Tailored Cognitive Therapy Helps Black Women With Insomnia Symptoms

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.

“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. 


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