CBT Trumps Either BT, CT Alone for Chronic Insomnia
SEATTLE, WA—Cognitive behavioral therapy (CBT) provides more long-term improvement in nighttime and daytime symptoms of insomnia than either of its two components—behavioral therapy (BT) and cognitive therapy (CT)—used alone, investigators reported at SLEEP 2015.
“The findings suggest that full CBT may produce a synergistic effect and contribute to optimize both short- and long-term outcomes,” according to presenter Charles M. Morin, PhD, of Université Laval, Quebec, Canada. Strong evidence has documented the efficacy of CBT for insomnia; however, less information is available about the unique contribution to long-term outcomes of its two therapeutic components.
For this reason, Dr. Morin and colleagues analyzed 12-month follow-up data from a controlled trial that assessed the relative efficacy of BT and CT, compared to full CBT, in both daytime and nighttime insomnia symptoms in 188 adults. The primary endpoint was based on Insomnia Severity Index (ISI) total scores, treatment response, and remission; secondary outcomes included several measures of sleep and daytime symptoms.
Mean age was 47.4 years and 62.2% were women. Duration of insomnia was 14.5 years, with 45 patients (24%) having a comorbid condition; 40, major depressive disorder or dysthymia and 12, generalized anxiety disorder or panic disorder. Treatment comprised 8-week individual therapy, with 63 patients receiving BT (sleep restriction and stimulus control); 65 receiving CT; and 60, CBT (CT plus BT).
“Treatment response and remission rates were generally well maintained over time in all three conditions,” Dr. Morin reported. For CBT, there were higher rates of responders at six-month follow-up (72%) and higher rates of remitters at the 12-month follow-up (63%) relative to BT, which demonstrated a 58% response and a 40% remission, and CT, which had a 63% response, 38% remission. With the exception of sleep efficiency, which was higher at 12-month follow-up for CBT (82%) and BT (83%) vs. CT (77%), all other sleep variables remained equally improved in all three conditions.
In all three groups, significant pre- to post-treatment reductions were observed for symptoms of anxiety and depression; however, there was no significant change in fatigue, either during treatment or at the six-month and 12-month follow-up periods. In addition, significant improvements in quality of life (Mental) occurred during treatment, with additional improvements achieved at six-month follow-up for CBT; at 12-month follow-up, there were no further changes and no group differences. Few changes on quality of life (Physical) occurred pre- to post-treatment, “although CBT achieved better outcomes at 12-month follow-up relative to CT,” Dr. Morin noted.
“These results provide further evidence about the long-term efficacy of CBT for improving nighttime and daytime symptoms of insomnia, and new evidence that full CBT produces better outcomes than either of its two components used singly,” he concluded.