Insomnia disorder is a debilitating sleep disorder that impacts nearly 10% of Canadian adults. Cognitive Behavioural Therapy for insomnia (CBT-I) is a psychological treatment that targets cognitions and behaviours to improve sleep outcomes. CBT-I has been shown to be an effective treatment for insomnia symptoms; however, little is known about the cognitive and physiological underpinnings of the treatment response. This thesis examines correlates of cognitive, clinical, and biological markers of change across group CBT-I treatment. Specifically, we evaluated: (1) objective and subjective cognitive and psychosocial functioning, (2) discrepancies between objective and subjective measures of sleep, and (3) the relationship between a biological marker of stress and sleep parameters. The first study in this thesis investigated how objective and self-report measures of cognitive functioning, and psychosocial functioning changed across CBT-I. Findings illustrated that changes in self-report cognitive ability and psychosocial functioning were related to the improvements in insomnia symptom severity across treatment. The second study investigated the discrepancy between objectively measured sleep with actigraphy and self-reported sleep variables. Findings showed that the mismatch between objective and subjective sleep parameters decreased early on during the implementation of CBT-I. Additionally, improvement of clinical symptoms was related to a decrease in sleep discrepancies across treatment. In the third study, we examined if there was a relationship between a biological marker of oxidative stress across CBT-I. Results showed that following CBT-I, the biological marker was related to both objective sleep parameters and self-reported symptom improvement. Overall, this thesis demonstrates that in our well-characterized sample of adults with insomnia disorder, group CBT-I was associated with significant post-group changes in cognitive, clinical, and biological factors. This has important implications for the factors that may influence an individual’s treatment response to CBT-I, and thus lead to improvements in tailoring treatments to optimize outcomes for treatment of insomnia disorder. / Dissertation / Doctor of Philosophy (PhD) / Insomnia disorder is a sleep disorder that negatively affects day-to-day-functioning and is associated with poorer mental and health outcomes. Cognitive Behavioural Therapy for insomnia (CBT-I) is an established psychological treatment that focuses on changing sleep behaviours and thinking patterns for improving sleep. This thesis aimed to examine factors that may be related to how CBT-I works to improve sleep with both self-reported and objective measures. We investigated whether cognition (e.g., memory and attention), different measures of sleep, clinical symptoms, and biological factors associated with sleep changed across treatment with CBT-I. Results indicated that several self-reported measures of cognition and sleep improved across CBT-I. Our findings suggest that these variables were related to improvements in sleep following CBT-I. By understanding what factors may be contributing to sleep difficulties and change across CBT-I, we can improve treatment outcomes and better adapt treatment strategies to those struggling with insomnia disorder.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/30057 |
| Date | January 2024 |
| Creators | Cudney, Lauren E. |
| Contributors | Green, Sheryl M., McCabe, Randi E., Psychology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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