The Effectiveness of Cognitive-Behavioral Therapy on Sleep Disorder and Death Anxiety in the Elderly

Document Type : Original Article

Authors

Dept. of Psychology, Garmsar Branch, Islamic Azad University, Garmsar, Garmsar, Iran

Abstract

Death anxiety and sleep disorder seem to be of the common disorders in the elderly. Among the different treatment methods, cognitive-behavioral therapy (CBT) is considered as a potential solution in relation to reducing death anxiety and sleep disorder. Therefore, the purpose of the current study was to consider the effectiveness of CBT on sleep disorder and death anxiety in the elderly. This was a practical study in terms of its purpose and according to the nature of the research, it was a quasi-experimental study with a pretest-posttest and a control group design. The statistical population included all the elderly living in nursing homes in Sari, Iran among which one nursing home was randomly selected, and a sample of 32 people was selected among its members by convenience sampling method and based on the inclusion and exclusion criteria of the study and were randomly assigned to two experimental and control groups in the same ratio. The tools applied in the study included Baisi et al.’s Petersburg sleep questionnaires, Templer’s death anxiety scale, and Beck et al.’s CBT protocol which represented in form of eight 90-minute sessions. Data were analyzed using univariate covariance analysis (ANCOVA) in SPSS-16 software. The findings illustrated that CBT resulted in a significant decrease of sleep disorder and death anxiety in the elderly. The findings of this research indicated that using a suitable treatment method can improve the quality of sleep in the elderly and reduce the level of their death anxiety.
References
Atwood, M. E., & Friedman, A. (2020). A Systematic review of enhanced cognitive behavioral therapy (CBT‐E) for eating disorders. International Journal of Eating Disorders, 53(3), 311-330.
Axfors, C., & Ioannidis, J. P. (2022). Infection fatality rate of COVID-19 in community-dwelling elderly populations. European Journal of Epidemiology, 37(3), 235-249.
Bala, R., & Maheshwari, S. K. (2019). Death anxiety and death depression among elderly. International Journal of Psychiatric Nursing, 5(1), 55-59.
Barthel, A. L., Pinaire, M. A., Curtiss, J. E., Baker, A. W., Brown, M. L., Hoeppner, S. S., & Hofmann, S. G. (2020). Anhedonia is central for the association between quality of life, metacognition, sleep, and affective symptoms in generalized anxiety disorder: a complex network analysis. Journal of affective disorders, 277, 1013-1021.
Buysse, D. J., Reynolds Iii, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213.
Cheatle, M. D., & Webster, L. R. (2015). Opioid therapy and sleep disorders: risks and mitigation strategies. Pain Medicine, 16(suppl_1), S22-S26.
Danny, J. Y., Angus, P. Y., Li, S. X., Chan, R. N., Fong, D. Y., Chan, D. K., & Siu, P. M. (2023). Effects of Tai Chi and cognitive behavioral therapy for insomnia on improving sleep in older adults: Study protocol for a non-inferiority trial. Journal of Exercise Science & Fitness, 21(1), 67-73.
Ehtshamzadeh, Parveen and Dakhilpour, Syed Ahmad. (2014), The Effectiveness of cognitive behavioral therapy group on reducing the death anxiety of cancer patients in Ahvaz city, the second national conference on research and treatment in clinical psychology, Torbat Jam, Islamic Azad University, Torbat Jam branch. [Persian]
Francis, J. (2022). Elder orphans on Facebook: Implications for mattering and social isolation. Computers in Human Behavior, 127, 107-123.
Ghamari kivi H, Zahed bablan A, Fathi D (2015). Effectiveness of GroupCognitive-Behavioral Therapy on Death Anxiety among the Breavement Elderly‌‌Man. Journal of elderly, 1 (4) :60-69 [Persian]
Guner, T. A., Erdogan, Z., & Demir, I. (2021). The effect of loneliness on death anxiety in the elderly during the COVID-19 pandemic. OMEGA-journal of Death and Dying, 13 (4), 98-106.
Hasan, F., Tu, Y. K., Yang, C. M., Gordon, C. J., Wu, D., Lee, H. C., & Chiu, H. Y. (2022). Comparative efficacy of digital cognitive behavioral therapy for insomnia: A systematic review and network meta-analysis. Sleep Medicine Reviews, 61(3), 101-113.
Hawes, N. J., Wiggins, A. T., Reed, D. B., & Hardin‐Fanning, F. (2019). Poor sleep quality is associated with obesity and depression in farmers. Public Health Nursing, 36(3), 270-275.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36, 427-440.
Honda, H., Ashizawa, R., Kiriyama, K., Take, K., Hirase, T., Arizono, S., & Yoshimoto, Y.      (2022). Chronic pain in the frail elderly mediates sleep disorders and influences falls. Archives of gerontology and geriatrics, 99, 204-213.
Kalmbach, D. A., Cheng, P., Ahmedani, B. K., Peterson, E. L., Reffi, A. N., Sagong, C., & Drake, C. L. (2022). Cognitive-behavioral therapy for insomnia prevents and alleviates suicidal ideation: insomnia remission is a suicidolytic mechanism. Sleep, 45(12), 251-259.
Karimi, S; Golparvar, M.; and Aghaei, A. (2022). Comparison of the effectiveness of healthy aging model training and existential spirituality therapy based on the emotional capital components of the elderly. Psychology of Aging, 8(3), 219-234. [Persian]
Karyotaki, E., Efthimiou, O., Miguel, C., genannt Bermpohl, F. M., Furukawa, T. A., Cuijpers, P., & Forsell, Y. (2021). Internet-based cognitive behavioral therapy for depression: a systematic review and individual patient data network meta-analysis. JAMA psychiatry, 78(4), 361-371.
Lashagri M, ahi Q, Shahabizaseh F, Mansouri A (2021). Effectiveness of Cognitive Behavioral Therapy based on Intolerance of Uncertainty on Worry and Anxiety in Women with Corona Anxiety (case study). RBS; 19 (3), 427-438. [Persian]
Ma, Y., Hall, D. L., Ngo, L. H., Liu, Q., Bain, P. A., & Yeh, G. Y. (2021). Efficacy of cognitive behavioral therapy for insomnia in breast cancer: a meta-analysis. Sleep Medicine Reviews, 55 (1), 299-308.
Manber, R., Bei, B., Simpson, N., Asarnow, L., Rangel, E., Sit, A., & Lyell, D. (2019). Cognitive behavioral therapy for prenatal insomnia: a randomized controlled trial. Obstetrics and gynecology, 133(5), 911-919.
Mansouri A, Mokhayeri Y, Mohammadi Farrokhran E, Tavakkol Z, Fotouhi A (2012). Sleep Quality of Students living in Dormitories in Tehran University of Medical Sciences (TUMS) in 2011. Irje, 8 (2), 71-82. [Persian]
Menzies, R. E., Sharpe, L., Helgadóttir, F. D., & Dar-Nimrod, I. (2021). Overcome death anxiety: the development of an online cognitive behaviour therapy programme for fears of death. Behaviour Change, 38(4), 235-249.
Mirzaeidoostan, Z., Zargar, Y., & Zandi Payam, A. (2019). The Effectiveness of acceptance and commitment therapy on death anxiety and mental health in women with HIV in Abadan city, Iran. Iranian Journal of Psychiatry and Clinical Psychology, 25(1), 2-13.
Mitchell, L. J., Bisdounis, L., Ballesio, A., Omlin, X., & Kyle, S. D. (2019). The Impact of cognitive behavioural therapy for insomnia on objective sleep parameters: A meta-analysis and systematic review. Sleep medicine reviews, 47, 90-102.
Momeni, Kh., and Rafiei, Z. (2017). Effectiveness of cognitive-behavioral group therapy on death anxiety and general health of bereaved elderly women. Psychology of Aging, 4 (2), 131-141. [Persian]
Motaghi, R., Kamkar, A., Mardpour, A. (2015). The Effectiveness of cognitive-behavioral therapy on the sleep quality of the elderly with insomnia. Salamand: Iranian Journal of Geriatrics. 11 (2), 243-234. [Persian]
Moradi, M., & Fathi, D. (2016). Effectiveness of cognitive behavioral therapy on life expectancy and spiritual health of grieved students. Journal of Psychological Studies, 12(3), 63-82. [Persian]
Mortazavi S S, Foroughan M, Hosseini S A, Nasiri E, Shahbazi F (2021). Negative Factors Affecting the Sleep Quality of the Elderly in Iran: A Systematic Review. Jrehab, 22 (2) :132-153[Persian]
Özer, Ö., Özkan, O., & Büyükşirin, B. (2022). Examination of pandemic awareness, death anxiety, and spiritual well-being in elderly individuals. OMEGA-Journal of Death and Dying, 11(3), 218-229
Potash, J. S., Ho, A. H., Chan, F., Wang, X. L., & Cheng, C. (2014). Can art therapy reduce death anxiety and burnout in end-of-life care workers? A quasi-experimental study. International journal of palliative nursing, 20(5), 233-240.
Pourfarakh M, Kerminia R, Ahadi H (2017). Effectiveness of group cognitive behavioral therapy on reduction of adjustment disorder in the elderly. RBS; 15 (2), 189-197. [Persian]
Rajabi, G., and Bahrani, M. (2008), factor analysis of death anxiety scale questions, Journal of Psychology, 3(20), 330-344. [Persian]
Ren, Q., Shi, Q., Ma, T., Wang, J., Li, Q., & Li, X. (2019). Quality of life, symptoms, and sleep quality of elderly with end-stage renal disease receiving conservative management: a systematic review. Health and quality of life outcomes, 17(1), 1-9.
Sadeghipur H R, zar A. (2022). The Effect of endurance training on sleep quality in the elderly: a review study. Systematic review in medical sciences, 2 (2), 1-10. [Persian]
Scott, H., Cheung, J. M., Muench, A., Ivers, H., Grandner, M. A., Morin, C. M., & Perlis, M. L. (2023). Baseline sleep characteristics are associated with gains in sleep duration after cognitive behavioral therapy for insomnia. Sleep Medicine. 8(1), 129-48.
Shakerinasab M, Azimzadeh Tehrani N, Rostami T, Parsa Nejad M. (2022). The Effectiveness of Cognitive-Behavioral Therapy Based on Marlatt's Model on Craving and Addiction Quitting Self-Efficacy in Patients under Treatment with Methadone. Etiadpajohi, 16 (64), 241-258. [Persian]
Sharafi M, Fadakar Davarani M M, Tohidi Nik H, Farvahari A, Borhaninejad V R (2022). Facilitating and inhibiting factors of social participation in the elderly based on health-promoting behaviors: a cross-sectional study. Salmand: Iranian Journal of Ageing; 17 (3), 304-321. [Persian]
Sharma, P., Asthana, H. S., Gambhir, I. S., & Ranjan, J. K. (2019). Death anxiety among elderly people: role of gender, spirituality and mental health. Indian Journal of Gerontology, 33(3), 567-581
van der Zweerde, T., Bisdounis, L., Kyle, S. D., Lancee, J., & van Straten, A. (2019). Cognitive behavioral therapy for insomnia: a meta-analysis of long-term effects in controlled studies. Sleep Medicine Reviews, 48 (3), 208-217
Yarahmadi, M., Hafizi, F., and Makundi, B. (2022). The Effectiveness of cognitive-behavioral treatment of insomnia on emotional regulation and ineffective sleep beliefs in people with insomnia. Iranian Journal of Psychiatry and Clinical Psychology. 28 (2), 196-209
Templer, D. I. (1970). The Construction and validation of a Death Anxiety scale. Journal of General Psychology, 82: 165-177.
Wang, C. F., Sun, Y. L., & Zang, H. X. (2014). Music therapy improves sleep quality in acute and chronic sleep disorders: A meta-analysis of 10 randomized studies. International journal of nursing studies, 51(1), 51-62.
 Xu, Y., Wen, H., Li, J., Yang, J., Luo, K., & Chang, L. (2022). The Relationship between sleep disorders, anxiety, depression, and cognitive function with restless legs syndrome (RLS) in the elderly. Sleep and breathing, 26(3), 1309-1318.
Zhang, J., Peng, J., Gao, P., Huang, H., Cao, Y., Zheng, L., & Miao, D. (2019). Relationship between meaning in life and death anxiety in the elderly: self-esteem as a mediator. BMC geriatrics, 19, 1-8.
Zhu, B., Shi, C., Park, C. G., & Reutrakul, S. (2020). Sleep quality and gestational diabetes in pregnant women: a systematic review and meta-analysis. Sleep Medicine, 67 (1), 47-55.

Keywords


References
Atwood, M. E., & Friedman, A. (2020). A Systematic review of enhanced cognitive behavioral therapy (CBT‐E) for eating disorders. International Journal of Eating Disorders, 53(3), 311-330.
Axfors, C., & Ioannidis, J. P. (2022). Infection fatality rate of COVID-19 in community-dwelling elderly populations. European Journal of Epidemiology, 37(3), 235-249.
Bala, R., & Maheshwari, S. K. (2019). Death anxiety and death depression among elderly. International Journal of Psychiatric Nursing, 5(1), 55-59.
Barthel, A. L., Pinaire, M. A., Curtiss, J. E., Baker, A. W., Brown, M. L., Hoeppner, S. S., & Hofmann, S. G. (2020). Anhedonia is central for the association between quality of life, metacognition, sleep, and affective symptoms in generalized anxiety disorder: a complex network analysis. Journal of affective disorders, 277, 1013-1021.
Buysse, D. J., Reynolds Iii, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213.
Cheatle, M. D., & Webster, L. R. (2015). Opioid therapy and sleep disorders: risks and mitigation strategies. Pain Medicine, 16(suppl_1), S22-S26.
Danny, J. Y., Angus, P. Y., Li, S. X., Chan, R. N., Fong, D. Y., Chan, D. K., & Siu, P. M. (2023). Effects of Tai Chi and cognitive behavioral therapy for insomnia on improving sleep in older adults: Study protocol for a non-inferiority trial. Journal of Exercise Science & Fitness, 21(1), 67-73.
Ehtshamzadeh, Parveen and Dakhilpour, Syed Ahmad. (2014), The Effectiveness of cognitive behavioral therapy group on reducing the death anxiety of cancer patients in Ahvaz city, the second national conference on research and treatment in clinical psychology, Torbat Jam, Islamic Azad University, Torbat Jam branch. [Persian]
Francis, J. (2022). Elder orphans on Facebook: Implications for mattering and social isolation. Computers in Human Behavior, 127, 107-123.
Ghamari kivi H, Zahed bablan A, Fathi D (2015). Effectiveness of GroupCognitive-Behavioral Therapy on Death Anxiety among the Breavement Elderly‌‌Man. Journal of elderly, 1 (4) :60-69 [Persian]
Guner, T. A., Erdogan, Z., & Demir, I. (2021). The effect of loneliness on death anxiety in the elderly during the COVID-19 pandemic. OMEGA-journal of Death and Dying, 13 (4), 98-106.
Hasan, F., Tu, Y. K., Yang, C. M., Gordon, C. J., Wu, D., Lee, H. C., & Chiu, H. Y. (2022). Comparative efficacy of digital cognitive behavioral therapy for insomnia: A systematic review and network meta-analysis. Sleep Medicine Reviews, 61(3), 101-113.
Hawes, N. J., Wiggins, A. T., Reed, D. B., & Hardin‐Fanning, F. (2019). Poor sleep quality is associated with obesity and depression in farmers. Public Health Nursing, 36(3), 270-275.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36, 427-440.
Honda, H., Ashizawa, R., Kiriyama, K., Take, K., Hirase, T., Arizono, S., & Yoshimoto, Y.      (2022). Chronic pain in the frail elderly mediates sleep disorders and influences falls. Archives of gerontology and geriatrics, 99, 204-213.
Kalmbach, D. A., Cheng, P., Ahmedani, B. K., Peterson, E. L., Reffi, A. N., Sagong, C., & Drake, C. L. (2022). Cognitive-behavioral therapy for insomnia prevents and alleviates suicidal ideation: insomnia remission is a suicidolytic mechanism. Sleep, 45(12), 251-259.
Karimi, S; Golparvar, M.; and Aghaei, A. (2022). Comparison of the effectiveness of healthy aging model training and existential spirituality therapy based on the emotional capital components of the elderly. Psychology of Aging, 8(3), 219-234. [Persian]
Karyotaki, E., Efthimiou, O., Miguel, C., genannt Bermpohl, F. M., Furukawa, T. A., Cuijpers, P., & Forsell, Y. (2021). Internet-based cognitive behavioral therapy for depression: a systematic review and individual patient data network meta-analysis. JAMA psychiatry, 78(4), 361-371.
Lashagri M, ahi Q, Shahabizaseh F, Mansouri A (2021). Effectiveness of Cognitive Behavioral Therapy based on Intolerance of Uncertainty on Worry and Anxiety in Women with Corona Anxiety (case study). RBS; 19 (3), 427-438. [Persian]
Ma, Y., Hall, D. L., Ngo, L. H., Liu, Q., Bain, P. A., & Yeh, G. Y. (2021). Efficacy of cognitive behavioral therapy for insomnia in breast cancer: a meta-analysis. Sleep Medicine Reviews, 55 (1), 299-308.
Manber, R., Bei, B., Simpson, N., Asarnow, L., Rangel, E., Sit, A., & Lyell, D. (2019). Cognitive behavioral therapy for prenatal insomnia: a randomized controlled trial. Obstetrics and gynecology, 133(5), 911-919.
Mansouri A, Mokhayeri Y, Mohammadi Farrokhran E, Tavakkol Z, Fotouhi A (2012). Sleep Quality of Students living in Dormitories in Tehran University of Medical Sciences (TUMS) in 2011. Irje, 8 (2), 71-82. [Persian]
Menzies, R. E., Sharpe, L., Helgadóttir, F. D., & Dar-Nimrod, I. (2021). Overcome death anxiety: the development of an online cognitive behaviour therapy programme for fears of death. Behaviour Change, 38(4), 235-249.
Mirzaeidoostan, Z., Zargar, Y., & Zandi Payam, A. (2019). The Effectiveness of acceptance and commitment therapy on death anxiety and mental health in women with HIV in Abadan city, Iran. Iranian Journal of Psychiatry and Clinical Psychology, 25(1), 2-13.
Mitchell, L. J., Bisdounis, L., Ballesio, A., Omlin, X., & Kyle, S. D. (2019). The Impact of cognitive behavioural therapy for insomnia on objective sleep parameters: A meta-analysis and systematic review. Sleep medicine reviews, 47, 90-102.
Momeni, Kh., and Rafiei, Z. (2017). Effectiveness of cognitive-behavioral group therapy on death anxiety and general health of bereaved elderly women. Psychology of Aging, 4 (2), 131-141. [Persian]
Motaghi, R., Kamkar, A., Mardpour, A. (2015). The Effectiveness of cognitive-behavioral therapy on the sleep quality of the elderly with insomnia. Salamand: Iranian Journal of Geriatrics. 11 (2), 243-234. [Persian]
Moradi, M., & Fathi, D. (2016). Effectiveness of cognitive behavioral therapy on life expectancy and spiritual health of grieved students. Journal of Psychological Studies, 12(3), 63-82. [Persian]
Mortazavi S S, Foroughan M, Hosseini S A, Nasiri E, Shahbazi F (2021). Negative Factors Affecting the Sleep Quality of the Elderly in Iran: A Systematic Review. Jrehab, 22 (2) :132-153[Persian]
Özer, Ö., Özkan, O., & Büyükşirin, B. (2022). Examination of pandemic awareness, death anxiety, and spiritual well-being in elderly individuals. OMEGA-Journal of Death and Dying, 11(3), 218-229
Potash, J. S., Ho, A. H., Chan, F., Wang, X. L., & Cheng, C. (2014). Can art therapy reduce death anxiety and burnout in end-of-life care workers? A quasi-experimental study. International journal of palliative nursing, 20(5), 233-240.
Pourfarakh M, Kerminia R, Ahadi H (2017). Effectiveness of group cognitive behavioral therapy on reduction of adjustment disorder in the elderly. RBS; 15 (2), 189-197. [Persian]
Rajabi, G., and Bahrani, M. (2008), factor analysis of death anxiety scale questions, Journal of Psychology, 3(20), 330-344. [Persian]
Ren, Q., Shi, Q., Ma, T., Wang, J., Li, Q., & Li, X. (2019). Quality of life, symptoms, and sleep quality of elderly with end-stage renal disease receiving conservative management: a systematic review. Health and quality of life outcomes, 17(1), 1-9.
Sadeghipur H R, zar A. (2022). The Effect of endurance training on sleep quality in the elderly: a review study. Systematic review in medical sciences, 2 (2), 1-10. [Persian]
Scott, H., Cheung, J. M., Muench, A., Ivers, H., Grandner, M. A., Morin, C. M., & Perlis, M. L. (2023). Baseline sleep characteristics are associated with gains in sleep duration after cognitive behavioral therapy for insomnia. Sleep Medicine. 8(1), 129-48.
Shakerinasab M, Azimzadeh Tehrani N, Rostami T, Parsa Nejad M. (2022). The Effectiveness of Cognitive-Behavioral Therapy Based on Marlatt's Model on Craving and Addiction Quitting Self-Efficacy in Patients under Treatment with Methadone. Etiadpajohi, 16 (64), 241-258. [Persian]
Sharafi M, Fadakar Davarani M M, Tohidi Nik H, Farvahari A, Borhaninejad V R (2022). Facilitating and inhibiting factors of social participation in the elderly based on health-promoting behaviors: a cross-sectional study. Salmand: Iranian Journal of Ageing; 17 (3), 304-321. [Persian]
Sharma, P., Asthana, H. S., Gambhir, I. S., & Ranjan, J. K. (2019). Death anxiety among elderly people: role of gender, spirituality and mental health. Indian Journal of Gerontology, 33(3), 567-581
van der Zweerde, T., Bisdounis, L., Kyle, S. D., Lancee, J., & van Straten, A. (2019). Cognitive behavioral therapy for insomnia: a meta-analysis of long-term effects in controlled studies. Sleep Medicine Reviews, 48 (3), 208-217
Yarahmadi, M., Hafizi, F., and Makundi, B. (2022). The Effectiveness of cognitive-behavioral treatment of insomnia on emotional regulation and ineffective sleep beliefs in people with insomnia. Iranian Journal of Psychiatry and Clinical Psychology. 28 (2), 196-209
Templer, D. I. (1970). The Construction and validation of a Death Anxiety scale. Journal of General Psychology, 82: 165-177.
Wang, C. F., Sun, Y. L., & Zang, H. X. (2014). Music therapy improves sleep quality in acute and chronic sleep disorders: A meta-analysis of 10 randomized studies. International journal of nursing studies, 51(1), 51-62.
 Xu, Y., Wen, H., Li, J., Yang, J., Luo, K., & Chang, L. (2022). The Relationship between sleep disorders, anxiety, depression, and cognitive function with restless legs syndrome (RLS) in the elderly. Sleep and breathing, 26(3), 1309-1318.
Zhang, J., Peng, J., Gao, P., Huang, H., Cao, Y., Zheng, L., & Miao, D. (2019). Relationship between meaning in life and death anxiety in the elderly: self-esteem as a mediator. BMC geriatrics, 19, 1-8.
Zhu, B., Shi, C., Park, C. G., & Reutrakul, S. (2020). Sleep quality and gestational diabetes in pregnant women: a systematic review and meta-analysis. Sleep Medicine, 67 (1), 47-55.