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Comparison between group and individual cognitive-behavioral therapy for insomnia approach: a pilot study
Insomnia is the most common sleep disorder in the general population. Cognitive-behavioral therapy for insomnia (CBT-I) is a gold standard treatment and it’s preferable to pharmacotherapy. However, there are few trials on the effectiveness of group CBT-I approach.
To assess the clinical effectiveness of group mode of CBT-I compared with the individual CBT-I.
This interventional study evaluated 25 subjects, recruited from 2015 to 2019 at a sleep clinic, all of whom met ICSD-3 criteria for a diagnosis of chronic insomnia. Subjects were assigned successively to receive 6-8 sessions of either group cognitive-behavioral therapy (until 6 patients) or individual cognitive-behavioral therapy (control). Treatment evaluation was non-blind and used self-report scales and sleep diaries. The primary outcome measure was the improvement of insomnia as assessed by the Insomnia Severity Index (ISI) and Dysfunctional Beliefs and Attitudes about Sleep Scale 10 (DBAS-10). Secondary measures included scores on the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Epworth Sleepiness Scale (ESS). Successful treatment was considered when observed clinical remission of the insomnia symptoms and improvement of the sleep diaries parameters.
25 patients were assigned to group CBT-I (13 subjects) or individual CBT-I (12 subjects) and followed-up for 2 months; 68% were women (84% in group CBT-I); mean age was 54.4±11,8 years in group CBT-I and 51.5±14,3 years in individual CBT-I (P=0.640). Both arms of treatment improved subjective measures of sleep (sleep efficiency and awaked time in bed), and reduced ISI (-11.8±2,7 and -6.2±8.7; P=0.008 and 0.020, respectively, group and individual CBT-I) and DBAS-10 scores (-19.4±25.7 and -26.8±26.3; P=0.046 and P=0.002, respectively, group and individual CBT-I). No statistically differences were found in the variations of ISI and DBAS-10 scores between group or individual CBT-I (P=0.279 and 0.558, respectively). Variations in psychometric features – depression, anxiety and sleepiness scores – between group and individual CBT-I, before and after intervention, had not statistically difference.
Findings suggest that group CBT-I may have clinical effectiveness if compared to usual treatment and it could be an option for insomnia treatment. Further studies are needed to establish the most appropriate selection of patients for group CBT-I.
Sleep Initiation and Maintenance Disorders; Chronic Insomnia; Cognitive Behavioral Therapy.
Instituto de Psiquiatria (IPq) - Sao Paulo - Brasil
Andrea Cecília Toscanini, Cássio Batista Lacerda, Daniel Guilherme Suzuki Borges, Israel Soares Pompeu de Sousa Brasil, Joao Guilherme de Mello e Gallinaro, José Humberto Zago Ribeiro Júnior, Alexandre Pinto Azevedo, Rosa Hasan