Sleep-Wake Disorders

Tailored Cognitive Therapy Helps Black Women With Insomnia Symptoms

Mary Stroka
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Black-Woman-Insomnia
Beautiful black woman lying down on bed
Researchers sought to compare the efficacy of a standard version of an internet-delivered CBT-I program, a culturally tailored version, and a sleep education control at improving insomnia symptoms.

The Sleep Healthy Using the Internet (SHUTi)-Black Women’s Health Study (BWHS) cognitive behavioral therapy for insomnia (CBT-I) was more effective at engaging participants compared with the program version that did not involve cultural adaptation, according to a randomized clinical trial published in JAMA Psychiatry.

Black adults in the US tend to sleep more poorly compared with individuals of other races, studies have shown. About 45% of 26,139 BWHS participants have insomnia symptoms, and about 15% have suspect insomnia disorder. The American Academy of Sleep Medicine (AASM) and the American College of Physicians recommend CBT-I, which involves sleep restriction, stimulus control, sleep hygiene, cognitive therapy, and relaxation exercises. In a prior trial in the SHUTi, an internet-delivered program, Black women, compared with women of other races, had relatively low engagement. This is the first published trial of a CBT-I intervention adapted for Black women.

BWHS participants (n=333 aged mean 59.5±8.0 years) with clinical insomnia based on Insomnia Severity Index (ISI) scores were randomized to SHUTi-BWHS, SHUTi, or control group of patient education (PE) about sleep. Each group completed a questionnaire and sleep diaries at baseline, 9 weeks, and 6 months.

The women who were randomized to the intervention groups reported significantly greater decreases in ISI scores at 6-month follow-up compared with the individuals in the PE group (SHUTi: −10.0 points; 95% CI, −11.2 to −8.7; SHUTi-BWHS: −9.3 points; 95% CI, −10.4 to −8.2; PE −3.6 points; 95% CI, −4.5 to −2.1; P <.001). Intervention completion was greater in the SHUTi-BWHS group compared with the SHUTi group (78.2% vs 64.8%; P =.008). Intervention completers exhibited greater decreases in insomnia severity compared with individuals who did not complete interventions (−10.4 points 95% CI, −11.4 to −9.4 vs −6.2 points 95% CI, −8.6 to −3.7).

Study limitations included higher socioeconomic background among study participants compared with US Black women overall, generalizability to men, and insufficient power to detect small ISI differences between SHUTi intervention versions.

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“While it is important to demonstrate that SHUTi can improve the sleep of Black women, the significant differences in terms of treatment engagement are noteworthy: more Black women fully completed the version of the intervention that was tailored specifically for them,” the researchers noted.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Zhou ES, Ritterband LM, Bethea TN, et al. Effect of culturally tailored, internet-delivered cognitive behavioral therapy for insomnia in Black women: a randomized clinical trial. JAMA Psychiatry. Published online April 20, 2022. doi: 10.1001/jamapsychiatry.2022.0653

This article originally appeared on Neurology Advisor