Background: burnout syndrome is a serious and growing problem among medical staff. Its adverse outcomes not only affect health-care providers’ health, but also extend to their patients, resulting in bad-quality care. The COVID-19 pandemic puts frontline health-care providers at greater risk of psychological stress and burnout syndrome. Objectives: this study aimed to identify the levels of burnout among health-care professionals currently working at Assiut University hospitals during the COVID-19 pandemic. Methods: the current study adopted an online cross-sectional design using the SurveyMonkey® website for data collection. A total of 201 physicians were included and the Maslach Burnout Inventory (MBI) scale was used to assess the three burnout syndrome dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment. Results: about one-third, two-thirds, and one-quarter of the respondents had high emotional exhaustion, high depersonalization, and low personal accomplishment, respectively. Younger, resident, and single physicians reported higher burnout scores. The personal accomplishment score was significantly higher among males. Those working more than eight hours/day and dealing with COVID-19 patients had significantly higher scores. Conclusion: during the COVID-19 pandemic, a high prevalence of burnout was recorded among physicians. Age, job title, working duration, and working hours/day were significant predictors for burnout syndrome subscale results. Preventive and interventive programs should be applied in health-care organizations during pandemics.

https://www.mdpi.com/1660-4601/18/10/5368/pdf

Burnout Impact of COVID-19 Pandemic on Health-Care Professionals at Assiut University Hospitals, 2020

Cognitive behavioural therapy for insomnia is the recommended treatment for chronic insomnia. However, up to a quarter of patients dropout from cognitive behavioural therapy for insomnia programmes. Acceptance, mindfulness and values-based actions may constitute complementary therapeutic tools to cognitive behavioural therapy for insomnia. The current study sought to evaluate the efficacy of a remotely delivered programme combining the main components of cognitive behavioural therapy for insomnia (sleep restriction and stimulus control) with the third-wave cognitive behavioural therapy acceptance and commitment therapy in adults with chronic insomnia and hypnotic dependence on insomnia symptoms and quality of life. Thirty-two participants were enrolled in a pilot randomized controlled trial: half of them were assigned to a 3-month waiting list before receiving the four "acceptance and commitment therapy-enhanced cognitive behavioural therapy for insomnia" treatment sessions using videoconference. The primary outcome was sleep quality as measured by the Insomnia Severity Index and the Pittsburgh Sleep Quality Index. All participants also filled out questionnaires about quality of life, use of hypnotics, depression and anxiety, acceptance, mindfulness, thought suppression, as well as a sleep diary at baseline, post-treatment and 6-month follow-up. A large effect size was found for Insomnia Severity Index and Pittsburgh Sleep Quality Index, but also daytime improvements, with increased quality of life and acceptance at post-treatment endpoint in acceptance and commitment therapy-enhanced cognitive behavioural therapy for insomnia participants. Improvement in Insomnia Severity Index and Pittsburgh Sleep Quality Index was maintained at the 6-month follow-up. Wait-list participants increased their use of hypnotics, whereas acceptance and commitment therapy-enhanced cognitive behavioural therapy for insomnia participants evidenced reduced use of them. This pilot study suggests that web-based cognitive behavioural therapy for insomnia incorporating acceptance and commitment therapy processes may be an efficient option to treat chronic insomnia and hypnotic dependence.

Telehealth-delivered CBT-I programme enhanced by acceptance and commitment therapy for insomnia and hypnotic dependence: A pilot randomized controlled trial.

Objective To prospectively document changes in adolescents' sleep before versus during the COVID-19 pandemic, and to examine their impact on adolescents' perceived stress. Methods Sixty-two typically developing adolescents participated in the study before (Time 1: January 15 to March 13, 2020) and during (Time 2: May 15 to June 30, 2020) the COVID-19 pandemic in Canada. At Time 1, each participant's sleep pattern was assessed in the home environment using actigraphy and sleep logs for seven consecutive nights. Adolescents completed a battery of questionnaires in which they reported on their sleep schedule, duration, and quality, as well as their activities at bedtime, their daytime sleepiness, and their social/emotional behavior. The participants' parents provided demographic information. At Time 2, each participant completed a sleep log, the same battery of questionnaires regarding sleep, and the Perceived Stress Scale. Results (1) Adolescents' reported sleep was of longer duration and on a delayed schedule during the COVID-19 pandemic compared to pre-pandemic. (2) A larger proportion of adolescents reported meeting or exceeding the recommended amount of sleep during the COVID-19 pandemic compared to pre-pandemic sleep. (3) "Social jet lag" disappeared during the COVID-19 pandemic. (4) A shorter reported sleep duration and higher level of arousal at bedtime at Time 1 were significant predictors of adolescents' perceived stress at Time 2-during the COVID-19 pandemic. (5) A higher levels of arousal at bedtime and lower reported sleep quality at Time 2 were concurrently associated with higher levels of perceived stress among adolescents, even when we controlled for the levels of pre-pandemic emotional or behavioral issues, sleep duration, or sleep quality. Conclusion Sleep duration and cognitive-emotional arousal, which are both modifiable behaviors, were associated with adolescents' perceived stress during the COVID-19 pandemic. These behaviors could be useful targets for preventive interventions aiming to reduce adolescents' stress in the face of stressogenic situations, such as the COVID-19 pandemic.

/pdf/pre-pandemic-sleep-behavior-and-adolescents-stress-during-to7zvoni4t.pdf

Pre-pandemic sleep behavior and adolescents' stress during Covid-19: a prospective longitudinal study

Benzodiazepines have proven to be highly effective for treating insomnia and anxiety. Although considered safe when taken for a short period of time, a major risk-benefit dilemma arises in the context of long-term use, relating to addiction, withdrawal symptoms, and potential side effects. For these reasons, benzodiazepines are not recommended for treating chronic sleep disorders, anxiety disorders, nor for people over the age of 65, and withdrawal among long-term users is a public health issue. Indeed, only 5% of patients manage to discontinue using these drugs on their own. Even with the help of a general practitioner, this rate does not exceed 25 to 30% of patients, of which approximately 7% manage to remain drug-free in the long term. Cognitive Behavioral Therapies (CBT) offer a crucial solution to this problem, having been shown to increase abstinence success to 70-80%. This article examines traditional and novel CBT techniques in this regard, such as Acceptance and Commitment Therapy, which address both the underlying condition (insomnia/anxiety) and the substance-related disorder. The theoretical framework and evidence supporting the use of these approaches are reviewed. Finally, current research gaps are discussed, and key research perspectives are proposed.

Cognitive Behavioral Therapy and Acceptance and Commitment Therapy for the Discontinuation of Long-Term Benzodiazepine Use in Insomnia and Anxiety Disorders.

Background Insomnia is a sleep disorder frequently associated with the impairment of physical and mental health. Cognitive-Behavioral Therapy for Insomnia (CBT-I) is the treatment of choice, but this therapy has some limitations. Acceptance and Commitment Therapy (ACT) is a promising therapy because it is aimed at improving psychological flexibility instead of focusing on symptom control. This systematic review assessed the levels of evidence and the characteristics of interventions using ACT for insomnia as the primary outcome. Method The PubMed, PsyInfo, and Scopus databases were searched following the PRISMA statement. Articles published in English using ACT-based interventions with insomnia as the primary outcome were included. Results One hundred and five articles were identified and eleven were included in the systematic review. Of these, six were randomized and five were non-randomized trials. Seven studies combined ACT with behavioral and/or cognitive components, while four used only ACT. The results of the included articles showed that ACT reduces the severity of insomnia and is associated with improved sleep patterns. This modality is applied in different formats and with different intervention components. Conclusions ACT is used for the treatment of insomnia both as monotherapy (ACT-I) and combined with behavioral components of stimulus control and sleep restriction (ACT-BBI-I). ACT-I is a possibly efficacious treatment for insomnia, while ACT-BBI-I is a probably efficacious treatment for insomnia. ACT-based interventions can serve as treatment alternatives for insomnia and contribute to the construction of a process-based approach.

Evidence and characteristics of Acceptance and Commitment Therapy (ACT)-based interventions for insomnia: A systematic review of randomized and non-randomized trials

http://www.scielo.br/pdf/rbp/2020nahead/1516-4446-rbp-1516444620200947.pdf

Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial.

Study Objectives:To evaluate the impact of COVID-19 pandemic on insomnia and other sleep disturbances in health care professionals. Methods:A survey was distributed using social media and organizat...

Insomnia episodes, new-onset pharmacological treatments and other sleep disturbances during the COVID-19 pandemic: a nationwide cross-sectional study in Brazilian health care professionals.

Study objectives To evaluate the impact of COVID-19 pandemic on sleep, anxiety, and Burnout in healthcare professionals. Methods A survey was distributed using social media and organizational emails to Brazilian active healthcare professionals during the COVID-19 outbreak. We explored potential associated factors including age, gender, occupation, workplace, work hours, income, previous infection with COVID-19, recent/current contact with COVID-19 patients, regional number of incident deaths due to COVID-19, anxiety, and burnout. We evaluated new-onset or previous insomnia worsening (primary outcome), sleep quality, and duration (secondary outcomes). Results A total of 4,384 health professionals from all regions of the country were included in the analysis (mean age: 44±12 years, 76% females, 53.8% physicians). Overall, 55.7% were assisting patients with COVID-19, and 9.2% had a previous COVID-19 infection. New-onset insomnia symptoms or previous insomnia worsening occurred in 41.4% of respondents in parallel to 13% (n=572) new pharmacological treatments for insomnia. Prevalent anxiety and burnout during the pandemic were observed in 44.2% and 21% of participants, respectively. Multivariate analyses showed that females (OR:1.756; 95% CI 1.487-2.075), weight change (decrease: OR:1.852; 95% CI 1.531-2.240; increase: OR:1.542; 95% CI 1.323-1.799), prevalent anxiety(OR:3.209; 95% CI 2.796-3.684), new-onset burnout (OR:1.986; 95% CI 1.677-2.352), family income reduction >30% (OR:1.366; 95% CI 1.140-1.636) and assisting patients with COVID-19 (OR:1.293; 95% CI 1.104-1.514) were independently associated with new-onset or worsening of previous insomnia. Conclusions We observed a huge burden of insomnia in healthcare professionals during the COVID-19 pandemic. In this scenario, dedicated approaches for sleep health are highly desirable. Statement of Significance Considering the stressful routine and risk of infection by COVID-19 among healthcare professionals, it is conceivable that sleep disturbances are significantly impaired during the pandemic. This nationwide survey conducted in Brazil found that 41.4% developed new-onset or worsening of previous insomnia symptoms. Moreover, 572 (13%) of respondents initiated pharmacological treatments for insomnia. Females, weight change, anxiety, Burnout development, family income reduction >30%, and recent/current care of patients with COVID-19 were independently associated with the development of insomnia or exacerbated previous insomnia symptoms. Considering the potential impact of insomnia on work performance/healthcare decisions as well as the potential long-term dependence of pharmacological treatments for insomnia, this study underscores the need for dedicated sleep and mental health programs for healthcare professionals.

/pdf/sleep-disturbances-anxiety-and-burnout-during-the-covid-19-128htzowbj.pdf

Silvia G Conway

Papers

Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial.

Insomnia episodes, new-onset pharmacological treatments and other sleep disturbances during the COVID-19 pandemic: a nationwide cross-sectional study in Brazilian health care professionals.

Sleep Disturbances, Anxiety, and Burnout during the COVID-19 Pandemic: a nationwide cross-sectional study in Brazilian Healthcare Professionals

Acceptance and commitment therapy for insomnia: a pilot study