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In-person therapy boosts CBT for insomnia, study finds

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A combination of cognitive and behavioural strategies, ideally delivered in person by a therapist, maximises the benefits of cognitive behavioural therapy for insomnia (CBT-I), new research has found.

CBT-I is a form of talk therapy, which can be delivered with the support of a therapist or through independent study.

Previous research e shown that CBT-I can be a beneficial and low-risk option for patients with chronic insomnia.

However, as the treatment  encompasses a broad range of strategies which can be delivered in different ways, it has been difficult to determine which are most successful and if all are necessary for a patient to experience an improvement.

A team led by researchers at the University of Tokyo Hospital analysed 241 studies of chronic insomnia from 1980-2023, to try and connect the different threads of CBT-I with their outcomes.

The studies featured 31,452 adult participants, mainly from North America and Europe, with an average age of 45.4 years.

Yuki Furukaw is the study’s lead author and a medical doctor at the University of Tokyo Hospital.

The researcher said: “We expected to find some behavioural components (such as sleep restriction and stimulus control) beneficial, but it was surprising to find that some cognitive components (such as cognitive restructuring and third-wave components) were also effective.”

The researchers ranked the effects of different interventions using a statistical method called component network meta-analysis.

They discovered that although following a self-help guide with encouragement from other people was helpful, in-person interaction with a therapist was more beneficial.

Other critical components included: cognitive restructuring (skills to identify, challenge and change unhelpful beliefs about sleep), sleep restriction (limiting time in bed), stimulus control (re-associating bed with sleep) and third-wave components, such as mindfulness, acceptance and commitment therapy.

Meanwhile, sleep hygiene education did not appear to be essential to the success of the treatment.

The research also found that trying follow relaxation procedures could be counterproductive.

Furukaw said: “Overall, our findings identified several essential components of CBT-I which can lead to an intervention that maximises treatment efficacy, minimises treatment burden and increases scalability, that is, makes it easier to offer this treatment to more patients.

“We hope that our research encourages practitioners who are interested in CBT-I to learn streamlined CBT-I, so that in turn more people who experience insomnia can be offered this relatively simple, non-invasive yet potentially powerful psychotherapy.”

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