Suffolk University, Boston, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
Framingham State University, Framingham, MA, United States.
Sleep Med. 2023 Mar;103:29-32. doi: 10.1016/j.sleep.2023.01.011. Epub 2023 Jan 14.
OBJECTIVE/BACKGROUND: Cancer survivors have elevated rates of insomnia and depression. Insomnia increases risk for depression onset, and the Integrated Sleep and Reward (ISR) Model suggests that impairments in reward responding (e.g., ability to anticipate and/or experience pleasure) plays a central role in this relationship. Cognitive behavioral therapy for insomnia (CBT-I) is efficacious for treating chronic insomnia and reducing depression in cancer survivor populations. The effects of CBT-I on anticipatory and consummatory pleasure are theoretically and clinically meaningful, yet remain unexamined.
PATIENTS/METHODS: This secondary analysis of a pilot RCT (N = 40 cancer survivors with insomnia) explicated changes in anticipatory and consummatory pleasure and depression symptoms following a 4-session, synchronous, virtual CBT-I program versus enhanced usual care (referral to a behavioral sleep medicine clinic + sleep hygiene handout). Linear mixed models examined changes in anticipatory and consummatory pleasure and depression symptoms as predictors of changes in insomnia severity from baseline to post-intervention and 1-month follow-up.
CBT-I buffered against deterioration in anticipatory pleasure but not consummatory pleasure or depression symptoms. Across conditions, increased anticipatory pleasure was associated with insomnia reduction through 1-month follow-up, even after adjusting for changes in depression symptoms.
CBT-I may improve reward processing deficits in cancer survivors with insomnia. Findings provide support for the ISR Model and implicate pleasure as an important target for insomnia and depression.
目的/背景：癌症幸存者的失眠和抑郁发生率较高。失眠会增加抑郁发作的风险，而综合睡眠和奖励（ISR）模型表明，奖励反应受损（例如，预测和/或体验愉悦的能力）在这种关系中起着核心作用。失眠认知行为疗法（CBT-I）对治疗慢性失眠症和降低癌症幸存者群体的抑郁症状有效。CBT-I 对预期和满足愉悦的影响在理论和临床上都具有重要意义，但尚未得到检验。
患者/方法：这是一项针对失眠症癌症幸存者的先导性随机对照试验（N=40 例）的二次分析，详细说明了在接受 4 次同步虚拟 CBT-I 方案与增强的常规护理（转诊至行为睡眠医学诊所+睡眠卫生手册）后，预期和满足愉悦感以及抑郁症状的变化。线性混合模型检查了预期和满足愉悦感以及抑郁症状的变化，作为从基线到干预后和 1 个月随访时失眠严重程度变化的预测因素。
CBT-I 缓冲了预期愉悦感的恶化，但对满足愉悦感或抑郁症状没有影响。在所有条件下，预期愉悦感的增加与通过 1 个月随访的失眠症缓解相关，即使在调整了抑郁症状的变化后也是如此。
CBT-I 可能会改善失眠症癌症幸存者的奖励处理缺陷。研究结果为 ISR 模型提供了支持，并暗示愉悦感是失眠症和抑郁症的一个重要治疗靶点。
