Behavioral Intervention Based on Functional Assessment for an Individual with Residual Insomnia after Remission of a Major Depressive Disorder with Pharmacotherapy : A Case Study

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  • OKAJIMA Isa
    Department of Somnology, Tokyo Medical University:Yoyogi Sleep Disorder Center:Japan Somnology Center, Neuropsychiatric Research Institute

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  • うつ病改善後の残遺不眠を訴える慢性不眠症患者に対する機能的アセスメントに基づく介入効果

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Abstract

Evidence suggests that insomnia persists for many depressive patients after their other symptoms have responded to pharmacotherapy. The present case study reports an attempt to use a behavioral intervention based on functional assessment with a retired 69-year-old man who had residual insomnia despite having taken several types of sleep medication. The functional assessment suggested that his tendency to perform various activities daily had been functioning as a coping mechanism for avoiding the anxiety and discomfort that he felt from not being able to sleep. These avoidance behaviors were provoked by various discriminative stimuli, including his own verbal behaviors. After conducting the functional assessment in five 50-minute sessions, 11 booster sessions were held in order to discontinue his consumption of sleep medications. The results showed that his sleep onset latency (SOL) was reduced from 60 to 10 minutes, and his wake after sleep onset (WASO), from 180 to 33 minutes after the second session. Furthermore, the man's Insomnia Severity Index (ISI) scores decreased from 24 (severe) to 7 (in remission) after discontinuation of the sleep medications. The present results suggest that this functional-assessment-based intervention may be effective in treating individuals who have residual insomnia after remission of their major depressive disorder.

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