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1.
J Sleep Res ; : e14147, 2024 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-38246598

RESUMO

Insomnia and pain disorders are among the most common conditions affecting United States adults and veterans, and their comorbidity can cause detrimental effects to quality of life among other factors. Cognitive behavioural therapy for insomnia and related behavioural therapies are recommended treatments for insomnia, but chronic pain may hinder treatment benefit. Prior research has not addressed how pain impacts the effects of behavioural insomnia treatment in United States women veterans. Using data from a comparative effectiveness clinical trial of two insomnia behavioural treatments (both including sleep restriction, stimulus control, and sleep hygiene education), we examined the impact of pain severity and pain interference on sleep improvements from baseline to post-treatment and 3-month follow-up. We found no significant moderation effects of pain severity or interference in the relationship between treatment phase and sleep outcomes. Findings highlight opportunities for using behavioural sleep interventions in patients, particularly women veterans, with comorbid pain and insomnia, and highlight areas for future research.

2.
J Psychosom Res ; 175: 111536, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37913677

RESUMO

OBJECTIVE: Insomnia is known to exacerbate pain symptoms. The purpose of the present study was to compare the secondary effects of cognitive behavioral therapy for insomnia (CBTI) against a novel treatment for insomnia called acceptance and behavioral changes for insomnia (ABC-I) among individuals with comorbid pain. Differences in the potential mechanisms through which these treatments impact pain were also examined. METHODS: Data consisted of a secondary analysis from a randomized comparative effectiveness trial of CBT-I and ABC-I among women veterans with insomnia and comorbid pain. Pain outcomes, beliefs about sleep, and psychological flexibility were assessed at baseline, post-treatment, and at three-months follow-up. RESULTS: At baseline, 93 women veterans reported comorbid insomnia and pain (mean age = 46.7; 33.3% Black, 24.7% Hispanic/Latina). Both CBT-I (n = 48) and ABC-I (n = 45) were associated with decreased pain intensity (p < .001, Cohen's d = 0.41-0.67) and pain interference (p < .001, Cohen's d = 0.71-0.77) at post-treatment and three-months follow-up, with results indicating that ABC-I was non-inferior to CBT-I for pain improvement. Both conditions were associated with greater psychological flexibility post-treatment, and CBT-I resulted in larger reductions in dysfunctional beliefs about sleep (p = .01, Cohen's d = 0.59). CONCLUSION: CBT-I and ABC-I both had positive secondary effects on pain with ABC-I being non-inferior to CBT-I with respect to its impact on pain. The mechanisms of change associated with these treatments may differ with CBT-I leading to greater reductions in dysfunctional beliefs. Hybrid treatments which incorporate an acceptance and commitment approach to both insomnia and pain warrant further examination.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Veteranos , Humanos , Feminino , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/terapia , Distúrbios do Início e da Manutenção do Sono/complicações , Sono , Terapia Comportamental/métodos , Dor/complicações , Resultado do Tratamento
3.
Behav Sleep Med ; : 1-13, 2023 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-37749876

RESUMO

OBJECTIVES: Insomnia may contribute to fewer value-consistent choices and less engagement in meaningful life activities. We sought to identify values commonly expressed by women veterans engaged in a trial testing psychological treatment of insomnia disorder. METHODS: Seventy-four women veterans (mean age = 48.3 [±13] years), meeting DSM-5 diagnostic criteria for insomnia disorder received an acceptance-based behavioral treatment for insomnia. In the first session, participants responded to questions regarding personal values and the impact of insomnia on those values. Responses were categorized into values domains informed by the Bull's Eye Values survey (level 1 categories) and the Valued Living Questionnaire (level 2 categories). RESULTS: Raters reached 100% agreement after independent coding and adjudication. Level 1 value categories in frequency order were: relationships (n = 68), personal care/health (n = 51), work/education (n = 46), pets (n = 12), and leisure (n = 5). The most frequently reported level 2 value categories were: family (other than marriage/parenting; n = 50), parenting (n = 31), work (n = 31), physical health (n = 30), and spirituality (n = 19). The level 1 value categories impacted by insomnia in frequency order were: personal care/health (n = 65), relationships (n = 58), work/education (n = 46), pets (n = 12), and leisure (n = 5). CONCLUSIONS: Women veterans undergoing insomnia treatment highly value relationships and personal care/health, which should be considered patient-centered outcomes of insomnia treatments. CLINICAL TRIALS REGISTRATION: NCT02076165.

4.
J Consult Clin Psychol ; 91(11): 626-639, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37535521

RESUMO

OBJECTIVE: This randomized comparative effectiveness trial evaluated a novel insomnia treatment using acceptance and commitment therapy (ACT) among women veterans. Participants received either the acceptance and the behavioral changes to treat insomnia (ABC-I) or cognitive behavioral therapy for insomnia (CBT-I). The primary objectives were to determine whether ABC-I was noninferior to CBT-I in improving sleep and to test whether ABC-I resulted in higher treatment completion and adherence versus CBT-I. METHOD: One hundred forty-nine women veterans with insomnia disorder (Mage = 48.0 years) received ABC-I or CBT-I. The main sleep outcomes were Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and sleep efficiency (SE) by actigraphy (objective) and sleep diary (subjective). Measures were collected at baseline, immediate posttreatment, and 3-month posttreatment follow-up. Treatment completion and adherence were assessed during the interventions. RESULTS: Both interventions improved all sleep outcomes from baseline to immediate posttreatment and 3-month posttreatment follow-up. At immediate posttreatment, ABC-I was statically noninferior for sleep diary SE and objective SE, but noninferiority was not statistically confirmed for ISI or PSQI total scores. At 3-month posttreatment follow-up, ABC-I was noninferior for all four of the key outcome variables. There was not a statistically significant difference between the number of participants who discontinued CBT-I (11%) versus ABC-I (18%; p = .248) before completing treatment. ABC-I was superior to CBT-I for some adherence metrics. CONCLUSIONS: Overall, ABC-I was similar in effectiveness compared to CBT-I for the treatment of insomnia and may improve adherence to some behavioral elements of treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
Terapia de Aceitação e Compromisso , Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono , Veteranos , Humanos , Feminino , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/terapia , Sono , Terapia Cognitivo-Comportamental/métodos , Resultado do Tratamento
5.
Sleep Med Clin ; 18(1): 73-83, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36764788

RESUMO

Although cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment of insomnia, difficulties exist with adherence to recommendations and premature discontinuation of treatment does occur. The current article aims to review existing research on acceptance and commitment therapy (ACT)-based interventions, demonstrate differences and similarities between ACT for insomnia and CBT-I, and describe treatment components and mechanisms of ACT that can be used to treat insomnia disorder.


Assuntos
Terapia de Aceitação e Compromisso , Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/terapia , Resultado do Tratamento
6.
Womens Health Issues ; 32(2): 194-202, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34815139

RESUMO

OBJECTIVE: This study compared the benefits of cognitive-behavioral therapy for insomnia for sleep, mental health symptoms, and quality of life (QoL) in a sample of women veterans with and without probable post-traumatic stress disorder (PTSD) comorbid with insomnia disorder. METHODS: Seventy-three women veterans (30 with probable PTSD) received a manual-based 5-week cognitive-behavioral therapy for insomnia treatment as part of a behavioral sleep intervention study. Measures were completed at baseline, post-treatment, and 3-month follow-up. Sleep measures included the Insomnia Severity Index, Pittsburgh Sleep Quality Index, sleep efficiency measured by actigraphy, and sleep efficiency and total sleep time measured by sleep diary. Mental health measures included the PTSD Checklist-5, nightmares per week, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 scale. QoL was measured with the Short Form-12. Linear mixed models compared changes over time across groups. Independent t tests examined PTSD symptom changes in women veterans with probable PTSD. RESULTS: Both groups demonstrated improvements across sleep (ps < .001-.040), mental health symptoms (ps < .001), and QoL measures (ps < .001). The probable PTSD group reported greater improvements in diary sleep efficiency (p = .046) and nightmares per week (p = .001) at post-treatment and in total sleep time (p = .029) and nightmares per week (p = .006) at follow-up. Most participants with probable PTSD experienced clinically significant reductions in PTSD symptoms at post-treatment (66.7%) and follow-up (60.0%). Significant reductions in intrusive and arousal/reactivity symptoms were maintained at follow-up. CONCLUSIONS: Cognitive-behavioral therapy for insomnia improves insomnia, mental health symptoms, and QoL among women veterans, with greater improvement in those with probable PTSD.


Assuntos
Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono , Transtornos de Estresse Pós-Traumáticos , Veteranos , Feminino , Humanos , Masculino , Qualidade de Vida , Distúrbios do Início e da Manutenção do Sono/terapia , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia
7.
PLoS Pathog ; 17(1): e1009247, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33497419

RESUMO

Schmallenberg virus (SBV) is the cause of severe fetal malformations when immunologically naïve pregnant ruminants are infected. In those malformed fetuses, a "hot-spot"-region of high genetic variability within the N-terminal region of the viral envelope protein Gc has been observed previously, and this region co-localizes with a known key immunogenic domain. We studied a series of M-segments of those SBV variants from malformed fetuses with point mutations, insertions or large in-frame deletions of up to 612 nucleotides. Furthermore, a unique cell-culture isolate from a malformed fetus with large in-frame deletions within the M-segment was analyzed. Each Gc-protein with amino acid deletions within the "hot spot" of mutations failed to react with any neutralizing anti-SBV monoclonal antibodies or a domain specific antiserum. In addition, in vitro virus replication of the natural deletion variant could not be markedly reduced by neutralizing monoclonal antibodies or antisera from the field. The large-deletion variant of SBV that could be isolated in cell culture was highly attenuated with an impaired in vivo replication following the inoculation of sheep. In conclusion, the observed amino acid sequence mutations within the N-terminal main immunogenic domain of glycoprotein Gc result in an efficient immune evasion from neutralizing antibodies in the special environment of a developing fetus. These SBV-variants were never detected as circulating viruses, and therefore should be considered to be dead-end virus variants, which are not able to spread further. The observations described here may be transferred to other orthobunyaviruses, particularly those of the Simbu serogroup that have been shown to infect fetuses. Importantly, such mutant strains should not be included in attempts to trace the spatial-temporal evolution of orthobunyaviruses in molecular-epidemiolocal approaches during outbreak investigations.


Assuntos
Anticorpos Antivirais/imunologia , Infecções por Bunyaviridae/veterinária , Doenças dos Bovinos/virologia , Variação Genética , Orthobunyavirus/genética , Doenças dos Ovinos/virologia , Proteínas do Envelope Viral/genética , Animais , Anticorpos Neutralizantes/imunologia , Infecções por Bunyaviridae/virologia , Bovinos , Feminino , Feto , Glicoproteínas/genética , Glicoproteínas/imunologia , Mutação , Orthobunyavirus/imunologia , Orthobunyavirus/fisiologia , RNA Viral/genética , Deleção de Sequência , Ovinos , Proteínas do Envelope Viral/imunologia , Replicação Viral
8.
Disabil Rehabil ; 43(13): 1861-1871, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-31656109

RESUMO

PURPOSE: This study aimed to refine a behavioral sleep intervention program targeting patients with Alzheimer's disease and their caregivers. METHODS: In this case series, key components of the sleep program were built upon previous intervention studies of patients with cognitive impairment/dementia. The intervention consisted of five weekly sessions covering sleep hygiene, sleep compression, stimulus control, daily walking/light exposure, relaxation/mindfulness, and caregiver training to manage patients' behavioral problems. The materials and structure were iteratively refined based on feedback from caregivers and sleep educators. Sleep diaries were used to evaluate sleep outcomes. RESULTS: Five out of six enrolled dyads completed the sessions. Several revisions were made during testing: the last session was changed from telephone to in-person; some components (e.g., sleep scheduling, mindfulness) were rearranged within or across sessions; sleep educator guidelines for sleep scheduling, light exposure, and walking were revised. After the fifth dyad, no additional issues were identified by the caregiver or the sleep educator. Four patients and three caregivers had improved sleep at the last session. CONCLUSIONS: The iterative refinement process was successful in finalizing the intervention program, with evidence of sleep improvements. Formal pilot testing of the program will provide further information on feasibility and effectiveness.IMPLICATIONS FOR REHABILITATIONOur dyadic behavioral sleep program can be tailored to various types of sleep problems among patients with Alzheimer's disease and their family caregivers, with the goal of improving daytime function by reducing sleep disturbances at night.Caregiver training and participation of both members of the dyad in sleep management may benefit the patients' sleep and other health outcomes, reduce caregiver stress and burden, and ultimately delay or prevent institutionalization of Alzheimer's disease patients.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Cuidadores , Humanos , Institucionalização , Sono
9.
Behav Sleep Med ; 19(2): 243-254, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32116050

RESUMO

Objective/Background: Sleep problems are common in women and caregiving for an adult is a common role among women. However, the effects of caregiving on sleep and related daytime impairment are poorly understood among women veterans. This study compared stress-related sleep disturbances, insomnia symptoms, and sleep-related daytime impairment between women veterans who were caregivers and those who did not have a caregiving role. Participants: Of 12,225 women veterans who received care in one Veterans Administration Healthcare System, 1,457 completed data on a postal survey (mean age = 51.7 ± 15.9 years). Two hundred forty three (17%) respondents (mean age 53.8 ± 12.7 years) were caregivers for an adult, predominantly for a parent, providing transportation. Methods: The survey included items that addressed insomnia symptoms, total sleep time, sleep-related daytime impairments, caregiving characteristics, self-rated health, pain, stress, body mass index, and demographic information. Results: In adjusted analyses, caregiver status did not directly predict sleep complaints alone. However, in multiple regression analyses, being a caregiver (odds ratio 1.7, p = .001) significantly predicted stress-related sleep disturbance, even after adjusting for age, pain, self-rated health, and other characteristics. Furthermore, being a caregiver (ß = 3.9, p = .031) significantly predicted more symptoms of sleep-related daytime impairment after adjusting for age, pain, self-rated health, and other factors. Conclusions: Compared to noncaregivers, women veterans who were caregivers for an adult were more likely to report stress causing poor sleep, and more daytime impairment due to poor sleep. These findings suggest the need to target stress and other factors when addressing sleep disturbance among women veterans who are caregivers.


Assuntos
Cuidadores/psicologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Transtornos do Sono-Vigília/psicologia , Veteranos/psicologia , Atividades Cotidianas , Adulto , Idoso , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
10.
Behav Sleep Med ; 19(5): 672-688, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33251855

RESUMO

OBJECTIVE/BACKGROUND: The current study describes insomnia precipitating events reported by women Veterans and examines differences in sleep and psychological distress variables in those who endorsed traumatic, nontraumatic, or no insomnia precipitating events. PARTICIPANTS: Baseline data were collected from 347 women Veterans enrolled in a behavioral sleep intervention study (NCT02076165). METHODS: Participants completed self-report measures of insomnia symptoms, sleep quality, sleep efficiency (SE), nightmare frequency, and depression and posttraumatic stress disorder (PTSD) symptoms; SE was also assessed by wrist actigraphy. Participants responded to 2 open-ended questions assessing stressful life events and health changes that coincided with insomnia symptom onset. Responses were coded as traumatic, nontraumatic, and no events. Analyses of covariance examined the effect of insomnia precipitating event type on sleep and psychological symptom variables after controlling for sociodemographic factors. RESULTS: Overall, 25.80% of participants endorsed traumatic events, 65.80% endorsed only nontraumatic events, and 8.41% endorsed no events. Participants who endorsed traumatic events reported more severe insomnia (p = .003), PTSD (p = .001), and depression symptoms (p = .012), and poorer quality of sleep (p = .042) than participants who endorsed no events. Participants who endorsed traumatic events reported more severe PTSD symptoms (p = .004), a longer duration of sleep problems (p = .001), and poorer quality of sleep (p = .039) than participants who endorsed nontraumatic events. Participants who endorsed nontraumatic events reported more severe insomnia (p = .029) and PTSD (p = .049) symptoms than participants who endorsed no events. CONCLUSIONS: Trauma as a precipitant for insomnia may be related to higher symptom severity in women Veterans. Implications for treatment engagement and effectiveness remain unstudied.


Assuntos
Saúde Mental , Trauma Psicológico/complicações , Trauma Psicológico/psicologia , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/psicologia , Sono , Veteranos/psicologia , Depressão/complicações , Depressão/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/psicologia
11.
Virology ; 527: 116-121, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30496912

RESUMO

Hepatitis E virus (HEV) infection is widespread in the global pig population. Although clinically inapparent in pigs, HEV infection is the cause of Hepatitis E in humans and transmission via the food chain has been established. Following a 2013 study that investigated prevalence of HEV infection in UK slaughter-age pigs samples indicating highest viral load were selected for further characterisation. High throughput sequencing was used to obtain the complete coding sequence from five samples. An in-frame insertion was observed within the HEV hypervariable region in two samples. To interrogate whether this mutation may be the cause of high-level viraemia and faecal shedding as observed in the sampled pigs virus isolation and culture was conducted. Based on viral growth kinetics there was no evidence that these insertions affected replication efficiency in vitro, suggesting as yet undetermined host factors may affect the course of infection and consequently the risk of foodborne transmission.


Assuntos
Vírus da Hepatite E/genética , Hepatite E/veterinária , Sus scrofa/virologia , Viremia/veterinária , Animais , Fezes/virologia , Microbiologia de Alimentos , Genoma Viral/genética , Hepatite E/epidemiologia , Hepatite E/virologia , Vírus da Hepatite E/classificação , Vírus da Hepatite E/crescimento & desenvolvimento , Mutagênese Insercional , Fases de Leitura Aberta , Filogenia , Prevalência , RNA Viral/genética , Análise de Sequência de RNA , Suínos , Reino Unido/epidemiologia , Viremia/virologia
12.
Vet Microbiol ; 209: 66-74, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28228336

RESUMO

PRRS control is hampered by the inadequacies of existing vaccines to combat the extreme diversity of circulating viruses. Since immune clearance of PRRSV infection may not be dependent on the development of neutralising antibodies and the identification of broadly-neutralising antibody epitopes have proven elusive, we hypothesised that conserved T cell antigens represent potential candidates for development of a novel PRRS vaccine. Previously we had identified the M and NSP5 proteins as well-conserved targets of polyfunctional CD8 and CD4 T cells. To assess their vaccine potential, peptides representing M and NSP5 were encapsulated in hydrophobically-modified chitosan particles adjuvanted by incorporation of a synthetic multi-TLR2/TLR7 agonist and coated with a model B cell PRRSV antigen. For comparison, empty particles and adjuvanted particles encapsulating inactivated PRRSV-1 were prepared. Vaccination with the particulate formulations induced antigen-specific antibody responses, which were most pronounced following booster immunisation. M and NSP5-specific CD4, but not CD8, T cell IFN-γ reactivity was measurable following the booster immunisation in a proportion of animals vaccinated with peptide-loaded particles. Upon challenge, CD4 and CD8 T cell reactivity was detected in all groups, with the greatest responses being detected in the peptide vaccinated group but with limited evidence of an enhanced control of viraemia. Analysis of the lungs during the resolution of infection showed significant M/NSP5 specific IFN-γ responses from CD8 rather than CD4 T cells. Vaccine primed CD8 T cell responses may therefore be required for protection and future work should focus on enhancing the cross-presentation of M/NSP5 to CD8 T cells.


Assuntos
Antígenos Virais/imunologia , Síndrome Respiratória e Reprodutiva Suína/imunologia , Linfócitos T/imunologia , Vacinas Virais/imunologia , Animais , Anticorpos Antivirais/sangue , Formação de Anticorpos/imunologia , Quitosana/química , Peptídeos/administração & dosagem , Peptídeos/imunologia , Vírus da Síndrome Respiratória e Reprodutiva Suína/imunologia , Suínos , Vacinas Virais/química , Vacinas Virais/normas
13.
J Behav Ther Exp Psychiatry ; 54: 195-203, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27575635

RESUMO

BACKGROUND AND OBJECTIVES: Worry and anticipatory processing are forms of repetitive negative thinking (RNT) that are associated with maladaptive characteristics and negative consequences. One key maladaptive characteristic of worry is its abstract nature (Goldwin & Behar, 2012; Stöber & Borkovec, 2002). Several investigations have relied on inductions of worry that are social-evaluative in nature, which precludes distinctions between worry and RNT about social-evaluative situations. The present study examined similarities and distinctions between worry and anticipatory processing on potentially important maladaptive characteristics. METHODS: Participants (N = 279) engaged in idiographic periods of uninstructed mentation, worry, and anticipatory processing and provided thought samples during each minute of each induction. Thought samples were assessed for concreteness, degree of verbal-linguistic activity, and degree of imagery-based activity. RESULTS: Both worry and anticipatory processing were characterized by reduced concreteness, increased abstraction of thought over time, and a predominance of verbal-linguistic activity. However, worry was more abstract, more verbal-linguistic, and less imagery-based relative to anticipatory processing. Finally, worry demonstrated reductions in verbal-linguistic activity over time, whereas anticipatory processing demonstrated reductions in imagery-based activity over time. LIMITATIONS: Worry was limited to non-social topics to distinguish worry from anticipatory processing, and may not represent worry that is social in nature. Generalizability may also be limited by use of an undergraduate sample. CONCLUSIONS: Results from the present study provide support for Stöber's theory regarding the reduced concreteness of worry, and suggest that although worry and anticipatory processing share some features, they also contain characteristics unique to each process.


Assuntos
Ansiedade/psicologia , Formação de Conceito/fisiologia , Imaginação/fisiologia , Pensamento/fisiologia , Adolescente , Análise de Variância , Feminino , Humanos , Relações Interpessoais , Linguística , Masculino , Autorrelato , Inquéritos e Questionários , Comportamento Verbal , Adulto Jovem
14.
Behav Ther ; 47(4): 460-73, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27423163

RESUMO

There is growing evidence suggesting that worry and sleep are intimately linked. However, the relationship between these two phenomena over the course of a day remains largely unstudied. It is possible that (a) worry predicts sleep disturbance that night, (b) sleep disturbance predicts worry the following day, or (c) there is a bidirectional relationship between worry and sleep disturbance. The present study examined the daily relationship between worry (both during the day and immediately prior to sleep onset) and sleep in 50 high trait worriers who were randomly assigned to one of two interventions aimed at reducing worry as part of a larger study. A daily process approach was utilized wherein participants completed daily reports of sleep and worry during a 7-day baseline period followed by a 14-day intervention period. Results of repeated measures multilevel modeling analyses indicated that worry experienced on a particular day predicted increased sleep disturbance that night during both the baseline and intervention weeks. However, there was no evidence of a bidirectional relationship as sleep characteristics did not predict worry the following day. Additionally, the type of intervention that participants engaged in did not affect the daily relationship between worry and sleep. Results of the present study are consistent with the cognitive model of insomnia (Harvey, 2002) and highlight the importance of addressing and treating worry among individuals with high trait worry and sleep disturbance.


Assuntos
Ansiedade/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Sono/fisiologia , Adulto , Ansiedade/diagnóstico , Ansiedade/psicologia , Feminino , Humanos , Masculino , Prontuários Médicos , Testes Psicológicos , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Adulto Jovem
16.
Cogn Behav Ther ; 45(2): 163-75, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26838091

RESUMO

Insomnia is a common feature among individuals with anxiety disorders. Studies of cognitive behavioral therapy (CBT) for anxiety report moderate effects on concomitant insomnia symptoms, but further research is still needed especially toward understanding how CBT for anxiety renders beneficial effects on insomnia. The current study examined changes in insomnia symptoms reported by 51 Veterans who participated in a group-based transdiagnostic CBT for anxiety intervention. In addition, insomnia symptoms were examined in relation to symptoms of general distress (GD), anhedonic depression (AD), and anxious arousal (AA) pre- to post-treatment. Results revealed a small, though statistically significant (p < .05) beneficial effect on insomnia symptoms. When changes in GD, AD, and AA were simultaneously examined in relation to changes in insomnia, change in AA was the only significant predictor of insomnia symptoms. The current study highlights the role of AA in the relationship between anxiety disorders and insomnia and demonstrates that reductions in insomnia during transdiagnostic CBT for anxiety can be largely attributed to changes in AA.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental , Psicoterapia de Grupo , Distúrbios do Início e da Manutenção do Sono/terapia , Adulto , Idoso , Transtornos de Ansiedade/complicações , Nível de Alerta , Depressão/complicações , Depressão/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/complicações , Estresse Psicológico/complicações , Estresse Psicológico/terapia , Resultado do Tratamento , Veteranos/psicologia , Adulto Jovem
17.
Clin Ther ; 38(11): 2373-2385, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28314434

RESUMO

PURPOSE: Female veterans are at high risk for sleep problems, and there is a need to provide effective treatment for this population who experience insomnia. This study's primary goal was to compare the acceptability of medication versus nonmedication treatments for insomnia among female veterans. In addition, we examined the role of patient age, severity of sleep disturbance, and psychiatric symptoms on acceptability of each treatment approach and on the differences in acceptability between these approaches. METHODS: A large nationwide postal survey was sent to a random sample of 4000 female veterans who had received health care at a Veterans Administration (VA) facility in the previous 6 months (May 29, 2012-November 28, 2012). A total of 1559 completed surveys were returned. Survey items used for the current analyses included: demographic characteristics, sleep quality, psychiatric symptoms, military service experience, and acceptability of medication and nonmedication treatments for insomnia. For analysis, only ratings of "very acceptable" were used to indicate an interest in the treatment approach (vs ratings of "not at all acceptable," "a little acceptable," "somewhat acceptable," and "no opinion/don׳t know"). FINDINGS: In the final sample of 1538 women with complete data, 57.7% rated nonmedication treatment as very acceptable while only 33.5% rated medication treatment as very acceptable. This difference was statistically significant for the group as a whole and when examining subgroups of patients based on age, sleep quality, psychiatric symptoms, and military experience. The percentage of respondents rating medication treatment as very acceptable was higher for women who were younger, had more severe sleep disturbances, had more psychiatric symptoms, who were not combat exposed, and who had experienced military sexual trauma. By contrast, the percentage of respondents rating nonmedication treatment as very acceptable differed only by age (younger women were more likely to find nonmedication treatment acceptable) and difficulty falling asleep. IMPLICATIONS: Female veterans are more likely to find nonmedication insomnia treatment acceptable compared with medication treatment. Thus, it is important to match these patients with effective behavioral interventions such as cognitive behavioral therapy for insomnia. Efforts to educate providers about these preferences and about the efficacy of cognitive behavioral therapy for insomnia may serve to connect female veterans who have insomnia to the treatment they prefer. These findings also suggest that older female veterans may be less likely to find either approach as acceptable as their younger counterparts.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Distúrbios do Início e da Manutenção do Sono/terapia , Transtornos do Sono-Vigília/terapia , Veteranos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
18.
J Huntingtons Dis ; 4(3): 219-229, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26444021

RESUMO

BACKGROUND: The immune system In Huntington's disease (HD) is activated and may overreact to some therapies. RNA interference using siRNA lowers mutant huntingtin (mHTT) protein but could increase immune responses. OBJECTIVE: To examine the innate immune response following siRNA infusion into the striatum of wild-type (WT) and HD transgenic (YAC128) mice. METHODS: siRNAs (2'-O-methyl phosphorothioated) were infused unilaterally into striatum of four month-old WT and YAC128 mice for 28 days. Microglia number and morphology (resting (normal), activated, dystrophic), cytokine levels, and DARPP32-positive neurons were measured in striatum immediately or 14 days post-infusion. Controls included contralateral untreated striatum, and PBS and sham treated striata. RESULTS: The striata of untreated YAC128 mice had significantly fewer resting microglia and more dystrophic microglia than WT mice, but no difference from WT in the proportion of activated microglia or total number of microglia. siRNA infusion increased the total number of microglia in YAC128 mice compared to PBS treated and untreated striata and increased the proportion of activated microglia in WT and YAC128 mice compared to untreated striata and sham treated groups. Cytokine levels were low and siRNA infusion resulted in only modest changes in those levels. siRNA infusion did not change the number of DARPP32-positive neurons. CONCLUSION: Findings suggest that siRNA infusion may be a safe method for lowering mHTT levels in the striatum in young animals, since treatment does not produce a robust cytokine response or cause neurotoxicity. The potential long-term effects of a sustained increase in total and activated microglia after siRNA infusion in HD mice need to be explored.


Assuntos
Encéfalo/patologia , Doença de Huntington/imunologia , Imunidade Inata/imunologia , RNA Interferente Pequeno/imunologia , Animais , Citocinas/metabolismo , Modelos Animais de Doenças , Doença de Huntington/tratamento farmacológico , Camundongos , Camundongos Transgênicos , RNA Interferente Pequeno/uso terapêutico , Resultado do Tratamento
19.
J Virol Methods ; 207: 163-8, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25034125

RESUMO

Pan viral DNA microarrays, which can detect known, novel and multiple viral infections, are major laboratory assets contributing to the control of infectious diseases. The large quantity of ribosomal RNA (rRNA) found in tissue samples is thought to be a major factor contributing to the comparatively lower sensitivity of detecting RNA viruses, as a sequence-independent PCR is used to amplify unknown samples for microarray analysis. This study aimed to determine whether depletion or exclusion of rRNA can improve microarray detection and simplify its analysis. Therefore, two different rRNA depletion and exclusion protocols, RiboMinus™ technology and non-rRNA binding hexanucleotides, were applied to the microarray sample processing and the outcome was compared with those of the sequence-independent amplification protocol. This study concludes that the two procedures, described to deplete or exclude rRNA, have negligible effect on the microarrays detection and analysis and might only in combination with further techniques result in a significant enhancement of sensitivity. Currently, existing protocols of random amplification and background adjustment are pertinent for the purpose of sample processing for microarray analysis.


Assuntos
Análise em Microsséries/métodos , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Vírus de RNA/isolamento & purificação , RNA Ribossômico/isolamento & purificação , Manejo de Espécimes/métodos , Virologia/métodos , Animais , Vírus de RNA/genética , RNA Ribossômico/metabolismo , Sensibilidade e Especificidade
20.
Cogn Emot ; 28(1): 46-58, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23746071

RESUMO

Individuals with anxiety disorders have previously demonstrated abnormal habituation to aversiveness over time. As anxiety sensitivity (AS), or an individuals' propensity to fear of anxiety-related sensations, has been shown to be a risk factor for anxiety disorders (particularly panic disorder), the present study examined whether AS was also associated with abnormal habituation. This association was examined in two independent samples of undergraduates (Ntotal=178). Habituation was operationalised as the reduction in startle response to multiple startle probes presented over 2.5 minutes and three definitions of this reduction were employed. Results indicated that individuals with higher levels of AS evidenced deficits in startle habituation, but the strength of this relationship was somewhat dependent on the definition of startle habituation, with the most robust definition being an analysis of participants' individual slopes across all nine blinks. The present findings suggest that startle habituation is a key mechanism underlying AS, and may help elucidate the role this risk factor plays in the pathogenesis of anxiety disorders.


Assuntos
Ansiedade/fisiopatologia , Habituação Psicofisiológica/fisiologia , Reflexo de Sobressalto/fisiologia , Piscadela/fisiologia , Feminino , Humanos , Masculino , Adulto Jovem
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