Comparing Participants’ Satisfaction with Behavioral Therapies for Chronic Insomnia

Souraya Sidani,Mary Fox,Dana R Epstein,Laura Collins

doi:10.31770/2561-7516.1016

Abstract

Introduction. Extensive evidence supports the effectiveness of behavioral therapies for chronic insomnia, but there is limited information on patients’ satisfaction with these, which is a key factor in therapy uptake, adherence and effectiveness. Objective. This study compared participants’ satisfaction with the process and outcome attributes of single- and multi-component behavioral therapies for chronic insomnia. Methods. Data were obtained from 496 persons with chronic insomnia who chose or were randomized to one of three single-component behavioral therapies—sleep education and hygiene (SEH), stimulus control therapy (SCT), or sleep restriction therapy (SRT)—or a multi-component therapy (MCT) combining all three. At time of study, participants had experienced moderately severe insomnia on average for 11 years. Participants completed the measure of satisfaction within one week of treatment conclusion. The measure’s subscales assessed participants’ perception of the following attributes: suitability, utility and usefulness of mode and dose of therapy delivery; therapists’ competence and interpersonal style; and treatment outcomes. The subscales demonstrated good psychometric properties. Analysis of variance was used in the comparisons. Results. Significant differences (all p-values < .001) were found in the ratings of some process attributes and of all outcome attributes of the therapies. Education was rated as more suitable but less useful than behavioral instructions. Overall, results support patients’ satisfaction with SCT, SRT, and MCT and, to a lesser extent, with SEH as a single-component therapy. Discussion and conclusions. SCT, SRT and MCT were viewed favorably as therapies for successfully managing insomnia.

Highlights

Extensive evidence supports the effectiveness of behavioral therapies for chronic insomnia, but there is limited information on patients’ satisfaction with these, which is a key factor in therapy uptake, adherence and effectiveness
This study broadens knowledge of satisfaction with behavioral therapies by describing participants’ perceptions of single-‐ and multi-‐component therapies for managing chronic insomnia at treatment completion. It was informed by a clear conceptualization and appropriate operationalization of satisfaction with treatment
In contrast to previous research that measured overall satisfaction with treatment, this study examined patients’ satisfaction with treatment process and outcome attributes, thereby yielding information on aspects of therapy they appraised favorably and unfavorably

Summary

INTRODUCTION

Epstein, & Fox, 2017) in a large, pragmatic, partially randomized preference trial (Sidani, Epstein, Bootzin, Miranda, & Cousins, 2015). The. Cognitive-‐behavioral therapy for insomnia (CBT-‐I), recognized as the first-‐line treatment for chronic insomnia (Riemann et al, 2017), incorporates behavioral components such as stimulus control and sleep restriction. Cognitive-‐behavioral therapy for insomnia (CBT-‐I), recognized as the first-‐line treatment for chronic insomnia (Riemann et al, 2017), incorporates behavioral components such as stimulus control and sleep restriction These components, delivered independently or in combination, are recommended in professional guidelines (e.g., Pinto et al, 2010) as beneficial therapies for addressing the psychological and behavioral factors perpetuating chronic insomnia (Morin, 2015). The few studies that have examined patients’ satisfaction with CBT-‐I (e.g., Constantino et al, 2007; Holmqvist, Vincent, & Walsh, 2014; Sunnhed & Jansson-‐Fröjmark, 2015; Vincent, Lewycky, & Finnegan, 2008) using self-‐report trial offered three single-‐component therapies— sleep education and hygiene (SEH), stimulus control therapy (SCT) and sleep restriction therapy (SRT)—and one multi-‐component therapy (MCT). Therapy’s outcome attributes were assessed on the basis of perceived improvement in the health problem and general functioning, as well as attribution of the outcomes to the therapy (Sidani & Epstein, 2016)

METHODS

RESULTS

DISCUSSION

STUDY LIMITATIONS

CONCLUSIONS