Cognitive-behavioral therapy for insomnia (CBT-I) is most effective when delivered in-person, with individuals receiving treatment with components centered around cognitive restructuring, stimulus control, and sleep restriction, according to a recent study published in . You can get maximum profit. JAMA Psychiatry.
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Insomnia can be a debilitating condition that not only disrupts nighttime sleep schedules but also impairs daytime functioning and can lead to a variety of cognitive and physical comorbidities. Among the available treatments for insomnia, standard non-pharmacological approaches direct patients to CBT-I, a structured treatment that utilizes a rich set of behavioral, cognitive, and educational techniques.
As the authors of this study note, previous studies have shown that CBT-I is consistent with improvements in sleep quality, regardless of the presence of comorbidities. Although CBT-I is commonly associated with improved sleep outcomes, there is insufficient evidence to dissect the benefits associated with its unique treatment components. The authors emphasize the importance of investigating these factors to maximize the treatment effect patients receive. To address this gap, they conducted a component network meta-analysis (cNMA) to assess the impact of different components and delivery methods of CBT-I on patient outcomes.
Researchers retrospectively collected data from PubMed, PsychInfo, and the Cochrane Central Register of Controlled Trials from database inception to July 2023 (1980-2023). All randomized clinical trials (RCTs) comparing forms of CBT-I with each other or with controls were included. Delivery methods such as individual or group therapy, face-to-face contact, and automatic encouragement were also analyzed.
In total, more than 31,000 randomized participants across 241 trials were evaluated. Generally, these studies included middle-aged women whose Insomnia Severity Index (ISI) scores indicated, on average, moderate insomnia (mean ISI: 16.8). There were 528 studies across 241 RTCs, with CBT components such as cognitive restructuring (95%), sleep diaries (91%), sleep hygiene education (94%), stimulus control (92%), and sleep restriction being the most common. Frequently mentioned (94%). Patients were treated for periods ranging from 1 week to 16 weeks. Hypnosis was also administered in her 21% of cases.
In the meta-analysis, CBT was most frequently associated with patient remission (OR, 3.79; 95% CI, 3.21-4.47). Next on the list were behavioral therapy (OR, 2.50; 95% CI, 1.93-3.24) and cognitive therapy (OR, 2.49; 95% CI, 1.59-3.92).
A meta-analysis of individual components of CBT demonstrated that patient remission was most closely associated with components focused on cognitive restructuring (incidence odds ratio). [IOR]1.68; 95% CI, 1.28-2.20; P < .01), sleep restriction (IOR, 1.49; 95% CI, 1.04-2.13; P < .05), and stimulus control (IOR, 1.43; 95% CI 1.00-2.05; P < .05).
The authors review their results and highlight how each component of CBT-I is associated with improved sleep quality.
“This supports the idea that behavioral and cognitive therapies have different mechanisms of action,” the authors write. “Cognitive restructuring and third wave elements can influence patients' perceptions and beliefs about what constitutes severe, frequent, or intolerable symptoms. Sleep restriction can affect sleep homeostasis. “It may exert its effect through manipulation. And stimulus control may exert its effect by reducing sleep effort or introducing readjustment.”
The authors believe that the study results should not be used to draw definitive conclusions regarding CBT-I, and that larger trial designs should be conducted in the future to further test the benefits of these individual components. states that it is necessary to do so.
reference
Yuya Furukawa, Masato Sakata, Takashi Yamamoto, et al. Components and delivery format of cognitive behavioral therapy for chronic insomnia in adults. AMA Psychiatry. Published online on January 17, 2024. doi:10.1001/jamapsychiatry.2023.5060
