Cognitive-Behavioral Therapy for Insomnia

Perlis, Michael L.; Smith, Michael T.; Jungquist, Carla R.; Nowakowski, Sara; Orff, Henry J.; Soeffing, James

doi:10.1007/978-1-60327-042-7_22

Cited by 35 publications

(43 citation statements)

References 39 publications

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“…These include only using the bed for sleep and sex, only getting into bed when tired, leaving the bed if unable to fall asleep within 15 minutes, establishing a regular morning waking time, and avoiding napping. 30 CBTI can also include restrictions on the amount of time in bed. 30 In this case, baseline polysomnography or a sleep diary can be used to assess total sleep time.…”

Section: Nonpharmacologic Strategiesmentioning

confidence: 99%

“…30 CBTI can also include restrictions on the amount of time in bed. 30 In this case, baseline polysomnography or a sleep diary can be used to assess total sleep time. Initially, the patient is restricted to spending an amount of time in bed equal to their baseline total sleep time.…”

Section: Nonpharmacologic Strategiesmentioning

confidence: 99%

“…Cognitive therapies such as distraction techniques and cognitive restructuring can address negative and counterproductive beliefs about sleep. 30 Paradoxic intention, in which patients who fear insomnia intentionally stay awake, may be effective for some patients by reducing worry about the negative outcomes from an instance of poor sleep. 30 Several different relaxation therapies may also be used to address insomnia, although these are reported to be less effective than the other CBT techniques described above.…”

Section: Nonpharmacologic Strategiesmentioning

confidence: 99%

“…30 Paradoxic intention, in which patients who fear insomnia intentionally stay awake, may be effective for some patients by reducing worry about the negative outcomes from an instance of poor sleep. 30 Several different relaxation therapies may also be used to address insomnia, although these are reported to be less effective than the other CBT techniques described above. 30 In progressive muscle relaxation, patients tense and then relax muscles, concentrating on the way the muscle relaxation feels.…”

Section: Nonpharmacologic Strategiesmentioning

confidence: 99%

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Sleep Disturbances in Depression

Murphy

Peterson

2015

Sleep Medicine Clinics

238

140

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Section: Nonpharmacologic Strategiesmentioning

confidence: 99%

Section: Nonpharmacologic Strategiesmentioning

confidence: 99%

Section: Nonpharmacologic Strategiesmentioning

confidence: 99%

Section: Nonpharmacologic Strategiesmentioning

confidence: 99%

See 2 more Smart Citations

Sleep Disturbances in Depression

Murphy

Peterson

2015

Sleep Medicine Clinics

238

140

View full text Add to dashboard Cite

“…“Sleep restriction” addresses what is believed to be the primary perpetuating factor for chronic insomnia – the mismatch between sleep opportunity and sleep ability. “Stimulus control” targets stimulus “dyscontrol” (the occurrence of a diversity of non-sleep behaviors in the bedroom)36 and sets the stage for counterconditioning (ie, the reconditioning of sleep-related stimuli to elicit the physiology of sleep as opposed to the physiology of wakefulness). “Sleep hygiene”, while ineffective as a monotherapy, serves to promote behaviors and practices that facilitate sleep and to discourage those that are thought to contribute to insomnia 37.…”

Section: Introductionmentioning

confidence: 99%

Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients

Garland¹,

Johnson²,

Savard³

et al. 2014

NDT

131

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Individuals with cancer are disproportionately affected by sleep disturbance and insomnia relative to the general population. These problems can be a consequence of the psychological, behavioral, and physical effects of a cancer diagnosis and treatment. Insomnia often persists for years and, when combined with already high levels of cancer-related distress, may place cancer survivors at a higher risk of future physical and mental health problems and poorer quality of life. The recommended first-line treatment for insomnia is cognitive behavioral therapy for insomnia (CBT-I), a non-pharmacological treatment that incorporates cognitive and behavior-change techniques and targets dysfunctional attitudes, beliefs, and habits involving sleep. This article presents a comprehensive review of the literature examining the efficacy of CBT-I on sleep and psychological outcomes in cancer patients and survivors. The search revealed 12 studies (four uncontrolled, eight controlled) that evaluated the effects of CBT-I in cancer patients or survivors. Results suggest that CBT-I is associated with statistically and clinically significant improvements in subjective sleep outcomes in patients with cancer. CBT-I may also improve mood, fatigue, and overall quality of life, and can be successfully delivered through a variety of treatment modalities, making it possible to reach a broader range of patients who may not have access to more traditional programs. Future research in this area should focus on the translation of evidence into clinical practice in order to increase awareness and access to effective insomnia treatment in cancer care.

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Comparative Effectiveness of Digital Cognitive Behavioral Therapy vs Medication Therapy Among Patients With Insomnia

Zhang

et al. 2023

JAMA Netw Open

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ImportanceAlthough digital cognitive behavioral therapy for insomnia (dCBT-I) has been studied in many randomized clinical trials and is recommended as a first-line treatment option, few studies have systematically examined its effectiveness, engagement, durability, and adaptability in clinical settings.ObjectiveTo evaluate the clinical effectiveness, engagement, durability, and adaptability of dCBT-I.Design, Setting, and ParticipantsThis retrospective cohort study was conducted using longitudinal data collected via a mobile app named Good Sleep 365 between November 14, 2018, and February 28, 2022. Three therapeutic modes (ie, dCBT-I, medication, and their combination) were compared at month 1, month 3, and month 6 (primary). Inverse probability of treatment weighting (IPTW) using propensity scores was applied to enable homogeneous comparisons between the 3 groups.ExposuresTreatment with dCBT-I, medication therapy, or combination therapy according to prescriptions.Main Outcomes and MeasuresThe Pittsburgh Sleep Quality Index (PSQI) score and its essential subitems were used as the primary outcomes. Effectiveness on comorbid somnolence, anxiety, depression, and somatic symptoms were used as secondary outcomes. Cohen d effect size, P value, and standardized mean difference (SMD) were used to measure differences in treatment outcomes. Changes in outcomes and response rates (≥3 points change in PSQI score) were also reported.ResultsA total of 4052 patients (mean [SD] age, 44.29 [12.01] years; 3028 [74.7%] female participants) were selected for dCBT-I (n = 418), medication (n = 862), and their combination (n = 2772). Compared with the change in PSQI score at 6 months for participants receiving medication alone (from a mean [SD] of 12.85 [3.49] to 8.92 [4.03]), both dCBT-I (from a mean [SD] of 13.51 [3.03] to 7.15 [3.25]; Cohen d, −0.50; 95% CI, −0.62 to −0.38; P &lt; .001; SMD = 0.484) and combination therapy (from a mean [SD] of 12.92 [3.49] to 6.98 [3.43]; Cohen d, 0.50; 95% CI, 0.42 to 0.58; P &lt; .001; SMD = 0.518) were associated with significant reductions; dCBT-I had a comparable effect as combination therapy (Cohen d, 0.05; 95% CI, −0.05 to 0.15; P = .66; SMD = 0.05), but showed unstable durability. Outcomes of dCBT-I improved steadily and rapidly during the first 3 months, and then fluctuated. The response rates with dCBT-I and combination therapy were higher than with medication. Changes in secondary outcomes indicated statistically significant benefits from dCBT-I and combination therapy. The results of subgroup analysis were consistent with the main findings, demonstrating the superiority of dCBT-I vs medication therapy in various subpopulations.Conclusions and RelevanceIn this study, clinical evidence suggested that combination therapy was optimal, and dCBT-I was more effective than medication therapy, with long-term benefits for insomnia. Future studies are needed to analyze its clinical effectiveness and reliability in distinct subpopulations.

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Cognitive-Behavioral Therapy for Insomnia

Cited by 35 publications

References 39 publications

Sleep Disturbances in Depression

Sleep Disturbances in Depression

Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients

Comparative Effectiveness of Digital Cognitive Behavioral Therapy vs Medication Therapy Among Patients With Insomnia

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