College veterans' experiences of involvement in cognitive behavioral therapy for insomnia program

Smith, Jessica, author
Eakman, Aaron, advisor
Atler, Karen, committee member
Hughes, Shannon, committee member
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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.
2018 Spring.
Includes bibliographical references.
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occupational engagement
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