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Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part II:
Josée Savard1, Sébastien Simard, Hans Ivers
1Laval University Cancer Research Center, 11 Côte du Palais, Québec, Québec, Canada, G1R 2J6. josee.savard@psy.ulaval.ca
Insights
Cognitive-behavioral therapy (CBT) for chronic insomnia in breast cancer survivors improved immune function, increasing interferon gamma and altering lymphocyte levels. This suggests a causal link between insomnia and immune changes.
Area of Science:
- Immunology
- Oncology
- Sleep Medicine
Background:
- Cross-sectional studies indicate a link between clinical insomnia and immune system downregulation.
- Experimental evidence is needed to confirm the causal relationship between insomnia and immune function.
Purpose of the Study:
- To investigate the impact of an 8-week cognitive-behavioral therapy (CBT) for chronic insomnia on the immune functioning of breast cancer survivors.
- To assess changes in immune cell counts and cytokine production following CBT.
Main Methods:
- A randomized controlled study involving 57 women with chronic insomnia secondary to breast cancer.
- Participants were assigned to either CBT (n=27) or a waiting-list control (WLC; n=30).
- Immune measures, including blood cell counts and cytokine production (IFN-gamma, IL-1beta), were assessed at baseline, post-treatment, and at 3-, 6-, and 12-month follow-ups.
Main Results:
- CBT-treated patients showed higher interferon gamma (IFN-gamma) secretion and a lower increase in lymphocytes post-treatment compared to controls.
- Pooled data revealed significant increases in IFN-gamma and interleukin-1 beta (IL-1beta) from pre- to post-treatment.
- Follow-up assessments indicated significant changes in white blood cells (WBCs), lymphocytes, and IFN-gamma compared to post-treatment.
Conclusions:
- The study provides evidence supporting a causal relationship between clinical insomnia and immune functioning in breast cancer survivors.
- CBT intervention demonstrated a positive effect on specific immune markers.
- Further research is warranted to explore the clinical implications of these immune alterations.
Purpose:
Cross-sectional studies suggest that clinical insomnia is associated with immune downregulation. However, there is a definite need for experimental studies on this question. The goal of this randomized controlled study was to assess the effect of an 8-week cognitive-behavioral therapy (CBT) for chronic insomnia on immune functioning of breast cancer survivors. Previous analyses of this study showed that CBT was associated with improved sleep and quality of life, and reduced psychological distress.
Patients And Methods:
Fifty-seven women with chronic insomnia secondary to breast cancer were randomly assigned to CBT (n = 27) or to a waiting-list control condition (WLC; n = 30). Peripheral-blood samples were taken at baseline and post-treatment (and postwaiting for WLC patients), as well as at 3-, 6-, and 12-month follow-up for immune measures, including enumeration of blood cell counts (ie, WBCs, monocytes, lymphocytes, CD3+, CD4+, CD8+, and CD16+/CD56+) and cytokine production (ie, interleukin-1-beta [IL-1beta] and interferon gamma [IFN-gamma]).
Results:
Patients treated with CBT had higher secretion of IFN-gamma and lower increase of lymphocytes at post-treatment compared with control patients. Pooled data from both treated groups indicated significantly increased levels of IFN-gamma and IL-1beta from pre- to post-treatment. In addition, significant changes in WBCs, lymphocytes, and IFN-gamma were found at follow-up compared with post-treatment.
Conclusion:
This study provides some support to the hypothesis of a causal relationship between clinical insomnia and immune functioning. Future studies are needed to investigate the clinical impact of such immune alterations.
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