Treatment feasibility and preliminary evaluation of group-delivered cognitive behavioral therapy for insomnia adapted for patients with bipolar and related disorders: A pragmatic within-group study

Abstract

• CBT for insomnia is a feasible treatment in patients with bipolar disorder. • After treatment, insomnia severity is significantly reduced. • Reductions of sleep problem severity are maintained at three-month follow-up. Sleep disturbances, including insomnia, are common in bipolar disorder. Treatment of choice for insomnia is cognitive behavioral therapy (CBT-i), but evidence for CBT-i in patients with bipolar disorder is scarce. We investigated a group delivered treatment based on CBT-I; treatment feasibility in patients with bipolar and related disorders, and improvement in insomnia severity following treatment. This pragmatic within-group evaluation with a pre to post and three-month follow-up design was set at two psychiatric out-patient clinics specialized in bipolar and related disorders. As an adjunct to care-as-usual, the treatment was offered as six two-hour group sessions over eight weeks. Data were analyzed with intent-to-treat using hierarchical linear mixed models. Thirty-four patients (48 [range 19–72] years; 68% female) with bipolar and related disorders and sleep problems provided informed consent. Patients had suffered from sleep problems for 12.7 [range 0.3–65] years, 97% used sleep medications, 91% medicated for their primary disorder. Patient interest, attendance, dropout, satisfaction, credibility, and adverse events met feasibility criteria, and therapists endorsed the manual. Post-treatment, insomnia severity (Insomnia Severity Index; score range 0–28) had improved with 6.1 points (95% CI, 3.27–8.93, g = 1.11, p = 0.0001) and at three months with 7.0 points (95% CI, 4.03–9.97, g = 1.26, p < 0.0001) from pre-treatment. Lack of control group and no control for care-as-usual content. CBT-i adjusted for bipolar disorder delivered as a group treatment is promising for improving insomnia severity in patients with bipolar and related disorders and disturbed sleep.