CoChat
Sign Up
Cited by 71Restless Legs Syndrome ResearchSleep and related disordersPsychological Treatments and Assessments

Cognitive behavioural group therapy to improve patients' strategies for coping with restless legs syndrome: A proof-of-concept trial

Open access
Hornyak, M, Grossmann, C, Kohnen, R, Schlatterer, M, Richter, H, Voderholzer, U, Riemann, D, Berger, M·2008·Journal of Neurology, Neurosurgery & Psychiatry
DOI 10.1136/jnnp.2007.138867
Open this paper in CoChat — free accountOpen PDF

Abstract

Background: Restless legs syndrome (RLS) is a usually chronic disorder accompanied by clinically relevant psychosocial impairment. To date, no psychologically based approach is available to improve the coping strategies and quality of life of RLS sufferers. Objective: To develop cognitive behavioural therapy tailored to this disorder (the RELEGS coping therapy programme) and present the results of this proof-of-concept study. Methods: Twenty-five patients (five men, 20 women; 15 medicated, 10 unmedicated; mean (SD) age 56.1 (12.3) years) with subjective psychosocial impairment due to RLS participated in one of three consecutive therapy groups. The severity scales (IRLS and RLS-6) indicated moderate to severe RLS symptoms at baseline. Exclusion criteria were secondary RLS, foreseeable change of RLS medication during the study period, serious physical or psychiatric comorbidity, and severe cognitive deficits. Each group took part in eight group sessions (90 min each with a break). Results: At the end of the treatment, both the RLS-related quality of life and the mental health status of the subjects had improved significantly (QoL-RLS scale: from 28.6 (12.8) to 23.4 (13.1); SCL-90-R: from 51.3 (37.0) to 45.9 (32.9)). The improvement remained at follow-up 3 months later. Subjective ratings of RLS severity had improved at the end of therapy and at follow-up. Psychometric scales not specific for RLS-related impairment remained unaffected by the treatment. Conclusions: The study establishes the feasibility and high acceptance of the newly devised therapy programme. The application of RLS-oriented specific psychological strategies is a step toward an integrated treatment approach in RLS.

Integrity signals

Registry

Crossref · 10.1136/jnnp.2007.138867

Cites

25 of 25 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

1 of 19 cited sources checked · 1 supported · 0 flagged

  • Study design and conductcitation

    RLS diagnosis was based on accepted criteria.

    “RLS diagnosis was based on accepted criteria.2”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [2] 2. Allen RP, Picchietti D, Hening WA, et al. Restless legs syndrome: diagnostic criteria, special considerations and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institute of Health. Sleep Med 2003;4:101-19. source
  • Findingown data

    Mental health status (SCL-90-R) improved significantly from baseline to end of therapy.

    “SCL-90-R: from 51.3 (37.0) to 45.9 (32.9)).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] 14. Derogatis LR. Symptom Checklist-90-Revised. In: Handbook of psychiatric measures. Arlington, VA: American Psychiatric Association, 2000:81-4.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Findingown data

    Sleep quality improved at the end of therapy (RLS-6 scale 'sleep satisfaction').

    “Sleep quality had improved at the end of the therapy (RLS-6 scale ''sleep satisfaction'').”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] 17. Kohnen R, Oertel WH, Stiasny-Kolster K, et al. Severity rating of restless legs syndrome: validation of the RLS-6 scales. Sleep 2004;27(Abstract Suppl):A304.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Findingown data

    The anxiety subscale of the SCL-90-R decreased significantly between baseline and end of course.

    “Besides the global score of the SCL-90-R, the corresponding subscale ''anxiety'' had decreased significantly between baseline and the end of the course (from 6.0 (5.7) to 5.3 (4.7) points; p = 0.036).”
    Quote in the paperSubstantial claim
  • Findingown data

    Subjective ratings of RLS severity in the IRLS total score and the IRLS subscale 'symptom severity' showed an overall improvement in RLS symptoms.

    “Subjective ratings of RLS severity in the IRLS total score and the IRLS subscale ''symptom severity'' showed an overall improvement in RLS symptoms (see also table 1).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] 16. The International Restless Legs Syndrome Study Group. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs. Sleep Med 2003;4:121-32.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims. 12
  • Classified as probably not a substantial claim. 7

  • May combine two claims.

    Findingown data

    The anxiety and depression subscores of the Hospital Anxiety and Depression Scale and the total score of the Beck Depression Inventory did not change during the therapy.

    “The anxiety and the depression subscores of the Hospital Anxiety and Depression Scale 18 and the total score of the Beck Depression Inventory 19 did not change during the therapy.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [18] 18. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983;67:361-70. source
    • cites [19] 19. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    All patients completed the coping therapy programme.

    “All patients completed the coping therapy programme.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Patients ranked as most helpful the mindfulness-based exercises, stress reduction strategies, diary-based analysis of factors aggravating RLS, and medical education.

    “Patients ranked as most helpful (in descending order) the mindfulness-based exercises (including breathing exercises), stress reduction strategies, diary-based analysis of factors aggravating RLS, and medical education.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Improvements were noted in the WBS-5 and the SF-36 mental component summary score.

    “In addition, improvements were noted in the WBS-5 and the SF-36 mental component summary score.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] 15. World Health Organization. World Health Organization info package: mastering depression in primary care. Frederiksborg: World Health Organization, Regional Office for Europe, Psychiatric Research Unit, 1998.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [13] 13. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473-83.

  • May combine two claims.

    Findingown data

    The profiling of symptoms at different time periods during the day showed favourable changes in the RLS-6 scales 'severity at bedtime' and 'severity during the day when at rest', but no changes in the scale 'severity during the night'.

    “The profiling of symptoms at different time periods during the day showed favourable changes in the RLS-6 scales ''severity at bedtime'' and ''severity during the day when at rest'', but no changes in the scale ''severity during the night''.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] 17. Kohnen R, Oertel WH, Stiasny-Kolster K, et al. Severity rating of restless legs syndrome: validation of the RLS-6 scales. Sleep 2004;27(Abstract Suppl):A304.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data

    There was no statistically significant difference in outcome measures between unmedicated and medicated patients, although unmedicated patients showed a tendency to benefit more.

    “Unmedicated patients showed a tendency to benefit more than medicated patients, although there was no statistically significant difference between the groups.”
    • Also stated in: § DISCUSSION · plain
      “We found no differences in the outcome measures between the two subgroups.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    We did not have a control group and for this reason cannot exclude placebo effects.

    “As our main concern was to evaluate the feasibility of the therapy programme, we did not have a control group and for this reason cannot exclude placebo effects.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Evaluations of outcome parameters were performed by an independent rater not involved in therapy procedures.

    “Evaluations of outcome parameters were performed by an independent rater who was not involved in any of the therapy procedures.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The therapy presented in this paper may be an important step in the development of an integrated treatment approach to RLS management.

    “The therapy presented in this paper may be an important step in the development of an integrated treatment approach to RLS management.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Dopaminergic substances have good short-term efficacy in RLS, but complete remission does not occur in all patients, and long-term treatment may be complicated by loss of efficacy and augmentation.

    “In clinical trials, dopaminergic substances showed good efficacy in the short-term treatment of RLS, although complete remission of symptoms does not occur in all patients, 3 and long-term treatment with dopaminergic drugs may be complicated by loss of efficacy and augmentation.4”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] 3. Vignatelli L, Billiard M, Clarenbach P, et al. EFNS Task Force. EFNS guidelines on management of restless legs syndrome and periodic limb movement disorder in sleep. Eur J Neurol 2006;13:1049-65. source
    • cites [4] 4. Paulus W, Trenkwalder C. Less is more: pathophysiology of dopaminergic-therapy- related augmentation in restless legs syndrome. Lancet Neurol 2006;5:878-86. source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The study was a pre-post comparison of outcome measures at baseline, mid-treatment, final, and follow-up, with no control group.

    “For this pilot study, we performed a pre-post comparison of outcome measures taken at baseline, at an intermediate mid-treatment assessment after 4 weeks, and at the final visit after conclusion of the group therapy as well as at follow-up.There was no control group.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    RLS is associated with a high incidence of psychosocial impairment, reduced quality of life, and increased prevalence of depressive and anxiety disorders.

    “recent studies have shown a high incidence of psychosocial impairment, 5-7 a reduced quality of life, 1 and an increased prevalence of depressive and anxiety disorders associated with RLS. 8”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [5] 5. Abetz L, Allen R, Follet A, et al. Evaluating the quality of life of patients with restless legs syndrome. Clin Ther 2004;26:925-35. source
    • cites [6] 6. Hornyak M, Kopasz M, Berger M, et al. Impact of sleep-related complaints on depressive symptoms in patients with restless legs syndrome. J Clin Psychiatry 2005;66:1139-1145. source
    • cites [7] 7. Picchietti D, Winkelmann JD. Restless legs syndrome, periodic limb movements in sleep, and depression. Sleep 2005;28:891-8.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [1] 1. Allen RP, Walters AS, Montplaisir J, et al. Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med 2005;165:1286-92. source
    • cites [8] 8. Winkelmann J, Prager M, Lieb R, et al. ''Anxietas tibiarum'' depression and anxiety disorders in patients with restless legs syndrome. J Neurol 2005;252:67-71. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The analyses were based on data from all participants; two patients without valid values at follow-up were excluded from analysis.

    “The analyses were based on data from all participants; two patients without valid values at the follow-up assessment were excluded from analysis (one patient took additional RLS-specific medication during the follow-up period, and the other patient forgot to fill in the SF-36 questionnaire 13 at follow-up).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The evaluations indicate disorder-specific effects on RLS-related quality of life and demonstrate the feasibility and high patient acceptance of the therapy programme.

    “The evaluations indicate disorder-specific effects on RLS-related quality of life and demonstrate the feasibility and high patient acceptance of the therapy programme.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Increasing evidence shows that adequate coping strategies-that is, adequate self-management-improves outcome and reduces overall managed-care costs in chronically ill patients.

    “Increasing evidence shows that adequate coping strategies-that is, adequate self-managementimproves outcome and reduces overall managed-care costs in chronically ill patients.21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] 21. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002;288:1775-9.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

15 of 15

  • The paper relies on this without support.

    Current treatment trials in RLS still focus on drug therapy, and comprehensive psycho-biological management strategies have yet to be developed for this patient population.

    “Current treatment trials in RLS still focus on drug therapy, and comprehensive psycho-biological management strategies have yet to be developed for this patient population.”

  • The paper relies on this without support.

    To date, no psychologically based approach is available to improve the coping strategies and quality of life of RLS sufferers.

    “To date, no psychologically based approach is available to improve the coping strategies and quality of life of RLS sufferers.”

  • The paper relies on this without support.

    A lack of statistically significant difference in outcome measures between medicated and unmedicated patients indicates that the therapy is equally applicable to both groups.

    “We found no differences in the outcome measures between the two subgroups.The coping therapy therefore can be applied in both medicated and unmedicated patients.”

  • The paper relies on this without support.

    Relief from RLS symptoms during awake periods but not during the night reflects patients' use of acquired coping strategies in daily life.

    “The RLS-6 scales show that relief from symptoms occurred primarily when patients were awake but not during the night, indicating that the patients used the acquired coping strategies in their daily life.”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Abstract conflicts on changes in general psychometric measures

    Minor

    The abstract says measures not specific to RLS were unaffected, but it also reports a significant improvement in mental health on the SCL-90-R. Table 1 likewise reports significant follow-up changes on the general WBS-5 and SF-36 mental component measures.

1 of 1

Cites

Flagged first, then by citations

1 of the 26 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Hornyak, M., Grossmann, C., Kohnen, R., Schlatterer, M., Richter, H., Voderholzer, U., Riemann, D., & Berger, M.
Affiliations
  • University Medical Center Freiburg (DE)
  • University of Freiburg (DE)
  • Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
Corresponding author
Hornyak, M
ORCID
Venue
Journal of Neurology, Neurosurgery & Psychiatry
Publisher
BMJ
Published
2008-07-01
Volume
79
Issue
7
Pages
823-825
ISSN
0022-3050 (ISSN-L)
DOI
10.1136/jnnp.2007.138867
OpenAlex
W2117351869
Cited by
71
References
26
Citations by year
2026: 3 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 4 · 2019: 2 · 2018: 4 · 2016: 2 · 2015: 8 · 2014: 3 · 2013: 6 · 2012: 4
FWCI
5.44
Type
journal article
Language
en
Open access
Locations
  • Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Restless Legs Syndrome Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
restless legs syndrome, cognitive behavioral therapy, group therapy, coping strategies, quality of life, psychosocial impairment, mental health, treatment feasibility, treatment acceptance, RLS severity
MeSH terms
Adaptation, Psychological, Adult, Aged, Feasibility Studies, Female, Humans, Male, Middle Aged, Pilot Projects, Quality of Life, Restless Legs Syndrome, Cohort Studies, Cognitive Behavioral Therapy, Treatment Outcome, Patient Satisfaction

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review