Comparisons of short-term efficacy between individual and group cognitive behavioral therapy for primary insomnia.

Wataru Yamadera,Ryo Aoki,Kazuhiko Nakayama,Masayuki Iwashita,Motohiro Ozone,Hiroshi Itoh,Miki Sato,Daisuke Harada,Keita Obuchi

doi:10.1111/sbr.12019

Abstract

The purpose of this study was to compare the efficacy of individual and group cognitive behavioral therapy for insomnia (CBT-I) in outpatients with primary insomnia diagnosed by DSM-IV-TR. The participants were 20 individually treated (I-CBT-I) and 25 treated in a group therapy format (three to five patients per group) (G-CBT-I), which showed no significant difference regarding demographic variables between groups. The same components of CBT-I stimulus control therapy, sleep restriction therapy, cognitive therapy, and sleep hygiene education were applied on both groups. The short-term outcome (4 weeks after treatment) was measured by sleep logs, actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), and was compared between I-CBT-I and G-CBT-I. The results indicated that CBT-I was effective in improving subjective and objective sleep parameters and subjective sleep evaluations for both individual and group treatment. However, I-CBT-I resulted in significantly better improvements over G-CBT-I, in (i) objective and subjective sleep onset latency time, (ii) objective sleep efficacy and moving time during sleeping, (iii) overall sleep quality and duration of actual sleep time in PSQI, (iv) consequences of insomnia, control and predictability of sleep, sleep requirement expectation, and sleep-promoting practices in DBAS. The present study suggested the superiority of I-CBT-I over G-CBT-I in clinical settings, and further evaluations are necessary.

Highlights

Primary insomnia, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. text version (DSM-IV-TR),[1] is the most common type of chronic insomnia and is almost the same concept as psychophysiological insomnia as defined in the International Classification of Sleep Disorders 2nd ed. (ICSD-2).[2]Primary insomnia is characterized by morbid fear of insomnia, mental arousal, and heightened somatic tension in bed
The participants for I-cognitive behavioral therapy for insomnia (CBT-I) consisted of 20 patients, and they participated in a study in 2004 to 2005.11 From 2009, the authors switched to G-CBT-I
Controlled trials have established the efficacy of CBT-I for primary insomnia.[5,6]

Summary

Introduction

As defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. text version (DSM-IV-TR),[1] is the most common type of chronic insomnia and is almost the same concept as psychophysiological insomnia as defined in the International Classification of Sleep Disorders 2nd ed. (ICSD-2).[2]Primary insomnia is characterized by morbid fear of insomnia, mental arousal, and heightened somatic tension in bed. As providing the I-CBT-I format is a time-consuming and cost-inefficient form of treatment delivery, the most common alternative delivery format is group therapy (G-CBT-I). A previous meta-analysis suggested a modest superiority of I-CBT-T over G-CBTI.[7] On the other hand, a few clinical trials[8,9] that provided direct comparisons of I-CBT-I and G-CBT-I within the same study mentioned no different outcomes between I-CBT-I and G-CBT-I. They concluded that G-CBT-I represented a cost-effective alternative to I-CBT-I for the management of insomnia. G-CBT-I is a popular approach, studies directly comparing the relative efficacy of individual and group formats are limited.[10]

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Conclusion