Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-26T21:23:32.285Z Has data issue: false hasContentIssue false
  • English
  • Français

Group cognitive behavioural treatment for insomnia in primary care: a randomized controlled trial

Published online by Cambridge University Press:  16 December 2015

J. Cape ,
J. Leibowitz ,
C. Whittington ,
C. A. Espie  and
S. Pilling
J. Cape*
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK Camden and Islington NHS Foundation Trust, London, UK
J. Leibowitz
Affiliation:
Camden and Islington NHS Foundation Trust, London, UK
C. Whittington
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
C. A. Espie
Affiliation:
Nuffield Department of Clinical Neurosciences/ Sleep & Circadian Neuroscience Institute, University of Oxford, Oxford, UK
S. Pilling
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK Camden and Islington NHS Foundation Trust, London, UK
*
*Address for correspondence: Dr J. Cape, Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK. (Email: j.cape@ucl.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Insomnia disorder is common and often co-morbid with mental health conditions. Cognitive behavioural therapy (CBT) for insomnia is effective, but is rarely implemented as a discrete treatment. The aim of this study was to evaluate the effectiveness of brief CBT groups for insomnia compared to treatment as usual (TAU) for insomnia delivered by mental health practitioners in a primary-care mental health service.

Method

A total of 239 participants were randomized to either a five-session CBT group or to TAU. Assessments of sleep and of symptoms of depression and anxiety were carried out at baseline, post-treatment and at 20 weeks. Primary outcome was sleep efficiency post-treatment.

Results

Group CBT participants had better sleep outcomes post-treatment than those receiving TAU [sleep efficiency standardized mean difference 0.63, 95% confidence interval (CI) 0.34–0.92]. The effect at 20 weeks was smaller with a wide confidence interval (0.27, 95% CI −0.03 to 0.56). There were no important differences between groups at either follow-up period in symptoms of anxiety or depression.

Conclusions

Dedicated CBT group treatment for insomnia improves sleep more than treating sleep as an adjunct to other mental health treatment.

Keywords

Cognitive behavioural therapiesoutcome studiesprimary carerandomized controlled trialsleep disorders
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 5 , April 2016 , pp. 1015 - 1025
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

APA (2013). Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition. American Psychiatric Association: Arlington, VA.Google Scholar
Attkisson, C, Zwick, R (2003). The client satisfaction questionnaire: psychometric properties and correlations with service utilisation and psychotherapy outcome. Evaluation and Program Planning 5, 233–237.CrossRefGoogle Scholar
Baglioni, C, Battagliese, G, Feige, B, Spiegelhalder, K, Nissen, C, Voderholzer, U, Lombardo, C, Riemann, D (2011). Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders 135, 10–19.CrossRefGoogle ScholarPubMed
Bothelius, K, Kyhle, K, Espie, CA, Broman, JE (2013). Manual-guided cognitive-behavioural therapy for insomnia delivered by ordinary primary care personnel in general medical practice: a randomized controlled effectiveness trial. Journal of Sleep Research 22, 688–696.Google Scholar
Cuipers, P, Munoz, RF, Clarke, GN, Lewinsohn, PM (2009). Psychoeducational treatment and prevention of depression: the ‘coping with depression’ course thirty years later. Clinical Psychology Review 29, 449–458.Google Scholar
Daley, M, Morin, CM, LeBlanc, M, Grégoire, J-P, Savard, J (2009). The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep 32, 55–64.Google Scholar
Espie, CA (2009). ‘Stepped care’: a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment. Sleep 32, 1549–1558.Google Scholar
Espie, CA, Fleming, L, Cassidy, J, Samuel, L, Taylor, LM, White, CA, Douglas, NJ, Engleman, HM, Kelly, HL, Paul, J (2008). Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. Journal of Clinical Oncology 26, 4651–4658.Google Scholar
Espie, CA, Inglis, SJ, Tessier, S, Harvey, L (2001). The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: implementation and evaluation of a sleep clinic in general medical practice. Behaviour Research and Therapy 39, 45–60.Google Scholar
Espie, CA, Kyle, SD, Hames, P, Gardani, M, Fleming, L, Cape, J (2014). The Sleep Condition Indicator: a clinical screening tool to evaluate insomnia disorder. BMJ Open 4, e004183.CrossRefGoogle ScholarPubMed
Espie, CA, Kyle, SD, Williams, C, Ong, JC, Douglas, NJ, Hames, P, Brown, JLS (2012). A randomized, placebo- controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep 35, 769–781.CrossRefGoogle ScholarPubMed
Espie, CA, MacMahon, KMA, Kelly, HL, Broomfield, NM, Douglas, NJ, Engleman, HM, McKinstry, B, Morin, CM, Walker, A, Wilson, P (2007). Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice. Sleep 30, 574–584.Google Scholar
Gilbody, S, Richards, D, Barkham, M (2007). Diagnosing depression in primary care using self-completed instruments: a UK validation of the PHQ9 and CORE-OM. British Journal of General Practice 57, 650–652.Google ScholarPubMed
Irwin, MR, Cole, JC, Nicassio, PM (2006). Comparative meta-analysis of behavioural interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychology 25, 3–14.Google Scholar
Kroenke, K, Spitzer, RL, Williams, JB (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606–613.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL, Williams, JBW, Monahan, PO, Lowe, B (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine 146, 317–325.Google Scholar
Larsen, DL, Attkisson, CC, Hargreaves, WA, Nguyen, TD (1979). Assessment of client/patient satisfaction: development of a general scale. Evaluation and Program Planning 2, 197–207.CrossRefGoogle ScholarPubMed
Leblanc, M, Merette, C, Savard, J, Ivers, H, Baillaregeon, L, Morin, CM (2009). Incidence and risk factors of insomnia in a population-based sample. Sleep 32, 1027–1037.Google Scholar
Manber, R, Edinger, JD, Gress, JL, San Pedro-Salcedo, MG, Kuo, TF, Kalista, T (2008). Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep 31, 489–495.Google Scholar
Morin, CM, Bootzin, RR, Buysse, DJ, Edinger, JD, Espie, CA, Lichstein, KL (2006). Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep 29, 1398–1414.Google Scholar
Morin, CM, Hauri, PJ, Espie, CA, Spielman, AJ, Buysse, DJ, Bootzin, RR (1999). Non-pharmacologic treatment of chronic insomnia. Sleep 22, 1134–1156.Google Scholar
Mundt, JC, Marks, IM, Shear, MK, Greist, JM (2002). The work and social adjustment scale: a simple measure of impairment in functioning. British Journal of Psychiatry 180, 461–464.Google Scholar
National Institute of Health (2005). NIH state-of-the-science conference statement on manifestations and management of chronic insomnia in adults. NIH Consensus State of the Science Statements 22, 1–30.Google Scholar
Pearson, NJ, Johnson, LL, Nahin, RL (2006). Insomnia, trouble sleeping, and complementary and alternative medicine: analysis of the 2002 National Health Interview Survey data. Archives of Internal Medicine 166, 1775–1782.CrossRefGoogle ScholarPubMed
Riemann, D, Perlis, ML (2009). The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Medicine Reviews 13, 205–214.CrossRefGoogle ScholarPubMed
Ritterband, LM, Thorndike, FP, Gonder-Frederick, LA, Magee, JC, Bailey, ET, Saylor, DK, Morin, CM (2009). Efficacy of an internet-based behavioral intervention for adults with insomnia. Archives of General Psychiatry 66, 692–698.Google Scholar
Schutte-Rodin, S, Broch, L, Buysse, D, Dorsey, C, Sateia, M (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine 4, 487–504.Google Scholar
Sivertsen, B, Krokstad, S, Mykletun, A, Overland, S (2009). Insomnia symptoms and use of health services and medications. Behavioral Sleep Medicine 7, 210–222.Google Scholar
Spitzer, RL, Kroenke, K, Williams, JBW, Lowe, B (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine 166, 1092–1097.Google Scholar
van Straten, A, Emmelkamp, J, de Wit, J, Lancee, J, Andersson, G, van Someren, EJW, Cuijpers, P (2013). Guided internet-delivered cognitive behavioural treatment for insomnia: a randomized trial. Psychological Medicine 44, 1521–1532.Google Scholar
Wilson, SJ, Nutt, DJ, Alford, C, Argyropoulos, SV, Baldwin, DS, Bateson, AN, Britton, TC, Crowe, C, Dijk, DJ, Espie, CA, Gringras, P, Hajak, G, Idzikowski, C, Krystal, AD, Nash, JR, Selsick, H, Sharpley, AL, Wade, AG (2010). British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. Journal of Psychopharmacology 24, 1577–1600.CrossRefGoogle ScholarPubMed
Zwarenstein, M, Treweek, S, Gagnier, JJ, Altman, DG, Tunis, S, Haynes, B, Oxman, AD, Moher, D (2008). Improving the reporting of pragmatic trials: an extension of the CONSORT statement. British Medical Journal 337, a2390.Google Scholar
Supplementary material: File

Cape supplementary material

Cape supplementary material 1

Download Cape supplementary material(File)
File 51.9 KB