Abstract
ABSTRACTObjectives/Background: Insomnia is a serious condition that affects over 60% of the prison population and has been associated with aggression, anger, impulsivity, suicidality, and increased prison health care use. Nonpharmacological interventions for prison inmates are scarce despite the high prevalence and significant consequences of insomnia among those incarcerated. The aim of the present study was to examine the preliminary efficacy and effectiveness of a one-shot session of cognitive behavioral therapy for insomnia (CBT-I) for prison inmates with acute insomnia in an open trial. Method/Participants: The intervention consisted of one 60–70 min session of CBT-I and a self-management pamphlet. A consecutive series of 30 adult male offenders with acute insomnia from a UK prison completed measures of prospective sleep (daily sleep diary), insomnia symptoms severity (Insomnia Severity Index), and mood symptoms (Patient Health Questionnaire and General Anxiety Disorder) one week before and four weeks after receiving the intervention. Results: Pairwise t-tests revealed that a single shot of CBT-I was effective in reducing the severity of insomnia in adult male offenders (t = [29], 12.65, p < 0.001). Further, the results demonstrated moderate to large effect sizes for reductions in depressive (dRM = 0.77) and anxious (dRM = 0.83) symptoms, as well as insomnia severity (dRM = 2.35). Conclusions: A single-shot session of CBT-I is effective in managing acute insomnia and mood (depression, anxiety) symptoms in adult male prison inmates. Future research should focus on testing if the single-shot CBT-I intervention can be implemented and disseminated in other settings and populations (e.g., female and juvenile or youth offenders).
Highlights
An estimated 11–81% of prison inmates report insomnia symptoms (Dewa, Kyle, Hassan, Shaw, & Senior, 2015)
Paired t-tests showed that participants experienced a significant reduction in insomnia-related symptoms (ISI) one month postintervention (t[29] = 12.65, p < 0.001)
While these findings are in line with the previous literature on the impact of a single-shot cognitive behavioral therapy for insomnia (CBT-I) intervention for acute insomnia (Boullin et al, 2016; Ellis et al, 2015), they suggest that the intervention can be successfully delivered in a prison environment with minor modifications
Summary
An estimated 11–81% of prison inmates report insomnia symptoms (Dewa, Kyle, Hassan, Shaw, & Senior, 2015). The transition to chronic insomnia is usually perpetuated by several factors, which may include an increased effort to induce sleep in response to distress about poor sleep and conditioned arousal (whereby the bed becomes a cue for arousal rather than sleep), which serve to maintain the sleep problem. Within this context, imprisonment may act as the initial precipitating factor contributing to the onset of insomnia (Elger & Sekera, 2009). It is not surprising that hypnotic and anxiolytic use is 10 times higher for prison inmates (even when limiting to patients with no known history of substance misuse) compared to community-dwelling outpatients (Elger, Goehring, Revaz, & Morabia, 2002; Hassan et al, 2014)
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