Next Steps for Patients Who Fail to Respond to Cognitive Behavioral Therapy for Insomnia (CBT-I): the Perspective from Behavioral Sleep Medicine Psychologists

Baron, Kelly Glazer; Hooker, Stephanie Ann

doi:10.1007/s40675-017-0096-x

Cited by 15 publications

(10 citation statements)

References 37 publications

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“…The primary outcome was the ISI score, a validated, selfrating 7-item questionnaire assessing the severity of insomnia and associated daily life disturbances. 32 Total ISI scores ranged from 0 to 28, and were interpreted as follows: no clinically significant insomnia (0-7), subthreshold insomnia (8)(9)(10)(11)(12)(13)(14), moderate insomnia (15)(16)(17)(18)(19)(20)(21), and severe insomnia (22)(23)(24)(25)(26)(27)(28) (follow-up after the final intervention). 33 Secondary outcome measures included the following: (1) the Pittsburgh Sleep Quality Index (PSQI) score, (2) sleep diary-derived variables, (3) HADS score, (4) EuroQoL five dimension (EQ-5D) score, (5) Patient Global Impression of Change (PGIC) score, and (6) salivary melatonin and cortisol levels.…”

Section: Discussionmentioning

confidence: 99%

“…Further, 25%-40% of insomnia patients do not achieve remission by CBT-I. 10,11 In addition, hypnotics are associated with diverse adverse effects such as residual daytime sedation, dizziness, drowsiness, nausea, mood changes, cognitive impairment, motor incoordination, and dependence. [12][13][14] Because of these limitations of conventional medicine, the use of complementary alternative medicine (CAM) for treating insomnia has increased from 20.6% in 1990 to 45% in 2007 in the United States.…”

Section: Introductionmentioning

confidence: 99%

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<p>Efficacy and Safety of Electroacupuncture for Insomnia Disorder: A Multicenter, Randomized, Assessor-Blinded, Controlled Trial</p>

Lee¹,

Kim²,

Jung³

et al. 2020

NSS

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Efficacy and Safety of Electroacupuncture for Insomnia Disorder: A Multicenter, Randomized, Assessor-Blinded, Controlled Trial</p>

Lee¹,

Kim²,

Jung³

et al. 2020

NSS

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“…progressive muscle relaxation) can be included in CBT‐I to reduce somatic tension or intrusive thoughts at bedtime (Morin et al, 2006). Although CBT‐I is effective and recommended to treat insomnia, there are ~40% of people who have no significant therapeutic gains after treatment (Baron & Hooker, 2017; Winkelman et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of stimulus control in cognitive behavioural therapy for insomnia in adults: A systematic review and network meta‐analysis

Verreault,

Granger,

Neveu

et al. 2023

Journal of Sleep Research

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SummaryStimulus control is part of the widely used cognitive behavioural therapy for insomnia. However, there is a lack of knowledge about its mechanisms of action and effectiveness when used alone. This systematic review with network meta‐analysis aimed to evaluate stimulus control efficacy when used alone compared with cognitive behavioural therapy for insomnia or its components. The review also documented stimulus control mechanisms of action proposed by the authors. A search was conducted in several bibliographic databases (MEDLINE, PsycINFO, Embase, CINAHL, Psychology Behavioural Sciences Collection, Web of Science, and Cochrane Library) and in two registers from 1972 to June 2022. Randomised studies with adult participants presenting a diagnosis of insomnia and including at least one stimulus control instruction in a treatment group were included. Risk of bias was assessed with the Quality Assessment of Controlled Intervention Studies. Twenty‐three studies were included and three network meta‐analyses were conducted. The quality of included studies was generally poor. Results indicate that stimulus control is an effective intervention to improve insomnia compared with control conditions. Not all stimulus control instructions seem essential, especially those known to recondition the bedroom for sleep. The review challenges the classical conditioning hypothesis. Results should be interpreted cautiously given the small number of studies included, bias risk, and inconsistencies in the network meta‐analysis. Rigorous research is needed in evaluating stimulus control efficacy and mechanisms.

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“…Up to 40% of insomnia patients do not adequately respond to CBT-I [ 10 ], likely due to insomnia heterogeneity [ 10 – 12 ]. For instance, insomnia patients with evening chronotype, unhelpful beliefs about sleep, short sleep, comorbidity, or high reactivity to stress may have a blunted response to CBT-I [ 12 – 15 ], possibly due to the influence of overactive neurobiological and psychological systems in insomnia pathophysiology [ 16 ]. Adherence to the therapeutic regime may also predict outcome [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Group-delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia in primary care: study protocol for a pragmatic, multicentre randomized controlled trial

Hrozanova

Meisingset²,

Kallestad³

et al. 2023

BMC Prim. Care

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Background Insomnia is common in the general population and is a risk factor for ill-health, which highlights the importance of treating insomnia effectively and cost-efficiently. Cognitive-behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment due to its long-term effectiveness and few side-effects, but its availability is limited. The aim of this pragmatic, multicentre randomized controlled trial is to investigate the effectiveness of group-delivered CBT-I in primary care compared to a waiting-list control group. Methods A pragmatic multicentre randomized controlled trial will be conducted with about 300 participants recruited across 26 Healthy Life Centres in Norway. Participants will complete online screening and provide consent before enrolment. Those who meet the eligibility criteria will be randomized to a group-delivered CBT-I or to a waiting list according to a 2:1 ratio. The intervention consists of four two-hour sessions. Assessments will be performed at baseline, 4 weeks, 3- and 6 months post-intervention, respectively. The primary outcome is self-reported insomnia severity at 3 months post-intervention. Secondary outcomes include health-related quality of life, fatigue, mental distress, dysfunctional beliefs and attitudes about sleep, sleep reactivity, 7-day sleep diaries, and data obtained from national health registries (sick leave, use of relevant prescribed medications, healthcare utilization). Exploratory analyses will identify factors influencing treatment effectiveness, and we will conduct a mixed-method process evaluation to identify facilitators and barriers of participants’ treatment adherence. The study protocol was approved by the Regional Committee for Medical and Health Research ethics in Mid-Norway (ID 465241). Discussion This large-scale pragmatic trial will investigate the effectiveness of group-delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia, generating findings that are generalizable to day-to-day treatment of insomnia in interdisciplinary primary care services. The trial will identify those who would benefit from the group-delivered therapy, and will investigate the rates of sick leave, medication use, and healthcare utilization among adults who undergo the group-delivered therapy. Trial registration The trial was retrospectively registered in the ISRCTN registry (ISRCTN16185698).

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Next Steps for Patients Who Fail to Respond to Cognitive Behavioral Therapy for Insomnia (CBT-I): the Perspective from Behavioral Sleep Medicine Psychologists

Cited by 15 publications

References 37 publications

<p>Efficacy and Safety of Electroacupuncture for Insomnia Disorder: A Multicenter, Randomized, Assessor-Blinded, Controlled Trial</p>

<p>Efficacy and Safety of Electroacupuncture for Insomnia Disorder: A Multicenter, Randomized, Assessor-Blinded, Controlled Trial</p>

The effectiveness of stimulus control in cognitive behavioural therapy for insomnia in adults: A systematic review and network meta‐analysis

Group-delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia in primary care: study protocol for a pragmatic, multicentre randomized controlled trial

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