![]() “That knowledge may motivate some clinicians to seek further training and others to make more informed decisions on when and where to refer.” “CBT-I training can begin with taking a CBT-I CME course and/or reading a CBT-I manual,” he said. “I hope ACP’s report prompts more clinicians to seek CBT-I training. “Treatment of people with chronic insomnia gets complicated when you encounter patient resistance, and you always do,” Perlis said. A team of researchers led by Rachel Manber, Ph.D., a professor of psychiatry and behavioral sciences at Stanford University School of Medicine, reported these findings in the journal Sleep in February 2015.ĪCP’s report suggests CBT-I can be provided in primary care, but, Perlis said, given the limited number of trained and experienced CBT-I providers, that’s more a goal than present reality. At baseline, 32 percent of the veterans endorsed some level of suicidal ideation at final assessment, after five or fewer treatment sessions, 21 percent did. Treating insomnia concurrently with comorbid psychiatric disorders not only will improve sleep, but also may have a halo effect on those disorders, Perlis, who was not involved in developing the ACP guideline, told Psychiatric News.Īn evaluation of 405 veterans who presented for treatment of insomnia at the Veterans Affairs Health Care System nationwide, for example, found CBT-I reduced both insomnia severity and suicidal ideation. CBT-I works as well as hypnotic medications and has the added benefits of fewer adverse effects during treatment and long-term durability after treatment, said Michael Perlis, Ph.D., an associate professor of psychiatry and director of the behavioral sleep medicine program at the University of Pennsylvania School of Medicine. ![]() Published by Oxford University Press on behalf of the Sleep Research Society.CBT-I May Improve Comorbid Psychiatric DisordersĪs the report from the American College of Physicians (ACP) suggests, chronic insomnia needs targeted treatment, specifically, cognitive-behavioral therapy for insomnia (CBT-I). : NCT02044263: Cognitive Behavioral Therapy for Insomnia Delivered by a Therapist or on the Internet: a Randomized Controlled Non-inferiority Trial.Ĭognitive Behavioral Therapy for Insomnia digital face-to-face insomnia disorder non-inferiority randomized controlled trial. These findings highlight the need for more clinical research to clarify the optimal application, dissemination, and implementation of dCBT-I. At week 9, dCBT-I was inferior to FtF CBT-I as the 95% CI was fully outside the non-inferiority margin. Thus, this result is inconclusive regarding the possible inferiority or non-inferiority of dCBT-I over FtF CBT-I, but dCBT-I performed significantly worse than FtF CBT-I. There was a significant time effect for both interventions (p < 0.001) and the mean difference in ISI at week 33 was -2.8 (95% CI: -4.8 to -0.8 p = 0.007, Cohen's d = 0.7), and -4.6 at week 9 (95% CI -6.6 to -2.7 p < 0.001), Cohen's d = 1.2.Īt the primary endpoint at week 33, the 95% CI of the estimated treatment difference included the non-inferiority margin and was wholly to the left of zero. At week 33, the mean scores were 8.9 (SD 6.0) and 12.3 (SD 6.9), respectively. Individuals were randomized to FtF CBT-I (n = 52) or dCBT-I (n = 49) mean baseline ISI scores were 18.4 (SD 3.7) and 19.4 (SD 4.1), respectively. The non-inferiority margin was defined a priori as 2.0 points on the ISI at week 33. The Insomnia Severity Index (ISI) was the primary outcome measure. ![]() We undertook a randomized controlled trial to test whether fully automated dCBT-I is non-inferior to individual FtF CBT-I in reducing insomnia severity.Įligible participants were adult patients with a diagnosis of insomnia disorder recruited from a sleep clinic provided via public mental health services in Norway. It is unknown, however, how dCBT-I compares to individual face-to-face (FtF) CBT-I for individuals referred to clinical secondary services. ![]() Digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) has demonstrated efficacy in reducing insomnia severity in self-referred and community samples. ![]()
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