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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    • "These promising studies extend the large body of CBT-I research by focusing on the biological underpinnings of treatment effects, durable effects on daytime symptoms, and the potential condition-specific benefits of CBT-I for people with or at risk for CVD. The effects of the small group of studies reviewed are remarkable because they used attention control conditions with elements that might be expected to have some benefits for insomnia and sleep characteristics, in contrast with several past studies[66]in which the comparator was usual care or less robust modalities such as sleep hygiene, without controlling for the time with the therapist. Although the studies reviewed are promising, continued study is needed to confirm and extend the findings. "
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    ABSTRACT: Cardiovascular disease (CVD) is the leading cause of death worldwide and is associated with high levels of morbidity, disability and poor quality of life. The prevalence of insomnia symptoms and diagnosis of insomnia are high among those with CVD. Although insomnia appears to be important to CVD, less is known about the effects of insomnia treatment on important biological, sleep, symptom, quality of life, functional and morbidity or mortality outcomes in people with or at-risk for CVD. The purposes of this paper are to review the literature on the effects of CBT-I on insomnia, sleep, daytime symptoms, function, and biological outcomes in the context of CVD and to suggest implications for future research and practice. Limited available evidence suggests that CBT-I improves biomarkers that may contribute to CVD risk. CBT-I shows promise as a way to improve cardiovascular morbidity associated with the negative biological consequences of chronic insomnia, as well as symptom burden, functional performance and quality of life in the large population of people who are living with chronic CVD and insomnia. Additional research is needed to answer basic questions about short and long term outcomes, the role of biomarkers, and optimal delivery methods of CBT-I in cardiac conditions.
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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.
    Full-text · Article · Jan 2015 · Sleep Medicine Reviews
    • "For the typically-developing population, cognitive behaviour therapy (CBT) interventions are used routinely to treat a wide range of mental health disorders (NICE, 2011), as well as associated transdiagnostic characteristics such as insomnia (Vitiello, McCurry, & Rybarczyk, 2013) and worry (Covin, Ouimet, Seeds, & Dozois, 2008). CBT is a type of talking therapy (psychotherapy), which primarily aims to help individuals to (1) notice and understand how their thoughts, behaviours and emotions are inter-related and (2) develop new ways of thinking about, coping with and responding to, anxiety-provoking or distressing situations (Beck, 2011). "

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