Cognitive Behavioural Therapy for Insomnia: A treatment feasibility Pilot study

Introduction: Sleep difficulties are commonly reported by patients with depression and can have a detrimental impact on mood. Repetitive Negative Thinking (RNT) is a longitudinal precursor of depression and anxiety, which are often co-present alongside insomnia. Cognitive Behavioural Therapy for Insomnia (CBT-I) is an effective treatment for insomnia which seems to have an impact on depressive mood and general measures of RNT. The aim of the present pilot study is to investigate the acceptability and feasibility of a CBT-I with a group format and to test the effects on sleep quality, anxiety-depressive mood and negative repetitive thoughts.

The CBT-I consisted of 2-hour group psychotherapy session every two weeks. The six persons group underwent five treatment sessions with traditional cognitive behavioral therapy techniques, including stimulus control, sleep restriction, and sleep hygiene. We added a RNT intervention. Sleep quality, depressive and anxious mood and abstract rumination and worry were assessed using self-reported measures, before and after the treatment period.

Methods: We computed a change score assessing the proportion of individuals showing reliable change (RC) at post-treatment, relative to pre-treatment to rule out the possibility that a difference between two scores was due to a measurement error rather than to the intervention.

Results: The six participants were adults aged between 45 and 67 (four women and two men). Prior to the intervention, the participants' assessment revealed the presence of significant sleep difficulties and insomnia, some mild (n=2), others moderate (n=3) and finally severe (n=1). Three participants also reported an anxious mood, and one participant a depressive mood. Ruminations and worry scores were within the normal range for all participants. Three of the six participants completed the entire intervention. The participant’s feedback support the acceptability and feasbility of a group protocol of CBT-I with a group format for patients with depressive mood. Pre-post RC analyses suggested significant improvement in insomnia in two participants and deterioration in one. No significant change scores were found for measures of anxious-depressive mood and repetitive negative thoughts.

Discussion: The results suggest that the CBT-I group format is feasible for clinicians, acceptable to participants and effective in improving insomnia in two out of three participants. The significant deterioration reported by one participant may be explained by the complete cessation of the participant's medication during the intervention. Nevertheless, this pilot study did not demonstrate the effect of this intervention on anxious-depressive mood and repetitive negative thoughts.

It would be appropriate to reiterate this study with a larger number of clinical subjects, to multiply the number of assessments over time and to monitor medication intake.