Treating narcolepsy-related nightmares with cognitive behavioural therapy and targeted lucidity reactivation: A pilot study.

Autor: Mundt JM; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Pruiksma KE; Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA., Konkoly KR; Department of Psychology, Northwestern University, Evanston, Illinois, USA., Casiello-Robbins C; Triangle Area Psychology Clinic, Durham, North Carolina, USA.; Unified Protocol Institute, Boston, Massachusetts, USA., Nadorff MR; Department of Psychology, Mississippi State University, Starkville, Mississippi, USA., Franklin RC; Department of Psychology, Mississippi State University, Starkville, Mississippi, USA.; Patient advocate., Karanth S; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Patient advocate., Byskosh N; McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Morris DJ; Department of Psychology, Northwestern University, Evanston, Illinois, USA., Torres-Platas SG; Department of Psychology, Northwestern University, Evanston, Illinois, USA., Mallett R; Department of Psychology, Northwestern University, Evanston, Illinois, USA., Maski K; Harvard Medical School, Boston, Massachusetts, USA., Paller KA; Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Department of Psychology, Northwestern University, Evanston, Illinois, USA.
Jazyk: angličtina
Zdroj: Journal of sleep research [J Sleep Res] 2024 Oct 22, pp. e14384. Date of Electronic Publication: 2024 Oct 22.
DOI: 10.1111/jsr.14384
Abstrakt: Nightmares are a common symptom in narcolepsy that has not been targeted in prior clinical trials. This study investigated the efficacy of Cognitive Behavioural Therapy for Nightmares (CBT-N), adapted for narcolepsy, in a small group of adults. Given the high prevalence of lucid dreaming in narcolepsy, we added a promising adjuvant component, targeted lucidity reactivation (TLR), a procedure designed to enhance lucid dreaming and dream control. Using a multiple baseline single-case experimental design, adults with narcolepsy and frequent nightmares (≥3/week, N = 6) were randomised to a 2 or 4 week baseline and received seven treatment sessions (CBT-N or CBT-N + TLR). Across the groups, there was a large effect size (between-case standardised mean difference [BC-SMD] = -0.97, 95% CI -1.79 to -0.14, p < 0.05) for reduced nightmare frequency from baseline (M = 8.38/week, SD = 7.08) to posttreatment (M = 2.25/week, SD = 1.78). Nightmare severity improved significantly with large effect sizes on sleep diaries (BC-SMD = -1.14, 95% CI -2.03 to -0.25, p < 0.05) and the Disturbing Dream and Nightmare Severity Index (z = -2.20, p = 0.03, r = -0.64). Treatment was associated with a reduction for some participants in sleep paralysis, sleep-related hallucinations, and dream enactment. NREM parasomnia symptoms (z = -2.20, p = 0.03, r = -0.64) and self-efficacy for managing symptoms (z = -2.02, p = 0.04, r = -0.58) improved significantly with large effect sizes. Participants who underwent TLR (n = 3) all recalled dreams pertaining to their rescripted nightmare. In interviews, participants noted reduced shame and anxiety about sleep/nightmares. This study provides a proof of concept for the application of TLR as a therapeutic strategy with clinical populations, as well as preliminary evidence for the efficacy of CBT-N in treating narcolepsy-related nightmares.
(© 2024 The Author(s). Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)
Databáze: MEDLINE
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