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Does Perfectionism Increase the Risk for Dropout From Cognitive Behavioral Therapy for Insomnia?

2018; American Academy of Sleep Medicine; Volume: 14; Issue: 03 Linguagem: Inglês

10.5664/jcsm.7012

1550-9397

Anna F. Johann, Dieter Riemann, Kai Spiegelhalder,

Circadian rhythm and melatonin

Free AccessSleep RestrictionDoes Perfectionism Increase the Risk for Dropout From Cognitive Behavioral Therapy for Insomnia? Anna F. Johann, MSc, Dieter Riemann, PhD, Kai Spiegelhalder, MD, PhD Anna F. Johann, MSc Address correspondence to: Anna F. Johann, MSc, E-mail Address: [email protected]. de Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany. Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany , Dieter Riemann, PhD Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany , Kai Spiegelhalder, MD, PhD Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany Published Online:March 15, 2018https://doi.org/10.5664/jcsm.7012Cited by:13SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONAssociations between personality and objective markers of poor sleep are still poorly studied. Particularly the relationship between perfectionism and objective sleep measures is relatively overlooked, as Akram1 correctly points out. Thus, we take this opportunity to briefly sketch potential routes further research in this area may take because perfectionism may play a crucial role for whether or not cognitive behavioral therapy for insomnia (CBT-I) is successful.Evidence shows that those who do not adhere to CBT-I often drop out when they are to be restricting their sleep.2 This finding is particularly pertinent as sleep restriction is the core element of CBT-I3 and as such, crucial for treatment success. Sleep restriction is a process that may be understood as a set of repeated attempts to determine a patient's individual sleep duration in an iterative manner by gradually approximating the appropriate sleep duration. This process necessarily involves trial and error. Indeed, sleep restriction may be conceived of as a behavioral experiment in which patients are required to explore their individual sleep time independent from dysfunctional beliefs, such as a person needs 7 to 8 hours of sleep. Patients with insomnia presenting with high levels of perfectionism may find it difficult to submit to that type of experiment. The reason behind this may be the very nature of the process of sleep restriction, which necessarily involves the repeated experience of failure, although that failure may ultimately be only partial and temporary. From this perspective, sleep restriction may pose a crucial obstacle for patients with increased levels of perfectionism and may prevent them from entering one of the most effective aspects of the CBT-I curriculum and progressing to treatment success.There is a further dimension to the relationship between perfectionism and poor sleep. Not all patients with insomnia presenting with increased levels of perfectionism may have the same risk for not adhering to treatment. The risk may vary according to sleep duration and levels of perfectionism. Recent research suggested that there are two groups of patients with insomnia that differ with respect to their sleep duration, patients with normal sleep duration (> 6 hours) and patients with short sleep duration (< 6 hours).4 The patients with short sleep duration may have a higher risk for not adhering to treatment if they present with increased levels of perfectionism because these patients may experience a larger difference between the commonly held ideal of a sleep duration of 7 to 8 hours and the CBT-I imposed sleep duration (eg, 4 hours) than the patients with insomnia and normal sleep duration. That difference may cause even greater distress in those patients because it increases their perceived failure to not comply with the purported norm of 7 to 8 hours of sleep.5Thus far, perfectionism is not part of the established CBT-I curriculum. However, in light of the aforementioned findings, we would argue that those who do not adhere to CBT-I who present with high perfectionism scores may benefit from a modified CBT-I. Therefore, we propose that future research may investigate whether a modified CBT-I curriculum that takes perfectionism into account may increase treatment success.DISCLOSURE STATEMENTAll authors have seen and approved the manuscript. The authors report no conflicts of interest.CITATIONJohann AF, Riemann D, Spiegelhalder K. Does perfectionism increase the risk for dropout from cognitive behavioral therapy for insomnia? J Clin Sleep Med. 2018;14(3):487–488.REFERENCES1 Akram UObjective sleep and personality. J Clin Sleep Med; 2018;143:485-486. LinkGoogle Scholar2 Ong JC, Gracy FK, Manber RWho is at risk for dropout from group cognitive-behavior therapy for insomnia?J Psychosom Res; 2008;644:419-425, 18374742. CrossrefGoogle Scholar3 Riemann D, Baum E, Cohrs Set al.S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen: Kapitel "Insomnie bei Erwachsenen" (AWMFRegisternummer 063-003), Update 2016. Somnologie; 2017;211:2-44. CrossrefGoogle Scholar4 Vgontzas AN, Fernandez-Mendoza J, Liao D, Bixler EOInsomnia with objective short sleep duration: the most biologically severe phenotype of the disorder. Sleep Med Rev; 2013;174:241-254, 23419741. CrossrefGoogle Scholar5 Watson NF, Badr MS, Belenky Get al.Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep; 2015;386:843-844, 26039963. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited by The Effects of Cognitive Behavioral Therapy for Insomnia on Multidimensional PerfectionismJohann A, Feige B, Hertenstein E, Nissen C, Benz F, Steinmetz L, Baglioni C, Riemann D, Spiegelhalder K and Akram U Behavior Therapy, 10.1016/j.beth.2022.10.001, Vol. 54, No. 2, (386-399), Online publication date: 1-Mar-2023. The importance of cumulative science and the perils of perfectionistic strivings: A reply to Akram and Stevenson (2023)Stricker J, Kröger L, Küskens A, Gieselmann A and Pietrowsky R Sleep Health, 10.1016/j.sleh.2023.01.008, , Online publication date: 1-Feb-2023. The joy of repetition: Perfectionism and poor sleep Comment on "Multidimensional perfectionism and poor sleep: A meta-analysis of bivariate associations"Akram U and Stevenson J Sleep Health, 10.1016/j.sleh.2023.01.003, , Online publication date: 1-Feb-2023. 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Diagnosis and treatmentPentagna Á, Castro L and Conway B Arquivos de Neuro-Psiquiatria, 10.1590/0004-282x-anp-2022-s124, Vol. 80, No. 5 suppl 1, (307-312) Identifying Insomnia From Social Media Posts: Psycholinguistic Analyses of User TweetsSakib A, Mukta M, Huda F, Islam A, Islam T and Ali M Journal of Medical Internet Research, 10.2196/27613, Vol. 23, No. 12, (e27613) Persönlichkeit und InsomnienPersonality and insomniaKüskens A, Pietrowsky R and Gieselmann A Somnologie, 10.1007/s11818-021-00315-7 Perfectionism and insomnia in adolescents: The role of vulnerability to stress and genderRichardson C and Gradisar M Journal of Adolescence, 10.1016/j.adolescence.2020.10.003, Vol. 85, No. 1, (70-79), Online publication date: 1-Dec-2020. Experience of Treatment and Adherence to Cognitive Behavioral Therapy for Insomnia for Patients with Depression: An Interview StudyDyrberg H, Juel A and Kragh M Behavioral Sleep Medicine, 10.1080/15402002.2020.1788033, (1-11) Dysfunctional sleep-related cognition and anxiety mediate the relationship between multidimensional perfectionism and insomnia symptomsAkram U, Gardani M, Riemann D, Akram A, Allen S, Lazuras L and Johann A Cognitive Processing, 10.1007/s10339-019-00937-8, Vol. 21, No. 1, (141-148), Online publication date: 1-Feb-2020. Anxiety and depression mediate the relationship between insomnia symptoms and the personality traits of conscientiousness and emotional stabilityAkram U, Gardani M, Akram A and Allen S Heliyon, 10.1016/j.heliyon.2019.e01939, Vol. 5, No. 6, (e01939), Online publication date: 1-Jun-2019. Volume 14 • Issue 03 • March 15, 2018ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationDecember 18, 2017Submitted in final revised formDecember 18, 2017Accepted for publicationDecember 20, 2017Published onlineMarch 15, 2018 Information© 2018 American Academy of Sleep MedicinePDF download