CBT Effective for Insomnia Comorbid With Psychiatric Disorders

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the Psychiatry Advisor take:

Cognitive-behavioral therapy (CBT) is an effective, non-pharmacologic treatment for insomnia in patients who also have co-morbid mental illness.

Jason C. Ong, PhD, of Rush University Medical Center in Chicago, and colleagues conducted a meta-analysis that included 37 studies incorporating data from 2,189 subjects. Their goal was to measure the effectiveness of CBT for insomnia in patients with psychiatric conditions, such as alcohol abuse, depression and post-traumatic stress disorder, as well as some medical conditions, including chronic pain, cancer and fibromyalgia.

Twice the percentage of patients who received CBT for insomnia were in remission, compared to patients in a control group, the researchers reported in the journal JAMA Internal Medicine. In addition, the participants who also had psychiatric disorders saw greater symptom improvement in those conditions compared to the patients who had comorbid medical illnesses.

"These findings provide empirical support for the recommendation of using CBT-I (cognitive behavioral therapy for insomnia) as the treatment of choice for co-morbid insomnia disorder,” the researchers concluded.

In an commentary to the study, Michael A. Grandner, PhD, MTR., and Michael L. Perlis, PhD, of the University of Pennsylvania, Philadelphia, wrote: “Further research is needed to better understand (1) treatment response with CBT-I in comorbid insomnia; (2) what components of CBT-I work best for co-morbid insomnia; (3) to what extent CBT-I has effects on severity of and tolerance for non-insomnia symptoms; (4) the role of insomnia treatment in other chronic health conditions, such as obesity and cardiometabolic disease; and (5) the role of insomnia as an important indicator of health and functioning.”

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Patients with mental illness who received CBT for insomnia saw symptom improvements in both insomnia and their psychiatric condition.

Cognitive-behavioral therapy is a widely used nonpharmacologic treatment for insomnia disorders and an analysis of the medical literature suggests it also can work for patients whose insomnia is coupled with psychiatric and medical conditions, according to an article published online by JAMA Internal Medicine.

Previous meta-analyses have suggested that cognitive behavioral therapy for insomnia can improve sleep, although many of these studies excluded individuals with co-existing psychiatric and medical conditions.

Jason C. Ong, Ph.D., of Rush University Medical Center, Chicago, and coauthors reviewed medical literature to examine the efficacy of cognitive behavioral therapy for insomnia in patients with psychiatric conditions (including alcohol dependence, depression and post-traumatic stress disorder) and/or medical conditions (including chronic pain, cancer and fibromyalgia). The authors included 37 studies with data from 2,189 participants in their final analysis.

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