More Support for the Advantage of CBT for Treating Insomnia

On Wednesday of last week, the journal “SLEEP” published the “longest controlled follow-up of CBT-i thus far.” The report found that CBT-i (Cognitive Behavioural Therapy for Insomnia) “reduced use of sleep medications and other additional insomnia treatments, compared to a control treatment.”  

Background

The study consisted of two groups, ICBT-ctrl and ICBT-I

The active control treatment (ICBT-ctrl) was modelled after credible insomnia treatments and was delivered online. The treatment consisted of a sleep diary, psychoeducation about sleep, sleep hygiene, and limited relaxation/mindfulness/stress management training. This group also had access to an online forum to interact with other patients, however there was no therapist support.

The insomnia treatment group (ICBT-i) worked through 8 online modules with a psychoeducative textbook. Patients completed worksheets, wrote a weekly sleep diary with homework assignments, and had a secure email system to contact a therapist. Their treatment applied many current recommendations for CBT-I, such as education and daytime cognitive reappraisal. Patients were also taught and encouraged to quit using sleep medications or taper them off.

Participants were also trained to use several optional mental techniques in bed. Different techniques were used in different studies reported by the authors. Some participants were trained to use visualization techniques. Some were given relaxation training. Some were taught to do a “body scan.”

Analysis

Over the 36 months of treatment and follow-up, there was a significant drop in total sleep medication use by the ICBT-i patients . Whereas, the control group totals dropped less significantly . Furthermore, insomnia severity dropped significantly in both groups .

Discussion

This study lends further support to the CBT for Insomnia framework. The authors suggested that patients can reduce the severity of their insomnia without using sleep medications, which are not recommended for long term use.

While visualization was not a focus of this particular paper, some of the participants were given training in various visualization techniques. Prior research has shown that some forms of visualization can help alleviate sleep concerns. CogSci Apps Corp. co-founder, Dr. Beaudoin, discussed cognitive  techniques in a recent article on SharpBrains..

Next week, at SLEEP-2016, Dr. Beaudoin will be presenting a paper of an experiment that showed positive results of the Serial Diverse Imagining technique used by mySleepButton. Serial diverse imagining is a cognitive technique for insomnia, and also for decreasing sleep onset latency for other populations. SLEEP-2016 is the joint meeting of the American Academy of Sleep Medicine and the Sleep Research Society, SLEEP-2016 Conference in Denver, CO. (June 14, 2016 at 2:00 PM).

References

Blom, K., Jernelöv, S., Rück, C., Lindefors, N., & Kaldo, V. (2016, June 01). Three-Year Follow-Up of Insomnia and Hypnotics after Controlled Internet Treatment for Insomnia. Sleep, 39(06), 1267-1274. doi:10.5665/sleep.5850
http://www.journalsleep.org/ViewAbstract.aspx?pid=30644

Beaudoin, L. P. (2015). The possibility of super-somnolent mentation: A new information-processing approach to sleep-onset acceleration and insomnia exemplified by serial diverse imagining. (First version published 2013-03). http://summit.sfu.ca/item/12143

Beaudoin, L. P., Digdon, N., O’Neill, K. & Racour, G. (Abstract accepted for 2016 publication). Serial diverse imagining task: A new remedy for bedtime complaints of worrying and other sleep-disruptive mental activity. Poster to be presented at SLEEP-2016 (A joint meeting of the American Academy of Sleep Medicine and the Sleep Research Society). Denver, CO. http://summit.sfu.ca/item/16196

Digdon, N. & Beaudoin, L. P. (2015, July). A test of the somnolent mentation theory and the cognitive shuffle insomnia treatment. Poster presented at the 37th Annual Conference of the Cognitive Science Society. Pasadena, California USA. http://summit.sfu.ca/item/15270