Cognitive therapy helps insomnia & pain

Sufferers from osteoarthritis often experience sleeplessness and around 60 percent report feeling pain at night due to their condition. Now some new research suggests cognitive behavioural therapy could be an effective way of dealing with the problem.

The Journal of Clinical Sleep Medicine has reported on a study done at the University of Washington, USA that specifically tested behavioural therapy on patients with arthritis. The majority of the test subjects were female, so it can’t be deemed conclusive for men as well, but the older adults in the study initially reported sleeping 21 minutes longer per night on average and 27 minutes longer a year after treatment.

That might not sound like much, but for anyone who has known the exhaustion of sleep deprivation then any increase is a bonus. Further, the patients also experienced a significant reduction in arthritis pain compared to those in a control group.

Cognitive Behavioural Therapy is a well established method for helping facilitate behavioural change and attitude. For the study the subjects took part in for two months in weekly two-hour group classes led by an experienced clinical psychologist. They were put on a strict schedule of bedtimes and waking times, beginning with the amount of time they were actually sleeping told to lie in bed awake no longer than 15 minutes and to engage in no activities in bed other than sleep and sex. If they began to spend more of their time in bed asleep, their hours of sleep were increased by a maximum of one-half hour each week.

Cognitive restructuring techniques helped participants change unrealistic beliefs and irrational fears regarding sleep or lack of it. They also received relaxation training and instruction about other factors that might affect their sleep, such as getting enough sunlight and exercise and avoiding alcohol and caffeine.

They kept both sleep and pain logs and for the majority in the study there was a definite, and continued, improvement in both these areas. since most of the participants were women.

Heart disease and depression link

Being diagnosed with coronary heart disease can be frightening and stressful, however optimistic the prognosis. It can be a time to revaluate lifestyle, relationships and work and can place enormous pressure on the individual and their family, affecting all aspects of life – including mental health. Now, the American Heart Association has recommended that coronary patients should also be screened early and regularly for depression. They have spoken out because of the growing body of evidence that shows a link between depression in cardiac patients and a poorer long-term outlook.

Many studies have now shown that major depression is associated with worse prognosis in patients with coronary disease. What has also now been confirmed is that more severe depression is associated with the patient having earlier and more severe cardiac events.

In many cases, depression can often be treated with exercise, counselling, good nutrition and cognitive-behavioural therapy. American Psychiatric Association suggests that two questions can identify patients who may need further follow up and treatment. The doctor should ask: ‘Over the past two weeks, how often have you been bothered by the following two symptoms?

1. Little interest or pleasure in doing things

2. Feeling down, depressed, or hopeless

If the answer to either question is yes, they have been bothered by those symptoms then the follow up questions are: ‘how often have you been bothered in the past two weeks by:

1. Trouble falling asleep, staying asleep, or sleeping too much

2. Feeling tired or having little energy

3. Poor appetite or overeating

4. Feeling bad about yourself, that you are a failure, or that you have let yourself or your family down

5. Trouble concentrating on things such as reading the newspaper or watching television

6. Moving or speaking so slowly that other people could have noticed or being so fidgety or restless that you have been moving around a lot more than usual

7. Thinking that you would be better off dead or that you want to hurt yourself in some way.

This is not a definitive way to define depression, but it is a useful tool to evaluate how someone is coping after having a coronary and can help you decide whether or not help is needed.

Often used strategies for patients who have coronary disease and depression are antidepressant drugs, cognitive behavioural therapy, and physical activity, such as aerobic exercise. Diet can also play a part, and most nutritionists would recommend a diet that excluded sugar, caffeine and alcohol.