Eficacia de aceptación y cambio de conducta para insomnio (ACC-I): Serie de casos
Palabras clave:
insomnio, terapia de aceptación, sueño, compromisoResumen
El insomnio es el trastorno de sueño de mayor prevalencia a nivel mundial, derivado de la pandemia por COVID-19 se ha observado un incremento en la población mundial. Actualmente la Terapia Cognitivo Conductual para Insomnio representa el tratamiento de primera elección, sin embargo, se ha reportado una alta tasa de abandono y baja adherencia. Debido a ello, han surgido tratamientos complementarios como la Terapia de Aceptación y Compromiso (ACT) que ha mostrado tener buenos resultados. El objetivo de la presente investigación es manifestar la eficacia del protocolo de Aceptación y Cambio de Conducta para Insomnio en parámetros de sueños. Se realizó un reporte de caso con mediciones pretratamiento, postratamiento y seguimiento al mes en tres hombres (n=3) con insomnio crónico. Los instrumentos utilizados fueron el Índice de Severidad del Insomnio (ISI), la Escala Atenas de Insomnio (EAI), Índice de calidad de sueño de Pittsburg (PSQI), Escala de Somnolencia Epworth (ESE) y el diario de sueño. Se observó una disminución de puntajes en los cuestionarios ISI (Pre=13; Post=3; Seg. =2; CCO= 76.9%), EAI (Pre= 17; Post=4; Seg=2, CCO=76.4%), ESE (Pre= 14; Post=2; Seg=2, CCO=85.7%) y PSQI (Pre= 15; Post=4; Seg=3, CCO=73.3%) de los tres participantes. Discusión: A pesar de los resultados clínicos favorables se sugiere tomar los datos con precaución debido al tamaño de la muestra tan reducido y al diseño metodológico. Sin embargo, se concluye que la intervención fue clínicamente significativa y cubrió las necesidades de los participantes
Descargas
Citas
Agnew, S., Vallières, A., Hamilton, A., McCrory, S., Nikolic, M., Kyle, S. D., Fleming, L., & Crawford, M. R. (2021). Adherence to Cognitive Behavior Therapy for Insomnia: An Updated Systematic Review. Sleep medicine clinics, 16(1), 155–202. https://doi.org/10.1016/j.jsmc.2020.11.002
American Academy Sleep Medicine. (2014). International Classification of Sleep Disorders (ICSD-3) 3rd ed. Darien, JL.: American Academy of Sleep Medicine.
Bao, Y., Sun, Y., Meng, S., Shi, J., & Lu, L. (2020). 2019-nCoV epidemic: address mental health care to empower society. Lancet (London, England), 395(10224), e37–e38. https://doi.org/10.1016/S0140-6736(20)30309-3
Barnes-Holmes, D., & Harte, C. (2022). Relational frame theory 20 years on: The Odysseus voyage and beyond. Journal of the experimental analysis of behavior, 117(2), 240–266. https://doi.org/10.1002/jeab.733
Cardiel, R. (1994). La medición de la calidad de vida. En L. Moreno, F. Cano-Valle y H. García-Romero (Eds.): Epidemiología clínica (pp. 189-199). McGraw-Hill.
Carney, C., Buysse, D., Ancoli-Israel, S., Edinger, J., Krystal, A., Lichstein, K., & Morin, C. (2012). The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep, 35(2), 287–302. https://doi.org/10.5665/sleep.1642
Chapoutot, M., Peter-Derex, L., Schoendorff, B., Faivre, T., Bastuji, H., & Putois, B. (2021). Telehealth-delivered CBT-I programme enhanced by acceptance and commitment therapy for insomnia and hypnotic dependence: A pilot randomized controlled trial. Journal of sleep research, 30(1), e13199. https://doi.org/10.1111/jsr.13199
Cheung, J. M. Y., Jarrin, D. C., Ballot, O., Bharwani, A. A., & Morin, C. M. (2019). A systematic review of cognitive behavioral therapy for insomnia implemented in primary care and community settings. Sleep medicine reviews, 44, 23–36. https://doi.org/10.1016/j.smrv.2018.11.001
Colten, H., & Altevogt, B. (2006). Functional and Economic Impact of Sleep Loss and Sleep-Related Disorders. En H. Colten, & B. Altevogt, Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem (págs. 137-163). National Academy of Sciences.
Dalrymple, K. L., Fiorentino, L., Politi, M. C., & Posner, D. (2010). Incorporating principles from acceptance and commitment therapy into cognitive-behavioral therapy for insomnia: A case example. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy, 40(4), 209–217. https://doi.org/10.1007/s10879-010-9145-1
El Rafihi-Ferreira, R., Morin, C. M., Hasan, R., Brasil, I. S., Zago Ribeiro, J. H., Júnior, & Cecília Toscanini, A. (2022). A Pilot Randomized Controlled Trial (RCT) of Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy for Chronic Insomnia. Behavioral sleep medicine, 1–15. Advance online publication. https://doi.org/10.1080/15402002.2022.2071272
El Rafihi-Ferreira, R., Morin, C. M., Toscanini, A. C., Lotufo Neto, F., Brasil, I. S., Gallinaro, J. G., Borges, D. S., Conway, S. G., & Hasan, R. (2021). Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial. Revista brasileira de psiquiatria (Sao Paulo, Brazil: 1999), 43(5), 504–509. https://doi.org/10.1590/1516-4446-2020-0947
Fernández-Mendoza, J., Rodríguez-Muñoz, A., Vela-Bueno, A., Olavarrieta-Bernardino, S., Calhoun, S., Bixler, E., & Vgontzas, A. (2012). The Spanish version of the Insomnia Severity Index: a confirmatory factor analysis. Sleep medicine, 13(2), 207–210. https://doi.org/10.1016/j.sleep.2011.06.019
Fiorentino, L., Martin, J.L., Alessi, C.A. (2020). The ABCs of Insomnia (ABC-I): An Acceptance Commitment Therapy (ACT)-Based Insomnia Treatment Development Study: Pilot Results and Future Directions. In: Sedky, K., Nazir, R., Bennett, D. (eds) Sleep Medicine and Mental Health. Springer, Cham. https://doi.org/10.1007/978-3-030-44447-1_5
Hayes, L.J., & Fryling, M. J., (2019). Functional and descriptive contextualism. Journal of Contextual Behavioral Science, 14, 119-126, https://doi.org/10.1016/j.jcbs.2019.09.002.
Hayes, S. (2016). Acceptance and Commitment Therapy, Relational Frame Theory, and the Third Wave of Behavioral and Cognitive Therapies - Republished Article. Behavior therapy, 47(6), 869-885. https://doi.org/10.1016/j.beth.2016.11.006
Hayes, S., Strosahl, K., & Wilson, K. (2012). Terapia de Aceptación y Compromiso. Proceso y práctica del cambio consciente (mindfulness). Desclée de Brouwer, Biblioteca de Psicología.
Hillman, D. R., Murphy, A. S., & Pezzullo, L. (2006). The economic cost of sleep disorders. Sleep, 29(3), 299–305. https://doi.org/10.1093/sleep/29.3.299
Hillman, D., Mitchell, S., Streatfeild, J., Burns, C., Bruck, D., & Pezzullo, L. (2018). The economic cost of inadequate sleep. Sleep, 41(8), 10.1093/sleep/zsy083. https://doi.org/10.1093/sleep/zsy083
Jiménez-Genchi, A., Monteverde-Maldonado, E., Nenclares-Portocarrero, A., Esquivel-Adame, G., & Vega-Pacheco, A. (2008). Confiabilidad y análisis factorial de la versión en español del índice de calidad de sueño de Pittsburgh en pacientes psiquiátricos. Gaceta Médica de México, 144(6), 491-496.
Kim H. G. (2021). Effects and mechanisms of a mindfulness-based intervention on insomnia. Yeungnam University journal of medicine, 38(4), 282–288. https://doi.org/10.12701/yujm.2020.00850
Kirk, A., Broman-Fulks, J. J., & Arch, J. J. (2021). A Taxometric Analysis of Experiential Avoidance. Behavior therapy, 52(1), 208–220. https://doi.org/10.1016/j.beth.2020.04.008
Mazza, M. G., De Lorenzo, R., Conte, C., Poletti, S., Vai, B., Bollettini, I., Melloni, E. M. T., Furlan, R., Ciceri, F., Rovere-Querini, P., COVID-19 BioB Outpatient Clinic Study group, & Benedetti, F. (2020). Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain, behavior, and immunity, 89, 594–600. https://doi.org/10.1016/j.bbi.2020.07.037
Morin, C. M., & Carrier, J. (2021). The acute effects of the COVID-19 pandemic on insomnia and psychological symptoms. Sleep medicine, 77, 346–347. https://doi.org/10.1016/j.sleep.2020.06.005
Nenclares Portocarrero, A., & Jiménez Genchi, A. (2005). Estudio de validación de la traducción al español de la Escala Atenas de Insomnio. Salud mental, 28(5), 34-39.
Ong, J. C., & Smith, C. E. (2017). Using Mindfulness for the Treatment of Insomnia. Current sleep medicine reports, 3(2), 57–65. https://doi.org/10.1007/s40675-017-0068-1
Ong, J. C., Ulmer, C. S., & Manber, R. (2012). Improving sleep with mindfulness and acceptance: a metacognitive model of insomnia. Behaviour research and therapy, 50(11), 651–660. https://doi.org/10.1016/j.brat.2012.08.001
Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V. G., Papoutsi, E., & Katsaounou, P. (2020). Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, behavior, and immunity, 88, 901–907. https://doi.org/10.1016/j.bbi.2020.05.026
Quartly-Scott, G. I., Miller, C. B., & Hawes, D. J. (2020). A brief behavioral treatment for unresolved insomnia in adolescents: a single-case multiple baseline pilot study, evaluating self-reported outcomes of efficacy, safety, and acceptability. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 16(1), 97–105. https://doi.org/10.5664/jcsm.8132
Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., Espie, C. A., Garcia-Borreguero, D., Gjerstad, M., Gonçalves, M., Hertenstein, E., Jansson-Fröjmark, M., Jennum, P. J., Leger, D., Nissen, C., Parrino, L., Paunio, T., Pevernagie, D., Verbraecken, J., Weeß, H. G., … Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of sleep research, 26(6), 675–700. https://doi.org/10.1111/jsr.12594
Ruiz, F. J., & Perete, L. (2015). Application of a relational frame theory account of psychological flexibility in young children. Psicothema, 27(2), 114–119. https://doi.org/10.7334/psicothema2014.195
Salari, N., Khazaie, H., Hosseinian-Far, A., Khaledi-Paveh, B., Ghasemi, H., Mohammadi, M., & Shohaimi, S. (2020). The effect of acceptance and commitment therapy on insomnia and sleep quality: A systematic review. BMC neurology, 20(1), 300. https://doi.org/10.1186/s12883-020-01883-1
Sandoval-Rincón, M., Alcalá-Lozano, R., Herrera-Jiménez, I., & Jiménez-Genchi, A. (2013). Validación de la escala de somnolencia de Epworth en población mexicana. Gaceta Médica de México, 149(4), 409-416.
Sigurdson, K., & Ayas, N. T. (2007). The public health and safety consequences of sleep disorders. Canadian journal of physiology and pharmacology, 85(1), 179–183. https://doi.org/10.1139/y06-095
Thiart, H., Ebert, D. D., Lehr, D., Nobis, S., Buntrock, C., Berking, M., Smit, F., & Riper, H. (2016). Internet-Based Cognitive Behavioral Therapy for Insomnia: A Health Economic Evaluation. Sleep, 39(10), 1769–1778. https://doi.org/10.5665/sleep.6152
World Health Organization. (2020). Coronavirus disease (COVID-2019) situation reports. World Health Organization. Recuperado el 29 de 07 de 2020, de https://www.who.int/emergencies/diseases/nove-lcoronavirus-2019/situation-reports.
Ye, Y. Y., Chen, N. K., Chen, J., Liu, J., Lin, L., Liu, Y. Z., Lang, Y., Li, X. J., Yang, X. J., & Jiang, X. J. (2016). Internet-based cognitive-behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials. BMJ open, 6(11), e010707. https://doi.org/10.1136/bmjopen-2015-010707
Yin, X., Gou, M., Xu, J., Dong, B., Yin, P., Masquelin, F., Wu, J., Lao, L., & Xu, S. (2017). Efficacy and safety of acupuncture treatment on primary insomnia: a randomized controlled trial. Sleep medicine, 37, 193–200. https://doi.org/10.1016/j.sleep.2017.02.012
Zakiei, A., Khazaie, H., Rostampour, M., Lemola, S., Esmaeili, M., Dürsteler, K., Brühl, A. B., Sadeghi-Bahmani, D., & Brand, S. (2021). Acceptance and Commitment Therapy (ACT) Improves Sleep Quality, Experiential Avoidance, and Emotion Regulation in Individuals with Insomnia-Results from a Randomized Interventional Study. Life (Basel, Switzerland), 11(2), 133. https://doi.org/10.3390/life11020133
