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Behav Sleep Med. 2018 Feb 16:1-13. doi: 10.1080/15402002.2018.1435546. [Epub ahead of print]

Stroop Task-Related Brain Activity in Patients With Insomnia: Changes After Cognitive-Behavioral Therapy for Insomnia.

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a Seoul National University College of Medicine , Seoul , Republic of Korea.
b Neuroscience Research Institute , Gachon University , Incheon , Republic of Korea.
c Department of Psychiatry and Center for Sleep and Chronobiology , Seoul National University Hospital , Seoul , Republic of Korea.
d Department of Psychology , University at Buffalo , New York , USA.
e Department of Psychiatry , Sungkyunkwan University College of Medicine, Samsung Medical Center , Seoul , Republic of Korea.
f Department of Radiological Science, College of Health Science , Gachon University , Incheon , Korea.



In the present study, we compared differences in brain activity during the Stroop task between patients with chronic insomnia disorder (CID) and good sleepers (GS). Furthermore, we evaluated changes in Stroop task-related brain activity after cognitive-behavioral therapy for insomnia (CBT-I).


The final analysis included 21 patients with CID and 25 GS. All participants underwent functional magnetic resonance imaging (fMRI) while performing the color-word Stroop task. CBT-I, consisting of 5 sessions, was administered to 14 patients with CID in the absence of medication. After CBT-I, fMRI was repeated in the patients with CID while performing the same task. Sleep-related questionnaires and sleep variables from a sleep diary were also obtained before and after CBT-I.


No significant differences in behavioral performance in the Stroop task or task-related brain activation were observed between the CID and GS groups. No changes in behavioral performance or brain activity were found after CBT-I. However, clinical improvement in the Insomnia Severity Index (ISI) score was significantly associated with changes in the Stroop task-related regional blood oxygen level-dependent signals in the left supramarginal gyrus.


Our findings suggest that cognitive impairment in patients with CID was not detectable by the Stroop task or Stroop task-related brain activation on fMRI. Moreover, there was no altered brain activity during the Stroop task after CBT-I. However, the ISI score reflected changes in the neural correlates of cognitive processes in patients with CID after CBT-I.

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