Emphasizing adherence, individualized treatment, familial support, and behavioral approaches may help improve the success of Cognitive Behavioral Therapy for Insomnia (CBT-I), according to an interview study published in Behavioral Sleep Medicine.
Researchers at the Department for Affective Disorders, Aarhus University Hospital, Denmark interviewed 12 patients with depression and short term insomnia, drawn from a subgroup in a randomized clinical trial studying CBT-I. Patients were eligible if they met the International Statistical Classification of Diseases and Related Health Problems-10 definition for moderate to severe depression, had a Hamilton score of at least 18, had problems maintaining or initiating sleep for more than 30 minutes or had early morning awakenings for at least 3 nights per week for a month, and had daytime impairment.
The patients underwent a semistructured, 43-minute interview after 6 sessions of CBT-I treatment, which took place between 2016 and 2017. There were 5 group sessions and 1 individual session focusing on sleep restriction and stimulus control. The researchers conducted a conventional qualitative content analysis.
The 12 patients had a mean age of 42 years and had varying housing situations. Additionally, 8 patients had an additional comorbid mental disorder, 5 had previously received CBT treatment, 9 were taking antidepressant medication, 2 were taking sleeping medication, and 3 dropped out of the clinical trial. All participants reported both positive and negative attitudes for the CBT-I methods.
The CBT-I had a multicomponent treatment design, so participants reported that they selected only the aspects of therapy they felt worked best for them. For instance, patients were advised to keep a sleep diary. Some patients reported a benefit from knowing how much they had slept but others were annoyed at the time-consuming task.
Patients were advised to practice cognitive therapy techniques like restructuring negative thoughts or scheduling times to worry. The patients who were familiar with CBT had an easier time following these guidelines and those who were unfamiliar with CBT practices found them to be too complicated.
The patients expressed that they had difficulty following the advice from their therapists. Some individuals reported support from family members, which helped them to maintain advised practices. However, participants reverted to their old sleep patterns after treatment ended. Overall, they did not feel that group therapy was helpful, as there was a poor rapport among participants. Despite the negative opinion of group therapy, the patients had a general preference for nonpharmacological treatment.
A limitation of this study was that the time between treatment and interview was varied among participants. For some patients, a long period of time had elapsed, which may have led them to forget some details of their CBT-I treatment.
The study authors concluded that treatment for insomnia with depression should be performed on an individual level and that not all suggestions will be helpful for all participants. They promoted support from family members, which may help patients to keep on track, as well as the introduction of cognitive components only after the negative effects of sleep deprivation have diminished.
Dyrberg H, Juel A, and Kragh M. Experience of treatment and adherence to cognitive behavioral therapy for insomnia for patients with depression: an interview study. Behav Sleep Med. 2020;1-11. doi:10.1080/15402002.2020.1788033.