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Theses and Dissertations

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Browsing Theses and Dissertations by Subject "adherence"

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    College veterans' experiences of involvement in cognitive behavioral therapy for insomnia program
    (Colorado State University. Libraries, 2018) Smith, Jessica, author; Eakman, Aaron, advisor; Atler, Karen, committee member; Hughes, Shannon, committee member
    Objective. Despite quantitative research which indicates that cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for chronic insomnia, there is little qualitative research which exists regarding the experiences related to participation and adherence. The purpose of this study was to explore veterans' experiences of adherence to a multicomponent CBT-I program and its impact on occupational engagement. Method. To answer the two research questions:1)What, from the perspective of veteran participants, influenced adherence to a multicomponent CBT-I program? And 2) How is adherence to multicomponent CBT-I experienced in relation to its impacts on occupational engagement? Qualitative data were gathered through the use of semi-structured interviews which were then transcribed and coded via a process of First and Second Cycle coding by three separate researchers. Self-Determination Theory (SDT) was used as a guiding framework to interpret results related to motivation in the current study due to its proven application in behavior change programs such as CBT-I. Results. Qualitative data analysis revealed the presence of three categories that captured the experience of adherence and occupational engagement as a result of participation in a CBT-I program: Extrinsic Forms of Motivation Influenced Adherence, Social Environment can Support or Hinder Adherence and Bidirectional Relationship between Activities and Routines. Extrinsic Forms of Motivation were influenced by the receipt of a reward, emotional responses (i.e. guilt), past experiences and understanding the mechanisms that impact sleep and gaining "tools" as a result of this understanding. An additional motivating factor came from the body itself. As the body's sleep-wake system became entrained as a result of continued adherence, participants experienced the body as motivating. The social environment was determined to be composed of factors within the home and outside of the home. Both people and obligations (such as being a part of a sports team) had the potential to support or hinder adherence to CBT-I components. Additionally, there was evidence that coursework and academic commitments associated with being a college student were important facets of the social environment that influenced participants' ability to adhere. Finally, research revealed that activities and routines played an important role in adherence. The restructuring of activities and the purposeful use of activities as a way to occupy waking time were strategies participants used to support adherence. The development of routines also went on to aid in building sleep drive, which in turn positively impacted adherence. Conclusion. The present study provides novel qualitative data regarding adherence and occupational engagement as a result of participation in CBT-I that can be understood in regards to three categories: Extrinsic forms of motivation influenced adherence, social environment can support or hinder adherence and bidirectional relationship between activities and routines. Designing CBT-I programs which are built on factors that are experienced as supportive has the potential to impact overall adherence and therefore effectiveness, of CBT-I programs.
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    ItemEmbargo
    Promoting adherence to cognitive-behavioral therapy for insomnia in the medically complex case
    (Colorado State University. Libraries, 2023) Lovell, Emily R., author; Eakman, Aaron, advisor; Weaver, Jennifer, committee member; Broussard, Josiane, committee member
    Objective. The purpose of this study is to explore how a medically complex case responded to cognitive-behavioral therapy for insomnia (CBT-I) in a community-based setting based on adherence to treatment recommendations. Method. A mixed-methods retrospective case study design was used to explore answers to two research questions: 1) How effective is CBT-I for an individual with insomnia comorbid with bipolar disorder? 2) How is CBT-I tailored for an individual with insomnia comorbid with bipolar disorder in a real-world setting? 3) How do we assess adherence to CBT-I delivered by an occupational therapist? Data sources included sleep diaries, service logs, pre-/post-treatment assessments, and interviews with the client and therapist. Results. Improvements in sleep latency, wake after sleep onset, early morning awakening, total sleep time, and sleep efficiency were observed. The most noteworthy improvements were a gain of almost two hours of total sleep time and a post-treatment SE of 95%. Likewise, scores on the Insomnia Severity Index, Epworth Sleepiness Scale, Sleep Disorders Symptoms Checklist-25, Dysfunctional Beliefs and Attitudes about Sleep scale, Sleep Hygiene Index, Quick Inventory of Depressive Symptomatology, and Patient Health Questionnaire-9 all improved to the extent that the client no longer met criteria for chronic insomnia. Overall adherence to the behavior components of CBT-I was very high. High motivation and scheduling and engaging in activities emerged as factors that promote adherence from the interview conducted with the client. A therapeutic relationship emerged as a factor that promotes adherence from the interview conducted with the therapist. Conclusion. CBT-I can be safely delivered by occupational therapists to individuals with bipolar disorder. Large improvements in sleep were observed and the client had high adherence to treatment protocols.