstrate the human ability to detect facial expressions presented in the far periphery up to 40° of eccentricity. The increasing advantage of emotion compared to gender processing with increasing eccentricity might reflect a major implication of the magnocellular visual pathway in facial expression processing. This advantage may suggest that emotion detection, relative to gender identification, is less impacted by visual acuity and within-face crowding in the periphery. These results are consistent with specific and automatic processing of danger-related information, which may drive attention to those messages and allow for a fast behavioral reaction.

BrainTV: a novel approach for online mapping of human brain functions.

Our understanding of the brain's functional organisation has greatly benefited from occasional exploratory sessions during electrophysiological studies, trying various manipulations of an animal's environment to trigger responses in particular neurons. Famous examples of such exploration have unveiled various unexpected response properties, such as those of mirror neurons. This approach, which relies on the possibility to test online the reactivity of precise neural populations has no equivalent so far in humans. The present study proposes and applies a radically novel framework for mapping human brain functions in ecological situations based on a combination of a) exploratory sessions, using real-time electrophysiology to formulate hypotheses about the functional role of precise cortical regions and b) controlled experimental protocols specifically adapted to test these hypotheses. Using this two-stage approach with an epileptic patient candidate for surgery and implanted with intracerebral electrodes, we were able to precisely map high-level auditory functions in the patients' superior temporal lobe. We propose that this procedure constitutes at the least a useful complement of electrical cortical stimulations to map eloquent brain areas in epileptic patients before their surgery, but also a path of discovery for human functional brain mapping.

A blueprint for real-time functional mapping via human intracranial recordings.

BACKGROUND: The surgical treatment of patients with intractable epilepsy is preceded by a pre-surgical evaluation period during which intracranial EEG recordings are performed to identify the epileptogenic network and provide a functional map of eloquent cerebral areas that need to be spared to minimize the risk of post-operative deficits. A growing body of research based on such invasive recordings indicates that cortical oscillations at various frequencies, especially in the gamma range (40 to 150 Hz), can provide efficient markers of task-related neural network activity. PRINCIPAL FINDINGS: Here we introduce a novel real-time investigation framework for mapping human brain functions based on online visualization of the spectral power of the ongoing intracranial activity. The results obtained with the first two implanted epilepsy patients who used the proposed online system illustrate its feasibility and utility both for clinical applications, as a complementary tool to electrical stimulation for presurgical mapping purposes, and for basic research, as an exploratory tool used to detect correlations between behavior and oscillatory power modulations. Furthermore, our findings suggest a putative role for high gamma oscillations in higher-order auditory processing involved in speech and music perception. CONCLUSION/SIGNIFICANCE: The proposed real-time setup is a promising tool for presurgical mapping, the investigation of functional brain dynamics, and possibly for neurofeedback training and brain computer interfaces.

BrainTV: a novel approach for online mapping of human brain functions

Our understanding of the brain's functional organisation has greatly benefited from occasional exploratory sessions during electrophysiological studies, trying various manipulations of an animal's environment to trigger responses in particular neurons. Famous examples of such exploration have unveiled various unexpected response properties, such as those of mirror neurons. This approach, which relies on the possibility to test online the reactivity of precise neural populations has no equivalent so far in humans. The present study proposes and applies a radically novel framework for mapping human brain functions in ecological situations based on a combination of a) exploratory sessions, using real-time electrophysiology to formulate hypotheses about the functional role of precise cortical regions and b) controlled experimental protocols specifically adapted to test these hypotheses. Using this two-stage approach with an epileptic patient candidate for surgery and implanted with intracerebral electrodes, we were able to precisely map high-level auditory functions in the patients' superior temporal lobe. We propose that this procedure constitutes at the least a useful complement of electrical cortical stimulations to map eloquent brain areas in epileptic patients before their surgery, but also a path of discovery for human functional brain mapping.