The Future of Cognitive Behavioral Therapy for Insomnia: What Important Research Remains to Be Done?

University of Washington.
Journal of Clinical Psychology (Impact Factor: 2.12). 10/2013; 69(10). DOI: 10.1002/jclp.21948
Source: PubMed


The efficacy of cognitive-behavioral therapy for insomnia (CBT-I) to improve both short- and long-term outcomes in both uncomplicated and comorbid insomnia patients has been repeatedly and conclusively demonstrated. Further demonstrations of efficacy, per se, in additional comorbid insomnia populations are likely not the best use of limited energy and resources. Rather, we propose that future CBT-I research would be better focused on three key areas: (a) increasing treatment efficacy, particularly for more clinically relevant outcomes; (b) increasing treatment effectiveness and potential for translation into the community, with a particular focus on variants of CBT-I and alternative delivery modalities within primary healthcare systems; and (c) increasing CBT-I practitioner training and dissemina-tion.

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Available from: Susan M Mccurry, Mar 06, 2014
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    • "Our findings support the effectiveness of CBT-I across a wide variety of medical and psychiatric disorders, regardless of the specific disorder or its severity. This suggests that additional studies of CBT-I in new comorbid conditions, while of interest, are unlikely to yield different results than those found in the present meta-analysis and may not be the best use of the limited time, money and energies available for insomnia research, in line with the above recommendations by Vitiello et al. [83]. "
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    ABSTRACT: s u m m a r y Cognitive behavioral therapy for insomnia (CBT-I) is effective for treatment of primary insomnia. There has been no synthesis of studies quantifying this effect on insomnia comorbid with medical and psy-chiatric disorders using rigorous selection criteria. The objective of this study was to quantify the effect of CBT-I in studies including patients with medical or psychiatric disorders. Studies were identified from 1985 through February 2014 using multiple databases and bibliography searches. Inclusion was limited to randomized controlled trials of CBT-I in adult patients with insomnia diagnosed using standardized criteria, who additionally had a comorbid medical or psychiatric condition. Twenty-three studies including 1379 patients met inclusion criteria. Based on weighted mean differences, CBT-I improved subjective sleep quality post-treatment, with large treatment effects for the insomnia severity index and Pittsburgh sleep quality index. Sleep diaries showed a 20 min reduction in sleep onset latency and wake after sleep onset, 17 min improvement in total sleep time, and 9% improvement in sleep efficiency post-treatment, similar to findings of meta-analyses of CBT-I in older adults. Treatment effects were durable up to 18 mo. Results of actigraphy were similar to but of smaller magnitude than subjective measures. CBT-I is an effective, durable treatment for comorbid insomnia.
    Sleep Medicine Reviews 01/2015; 23:54-67. DOI:10.1016/j.smrv.2014.11.007 · 8.51 Impact Factor
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    ABSTRACT: Cognitive behavioral therapy for insomnia (CBT-I) is a group of strategies which includes sleep restriction, stimulus control therapy, relaxation training, cognitive therapy, and various combinations of those methods. Growing evidence from controlled clinical trials indicates that the majority of patients (70 to 80%) with persistent insomnia respond to CBT, and approximately half of them achieve clinical remission. CBT-I produces significant improvements of sleep-onset latency, wake after sleep onset, sleep efficiency, and sleep quality. These benefits are paralleled by reductions of daytime fatigue, improvement in psychological symptoms, and decreased usage of hypnotics. Changes in sleep patterns are well maintained after completing therapy. Treatment outcomes have been documented primarily with prospective sleep diaries; studies using polysomnography and actigraphy have also supported these results. Considering the results of current peer-reviewed research, CBT-I should be the first-line therapy for persistent insomnia. Despite strong evidence supporting its efficacy and effectiveness, CBT-I remains under utilized by health care practitioners. Increased application of evidence-based CBT-I therapies and their extension into primary medical practices should be highly effective and should be recommended in the future for better clinical management of insomnia-related disorders.
    01/2013; 33(4):210. DOI:10.7599/hmr.2013.33.4.210
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    ABSTRACT: In this month's issue of the Journal of Clinical Psychology, Vitiello and colleagues articulate an important research agenda that will help advance cognitive-behavioral therapy for insomnia (CBT-I) research and clinical practice. In addition to this ambitious agenda, we also propose that pursuing a parallel research program, focusing on treatment mechanisms and process will help move the CBT-I field forward and optimize therapeutic dissemination and uptake.
    Journal of Clinical Psychology 10/2013; 69(10). DOI:10.1002/jclp.22010 · 2.12 Impact Factor
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