Compatibility between biological and psychological hyperarousal in response to cognitive behavior therapy (with or without metacognitive techniques) in patients with chronic insomnia disorder: A multiple baselines single case

Hyperarousal is one of the main pathological mechanism in chronic insomnia. This study aimed to comparing biological and psychological hyperarousal in response to cognitive behavior therapy (with or without metacognitive techniques) in insomnia patients.

After taking diagnostic assessment and checking inclusive and exclusive criteria, four patients (1 male and 3 female; age 21-34) were allocated to two condition, cognitive behavior therapy (CBT) and cognitive behavior therapy with metacognitive techniques (CBT+). All of the patients were assessed six times by indirect calorimeter, pre-sleep arousal scale, and sleep efficiency (SE). The data were analyzed using clinical significant (recovery percent), effect size, and diagnostic recovery.

In initial sessions (session 1 to 3), we observed a little compatibility between the biological and psychological hyperarousal. As sessions of CBT or CBT+ proceed, compatibility between the biological and psychological hyperarousal increased. In addition, in post-treatment and 3 month follow-up, both the interventions decreased hyperarousal significantly. Effect sizes were between 0.74 to 1.93. Furthermore, sleep efficiency of all the patients in the post-treatment and 3-month follow-up was between 89 to 94 and 88 to 90, respectively.

Unlike few initial sessions, compatibility between the biological and psychological hyperarousal increased at the post-treatment and 3-month follow-up. Both the treatments can decrease the hyperarousal and increase the sleep efficiency significantly.