. 2023 Feb 17;13(2):347.

doi: 10.3390/brainsci13020347.

Group Cognitive Behavioural Therapy for Non-Rapid Eye Movement Parasomnias: Long-Term Outcomes and Impact of COVID-19 Lockdown

Matthias Laroche¹, Nazanin Biabani¹, Panagis Drakatos^{1

2}, Hugh Selsick^{2

3}, Guy Leschziner^{1

2

4

5}, Joerg Steier^{1

2}, Allan H Young⁶, Sofia Eriksson⁷, Alexander Nesbitt^{1

2

4}, Veena Kumari^{2

8}, Ivana Rosenzweig^{1

2}, David O'Regan^{2

9}

Affiliations

¹ Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Box 089, De Crespigny Park, London SE5 8AF, UK.
² Sleep Disorder Centre, Nuffield House, Guy's Hospital, London SE1 9RT, UK.
³ Insomnia and Sleep Medicine Behavioural Clinic, Royal London Hospital for Integrated Medicine, London WCIN 3HR, UK.
⁴ Department of Neurology, Guy's Hospital, London SE1 9RT, UK.
⁵ Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Box 089, De Crespigny Park, London SE5 8AF, UK.
⁶ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK.
⁷ National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
⁸ Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK.
⁹ Faculty of Life Sciences and Medicine, King's College, London WC2R 2LS, UK.

PMID: 36831890
PMCID: PMC9953888
DOI: 10.3390/brainsci13020347

Group Cognitive Behavioural Therapy for Non-Rapid Eye Movement Parasomnias: Long-Term Outcomes and Impact of COVID-19 Lockdown

Matthias Laroche et al. Brain Sci. 2023.

. 2023 Feb 17;13(2):347.

doi: 10.3390/brainsci13020347.

Authors

Affiliations

¹ Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Box 089, De Crespigny Park, London SE5 8AF, UK.
² Sleep Disorder Centre, Nuffield House, Guy's Hospital, London SE1 9RT, UK.
³ Insomnia and Sleep Medicine Behavioural Clinic, Royal London Hospital for Integrated Medicine, London WCIN 3HR, UK.
⁴ Department of Neurology, Guy's Hospital, London SE1 9RT, UK.
⁵ Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Box 089, De Crespigny Park, London SE5 8AF, UK.
⁶ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK.
⁷ National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
⁸ Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK.
⁹ Faculty of Life Sciences and Medicine, King's College, London WC2R 2LS, UK.

PMID: 36831890
PMCID: PMC9953888
DOI: 10.3390/brainsci13020347

Abstract

Prior to the COVID-19 pandemic, we demonstrated the efficacy of a novel Cognitive Behavioural Therapy programme for the treatment of Non-Rapid Eye Movement Parasomnias (CBT-NREMP) in reducing NREM parasomnia events, insomnia and associated mood severities. Given the increased prevalence and worsening of sleep and affective disorders during the pandemic, we examined the sustainability of CBT-NREMP following the U.K.'s longest COVID-19 lockdown (6 January 2021-19 July 2021) by repeating the investigations via a mail survey in the same 46 patient cohort, of which 12 responded. The survey included validated clinical questionnaires relating to NREM parasomnia (Paris Arousal Disorder Severity Scale), insomnia (Insomnia Severity Index) and anxiety and depression (Hospital Anxiety and Depression Scale). Patients also completed a targeted questionnaire (i.e., Impact of COVID-19 Lockdown Questionnaire, ICLQ) to assess the impact of COVID-19 lockdown on NREM parasomnia severity, mental health, general well-being and lifestyle. Clinical measures of NREM parasomnia, insomnia, anxiety and depression remained stable, with no significant changes demonstrated in questionnaire scores by comparison to the previous investigatory period prior to the COVID-19 pandemic: p (ISI) = 1.0; p (HADS) = 0.816; p (PADSS) = 0.194. These findings support the longitudinal effectiveness of CBT-NREMP for up to three years following the clinical intervention, and despite of the COVID-19 pandemic.

Keywords: CBT; NREM parasomnia; cognitive behavioural therapy; parasomnia; treatment.

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Conflict of interest statement

Author AHY Declaration of Interests: Employed by King’s College London; Honorary Consultant SLaM (NHS UK); Deputy Editor, BJPsych Open; Paid lectures and advisory boards for the following companies with drugs used in affective and related disorders: Astrazenaca, Eli Lilly, Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, COMPASS, Sage, Novartis, Neurocentrx; Consultant to Johnson & Johnson; Consultant to Livanova; Received honoraria for attending advisory boards and presenting talks at meetings organised by LivaNova. Principal Investigator in the Restore-Life VNS registry study funded by LivaNova. Principal Investigator on ESKETINTRD3004: “An Open-label, Long-term, Safety and Efficacy Study of Intranasal Esketamine in Treatment-resistant Depression.”; Principal Investigator on “The Effects of Psilocybin on Cognitive Function in Healthy Participants”; Principal Investigator on “The Safety and Efficacy of Psilocybin in Participants with Treatment-Resistant Depression (P-TRD)”; UK Chief Investigator for Novartis MDD study MIJ821A12201; Grant funding (past and present): NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edin); BMA (UK); UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); NIHR (UK). Janssen (UK); No shareholdings in pharmaceutical companies. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

**Figure 1**
Flowchart of the studied cohort of patients with NREM parasomnia. Some patients reported two or more subtypes of NREM parasomnia. Percentages indicate the prevalence of each NREM parasomnia subtype in our cohort. CBT-NREMP: Cognitive Behavioural Therapy for NREM parasomnia; CA: confusional arousal; SRED: sleep-related eating disorder; NREM: Non-REM.

**Figure 2**
Box plot of Assessment Score for PRE and POST scores for ISI, HADS and PADSS (note: p values are from Wilcoxon tests). PRE: after CBT-NREMP intervention; POST: follow-up. Box represents the 50% of the central data (between 25th and 75th percentiles), with a line inside that represents the median. Dots represent points outside 1.5 times the interquartile range above the upper quartile and below the lower quartile.

See this image and copyright information in PMC

Cited by

Dreaming Characteristics in Non-Rapid Eye Movement Parasomnia and Idiopathic Rapid Eye Movement Sleep Behaviour Disorder: Similarities and Differences.
See QR, Raheel K, Duncan I, Biabani N, Di Giulio I, Romigi A, Kumari V, O'Regan D, Cairney S, Urso D, Chaudhuri KR, Gnoni V, Drakatos P, Rosenzweig I. See QR, et al. Nat Sci Sleep. 2024 Mar 8;16:263-277. doi: 10.2147/NSS.S435201. eCollection 2024. Nat Sci Sleep. 2024. PMID: 38482468 Free PMC article.

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Group Cognitive Behavioural Therapy for Non-Rapid Eye Movement Parasomnias: Long-Term Outcomes and Impact of COVID-19 Lockdown

Affiliations

Group Cognitive Behavioural Therapy for Non-Rapid Eye Movement Parasomnias: Long-Term Outcomes and Impact of COVID-19 Lockdown

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Affiliations

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Conflict of interest statement

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